IntroductionAs maternal deaths become rarer, monitoring near-miss or severe maternal morbidity becomes important as a tool to measure changes in care quality. Many calls have been made to use routinely available hospital administration data to monitor the quality of maternity care. We investigated 1) the feasibility of developing an English Maternal Morbidity Outcome Indicator (EMMOI) by reproducing an Australian indicator using routinely available hospital data, 2) the impact of modifications to the indicator to address potential data quality issues, 3) the reliability of the indicator.MethodsWe used data from 6,389,066 women giving birth in England from April 2003 to March 2013 available in the Hospital Episode Statistics (HES) database of the Health and Social care Information centre (HSCIC). A composite indicator, EMMOI, was generated from the diagnoses and procedure codes. Rates of individual morbid events included in the EMMOI were compared with the rates in the UK reported by population-based studies.ResultsEMMOI included 26 morbid events (17 diagnosis and 9 procedures). Selection of the individual morbid events was guided by the Australian indicator and published literature for conditions associated with maternal morbidity and mortality in the UK, but was mainly driven by the quality of the routine hospital data. Comparing the rates of individual morbid events of the indicator with figures from population-based studies showed that the possibility of false positive and false negative cases cannot be ruled out.ConclusionWhile routine English hospital data can be used to generate a composite indicator to monitor trends in maternal morbidity during childbirth, the quality and reliability of this monitoring indicator depends on the quality of the hospital data, which is currently inadequate.

Hypoxic-ischaemic encephalopathy (HIE) incidence is an important perinatal care quality measure as it is a near-miss marker of intrapartum-related stillbirth and neonatal death. Currently there are worldwide clinical and epidemiological HIE case definition inconsistencies. This has implications for clinical neonatal care and perinatal care quality research and audit. A literature review of clinical findings and their validity in HIE was conducted in response to a need identified by the National Patient Safety Association, the National Perinatal Epidemiology Unit and a systematic review of international population-based data. The literature review found heterogeneous descriptions of clinical findings and clinical definitions in HIE, with no study to date either comparing clinical findings in HIE with those in neonatal encephalopathy due to other causes, or validating a clinical definition using imaging techniques. A subsequent literature review found that MRI and magnetic resonance spectroscopy have been found to have good specificity and sensitivity for diagnosis of HIE. This review, together with an ongoing national clinician consensus-building exercise led by the NPEU have led to the designing of a retrospective study to serially revise and validate a simple definition of HIE for future clinical and research use in order to improve the quality of epidemiological, health care quality and therapeutic research into HIE.