Richardus Jan H, Graafmans Wilco C, Verloove-Vanhorick S Pauline, Mackenbach Johan P
Department of Public Health, Erasmus MC, Erasmus Medical Centre, Rotterdam, The Netherlands.
BJOG. 2003 Feb;110(2):97-105.
A European concerted action (the EuroNatal study) investigated the background of differences in perinatal mortality between countries of Europe. The study aimed to determine the contribution of differences in quality of care, by looking at differences in the presence of suboptimal factors in individual cases of perinatal death.
Retrospective audit study.
Regions of 10 European countries.
1619 cases of perinatal death.
Perinatal deaths between 1993 and 1998 in regions of 10 European countries were identified. Reviewed were singleton fetal deaths (28 or more weeks of gestational age), intrapartum deaths (28 or more weeks) and neonatal deaths (34 or more weeks). Deaths with (major) congenital anomalies were excluded. Cases were blinded for region and an international audit panel reviewed them using explicit audit criteria.
Presence of suboptimal factors.
The audit covered 1619 cases of perinatal death, representing 90% of eligible cases in the regions. Consensus was reached on 1543 (95%) cases. In 715 (46%) of these cases, suboptimal factors, which possibly or probably had contributed to the fatal outcome, were identified. The percentage of cases with such suboptimal care factors was significantly lower in the Finnish and Swedish regions compared with the remaining regions of Spain, the Netherlands, Scotland, Belgium, Denmark, Norway, Greece and England. Failure to detect severe IUGR (10% of all cases) and smoking in combination with severe IUGR and/or placental abruption (12%) was the most frequent suboptimal factor. There was a positive association between the proportion of cases with suboptimal factors and the overall perinatal mortality rate in the regions.
The findings of this international audit suggest that differences exist between the regions of the 10 European countries in the quality of antenatal, intrapartum and neonatal care, and that these differences contribute to the explanation of differences in perinatal mortality between these countries. The background to these differences in quality of care needs further investigation.
一项欧洲协同行动（欧洲围产期研究）调查了欧洲各国围产期死亡率差异的背景。该研究旨在通过观察围产期死亡个体病例中存在的次优因素差异，来确定护理质量差异所起的作用。
回顾性审计研究。
10个欧洲国家的地区。
1619例围产期死亡病例。
确定1993年至1998年期间10个欧洲国家地区的围产期死亡病例。审查的是单胎胎儿死亡（孕龄28周及以上）、产时死亡（28周及以上）和新生儿死亡（34周及以上）。排除伴有（主要）先天性异常的死亡病例。病例对地区进行了盲法处理，一个国际审计小组使用明确的审计标准对其进行审查。
次优因素的存在情况。
审计涵盖了1619例围产期死亡病例，占这些地区符合条件病例的90%。1543例（95%）病例达成了共识。在其中715例（46%）病例中，确定了可能或很可能导致致命结局的次优因素。与西班牙、荷兰、苏格兰、比利时、丹麦、挪威、希腊和英格兰的其余地区相比，芬兰和瑞典地区存在此类次优护理因素的病例百分比显著更低。未能检测出严重胎儿生长受限（占所有病例的10%）以及吸烟与严重胎儿生长受限和/或胎盘早剥同时存在（12%）是最常见的次优因素。存在次优因素的病例比例与这些地区的总体围产期死亡率之间存在正相关。
这项国际审计的结果表明，10个欧洲国家的地区在产前、产时和新生儿护理质量方面存在差异，并且这些差异有助于解释这些国家之间围产期死亡率的差异。护理质量这些差异的背景需要进一步调查。
