[Quality of prenatal data in the Hessian Perinatal Registry. A comparison with data from maternal health record and results of a pregnancy survey].

In the Federal State of Hesse, Germany, pregnancy and delivery related data are collected in a central perinatal registry called "Hessische Perinatalerhebung" (HEPE) since 1981, the objective being to enforce quality assurance and to contribute to a reduction in perinatal mortality and morbidity. The delivery unit compiles these data based on the antenatal record called "Mother Passport" and the actual delivery. In order to check on the quality of data, information on risk factors obtained from the perinatal register was compared to information from antenatal records and from a questionnaire administered to pregnant women prior to delivery. The study population comprised 1978 women who delivered at the maternity unit of the Municipal Hospital of Wiesbaden, the Dr. Horst Schmidt Kliniken, in 1990 and 1991. Comparison of the three data sources revealed substantial differences: Almost all risk factors were most frequently mentioned by the mothers themselves, less by the antenatal record and even less by the perinatal register. These differences were less pronounced for data on previous pregnancies and pre-existing disease and on abnormal positioning. Considerable differences were found in relation to pregnancy induced hypertension, intra-uterine growth retardation, incapacity of the cervix, preterm labour and bleeding. Risk factors related to the social environment and personal habits like psycho-social stress and smoking were found to be extremely under-reported in the antenatal records as well as in the perinatal register. The following factors could be identified as major reasons for the different risk profiles obtained from the various data sources: [1] Data loss through the transfer of data from the antenatal record to the record form of the perinatal register or to the computer, [2] selective recording of those risk factors considered by doctors to be particularly relevant, [3] missing definition of some risk factors and [4] recording of antenatal data for the perinatal register by the delivery unit after knowing the pregnancy outcome. Antenatal data in the perinatal register of Hessen are doubtful and should not be used uncritically for comparative studies and the assessment of relative risks. The extreme under-reporting of some risk factors may even lead to giving some interventions undue priority. In future, regular validity studies should become routine. A reduction of the data losses as well as a clear separation of antenatal data and delivery data could be achieved if antenatal data would be transferred from the doctor providing antenatal care direct to the perinatal register.