Value of perinatal audit in obstetric care in the developing world: a ten-year experience of the Maputo model.

A decade of perinatal audit in the Maputo Central Hospital is reviewed with the objective of addressing the potential value of the audit process in monitoring the different constituents of morbidity and mortality in the perinatal period. The perinatal mortality showed a significant but transient change during the observation period 1982-1991, while intrapartum fetal mortality was significantly reduced from 10.9 to 3.9 per thousand (p < 0.0005). Staff members were sensitized towards immediate and long-term effects of implemented surveillance routines by regular feedback of perinatal data on visible wall charts and by weekly conferences. The advantages of a comprehensive audit approach in perinatal medicine comprising both maternal and fetal/infant aspect are underscored. An ethical commitment to nonconfidential straight-forwardness and open-mindedness in critical discussions regarding mismanagement is emphasized for a successful audit strategy.