Term perinatal mortality audit in the Netherlands 2010-2012: A population-based cohort study

Objective: Investigation of the implementation and results of the national term perinatal mortality audit. Design: Populationbased cohort study. Method: Perinatal audits were carried out in all 90 Dutch hospitals with obstetric departments together with the surrounding midwifery practices. These audits involved cases of term perinatal mortality. Various registries were used to collect data relating to audit participation, perinatal death classification, shortcomings in care (substandard factors; SSF) and their relation to death, recommendations for quality improvement in care and antepartum risk assessment. Results: 1,102 term perinatal deaths occurred between 2010 and 2012. 645 audit sessions took place with an average of 31 participants per session. Data were recorded for 943 cases of term perinatal death (86%), and audit results for 707 (64%). In 53% of the cases at least one SSF was identified. Noncompliance with guidelines (35%) and deviation from conventional professional care (41%) were the most common. The percentage of cases of mortality in which there was a probable relation between SSFs and death decreased from 10% (n = 23) in 2010 to 5% (n = 10) in 2012 (p = 0.060). Term perinatal mortality decreased from 2.3 to 2.0 per 1000 births (p < 0.001). Possibilities for improvement were identified in the organisation of care (35%), compliance with guidelines or conventional care (19%) and in better documentation (15%). Conclusion: The perinatal audit was implemented over a short period of time. Term perinatal mortality in the Netherlands decreased during the period in which this study took place.