Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in Norway
Abstract Background In a recent population-based study we reported excess risk of neonatal mortality associated with vaginal breech delivery. In this case-control study we examine whether deviations from Norwegian guidelines are more common in breech deliveries resulting in intrapartum or neonatal d...
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| Format: | Article |
| Language: | English |
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BMC
2019-09-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | http://link.springer.com/article/10.1186/s12884-019-2464-7 |
| _version_ | 1818208307918143488 |
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| author | Solveig Bjellmo Sissel Hjelle Lone Krebs Elisabeth Magnussen Torstein Vik |
| author_facet | Solveig Bjellmo Sissel Hjelle Lone Krebs Elisabeth Magnussen Torstein Vik |
| author_sort | Solveig Bjellmo |
| collection | DOAJ |
| description | Abstract Background In a recent population-based study we reported excess risk of neonatal mortality associated with vaginal breech delivery. In this case-control study we examine whether deviations from Norwegian guidelines are more common in breech deliveries resulting in intrapartum or neonatal deaths than in breech deliveries where the offspring survives, and if these deaths are potentially avoidable. Material and methods Case-control study completed as a perinatal audit including term breech deliveries of singleton without congenital anomalies in Norway from 1999 to 2015. Deliveries where the child died intrapartum or in the neonatal period were case deliveries. For each case, two control deliveries who survived were identified. All the included deliveries were reviewed by four obstetricians independently assessing if the deaths in the case group might have been avoided and if the management of the deviations from Norwegian guidelines were more common in case than in control deliveries. Results Thirty-one case and 62 control deliveries were identified by the Medical Birth Registry of Norway. After exclusion of non-eligible deliveries, 22 case and 31 control deliveries were studied. Three case and two control deliveries were unplanned home deliveries, while all in-hospital deliveries were in line with national guidelines. Antenatal care and/or management of in-hospital deliveries was assessed as suboptimal in seven (37%) case and two (7%) control deliveries (p = 0.020). Three case deliveries were completed as planned caesarean delivery and 12 (75%) of the remaining 16 deaths were considered potentially avoidable had planned caesarean delivery been done. In seven of these 16 deliveries, death was associated with cord prolapse or difficult delivery of the head. Conclusion All in-hospital breech deliveries were in line with Norwegian guidelines. Seven of twelve potentially avoidable deaths were associated with birth complications related to breech presentation. However, suboptimal care was more common in case than control deliveries. Further improvement of intrapartum care may be obtained through continuous rigorous training and feedback from repeated perinatal audits. |
| first_indexed | 2024-12-12T04:42:45Z |
| format | Article |
| id | doaj.art-f506fb1b5ea143af92ce584d5481ae1b |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-12T04:42:45Z |
| publishDate | 2019-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-f506fb1b5ea143af92ce584d5481ae1b2022-12-22T00:37:44ZengBMCBMC Pregnancy and Childbirth1471-23932019-09-011911910.1186/s12884-019-2464-7Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in NorwaySolveig Bjellmo0Sissel Hjelle1Lone Krebs2Elisabeth Magnussen3Torstein Vik4Department of Obstetrics and Gynecology, More and Romsdal Hospital TrustDepartment of Obstetrics and Gynecology, More and Romsdal Hospital TrustDepartment of Gynecology and Obstetrics, University of Copenhagen Holbaek HospitalDepartment of Obstetrics and Gynecology, St Olav’s University HospitalDepartment of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU)Abstract Background In a recent population-based study we reported excess risk of neonatal mortality associated with vaginal breech delivery. In this case-control study we examine whether deviations from Norwegian guidelines are more common in breech deliveries resulting in intrapartum or neonatal deaths than in breech deliveries where the offspring survives, and if these deaths are potentially avoidable. Material and methods Case-control study completed as a perinatal audit including term breech deliveries of singleton without congenital anomalies in Norway from 1999 to 2015. Deliveries where the child died intrapartum or in the neonatal period were case deliveries. For each case, two control deliveries who survived were identified. All the included deliveries were reviewed by four obstetricians independently assessing if the deaths in the case group might have been avoided and if the management of the deviations from Norwegian guidelines were more common in case than in control deliveries. Results Thirty-one case and 62 control deliveries were identified by the Medical Birth Registry of Norway. After exclusion of non-eligible deliveries, 22 case and 31 control deliveries were studied. Three case and two control deliveries were unplanned home deliveries, while all in-hospital deliveries were in line with national guidelines. Antenatal care and/or management of in-hospital deliveries was assessed as suboptimal in seven (37%) case and two (7%) control deliveries (p = 0.020). Three case deliveries were completed as planned caesarean delivery and 12 (75%) of the remaining 16 deaths were considered potentially avoidable had planned caesarean delivery been done. In seven of these 16 deliveries, death was associated with cord prolapse or difficult delivery of the head. Conclusion All in-hospital breech deliveries were in line with Norwegian guidelines. Seven of twelve potentially avoidable deaths were associated with birth complications related to breech presentation. However, suboptimal care was more common in case than control deliveries. Further improvement of intrapartum care may be obtained through continuous rigorous training and feedback from repeated perinatal audits.http://link.springer.com/article/10.1186/s12884-019-2464-7Breech deliveryMortalityPerinatal auditObstetrics |
| spellingShingle | Solveig Bjellmo Sissel Hjelle Lone Krebs Elisabeth Magnussen Torstein Vik Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in Norway BMC Pregnancy and Childbirth Breech delivery Mortality Perinatal audit Obstetrics |
| title | Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in Norway |
| title_full | Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in Norway |
| title_fullStr | Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in Norway |
| title_full_unstemmed | Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in Norway |
| title_short | Adherence to guidelines and suboptimal practice in term breech delivery with perinatal death- a population-based case-control study in Norway |
| title_sort | adherence to guidelines and suboptimal practice in term breech delivery with perinatal death a population based case control study in norway |
| topic | Breech delivery Mortality Perinatal audit Obstetrics |
| url | http://link.springer.com/article/10.1186/s12884-019-2464-7 |
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