Quality measures for the emergency obstetrics and gynaecology services.

The maternal mortality rate was the first measure of quality in the obstetric services. It is a crude indicator but is still used for international comparisons. In the UK, confidential enquiries into maternal and perinatal deaths produce recommendations the implementation of which is not well audited as yet. 'Near misses' are harder to define but are audited in individual units. Standards drawn up by the Central Negligence Scheme for Trusts could potentially promote improvements. The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists have jointly published standards of care in labour wards. Gynaecological standards are less well developed but should evolve as NHS audit improves.