Richardus J H, Graafmans W C, Bergsjø P, Lloyd D J, Bakketeig L S, Bannon E M, Borkent-Polet M, Davidson L L, Defoort P, Leitão A Esparteiro, Langhoff-Roos J, Garcia A Moral, Papantoniou N E, Wennergren M, Amelink-Verburg M P, Verloove-Vanhorick S P, Mackenbach J P
Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
J Matern Fetal Neonatal Med. 2003 Oct;14(4):267-76. doi: 10.1080/jmf.14.4.267.276.
A European concerted action (the EuroNatal study) investigated differences in perinatal mortality between countries of Europe. This report describes the methods used in the EuroNatal international audit and discusses the validity of the results.
Perinatal deaths between 1993 and 1998 in regions of ten European countries were identified. The categories of death chosen for the study were singleton fetal deaths at 28 or more weeks of gestational age, all intrapartum deaths at 28 or more weeks of gestational age and neonatal deaths at 34 or more weeks of gestational age. Deaths with major congenital anomalies were excluded. An international audit panel used explicit criteria to review all cases, which were blinded for region. Subjective interpretation was used in cases of events or interventions where explicit criteria did not exist. Suboptimal factors were identified in the antenatal, intrapartum and neonatal periods, and classified as 'maternal/social', due to 'infrastructure/service organization', or due to 'professional care delivery'. The contribution of each suboptimal factor to the fatal outcome was listed and consensus was reached on a final grade using a procedure that included correspondence and plenary meetings.
In all regions combined, 90% of all known or estimated cases in the selected categories were included in the audit. In total, 1619 cases of perinatal death were audited. Consensus was reached in 1543 (95%) cases. In 75% of all cases, the grade was based on explicit criteria. In the remaining cases, consensus was reached within subpanels without reference to predefined criteria. There was reasonable to good agreement between and within subpanels, and within panel members.
The international audit procedure proved feasible and led to consistent results. The results that relate to suboptimal care will need to be studied in depth in order to reach conclusions about their implications for assessing the quality of perinatal care in the individual regions.
一项欧洲联合行动（欧洲围产期研究）调查了欧洲各国围产期死亡率的差异。本报告描述了欧洲围产期国际审计所采用的方法，并讨论了结果的有效性。
确定了1993年至1998年期间十个欧洲国家各地区的围产期死亡情况。本研究选定的死亡类别为孕龄28周及以上的单胎死胎、孕龄28周及以上的所有分娩期死亡以及孕龄34周及以上的新生儿死亡。排除患有严重先天性异常的死亡病例。一个国际审计小组使用明确的标准对所有病例进行审查，这些病例对地区进行了盲法处理。对于不存在明确标准的事件或干预措施的病例，采用主观解释。在产前、分娩期和新生儿期确定了次优因素，并将其归类为“母亲/社会因素”、“基础设施/服务组织因素”或“专业护理提供因素”。列出了每个次优因素对致命结局的贡献，并通过包括通信和全体会议的程序就最终等级达成共识。
在所有地区中，选定类别中所有已知或估计病例的90%被纳入审计。总共审计了1619例围产期死亡病例。1543例（95%）病例达成了共识。在所有病例的75%中，等级是基于明确标准确定的。在其余病例中，小组内部在未参考预定义标准的情况下达成了共识。小组之间、小组内部以及小组成员之间存在合理至良好的一致性。
国际审计程序证明是可行的，并产生了一致的结果。与次优护理相关的结果需要深入研究，以便就其对评估各个地区围产期护理质量的影响得出结论。
