title: Term perinatal mortality audit in the Netherlands 2010-2012: a population-based cohort study.
abstract: OBJECTIVE
  To assess the implementation and first results of a term perinatal internal audit by a standardised method.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  All 90 Dutch hospitals with obstetric/paediatric departments linked to community practices of midwives, general practitioners in their attachment areas, organised in perinatal cooperation groups (PCG).
  
  
  METHODS
  The population consisted of 943 registered term perinatal deaths occurring in 2010-2012 with detailed information, including 707 cases with completed audit results.
  
  
  METHODS
  Participation in the audit, perinatal death classification, identification of substandard factors (SSF), SSF in relation to death, conclusive recommendations for quality improvement in perinatal care and antepartum risk selection at the start of labour.
  
  
  RESULTS
  After the introduction of the perinatal audit in 2010, all PCGs participated. They organised 645 audit sessions, with an average of 31 healthcare professionals per session. Of all 1102 term perinatal deaths (2.3/1000) data were registered for 86% (943) and standardised anonymised audit results for 64% (707). In 53% of the cases at least one SSF was identified. Non-compliance to guidelines (35%) and deviation from usual professional care (41%) were the most frequent SSF. There was a (very) probable relation between the SSF and perinatal death for 8% of all cases. This declined over the years: from 10% (n=23) in 2010 to 5% (n=10) in 2012 (p=0.060). Simultaneously term perinatal mortality decreased from 2.3 to 2.0/1000 births (p<0.00001). Possibilities for improvement were identified in the organisation of care (35%), guidelines or usual care (19%) and in documentation (15%). More pregnancies were antepartum selected as high risk, 70% in 2010 and 84% in 2012 (p=0.0001).
  
  
  CONCLUSIONS
  The perinatal audit is implemented nationwide in all obstetrical units in the Netherlands in a short time period. It is possible that the audit contributed to the decrease in term perinatal mortality.
authors.affiliation: Foundation Perinatal Audit in The Netherlands (PAN), Utrecht, The Netherlands.|Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Martine
authors.initials: M
authors.lastname: Eskes
authors.affiliation: Foundation Perinatal Audit in The Netherlands (PAN), Utrecht, The Netherlands.
authors.forename: Adja J M
authors.initials: AJM
authors.lastname: Waelput
authors.affiliation: Department of Obstetrics and Gynaecology, University of Groningen, Groningen, The Netherlands.
authors.forename: Jan Jaap H M
authors.initials: JJHM
authors.lastname: Erwich
authors.affiliation: Department of Neonatology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Hens A A
authors.initials: HAA
authors.lastname: Brouwers
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Anita C J
authors.initials: ACJ
authors.lastname: Ravelli
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Achterberg
authors.affiliation: Foundation Perinatal Audit in The Netherlands (PAN), Utrecht, The Netherlands.
authors.forename: Hans J M W M
authors.initials: HJMWM
authors.lastname: Merkus
authors.affiliation: Foundation Perinatal Audit in The Netherlands (PAN), Utrecht, The Netherlands.
authors.forename: Hein W
authors.initials: HW
authors.lastname: Bruinse
mesh_terms: D002423:Cause of Death; D015331:Cohort Studies; D006801:Humans; D007231:Infant, Newborn; D008485:Medical Audit; D009426:Netherlands / Q000453:epidemiology; D066087:Perinatal Death / Q000209:etiology; D054238:Perinatal Mortality; D047929:Term Birth; D013997:Time Factors
keywords: OBSTETRICS; PERINATOLOGY; PRIMARY CARE; PUBLIC HEALTH