Implementation of an Interprofessional Team Review of Adverse Events in Obstetrics Using a Standardized Computer Tool: A Mixed Methods Study.

Objective: As part of a larger study, an interprofessional team piloted a computer tool called Standardized Clinical Outcome Review (SCOR) to review adverse obstetric events that occurred at a tertiary care hospital over a 12-month period. We sought to understand whether the SCOR tool offered a feasible, acceptable, and appropriate strategy for improving patient safety through improved review of incidents.

Methods: We designed a mixed methods implementation study.

Learning from Adverse Events in Obstetrics: Is a Standardized Computer Tool an Effective Strategy for Root Cause Analysis?

Objective: Adverse events occur in up to 10% of obstetric cases, and up to one half of these could be prevented. Case reviews and root cause analysis using a structured tool may help health care providers to learn from adverse events and to identify trends and recurring systems issues. We sought to establish the reliability of a root cause analysis computer application called Standardized Clinical Outcome Review (SCOR).

Trisomies 18 and 13: trends in prevalence and prenatal diagnosis - population based study.

Objective: The objective of this study was to determine trends in prenatal detection and current estimates of prevalence for trisomies 18 (T18) and 13 (T13) and their implications for screening policy.

Methods: We conducted a cohort study from a population-based regional anomaly register covering 995 003 births (1995-2009).

Results: There were 786 affected cases.

Maternal and fetal risk factors for stillbirth: population based study.

Objective: To assess the main risk factors associated with stillbirth in a multiethnic English maternity population.

Design: Cohort study.

Setting: National Health Service region in England.

Customised assessment of fetal growth potential: implications for perinatal care.

Assessment of fetal growth is a central requirement for good perinatal care. The concept of the individually customised growth potential has enhanced our understanding of the importance of intrauterine growth restriction and its effects on pregnancy outcome. Prospectively, it provides a promising tool for improving antenatal detection, and highlights the need for appropriate protocols and pathways, training and resources to implement effective strategies for prevention.

Clinical strategies for improving the detection of fetal growth restriction.

The single most important condition affecting the viable fetus is intrauterine growth retardation (IUGR). IUGR is a common condition, affecting about 10% to 15% of the general maternity population. Despite its importance and relatively high prevalence, IUGR detection is poor.

The customised growth potential: an international research tool to study the epidemiology of fetal growth.

Customised centiles based on individual fetal growth potential enhance our ability to differentiate between physiological and pathological smallness. A series of studies in different maternity populations has found striking similarities in the way fetal growth varies with maternal and pregnancy related characteristics, and has established the clear advantages of this method over generic, population-based birthweight or fetal weight standards. The method opens up many new avenues for the retrospective study of risk factors and fetal growth.

Fetal growth screening by fundal height measurement.

Fundal height assessment is an inexpensive method for screening for fetal growth restriction. It has had mixed results in the literature, which is likely to be because of a wide variety of methods used. A standardised protocol of measurement by tape and plotting on customised charts is presented, which in routine practice has shown to be able to significantly increase detection rates, while reducing unnecessary referral for further investigation.

Stillbirth classification--developing an international consensus for research: executive summary of a National Institute of Child Health and Human Development workshop.

Stillbirth is a major obstetric complication, with 3.2 million stillbirths worldwide and 26,000 stillbirths in the United States every year. The Eunice Kennedy Shriver National Institute of Child Health and Human Development held a workshop from October 22-24, 2007, to review the pathophysiology of conditions underlying stillbirth to define causes of death.

Intrauterine growth restriction: new standards for assessing adverse outcome.

The study of associations between intrauterine growth restriction (IUGR) and adverse outcome benefits from the use of a birthweight standard which is based on customised growth potential. Its application is able to retrospectively quantify the strength of the link with IUGR, whether fetal growth problems were identified antenatally or not. Furthermore, growth failure hitherto unrecognised by conventional standards, such as the average size but relatively small babies of mothers with high body mass index, identify IUGR as a cause of the increased perinatal mortality risk in obese pregnancies.

Adverse pregnancy outcome and association with small for gestational age birthweight by customized and population-based percentiles.

Objective: The objective of the study was to investigate the association between pregnancy complications and small for gestational age (SGA) birthweight, comparing SGA based on the customized growth potential with SGA based on the birthweight standard of the same population.

Study Design: This was a retrospective analysis of a database from a US multicenter study. Pregnancy complications included threatened preterm labor, antepartum hemorrhage, pregnancy-induced hypertension, preeclampsia, stillbirth, and early neonatal death.

A customized standard to assess fetal growth in a US population.

Objective: The objective of the study was to assess the factors that affect fetal growth and birthweight, and to derive coefficients for a customized growth chart applicable in an American population.

Study Design: This was a prospective cohort study of 35,235 pregnancies. Coefficients for physiological and pathological variables were derived by backward multiple regression.

Termination of pregnancy for fetal anomaly: a population-based study 1995 to 2004.

Terminations of pregnancy for fetal anomaly (TOPFAs) were analysed over a 10-year period from a population-based congenital anomaly register covering 646,342 births. A total of 3189 cases of TOPFA were identified, prevalence of 49.3 per 10,000 registerable births.

New definition of small for gestational age based on fetal growth potential.

Accurate definition of small for gestational age (SGA) is essential for antenatal as well as postnatal care. SGA is associated with significant antenatal and postnatal pathology. The term, however, includes constitutional smallness, and it is essential to adjust for physiological variation in order to identify those babies who are pathologically small.

The epidemiology of preterm birth.

Preterm birth is a major clinical problem, accounting for 47% of all neonatal deaths. The preterm delivery rate in UK is approximately 7%, and rates of preterm birth are steadily increasing. The diagnosis of preterm labour is difficult and most interventions to halt labour are unsuccessful.

Congenital malformations of the diaphragm: findings of the West Midlands Congenital Anomaly Register 1995 to 2000.

Objectives: To describe trends in incidence, associated anomalies, clinical outcomes and sensitivity of prenatal diagnosis for congenital malformations of the diaphragm in the West Midlands Region between 1995 and 2000.

Methods: Information was retrieved from a population-based register of major congenital malformations in a health region of England, the West Midlands Congenital Anomaly Register (WMCAR), between 1995 and 2000.

Results: One hundred and sixty-one confirmed cases of congenital malformations of the diaphragm were notified from 396 577 births.

Perinatal mortality and fetal growth restriction.

Stillbirths are the largest component of perinatal mortality. Most are currently classified as 'unexplained', which is not helpful for counselling and individual care or for setting priorities for maternity services. The new ReCoDe classification reduces the number of stillbirths categorized as 'unexplained' from 66 to 14%.

The use of volume expansion in preterm infants.

There is no consensus of opinion regarding the appropriate use of volume expansion in the sick preterm infant. Recent evidence suggests that excessive volume expansion may increase mortality in this group. We determined the use of volume expansion in non-surgical preterm infants (<30 weeks gestation) among neonatal consultants in the West Midlands.

Excessive volume expansion and neonatal death in preterm infants born at 27-28 weeks gestation.

Volume expansion is used commonly in preterm infants to treat presumed hypovolaemia. However, the amount that should be given is uncertain. We present data that were obtained from anonymised regional case notes of Project 27/28, a national case-controlled study run by the Confidential Enquiry into Stillbirths and Deaths in Infancy.