Results from the National Perinatal Patient Safety Program in Sweden: the challenge of evaluation

Luthander, Charlotte Millde; Källén, Karin; Nyström, Monica; Högberg, Ulf; Håkansson, Stellan; Härenstam, Karin Pukk; Grünewald, Charlotta

doi:10.1111/aogs.12873

Cited by 14 publications

(15 citation statements)

References 31 publications

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“…Other studies have examined the impact of CTG education on neonatal outcomes, most of them in the context of other interventions and most finding no effect on low pH values or Apgar score . The implementation of the Fetal Surveillance Education Program in Australia was associated with a decrease in incidence of hypoxic ischemic encephalopathy .…”

Section: Discussionmentioning

confidence: 99%

“…and most finding no effect on low pH values or Apgar score. 14,29,32,33 The implementation of the Fetal Surveillance Education Program in Australia was associated with a decrease in incidence of hypoxic ischemic encephalopathy. 16 However, changes in diagnostic coding could have affected the results.…”

Section: Discussionmentioning

confidence: 99%

“…Suggestions for improvement in CTG education have been proposed to overcome human errors in CTG management with the hope that improvements in neonatal outcomes would ensue . Although several studies conclude that CTG education leads to improved CTG knowledge and interpretation skills, few studies have evaluated the concomitant effect on neonatal outcomes and the results of these studies diverge …”

Section: Introductionmentioning

confidence: 99%

“…11,12 Although several studies conclude that CTG education leads to improved CTG knowledge and interpretation skills, few studies have evaluated the concomitant effect on neonatal outcomes and the results of these studies diverge. [13][14][15][16] To increase quality of care for mothers and infants and reduce the incidence of fetal hypoxia, a national obstetric project, Safe We aimed to examine the impact of the CTG education program on fetal hypoxia measured by umbilical cord pH <7.00, 5-minute Apgar score <7 and neonatal therapeutic hypothermia. As a secondary aim, we assessed whether the educational intervention was associated with an increase in the number of operative deliveries as an unintended consequence.…”

Section: Introductionmentioning

confidence: 99%

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The impact of a national cardiotocography education program on neonatal and maternal outcomes: A historical cohort study

Thellesen

Bergholt

Sørensen

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Studies indicate an association between errors in cardiotocography (CTG) management and hypoxic brain injuries among newborns. Continuing professional education is recommended. We aimed to examine whether the implementation of a national interprofessional CTG education program in Denmark was associated with a decrease in risk of fetal hypoxia measured by umbilical cord pH < 7.00, 5‐minute Apgar score <7 or neonatal therapeutic hypothermia. As a secondary aim, we assessed whether the educational intervention was associated with an increase in operative deliveries. Material and methods We conducted a historical cohort study from 2009 to 2015 including all intended vaginal deliveries with liveborn singletons in cephalic presentation and gestational age ≥37 weeks. Data were retrieved from the Medical Birth Register and the National Patient Register. The study period was divided in three: pre‐implementation (2009‐2012), implementation (2013) and post‐implementation (2014‐2015). Using logistic regression we estimated odds ratios (OR) of fetal hypoxia outcomes using the pre‐implementation period as reference. Analyses were adjusted for potential maternal, neonatal and delivery‐associated confounders. Missing data were accounted for by multiple imputation. Results In all, 331 282 deliveries were included. Overall risks of pH < 7.00, Apgar score <7 and therapeutic hypothermia were respectively 0.45%, 0.58% and 0.06%. Adjusted OR in the post‐implementation period were 1.12 (95% confidence interval [CI] 1.00‐1.26), 0.99 (95% CI 0.90‐1.10) and 1.34 (95% CI 0.99‐1.82) for the three outcomes, respectively. The pH missingness equaled 12.4%. Odds of emergency cesarean section was unaltered, whereas the odds of assisted vaginal delivery decreased by 14% (0.86, 95% CI 0.84‐0.89). Conclusions Healthcare professionals are considered the weakest link of CTG technology. We did not find that increasing healthcare professionals’ CTG interpretation skills affected the risk of fetal hypoxia. Missing data for pH values were substantial and represent a limitation of the study. We cannot with certainty rule out that missingness masked a true effect of the intervention. Our study indicates that assisted vaginal deliveries can be decreased without an increased risk of fetal hypoxia. Dilution of effect in a complex clinical setting, rare outcomes, insufficient intervention and a possible overestimation of the impact of errors in CTG management might explain the lack of effect.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of a national cardiotocography education program on neonatal and maternal outcomes: A historical cohort study

Thellesen

Bergholt

Sørensen

et al. 2019

Acta Obstet Gynecol Scand

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“…Maternal death due to pregnancy and childbirth is unusual and considered a major human tragedy (Nyfløt, Ellingsen, Yli, Øian, & Vangen, ). Research about patient safety in connection to childbirth often targets the neonate (Ashcroft, ; Millde Luthander, ), with fewer studies focusing on the woman giving birth (Jacobson, Zlatnik, Kennedy, & Lyndon, ; Sheldon et al, ).…”

Section: Introductionmentioning

confidence: 99%

Healthcare professionals' perceptions of patient safety for the woman in childbirth in Sweden – An interview study

et al. 2019

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Aim To describe healthcare professionals' perceptions of patient safety with a focus on the woman in connection to childbirth. Design A descriptive and qualitative design with a phenomenographic approach. Methods Individual qualitative face‐to‐face interviews with 19 healthcare professionals (midwives, nursing assistants and physicians) were conducted in three labour wards in Sweden. The data were analysed according to Dahlgren and Fallsberg's seven steps. Results The informants' perceptions of patient safety for the women were identified in four qualitative different descriptive categories: Safeguarding the woman, Safeguarding the birth process, Respecting the individual and the team and Managing workforce and learning. Supportive care and listening to the woman were important for patient safety. It was crucial to follow labour stages and to avoid unnecessary interventions. An open and tolerant atmosphere between the healthcare professionals improved decision‐making, and a reasonable workload was essential for ensuring safe care.

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Role of Training in Neonatal Encephalopathy Prevention

Loverro

Laforgia

Loverro

et al. 2023

Practical Guide to Simulation in Delivery Room Emergencies

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Results from the National Perinatal Patient Safety Program in Sweden: the challenge of evaluation

Cited by 14 publications

References 31 publications

The impact of a national cardiotocography education program on neonatal and maternal outcomes: A historical cohort study

The impact of a national cardiotocography education program on neonatal and maternal outcomes: A historical cohort study

Healthcare professionals' perceptions of patient safety for the woman in childbirth in Sweden – An interview study

Role of Training in Neonatal Encephalopathy Prevention

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