Term breech presentation in The Netherlands from 1995 to 1999: mortality and morbidity in relation to the mode of delivery of 33824 infants.

Objective: To analyse neonatal mortality and morbidity in term infants born in breech presentation in relation to the mode of delivery (planned caesarean section, emergency caesarean section or vaginal delivery) and to compare these findings with those of the Term Breech Trial Collaborative Group [Hannah et al. Lancet 2000; October].

Design: Retrospective observational study.

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.

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 Perinatal Database of the Netherlands.

Objective: In the Netherlands, the Perinatal Database of the Netherlands (Landelijke Verloskunderegistratie, LVR) was set up in 1982 for secondary care obstetric departments on a voluntary participation basis, its main goal being quality monitoring. At the outset of the database, 70% of Dutch obstetric departments participated immediately. This percentage has now increased to almost 100%.

Large differences in obstetrical intervention rates among Dutch hospitals, even after adjustment for population differences.

Within the framework of the 'Obstetric Peer Review' project (Verloskundige Onderlinge Kwaliteitsspiegeling, VOKS) statistical models have been developed to predict department specific intervention rates, based on the distribution of risk factors in each department. Subsequently the difference between the expected number of interventions (labour inductions, caesarean sections and vaginal operative deliveries) and the actual numbers were calculated for each year and subpopulation defined by the level of prematurity. Data used were available from the Perinatal Database of the Netherlands (Landelijke Verloskunde Registratie, LVR) concerning the years 1988-1992.

The Dutch obstetric intervention study--variations in practice patterns.

Objective: To compare obstetric intervention rates between Dutch hospitals.

Methods: A total of 28,934 hospital births under secondary care (specialist care for medium-/high-risk pregnancies) in 1990 were analyzed in a stratified, random sample of Dutch hospitals based on the records of the Dutch Netherlands perinatal database. Comparisons were made of the intervention rates between hospitals.

Trends in caesarean section rates among high- and medium-risk pregnancies in The Netherlands 1983-1992.

During the last two decades, the rates of operative deliveries have been rising constantly in all industrialized countries including the Netherlands. Within the framework of the project 'Obstetric Peer Review' (Verloskundige Onderlinge Kwaliteitsspiegeling), the trends in the caesarean section rates were investigated, using the data of the Perinatal Database of the Netherlands (LVR), but only among the high- and medium-risk pregnancies. To that end homogeneous high-risk subgroups, with respect to pregnancy- or delivery-related complications, were defined in various ways and caesarean section rates were calculated for these groups.

How to compare and report department specific mortality rates for peer review using the Perinatal Database of The Netherlands.

Since characteristics of patient populations of obstetric departments vary substantially with respect to the pathology presented, (perinatal) mortality rates as such can not be used for a fair peer review without adjustment for those differences. Using the Perinatal Database of The Netherlands (LVR), data on approximately 80,000 newborns annually from 1985 to 1991 inclusive were used in statistical models to predict the perinatal mortality risks of four subpopulations of different gestational age in about 125 obstetric departments. As predictors for perinatal mortality we used only those risk factors which were judged to reflect the 'pathology' of the patient; risk factors associated with or resulting from hospital care and/or policy are (by definition) excluded.

Comparing mortality and morbidity in hospitals: theory and practice of quality assessment in peer review.

The incidence of mortality in a specific hospital depends on many risk factors. These risk factors may be divided roughly into two categories. The intake category, consists of those risk factors for which the hospital has hardly any influence upon their incidence; and the care category being those for which the incidence depends partly or completely on the treatment policy of the hospital.

Differences in obstetrical intervention rates between Dutch hospitals.

Within the framework of the project 'Obstetric Peer Review' (Verloskundige Onderlinge Kwaliteitsspiegeling, VOKS) differences between Dutch hospitals concerning various obstetrical interventions were investigated. Using data of the Perinatal Database of the Netherlands from hospitals with at least 2000 newborns in the 5-year period 1987-1991, remarkable differences in frequencies of labour induction, caesarean section and vaginal operative deliveries can be shown, even when these interventions were considered within homogeneous subgroups with respect to pregnancy- or delivery-related complications. The incidence of caesarean section (and labour induction and vaginal operative delivery) appeared to depend more on the specific hospital policy than might be explained by populations differences alone.

Estimate of perinatal mortality risk.

Perinatal mortality is usually calculated according to the World Health Organisation as stillbirth and first week mortality at a specified week of gestation divided by all births at that same gestational week. This is not a meaningful indicator of the risk of future perinatal death for a living fetus. We have developed an approach to estimate the prospective risk of perinatal mortality.

Obstetric characteristics profiles as quality assessment of obstetric care.

In The Netherlands only about 50% of all pregnancies are defined as high risk pregnancies and consequently come into the domain of care of an obstetrician. In order to qualify as a high risk pregnancy, the pregnancy must satisfy certain criteria contained in an officially approved list of indications. Due to varying perceptions of these selection criteria by the selectors, larger differences in the treated population, obstetric interventions and results, respectively, were expected than in other countries.

[Underreporting of first-week mortality in premature childbirth in the National Obstetrics Register].

The reliability of the perinatal mortality as recorded in the Perinatal Database of the Netherlands (LVR), was studied over 1983. For this year is was possible to make a comparison between preterm infants in the LVR and the same infants recorded by paediatricians in the database of the Project on Preterm and Small for Gestational Age Infants in the Netherlands 1983 (POPS). The comparison between the recorded mortality of the same infants in these two anonymous databases was realised by a simple matching procedure.

Sucralfate and sodium sucrose sulphate in the treatment of superficial corneal disease in keratoconjunctivitis sicca.

We have studied the effect of the aluminum complex of sucrose sulphate (Sucralfate suspension) and the sodium salt of sucrose sulphate (sodium sucrose sulphate solution) on patients with keratoconjunctivitis sicca. Eyes treated with either of these two drugs showed a decrease in painfulness and blurring of vision. On examination the surface area of the corneal lesions, stained with fluorescein, diminished during treatment.

[Inflammatory sequelae after adenovirus infection].

Adenovirus infections are common. The period of virus replication is short, hardly ever exceeding two weeks. In 216 patients we studied the post-inflammatory period after infection with adenovirus types 8, 4, 3, 7, 19 and 37, in some patients up to three years.

Perinatal mortality in breech presentations as compared to vertex presentations in singleton pregnancies: an analysis based upon 57819 computer-registered pregnancies in The Netherlands.

In 1982, nationwide registration of obstetric data was instituted in The Netherlands with about 70% of all Dutch hospitals participating. The resultant data from 57819 singleton pregnancies in vertex or breech presentation at delivery was studied. The vertex and breech groups were compared.