1. A regional audit system for stillbirth: a way to better understand the phenomenon
- Author
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Po G., Monari F., Zanni F., Grandi G., Lupi C., Facchinetti F., Mancini L., Lugli L., Lanzoni C., Sgarbi L., Chiossi C., Ricchieri F., Roberta C., Contiero R., Garani G., Pedriali M., Rossi S., Fini S., Di Bartolo M., Radi D., Vancini A., Donati A., Guadalupi E., Righetti F., Salerno A., Cocchi G., Morandi R., Gabrielli L., Graziano C., Seri M., Caprara G., Mario S. N. C., Fantuz F., Ferlini F., Righi E., Silvestrini D., Foschi F., Fieni S., Frusca T., Ferretti A., Galli L., Magnani C., Silini E., Balduzzi L., Bellini M., Rodolfi A. M., Sgarabotto M. P., Fragni G., Comitini G., Bonasoni M. P., Fioroni L., Rozzi C., Tuzio A., Vito I., Mammoliti P., De Ambrosi E., Ricci M., Bandini A., Belosi C., Muratori C., Zago S., Turci A., Vitarelli M., Po G., Monari F., Zanni F., Grandi G., Lupi C., Facchinetti F., Mancini L., Lugli L., Lanzoni C., Sgarbi L., Chiossi C., Ricchieri F., Roberta C., Contiero R., Garani G., Pedriali M., Rossi S., Fini S., Di Bartolo M., Radi D., Vancini A., Donati A., Guadalupi E., Righetti F., Salerno A., Cocchi G., Morandi R., Gabrielli L., Graziano C., Seri M., Caprara G., Mario S.N.C., Fantuz F., Ferlini F., Righi E., Silvestrini D., Foschi F., Fieni S., Frusca T., Ferretti A., Galli L., Magnani C., Silini E., Balduzzi L., Bellini M., Rodolfi A.M., Sgarabotto M.P., Fragni G., Comitini G., Bonasoni M.P., Fioroni L., Rozzi C., Tuzio A., Vito I., Mammoliti P., De Ambrosi E., Ricci M., Bandini A., Belosi C., Muratori C., Zago S., Turci A., and Vitarelli M.
- Subjects
Clinical audit ,Multivariate analysis ,Placenta Diseases ,Perinatal Death ,Eastern ,Umbilical Cord ,Africa, Northern ,Pregnancy ,Risk Factors ,Cause of Death ,Northern ,Europe, Eastern ,Pregnancy Complications, Infectious ,Multivariate Analysi ,Causes of death ,Cause of death ,Fetal Growth Retardation ,Obstetrics ,Placenta Disease ,Infectious ,Obstetrics and Gynecology ,Stillbirth ,Perinatal audit ,Quality of care ,Adult ,Africa South of the Sahara ,Clinical Audit ,Female ,Fetal Death ,Fetal Diseases ,Humans ,India ,Italy ,Multivariate Analysis ,Pregnancy Complications ,Quality of Health Care ,Pregnancy Complication ,Europe ,Gestation ,Human ,Research Article ,medicine.medical_specialty ,Reproductive medicine ,Fetal Disease ,Audit ,lcsh:Gynecology and obstetrics ,medicine ,lcsh:RG1-991 ,Late Stillbirth ,business.industry ,Risk Factor ,medicine.disease ,Africa ,Pregnancy Complications, Infectiou ,business - Abstract
Background Implementation of high-quality national audits for perinatal mortality are needed to improve the registration of all perinatal deaths and the identification of the causes of death. This study aims to evaluate the implementation of a Regional Audit System for Stillbirth in Emilia-Romagna Region, Italy. Methods For each stillbirth (≥ 22 weeks of gestation, ≥ 500 g) occurred between January 1, 2014 to December 1, 2016 (n = 332), the same diagnostic workup was performed and a clinical record with data about mother and stillborn was completed. Every case was discussed in a multidisciplinary local audit to assess both the cause of death (ReCoDe classification) and the quality of care. Data were reviewed by the Regional Audit Group. Stillbirth rates, causes of death and the quality of care were established for each case. Results Total stillbirth rate was 3.09 per 1000 births (332/107,528). Late stillbirth rate was 2.3 per 1000 (251/107,087). Sixteen stillbirths were not registered by the Regional Birth Register. The most prevalent cause of death was placental disorder (33.3%), followed by fetal (17.6%), cord (14.2%) and maternal disorders (7.6%). Unexplained cases were 14%. Compared to local audits, the regional group attributed different causes of death in 17% of cases. At multivariate analysis, infections were associated with early stillbirths (OR 3.38, CI95% 1.62–7.03) and intrapartum cases (OR 6.64, CI95% 2.61–17.02). Placental disorders were related to growth restriction (OR 1.89, CI95% 1.06–3.36) and were more frequent before term (OR 1.86, CI95% 1.11–3.15). Stillbirths judged possibly/probably preventable with a different management (10.9%) occurred more frequently in non-Italian women and were mainly related to maternal disorders (OR 6.64, CI95% 2.61–17.02). Conclusions Regional Audit System for Stillbirth improves the registration of stillbirth and allows to define the causes of death. Moreover, sub-optimal care was recognized, allowing to identify populations which could benefit from preventive measures.
- Published
- 2019
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