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The Guadeloupean perinatal mortality audit: process, results, and implications
F de Caunes1, G R Alexander, C Berchel
1Department of Maternal and Child Health, School of Hygiene and Public Health, Johns Hopkins University.
Insights
Implementing a perinatal mortality audit in Guadeloupe significantly reduced avoidable deaths. This audit identified key factors like high blood pressure, infection, and preterm delivery, improving perinatal health outcomes.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Epidemiology
Background:
- Guadeloupe faced challenges with poor perinatal outcomes.
- An ongoing audit was initiated in 1983 to address these issues.
Purpose of the Study:
- To identify factors contributing to perinatal mortality.
- To motivate healthcare providers to improve perinatal care.
- To decrease avoidable perinatal deaths.
Main Methods:
- An active research approach was employed.
- All 320 perinatal deaths in Guadeloupe during 1984-1985 were investigated.
- A perinatal mortality audit with confidential inquiries was conducted.
Main Results:
- Maternal high blood pressure, infection, and preterm delivery were linked to nearly half of the deaths.
- Over half of the perinatal deaths were deemed avoidable.
- Perinatal mortality rates showed a significant decline during the audit period.
Conclusions:
- Perinatal audits, especially with confidential inquiries, can improve population perinatal health.
- Motivational incentives may enhance the effectiveness of perinatal audit programs.
Abstract:
In 1983, we implemented an ongoing perinatal mortality audit in Guadeloupe to identify factors underlying the current level of poor perinatal outcome and to stimulate increased provider motivation. The audit was part of an active research approach to document the specific nature of the perceived perinatal health problem, to modify provider behavior through the use of this acquired information, and, ultimately, to decrease avoidable perinatal deaths. We investigated all 320 perinatal deaths in Guadeloupe during 1984 and 1985. Nearly one-half of the perinatal deaths reviewed were determined to be related to maternal high blood pressure, maternal/fetal infection, and preterm delivery. Slightly more than one-half of the perinatal deaths were considered to be avoidable. Over the course of the audit, perinatal mortality rates exhibited a marked decline. The findings of this study support claims that perinatal audits with confidential inquiries may help effect change in perinatal health status in a population; the findings also call attention to the potential benefits of incorporating motivational incentives into these activities.