Perinatal mortality audits and reviews: current systems, challenges and the way forward

Perinatal mortality audits and reviews: current systems, challenges and the way forward

Änne Helps (1,2,3), Sara Leitao (2), Richard Greene (2), Keelin O’Donoghue (1,3)

1) Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Ireland, 2) National Perinatal Epidemiology Centre (NPEC), University College Cork, Ireland, 3) The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland

Background
Perinatal deaths occur and are devastating for parents, families and all health care professionals involved. Perinatal mortality reviews (PMRs) take place to highlight good care, as well as identify contributory factors and analyse weaknesses in health care services. Failure to examine perinatal deaths for substandard care prevents learning and may lead to recurrence of events.

Methodology
The different types of PMRs being done internationally were studied through a structured scientific literature review (1940 to 2018). This has been completed as part of a doctoral study in Ireland focusing on PMRs.

Findings
Differences in definitions of stillbirths and neonatal deaths have, and continue to, impede international comparisons. While confidential enquiries (CE) give impartial expert assessment on anonymised information, unit-based multi-disciplinary team (MDT) meetings provide extensive information on perinatal deaths with local knowledge. Detailed, impartial, multidisciplinary examination (e.g. CE) is required for a profound understanding of the care provided to women with poor perinatal outcome. Involving bereaved parents in the PMR process is essential, however it is still mostly unexplored.

Conclusions
Reliable national perinatal mortality data facilitates international comparison and benchmarking. Ongoing development of specific electronic PMR tools will promote a regulated, systematic national process for PMRs. To accomplish informative local PMRs, clinical staff and bereaved families are now and should be regularly involved. Well-attended local MDT perinatal mortality meetings are an efficient way of circulating findings to staff and encourage progress. A standardized and structured approach to the process should be developed to facilitate sharing of experiences and challenges at national (or international) level. To achieve a reduction in the number of perinatal deaths, substandard care must be identified and progress made accordingly.

Ethics statement:
Only publicly-available reports were analysed, therefore no ethics approval was required.

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