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.