Monitoring the quality of maternity care: how well are labour and delivery events reported in population health data?

Abstract

Administrative or population health data sets (PHDS), such as birth and hospital discharge data, are used increasingly to evaluate maternity care. Use of PHDS requires reliable identification of diagnoses and procedures. The aim of this study was to determine the accuracy and reliability of the reporting of diagnoses and procedures related to childbirth in both individual and linked, birth and ICD10-coded hospital discharge data. Data from a population-based validation study of 1200 women provided the 'gold standard' for labour and delivery events and were compared with the hospital discharge and birth databases. Reporting characteristics (sensitivity, specificity, positive and negative predictive values) were determined for: induction, augmentation and obstruction of labour, modes of delivery (including failed instrumental delivery), episiotomy, perineal tears and repairs, and manual removal of the placenta. Differences in reporting by mode of delivery were also examined. Of the 1184 records available for review, 25% had labour induced, 25% had labour augmented and, of those who laboured, 17% had obstructed labour reported. Fourteen per cent had an elective/planned caesarean section (CS) including 2% that went into labour prior to the planned date, and 11% had an emergency, unplanned CS including 2% who had no labour. With the exception of augmentation and obstruction of labour, failed instrumental delivery and manual removal, there were high levels of accuracy for reporting of diagnoses and procedures during labour and delivery. There were no significant differences in reporting by mode of delivery. The findings suggest that PHDS-reported induction of labour, mode of delivery, and 3rd and 4th degree tears and repairs can be reliably used to evaluate maternity care. Consistency in reporting in birth and hospital discharge data from different countries and over time suggests the findings are likely to be generalisable to high-income countries.

Delivery of a Small-For-Gestational-Age Infant and Risk of Maternal Cardiovascular Disease – A Population-Based Record Linkage Study

“…After excluding 3,022 women (0.4%) with missing covariate information, 812,372 women remained for the analysis. The perinatal exposures and covariates are reliably reported with high levels of agreement when compared with medical records [23][24][25].…”

Trends in planned early birth: a population-based study

“…17 Only factors that are well and accurately reported were included in the analyses. 16,[18][19][20][21][22] Missing data were infrequent, only 0.02% records were missing a gestational age and 0.02% were missing mode of onset of labor.…”

Episiotomy rate in Vietnamese-born women in Australia: support for a change in obstetric practice in Viet Nam

“…[13][14][15][16] Episiotomy was treated both as an outcome variable for factors associated with episiotomy use and as an exposure variable for third-or fourth-degree perineal tears, postpartum haemorrhage and prolonged postnatal hospitalization. A third-degree perineal tear is defined as partial or complete disruption of the anal sphincter muscles, which may involve either the external or internal anal sphincter muscles or both, and a fourthdegree tear, as disruption of the anal sphincter muscles involving a breach of the rectal mucosa.…”