The Italian Perinatal Surveillance System SPItOSS: insights from Confidential Enquiries

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Public Health Surveillance

Background:

• Effective perinatal mortality reduction strategies necessitate active surveillance systems.
• These systems involve case monitoring, multidisciplinary audits, confidential inquiries, and healthcare system modifications.
• The Italian Obstetric Surveillance System (SPItOSS) initiated a pilot Perinatal Surveillance System in 2017.

Purpose of the Study:

• To report findings from the SPItOSS Confidential Enquiries on perinatal deaths.
• To identify critical issues in obstetric and neonatal care.
• To analyze the organization of healthcare facilities contributing to perinatal mortality.

Main Methods:

• SPItOSS, a population-based system, analyzed perinatal deaths from July 2017 to June 2019 in three Italian regions.
• Cases included stillbirths (≥28 weeks gestation) and live newborns dying within 7 days.
• Confidential Enquiries focused on preventable deaths, using the International Statistical Classification of Diseases and related Health Problem-Perinatal Mortality for coding.

Main Results:

• 830 incident perinatal deaths were recorded: 58.3% antepartum, 4.3% intrapartum, 37.3% neonatal.
• Confidential Enquiries reviewed 19 intrapartum and 70 neonatal deaths deemed most preventable.
• 43.8% were unavoidable with appropriate care, 29.2% with improvable care, and 15.7% avoidable due to inappropriate care (e.g., delayed recognition of problems, inadequate resuscitation).

Conclusions:

• SPItOSS Confidential Enquiries offer valuable insights for enhancing maternity and perinatal services.
• Targeting key areas in obstetric and neonatal care through surveillance can lead to actionable recommendations.
• The system aims to prevent avoidable perinatal deaths by identifying and addressing critical care and organizational factors.