Perinatal death beyond 41 weeks pregnancy: an evaluation of causes and substandard care factors as identified in perinatal audit in the Netherlands
Perinatal death beyond 41 weeks pregnancy: an evaluation of causes and substandard care factors as identified in perinatal audit in the Netherlands
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DOI：
10.1186/s12884-018-1973-0
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发表时间：
2018-09-20
影响因子：
3.1
通讯作者：
van Dillen, Jeroen
中科院分区：
文献类型：
--
作者：
Kortekaas, Joep C.;Scheuer, Anke C.;van Dillen, Jeroen
背景：晚期和过期妊娠与不良围产期结局相关，例如围产期死亡。我们评估了足月和足月后围产期死亡的死亡原因和不合格护理因素 (SSF)。方法：我们使用来自荷兰围产期审计登记处 (PARS) 的数据。在 PARS 中登记的足月围产期死亡妇女按胎龄分为早产/足月（37.0-40.6）和晚产/产后（≥ 41.0 周）死亡。由当地围产期审计小组对死亡原因和≥41周的SSF进行评分和分类。结果：2010-2012年期间，发生了947/479,097（0.21%）足月死亡，其中登记了707例（75%），可用于分析。 PARS 数据库中登记了经审计的 598 例早产/足月死亡和 109 例晚期/产后死亡。在 PARS 数据库审计的所有围产期死亡病例中，早期/足月组的 55.2% 发生在产前，而晚期/过期组的这一比例为 42.2%；而在 PARS 数据库审计的病例中，早期/足月组的产时死亡率为 7.2%，而晚期/过期组的产时死亡率为 19.3%。根据当地围生儿审计，41周以上围产儿死亡的最相关原因是产前窒息（7.3%）、产时窒息（9.2%）、新生儿窒息（10.1%）和胎盘功能不全（10.1%）。在围产期 >= 41 死亡周的组中，68.8% 的患者出现 >= 1SSF。最常见的 SSF 涉及心宫缩监护 (CTG) 评估和/或分类不充分 (10.1%)、医疗档案中的登记或记录不完整 (4.6%) 或对胎动减少采取的措施不充分 (4.6%)。结论：在荷兰围产期审计登记处，与 37.0-40.6 周的妊娠相比，≥ 41 周妊娠的产前发生率相对较低，产时发生率较高。来自 PARS 数据库的审计案例。胎儿、产时和新生儿窒息更常被认为是妊娠 41 周以上的死亡原因。最常见的与妊娠 >= 41 周死亡相关的 SSF 涉及 CTG 监测（评估、分类、登记或记录）不充分以及对胎动减少的行动不充分。
Background: Late- and postterm pregnancy are associated with adverse perinatal outcomes, like perinatal death. We evaluated causes of death and substandard care factors (SSFs) in term and postterm perinatal death.Methods: We used data from the Perinatal Audit Registry of the Netherlands (PARS). Women with a term perinatal death registered in PARS were stratified by gestational age into early-/full-term (37.0-40.6) and late-/postterm (>= 41.0 weeks) death. Cause of death and SSFs >= 41 weeks were scored and classified by the local perinatal audit teams.Results: During 2010-2012, 947/479,097 (0.21%) term deaths occurred, from which 707 cases (75%) were registered and could be used for analyses. Five hundred ninety-eight early-/full-term and 109 late-/postterm audited deaths were registered in the PARS database. Of all audited cases of perinatal death in the PARS database, 55.2% in the early-/fullterm group occurred antepartum compared to 42.2% in the late-/postterm group, while intrapartum death occurred in 7.2% in the early-/full-term group compared to 19.3% in the late-/postterm group in the audited cases from the PARS database. According to the local perinatal audit, the most relevant causes of perinatal death >= 41 weeks were antepartum asphyxia (7.3%), intrapartum asphyxia (9.2%), neonatal asphyxia (10.1%) and placental insufficiency (10.1%). In the group with perinatal >= 41death weeks there was >= 1SSF identified in 68.8%. The most frequent SSFs concerned inadequate cardiotocography (CTG) evaluation and/or classification (10.1%), incomplete registration or documentation in medical files (4.6%) or inadequate action on decreased foetal movements (4.6%).Conclusions: In the Netherlands Perinatal Audit Registry, stillbirth occurred relatively less often antepartum and more often intrapartum in pregnancies >= 41 weeks compared to pregnancies at 37.0-40.6 weeks in the audited cases from the PARS database. Foetal, intrapartum and neonatal asphyxia were identified more frequently as cause of death in pregnancies >= 41 weeks. The most identified SSFs related to death in pregnancies >= 41 weeks concerned inadequate CTG monitoring (evaluation, classification, registration or documentation) and inadequate action on decreased foetal movements.