Gaps in obstetric care processes - we can only improve what is being measured.
A multifaceted intervention at all six obstetric units in the Stockholm Health Region was performed in 2008-2011 in order to increase safety for the newborn infants. Case-controlled criterion-based reviews of care processes during labor and delivery have been used to assess factors associated with suboptimal care during labor and delivery. Categories of increased risk of adverse outcome during labor and delivery were defined. Cases with low Apgar scores and healthy controls were scrutinized and compared to data from a study with an identical design performed before the intervention. The risk of suboptimal care increased twice among controls and three times among cases when reviewing specific criteria after a multifaceted intervention. There are still gaps in care processes that need attention. Improving guidelines is important but not enough alone, and the management of fetal surveillance needs further improvement. The complexity of reviewing care processes using criterion-based research methodology is highlighted.
Department of Obstetrics and Gynecology, Södersjukhuset, S-11883 Stockholm, Sweden.
Charlotte Millde
CM
Luthander
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Hans
H
Järnbert Pettersson
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Ulf
U
Högberg
Department of Clinical Science and Education Karolinska Institutet, Södersjukhuset, Stockholm, Sweden, Maternité, Centre Hospitalier de Luxembourg, Luxembourg.
Sophie
S
Berglund
Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Charlotta
C
Grunewald
D001034:Apgar Score; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000379:methods / Q000592:standards; D005260:Female; D005323:Fetal Monitoring / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D020380:Needs Assessment; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards; D058996:Quality Improvement; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
Cardiotochography (CTG); criterion-based review; delivery; education; fetal monitoring