Perinatal mortality audits and reporting of perinatal deaths: systematic review of outcomes and barriers

Abstract

Background Perinatal deaths are a devastating experience for all families and healthcare professionals involved. Audit of perinatal mortality (PNM) is essential to better understand the factors associated with perinatal death, to identify key deficiencies in healthcare provision and should be utilised to improve the quality of perinatal care. However, barriers exist to successful audit implementation and few countries have implemented national perinatal audit programs. Content We searched the PubMed, EMBASE and EBSCO host, including Medline, Academic Search Complete and CINAHL Plus databases for articles that were published from 1st January 2000. Articles evaluating perinatal mortality audits or audit implementation, identifying risk or care factors of perinatal mortality through audits, in middle and/or high-income countries were considered for inclusion in this review. Twenty articles met inclusion criteria. Incomplete datasets, nonstandard audit methods and classifications, and inadequate staff training were highlighted as barriers to PNM reporting and audit implementation. Failure in timely detection and management of antenatal maternal and fetal conditions and late presentation or failure to escalate care were the most common substandard care factors identified through audit. Overall, recommendations for perinatal audit focused on standardised audit tools and training of staff. Overall, the implementation of audit recommendations remains unclear. Summary This review highlights barriers to audit practices and emphasises the need for adequately trained staff to participate in regular audit that is standardised and thorough. To achieve the goal of reducing PNM, it is crucial that the audit cycle is completed with continuous re-evaluation of recommended changes.

Lessons learned in cases of late preterm mortality in the Netherlands: Results from nationwide perinatal audits, a mixed method study

“…Publications of outcomes of systematically organised perinatal audits are rare. A systematic review of Gutman et al [23] revealed 20 articles from 2000 and onwards evaluating perinatal mortality audits. Timely and adequate monitoring of foetal and maternal conditions were common improvable factors in cases of perinatal mortality.…”

From Pre-Implementation to Institutionalization: Lessons From Sustaining a Perinatal Audit Program in South Africa

“…These lessons relate to findings from other studies examining the history of implementation of MPDSR processes. 3,[71][72][73] More operational research and in-depth studies, especially from LMICs, will be needed to better understand implementation history and practice in different contexts. 71,74 Factors influencing implementation of MPDSR in LMICs have been identified and examined in the literature, 13 including for South Africa.…”

“…The uncertainty of impact of the current perinatal audit program on mortality reduction in South Africa 21 does not necessarily indicate failure of the program, especially when global systematic reviews on the impact of MPDSR rest on too few studies. 73,74,83 Quality of practice or "functional PPIP" is necessary for health system improvements. 22 A complementary article of this research presents evidence that there are other benefits to the perinatal audit program beyond mortality outcomes, such as skills development, individual and collective motivation, and improved teamwork and dynamics.…”

Factors associated with peri-neonatal mortality in Sao Tome & Principe: a prospective cohort study

“…Studies from SSA highlight that it is very frequent that some depressed but living fetuses with a possible heartbeat do not receive resuscitation maneuvers and are prompt classified as stillbirths [1,66]. This is supported by a systematic review of sixteen hospitals and community-based perinatal mortality studies [67,68].…”