Adverse outcomes in maternity care for women with a low risk profile in The Netherlands: a case series analysis.

Background: This study aimed to perform a structural analysis of determinants of risk of critical incidents in care for women with a low risk profile at the start of pregnancy with a view on improving patient safety.

Methods: We included 71 critical incidents in primary midwifery care and subsequent hospital care in case of referral after 36 weeks of pregnancy that were related to substandard care and for that reason were reported to the Health Care Inspectorate in The Netherlands in 36 months (n = 357). We performed a case-by-case analysis, using a previously validated instrument which covered five broad domains: healthcare organization, communication between healthcare providers, patient risk factors, clinical management, and clinical outcomes.

Finding the right indicators for assessing quality midwifery care.

Objective: To identify a set of indicators for monitoring the quality of maternity care for low-risk women provided by primary care midwives and general practitioners (GPs) in the Netherlands.

Design: A Project Group (midwives, GPs, policymakers and researchers) defined a long list of potential indicators based on the literature, national guidelines and expert opinion. This list was assessed against the AIRE (Appraisal of Indicators through Research and Evaluation) instrument criteria, resulting in a short list of draft indicators.

Pregnancy and labour in the Dutch maternity care system: what is normal? The role division between midwives and obstetricians.

Introduction: In the Dutch maternity care system, the role division between independently practising midwives (who take care of normal pregnancy and childbirth) and obstetricians (who care for pathologic pregnancy and childbirth) has been established in the so-called "List of Obstetric Indications"(LOI). The LOI designates the most appropriate care provider for women with defined medical or obstetric conditions.

Methods: This descriptive study analysed the evolution of the concept of "normality" by comparing the development and the contents of the consecutive versions of the LOI from 1958 onwards.

Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births.

Objective: To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care.

Design: A nationwide cohort study.

Setting: The entire Netherlands.

A trend analysis in referrals during pregnancy and labour in Dutch midwifery care 1988-2004.

Objective: To assess the trends and patterns of referral from midwives to obstetricians within the Dutch maternity care system from 1988 to 2004, and the differences in referral patterns between nulliparous and parous women.

Design: A descriptive study.

Setting: The Dutch midwifery database (LVR1), which monitored 74% (1988) to 94% (2004) of all midwifery care in the Netherlands between 1988 and 2004.

[Ethnic differences in preference for home delivery and in pregnancy care received by pregnant women].

Objective: To investigate differences among pregnant women from various ethnic groups in terms of pregnancy care and the place of delivery.

Design: Descriptive, retrospective study.

Method: Data from the Dutch Perinatal Registries during the period 1995-2002, representing a total of 1,401,892 pregnancies, were linked and analysed for perinatal care, the place of the delivery and the ethnic group of the mother.

Evaluation of 280,000 cases in Dutch midwifery practices: a descriptive study.

Objective: To assess the nature and outcome of intrapartum referrals from primary to secondary care within the Dutch obstetric system.

Design: Descriptive study.

Setting: Dutch midwifery database (LVR1), covering 95% of all midwifery care and 80% of all Dutch pregnancies (2001-03).

Cost-effectiveness of different treatment strategies with intrapartum antibiotic prophylaxis to prevent early-onset group B streptococcal disease.

Objective: To estimate the costs and effects of different treatment strategies with intrapartum antibiotic prophylaxis to prevent early-onset group B streptococcal (GBS) disease in the Netherlands. The treatment strategies include a risk-based strategy, a screening-based strategy, a combined screening/risk-based strategy and the current Dutch guideline.

Design: Cost-effectiveness analysis based on decision model.

Suboptimal care and perinatal mortality in ten European regions: methodology and evaluation of an international audit.

Background: A European concerted action (the EuroNatal study) investigated differences in perinatal mortality between countries of Europe. This report describes the methods used in the EuroNatal international audit and discusses the validity of the results.

Methods: Perinatal deaths between 1993 and 1998 in regions of ten European countries were identified.

[Evaluation and validation of a perinatal death audit by means of feedback to the caregivers].

Objective: To evaluate a perinatal audit procedure by communicating the results to the caregivers (midwives and obstetricians) involved, in order to determine whether the audit led to specific suggestions for improving practice and whether evaluation of the panel assessments by caregivers leads to a different evaluation of the audit process.

Design: Descriptive evaluation study.

Method: Because of privacy regulations, the results of a recently published audit concerning perinatal mortality were reported at an aggregated level.

Randomised clinical trial on the effect of the Dutch obstetric peer review system.

The project "Obstetric Peer Review Interventions" (Verloskundige Onderlinge Kwaliteitsspiegeling Interventies, VOKSINT) was set-up in The Netherlands in 1994. It provided annual comparison data (quality ranking, league tables) for secondary care obstetric departments adjusted for population differences, based on the data registered in the Perinatal Database of The Netherlands (Landelijke Verloskunde Registratie, LVR). The aim of the so-called VOKS reports was to influence obstetricians' interventions in such a way that they led to a more homogeneous policy.

[Perinatal mortality assessed: results of a regional audit].

Objective: To assess the level of suboptimal care prior to cases of perinatal death and the extent to which perinatal mortality can be reduced by further improvements in care.

Design: Retrospective panel audit investigation.

Method: Cases of perinatal death occurring in 1996 and 1997 among women living in the region Zuid-Holland-Noord, the Netherlands, were identified by approaching midwives, obstetricians/gynaecologists and paediatricians/neonatologists.

An European concerted action investigating the validity of perinatal mortality as an outcome indicator for the quality of antenatal and perinatal care.

In this paper the concepts, objectives, design, and data analysis procedures of the EuroNatal study are described. This study started in 1996 and is a concerted action including 14 countries in Europe. The EuroNatal study aims at determining the validity of national perinatal mortality rates as an outcome indicator for the quality of antenatal and perinatal care.