Vredevoogd C B, Wolleswinkel-van den Bosch J H, Amelink-Verburg M P, Verloove-Vanhorick S P, Mackenbach J P
Instituut Maatschappelijke Gezondheidszorg, Postbus 1738, 3000 DR Rotterdam.
Ned Tijdschr Geneeskd. 2001 Mar 10;145(10):482-7.
To assess the level of suboptimal care prior to cases of perinatal death and the extent to which perinatal mortality can be reduced by further improvements in care.
Retrospective panel audit investigation.
Cases of perinatal death occurring in 1996 and 1997 among women living in the region Zuid-Holland-Noord, the Netherlands, were identified by approaching midwives, obstetricians/gynaecologists and paediatricians/neonatologists. The medical records of the cases were studied by an expert panel using a checklist of evidence-based criteria for standard care in order to determine circumstances and actions that did not comply with professional protocols, or that indicated either low compliance of the mother or an inadequate healthcare infrastructure (so-called sub-standard factors). The panel also assessed whether the perinatal death could have been prevented.
A total of 342 perinatal deaths were found. For 332 cases sufficient information was available for a panel assessment and for 318 cases the panel reached a consensus on the assessment. One or more sub-standard care factors were identified in more than half of the cases. In 19% of the cases the panel agreed that the sub-standard factor had 'possibly' contributed to the death, and in 6% they agreed that the sub-standard factor had 'probably' contributed to the death. In the last group the main problems involved were antenatal care (particularly a failure to detect or inadequate management of intrauterine growth retardation) and intrapartum care (too much of a 'wait and see' approach).
This regional audit revealed that further quality improvement of obstetric care is possible if clinical practice guidelines for effective and safe care are better implemented. It is expected that these improvements could reduce the perinatal mortality rate by between 6% and 25%.
评估围产期死亡病例之前的医疗服务欠佳水平，以及通过进一步改善医疗服务能够降低围产期死亡率的程度。
回顾性小组审核调查。
通过联系助产士、妇产科医生和儿科医生/新生儿科医生，确定1996年和1997年在荷兰北荷兰省南部地区居住的妇女中发生的围产期死亡病例。一个专家小组使用基于证据的标准护理检查表研究这些病例的医疗记录，以确定不符合专业规范的情况和行为，或表明母亲依从性低或医疗基础设施不足的情况（所谓的不合标准因素）。该小组还评估了围产期死亡是否可以预防。
共发现342例围产期死亡病例。有332例病例有足够信息可供小组评估，318例病例小组达成了评估共识。超过一半的病例中发现了一个或多个不合标准的护理因素。在19%的病例中，小组一致认为不合标准因素“可能”导致了死亡，在6%的病例中，他们一致认为不合标准因素“很可能”导致了死亡。最后一组涉及的主要问题是产前护理（特别是未能检测到或对宫内生长迟缓管理不足）和产时护理（过多的“观望”方法）。
这项区域性审核显示，如果能更好地实施有效和安全护理的临床实践指南，产科护理质量有望进一步提高。预计这些改进可将围产期死亡率降低6%至25%。
