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A regional audit system for stillbirth: a way to better understand the phenomenon
- Source :
- BMC Pregnancy and Childbirth, Vol 19, Iss 1, Pp 1-9 (2019), BMC Pregnancy and Childbirth
- Publication Year :
- 2019
- Publisher :
- BMC, 2019.
-
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.
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 14712393
- Volume :
- 19
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC Pregnancy and Childbirth
- Accession number :
- edsair.doi.dedup.....ee7c06a2532dc4f7833d3db4eeed848d