Open AccessSubstandard care in delivery‐related asphyxia among term infants: prospective cohort study
Author(s) -
EVERS ANNEMIEKE C. C.,
BROUWERS HENS A. A.,
NIKKELS PETER G. J.,
BOON JANINE,
VAN EGMONDLINDEN ANNEKE,
GROENENDAAL FLORIS,
HART CLAARTJE,
HILLEGERSBERG JACQUELINE,
SNUIF YVETTE S.,
STERKENHOOISMA SIETSKE,
BISSCHOP CHARLOTTE N. STEINS,
WESTERHUIS MICHELLE E. M. H.,
BRUINSE HEIN W.,
KWEE ANNEKE
Publication year - 2013
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12012
Subject(s) - medicine , asphyxia , neonatal intensive care unit , referral , pediatrics , prospective cohort study , cohort , population , intensive care , fetal distress , cohort study , emergency medicine , pregnancy , obstetrics , intensive care medicine , fetus , family medicine , surgery , environmental health , pathology , biology , genetics
Objective . To assess substandard care factors in the case of delivery‐related asphyxia. Design. Prospective cohort study. Setting. Catchment area of the Neonatal Intensive Care Unit (NICU) of the University Medical Center Utrecht; a region in the middle of the Netherlands covering 13% of the Dutch population. Population. Term infants, without congenital malformations, who died intrapartum or were admitted to the Neonatal Intensive Care Unit due to asphyxia. Methods. During a two‐year period, cases were prospectively collected and audited by an expert panel. Main outcome measures. Substandard care factors. Results. 37 735 term infants without congenital malformations were born. There were 19 intrapartum deaths, and 89 NICU admissions of which 12 neonates died. In 63 (58%) cases a substandard care factor was identified that was possibly ( n = 47, 43%) or probably ( n = 16, 15%) related to perinatal death or NICU admission. In primary care, substandard care factors were mainly the low frequency of examination during labor and delay in referral to secondary care. In secondary care, misinterpretation of cardiotocography and failure to respond adequately to clinical signs of fetal distress were the most common substandard care factors. Conclusions . Substandard care is present in a substantial number of cases with delivery‐related asphyxia resulting in perinatal death or NICU admission. Improving the organization of obstetric care in the Netherlands as well as training of obstetric caregivers might reduce adverse outcomes.