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.

Substandard factors in perinatal care in The Netherlands: a regional audit of perinatal deaths.

Background: To determine: 1) whether substandard factors were present in cases of perinatal death, and to what extent another course of action might have resulted in a better outcome, and 2) whether there were differences in the frequency of substandard factors by level of care, particularly between midwives and gynecologists/obstetricians and between home and hospital births.

Methods: Population-based perinatal audit, with explicit evidence-based audit criteria.

Setting: The northern part of the province of South-Holland in The Netherlands.

The reliability of perinatal and neonatal mortality rates: differential under-reporting in linked professional registers vs. Dutch civil registers.

Official Dutch perinatal mortality rates are based on birth and death certificates. These civil registration data are not detailed enough for international comparisons or extensive epidemiological research. In this study, we linked and extrapolated three national, incomplete, professional registers from midwives, obstetricians and paediatricians, containing detailed perinatal information.

The hour of birth: comparisons of circadian pattern between women cared for by midwives and obstetricians.

Objective: To examine the difference, if any, between midwives' care and obstetricians' care in the circadian pattern of the hour of birth in spontaneous labour and delivery.

Design: A descriptive study comparing the circadian pattern of the hour of birth between women cared for by a midwife or an obstetrician.

Setting: Data were derived from the Perinatal Database of the Netherlands (LVR), comprising 83% of all births under midwives' care and 75% of all births under obstetricians' care.

Practice variation of test procedures reportedly used in routine antenatal care in The Netherlands.

Background: Pregnant women are encouraged to book for antenatal care. However, little is known about the contents of antenatal care, in particular regarding various test procedures. The present descriptive study was conducted to assess the variation in standard test procedures in antenatal care in The Netherlands.