Quality assurance in perinatal and obstetrical care: the Norwegian approach

To review the structure of all obstetrical units in Norway and to monitor the performance of care in terms of perinatal mortality, ultrasound examination and selected clinical events in routine obstetrical care.

I. Audit of all perinatal deaths (270) in five Norwegian counties during one year. II. Consensus conference to review the practice and distribution of all antenatal diagnostic ultrasounds performed country-wide over one week. III. Statistical review of quality indicators or flag events in routine obstetrical care.

I. Identification of a significant percentage of "avoidable" perinatal deaths, most frequently related to antenatal and neonatal care rather than to obstetrical care--resulting in official guidelines for antenatal care and the routine audit of perinatal deaths. II. 96% of women surveyed had ultrasonography, an average of 2.5 examinations each. An investigational procedure already established practice, it was recommended that one ultrasound performed in week 17-20 should be offered each pregnant woman. III. Clinical obstetrical practice varied significantly and it was noted that junior obstetricians had not adhered to established routines. Short and long term monitoring of clinical trends is considered.