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National perinatal mortality audits and resultant initiatives in four countries
Änne Helps1, Sara Leitao2, Arlene Gutman3
1National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland; Pregnancy Loss Research Group, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland.
Insights
National perinatal mortality audits identify risk factors for stillbirths and neonatal deaths. Recurring recommendations indicate implementation failures, highlighting the need for shared learning among high-income countries.
Area of Science:
- Public Health
- Maternal and Child Health
- Healthcare Auditing
Background:
- National mortality audits are crucial for identifying risk factors in perinatal deaths.
- Effective implementation and re-evaluation of audit recommendations are essential to prevent recurrent adverse outcomes.
- Failure to implement recommendations leads to their repetition, indicating systemic issues.
Purpose of the Study:
- To examine the methodologies of national perinatal mortality audits in four high-income countries: the UK, New Zealand, Ireland, and the Netherlands.
- To compare recommendations from these audits over the past five years.
- To review national initiatives and programs designed to address these recommendations.
Main Methods:
- An integrative review approach was employed.
- Two literature searches were conducted: one on national perinatal mortality audits and another on initiatives addressing their recommendations.
- Content analysis of audit recommendations was performed, categorizing them into thematic areas.
Main Results:
- Audit methodologies varied, but all were state-funded with standardized online data collection.
- Key recommendation themes included public awareness, fetal growth restriction detection, preterm birth prevention, and data resources.
- Initiatives varied by country; the UK focused on risk factors, New Zealand involved stakeholders, the Netherlands developed an implementation program, and Ireland formed a progress group.
Conclusions:
- National perinatal mortality audits effectively identify contributing factors and formulate recommendations.
- Recurring recommendations signal a failure in addressing identified issues.
- Common challenges in high-income countries' audits underscore the importance of sharing successful initiatives and learning.
Background:
It is important to examine perinatal deaths as part of a national mortality audit to identify risk factors. Implementing and re-evaluating recommendations from perinatal mortality audits completes the audit cycle, preventing similar deaths in the future. Lack of implementation results in recommendations recurring.
Objectives:
In this study we examine national perinatal mortality audits' methodology in four high-income countries (United Kingdom, New Zealand, Ireland, Netherlands) to highlight different approaches taken. We compare the recommendations made in these audits' reports over the last five years, as well as review national initiatives and programmes addressing them.
Study Design:
This study is an integrative review where two comprehensive literature searches were completed: on established national perinatal mortality audits in high-income countries; and on national initiatives addressing recommendations from these audits. Content analysis of the audits' recommendations was performed organising them into themes according to topics these focused on.
Results:
Though the methodology of the national perinatal mortality audits varied, all four were state-funded and had standardised online data collection forms to report deaths. The recommendations themes included: Raising public awareness of perinatal mortality risk factors, Detection of fetal growth restriction, Prevention of preterm birth, Resources for data collection and review. Only the UK had various initiatives addressing perinatal mortality risk factors directly. New Zealand included stakeholders in the audit recommendations' development and provided updates on their implementation. The Netherlands developed a programme for audit recommendation implementation. Ireland created a group which is progressing some recommendations from the audit.
Conclusions:
National perinatal mortality audits are important in identifying contributory factors and making recommendations to address these. Recurring recommendations suggest a failure to resolve the identified issues. This study shows how some challenges are common to high-income countries' audits, highlighting the need for shared learning of successful initiatives.
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