Berlage S, Grüßner S, Lack N, Franz H B G
Silvia Berlage, Centre for Quality and Management in Health Care (ZQ), Institution of the Lower Saxony Medical Chamber, Berliner Allee 20, 30175 Hannover, Germany, E-mail:
Methods Inf Med. 2015;54(5):406-11. doi: 10.3414/ME14-01-0141. Epub 2015 Jun 12.
Severe and very rare obstetric complications (e.g. eclampsia, postpartum haemorrhage or uterine rupture), typically culminate in a chaotic, uncontrollable sequence of events. Outcome for mother and child depends on whether doctors and midwives are able to quickly take correct decisions and initiate optimal treatment.
GerOSS (German Obstetric Surveillance System) aims at generating deeper insight into relevant risk factors to improve diagnosis and treatment of severe complications during pregnancy and delivery. As such it is primarily conceived as a system for quality improvement and less as a register. Another focus is the provision of an information and communication platform for dissemination of these insights. Finally, incidences of selected rare obstetric events may be derived.
These rare events are monitored for two to five years in Lower Saxony, Bavaria and Berlin. Quantitative analyses of aggregate data are complemented with in depth case based anonymised evaluations by experts. The temporal sequence of measures taken as well as the management of care is inspected. Participants receive a feedback of comments on the synopsis of individual cases. Aggregate data results are published and made available through the GerOSS platform. A scientific advisory committee ensures the link with the professional scientific bodies. A comparison within INOSS (International Network of Obstetric Survey Systems) allows additional insights into the treatment of obstetric rare diseases and complications. More reliable estimates of the incidence of such events can be computed and compared within a larger database.
Following the implementation in three federal states in Germany in 2010, participation in GerOSS-Project has increased to 100% of all hospitals with a delivery unit in Lower Saxony, 30% in Bavaria and 80% in Berlin. Feasibility of the project is shown by successful implementation of GerOSS. Quantitative analyses enable construction of risk profiles (e.g. for the prevalence of hysterectomies and uterine ruptures) such that tailored treatment algorithms may be derived. Age, body mass index and previous caesarean section are common risk factors when complications occur. Respective recommendations have not always been adhered to in the diagnosis and therapy of such cases. The presentation of initial GerOSS results has paved the path for first changes in obstetric care.
The envisaged expansion of GerOSS to an interactive platform will allow dissemination of insights such that optimal obstetric care and transferal among all involved medical facilities may see future enhancements via the internet or even through smartphone applications.
严重且极为罕见的产科并发症（如子痫、产后出血或子宫破裂）通常会引发一系列混乱且无法控制的事件。母婴的结局取决于医生和助产士能否迅速做出正确决策并启动最佳治疗。
德国产科监测系统（GerOSS）旨在更深入地了解相关风险因素，以改善孕期和分娩期间严重并发症的诊断和治疗。因此，它主要被视为一个质量改进系统，而非登记系统。另一个重点是提供一个信息和交流平台，以传播这些见解。最后，可以得出某些罕见产科事件的发生率。
在德国下萨克森州、巴伐利亚州和柏林对这些罕见事件进行两到五年的监测。对汇总数据的定量分析辅以专家基于病例的深入匿名评估。检查所采取措施的时间顺序以及护理管理。参与者会收到关于个别病例摘要的评论反馈。汇总数据结果会发布并通过GerOSS平台提供。一个科学咨询委员会确保与专业科学机构建立联系。在国际产科调查系统网络（INOSS）内进行比较，可以进一步了解产科罕见疾病和并发症的治疗情况。在更大的数据库中，可以计算并比较此类事件发生率的更可靠估计值。
2010年在德国三个联邦州实施后，参与GerOSS项目的比例在汉诺威州所有设有产房的医院中升至100%，在巴伐利亚州为30%，在柏林为80%。GerOSS的成功实施表明了该项目的可行性。定量分析能够构建风险概况（例如子宫切除术和子宫破裂的患病率），从而得出量身定制的治疗算法。年龄、体重指数和既往剖宫产是并发症发生时常见的风险因素。在这些病例的诊断和治疗中，相应的建议并非总是得到遵守。GerOSS初步结果的呈现为产科护理的首次变革铺平了道路。
设想将GerOSS扩展为一个交互式平台，将有助于传播见解，从而通过互联网甚至智能手机应用程序，在未来改进所有相关医疗设施之间的最佳产科护理和转诊。
