Danish Perinatal Quality Indicators
The Danish Society of Obstetricians and Gynaecologists (DSOG) - in collaboration with Danish National Board of Health – have analysed perinatal quality indicators for mothers and infants.
Here we present the results for all Danish hospitals (> 99 % of all deliveries) in 2005 and in the four-year period 2002-2005.
The indicators are shown in five tables and each indicator is shown graphically with 95% confidence intervals.
The indicator rates of each obstetric unit are compared with those of 1) all deliveries of residents in the same county, and 2) all deliveries in Denmark .
Tabels
The five tables present indicators regarding:
1. Deliveries with denominator = all deliveries
2. Deliveries with denominator = intended vaginal deliveries
3. A DSOG standard population of low risk nullipara
4. Newborn with a gestational age >= 37 weeks
5. Newborn with a gestational age < 37 weeks
These tables are – for technical reasons – presented in 3 files (table 1-2, table 3, and table 4-5)
Figures
All indicators – especially rare (serious) complications at birth – will due to random variation – and not always a real difference in levels of quality – differ a great deal between obstetric units.
In an attempt to adjust for some of this random variation, we have shown all indicators with bars indicating 95% confidence intervals when compared with other populations.
The figures are found in the files below the tables
One indicator – Base Excess – has (unlike all other indicators) only been measured in a minority of newborns. Therefore we have shown the total number of measurements of this specific indicator for each obstetric unit and the corresponding populations. Still, however, it is difficult to interpret the results of this indicator since we do not know whether the presented values are mainly from low risk deliveries or high risk deliveries.
Copenhagen, 21 September 2006
Jens Langhoff-Roos and Steen Rasmussen
Danish Society of Obstetrics & Gynaecology and Danish National Board of Health
Deliveries (mothers)
• Caesarean section Caesarean deliveries, both elective and emergency (denominator: all deliveries).
• Planned prelabour caesarean section Caesarean deliveries planned and performed before labour or rupture of membranes (denominator: all deliveries).
• Intended vaginal delivery Deliveries that were not planned to be caesarean deliveries regardless of whether they were carried out before or during labour, or emergency caesarean deliveries before labour (denominator: all deliveries).
• Emergency caesarean section Unplanned Caesarean section carried out during labour because of labour complications (denominator: intended vaginal deliveries).
• Induction of labour Deliveries induced by drugs, rupture of membranes or catheter (denominator: intended vaginal deliveries).
• Vacuum extraction/forceps Deliveries assisted by use of vacuum extractor or forceps (denominator: intended vaginal deliveries).
• Epidural analgesia Epidural analgesia for pain relief (denominator: intended vaginal deliveries).
• Episiotomy (denominator: intended vaginal deliveries).
• Rupture of anal sphincter Perineal rupture degree III or IV, thus including all types of perineal tears with some rupture of the external sphincter (denominator: intended vaginal deliveries).
• Oxytocin stimulation Deliveries where labour was augmented by oxytocin drip (denominator: intended vaginal deliveries).
• Postpartum haemorrhage Estimated blood loss above 500 ml (denominator: intended vaginal deliveries).
• Delivery without interventions “Natural delivery” All deliveries, without caesarean section, induction of labour, vacuum extraction or forceps, oxytocin stimulation, episiotomy and epidural analgesia. (denominator: all deliveries)
• Uncomplicated delivery Deliveries characterized by absence of caesarean section, vacuum extraction or forceps, episiotomy, sphincter rupture, postpartum haemorrhage, stillbirth, Apgar score below 7 after 5 min, and admittance to NICU (neonatal intensive care unit) (denominator: all deliveries)
Births
• Stillbirth Fetal death before or during labour, gestational age > 153 days (denominator: all births)
• Early neonatal death Neonatal death before 7 days (denominator: all live births)
• Late neonatal death Neonatal death after 6 days and before 28 days (denominator: all live births)
• Low Apgar score Apgar score below 7 after 5 min. (denominator: all live births)
• Low SBE Standard base excess below - 10 in umbilical artery at birth (denominator: all live births)
• Admittance to NICU for less than 24 hours Infants admitted to NICU on the day of birth or the day after, and who stayed for less than 24 hours (denominator: all live births)
• Admittance to NICU for more than 24 hours Infants admitted to NICU on the day of birth or the day after, and who stayed for 24 hours or more (denominator: all live births)
• Admittance to NICU – CPAP treatment (treatment code BGFC32) (denominator: all live births)
• Admittance to NICU – ventilator treatment (treatment code BGDA0) (denominator: all live births)
Codes applied
• Caesarean section KMCA10*
• Planned prelabour Caesarean section KMCA10B
• Intended vaginal delivery All – (KMCA10A + KMCA10B + KMCA10D)
• Emergency caesarean section KMCA10E
• Induction of labour KMAC00, KMAC96A, BKHD20, BKHD21 , BKHD2, ZZ4550 ,ZZ4561, ZZ4562 ,ZZ4569 O80.2, O80.3, O84.5
• Vacuum extraction/forceps KMAE*, KMAF*
• Epidural analgesia NAAD0B, NAAD0, ZV03, NAAD02, BABZ00
• Episiotomy KMTD00
• Rupture of sphincter ani O70.2, O70.2A, O70.2C, O70.2D, O70.2E, O70.3
• Oxytocin stimulation BKHD3, BKHD31
• Postpartum haemorrhage DO72*
• Delivery without interventions “Natural delivery” All – (caesarean section, induction of labour, vacuum extraction/forceps, episiotomy, oxytocin stimulation, epidural analgesia)
• Uncomplicated delivery All – (caesarean delivery, vacuum extraction/forceps, episiotomy, sphincter rupture, postpartum haemorrhage, still birth, low Apgar score, admittance to NICU)
DSOG standard population of low risk nullipara
Healthy pregnant nullipara (non-smokers, normal BMI (<30) and neither medical diseases nor serious pregnancy complications) with intended vaginal delivery of a singleton infant in vertex presentation at term (>= 37 weeks).
Parturients that fulfill all criteria below:
• No previous deliveries
• Gestational age >= 37 weeks
• No caesarean section before labour or intended caesarean carried out during labour (KMCA10A or KMCA10B or KMCA10D)
• No induction of labour
• Singleton
• No breech or transverse lie (DUP7-11 or DUP16)
• No medical disease or complication in pregnancy (DO99* with attachment of relevant organ specific diagnoses, DO24*, DO360, DO361, DO14*, DO150, DO359A, DO223, DO266G)
• No smoking
• BMI < 30
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