N Carrabin1, C Huissoud, C Dupont, C Colin, R-C Rudigoz. 1. Service de gynécologie-obstétrique, hospices civils de Lyon, hôpital de la Croix-Rousse, 69004 Lyon, France. nicolascarrabin@yahoo.fr
Abstract
OBJECTIVES: To assess the impact of morbidity mortality conferences on medical care in case of perinatal death and to point out situations with high risk of inappropriate care. PATIENTS AND METHODS: We have prospectively listed in the Aurore perinatal network all the perinatal deaths and their related causes using a controlled declarative system between January 2005 and December 2007. A multidisciplinary committee retrospectively analysed during morbidity mortality conferences the quality of care and subsequently classified the management as appropriate, inappropriate or doubtful. RESULTS: We analysed 687 perinatal deaths. The suboptimal care rates varied between 12 and 13% during the study (nonsignificant). Intrauterine growth restriction (IUGR) was the first cause of stillbirth (25 to 30%). IUGR was not suspected prenatally in more than 50% of the cases. IUGRs were significantly associated with higher rates of inappropriate management when compared to the other aetiologies of stillbirth (20 to 28% vs 7 to 11% respectively, p < or = 0.05). CONCLUSION: Despite the morbidity mortality conferences, the rate of inappropriate care stayed stable. Identification and management of IUGR fetuses have to be improved to decrease the suboptimal care rate in the Aurore perinatal network.
OBJECTIVES: To assess the impact of morbidity mortality conferences on medical care in case of perinatal death and to point out situations with high risk of inappropriate care. PATIENTS AND METHODS: We have prospectively listed in the Aurore perinatal network all the perinatal deaths and their related causes using a controlled declarative system between January 2005 and December 2007. A multidisciplinary committee retrospectively analysed during morbidity mortality conferences the quality of care and subsequently classified the management as appropriate, inappropriate or doubtful. RESULTS: We analysed 687 perinatal deaths. The suboptimal care rates varied between 12 and 13% during the study (nonsignificant). Intrauterine growth restriction (IUGR) was the first cause of stillbirth (25 to 30%). IUGR was not suspected prenatally in more than 50% of the cases. IUGRs were significantly associated with higher rates of inappropriate management when compared to the other aetiologies of stillbirth (20 to 28% vs 7 to 11% respectively, p < or = 0.05). CONCLUSION: Despite the morbidity mortality conferences, the rate of inappropriate care stayed stable. Identification and management of IUGR fetuses have to be improved to decrease the suboptimal care rate in the Aurore perinatal network.