Could a multidisciplinary regional audit identify avoidable factors and delays that contribute to stillbirths? A retrospective cohort study

Autor: E. Wiberg Itzel, I. Hulthén Varli, S. Perers Öberg, Irene Sterpu, J. Bolk
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Adult
medicine.medical_specialty
Population
Reproductive medicine
Psychological intervention
Audit
lcsh:Gynecology and obstetrics
Preventable stillbirth
03 medical and health sciences
0302 clinical medicine
Pregnancy
Risk Factors
Cause of Death
Health care
Preventive Health Services
medicine
Humans
030212 general & internal medicine
education
Fetal Death
Causes of death
reproductive and urinary physiology
lcsh:RG1-991
Quality of Health Care
Retrospective Studies
Sweden
education.field_of_study
Health Services Needs and Demand
030219 obstetrics & reproductive medicine
Clinical Audit
business.industry
Medical record
Quality of care
Obstetrics and Gynecology
Retrospective cohort study
Stillbirth
Monitoring program
female genital diseases and pregnancy complications
Family medicine
Female
business
Research Article
Zdroj: BMC Pregnancy and Childbirth, Vol 20, Iss 1, Pp 1-12 (2020)
BMC Pregnancy and Childbirth
ISSN: 1471-2393
Popis: Background The annual rate of stillbirth in Sweden has remained largely unchanged for the past 30 years. In Sweden, there is no national audit system for stillbirths. The aim of the study was to determine if a regional multidisciplinary audit could help in identifying avoidable factors and delays associated with stillbirths. Methods Population-based retrospective cohort study. Settings: Six labour wards in Stockholm County. Participants: Women delivering a stillbirth > 22 weeks of gestation in Stockholm during 2017. Intervention: A multidisciplinary team was convened. Each team member independently assessed the medical chart of each case of stillbirth regarding causes and preventability, level of delay, the standard of healthcare provided, the investigation of maternal/foetal diseases and if any recommendations were given for the next pregnancy. A decision was based on the agreement of all five members. If no agreement was reached, a reassessment of the case was done and the medical record was scrutinized again until a mutual decision was made. Primary outcomes: The frequency of probably/possibly preventable factors associated with a stillbirth and the level of delay (patient/caregiver). Secondary outcomes: The causes of death, the standard of antenatal/intrapartum/postpartum care, whether a summary of possible causes of the stillbirth was made and if any plans for future pregnancies were noted. Results Thirty percent of the stillbirths were assessed as probably/possibly preventable. More frequent ultrasound/clinical check-ups, earlier induction of labour and earlier interventions in line with current guidelines were identified as possibly preventable factors. A possibly preventable stillbirth was more common among non-Swedish-speaking women (p = 0.03). In 15% of the cases, a delay by the healthcare system was identified. Having multiple caregivers, absence of continuity in terms of attending the antenatal clinic and not following the basic monitoring program for antenatal care were also identified as risk factors for a delay. Conclusion A national/regional multidisciplinary audit group retrospectively identified factors associated with stillbirth. Access to good translation services or a more innovative approach to the problem regarding communication with mothers could be an important factor to decrease possible patient delays contributing to stillbirths. Trial registration NCT04281368.
Databáze: OpenAIRE
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