THE WORMERVEER STUDY - PERINATAL-MORTALITY AND NONOPTIMAL MANAGEMENT IN A PRACTICE OF INDEPENDENT MIDWIVES

In a prospective study in a group of 7980 pregnant women who booked in an independant midwife practice perinatal mortality was studied with the aim to assess non-optimal management. An internally generated audi t proved not to be successful because of emotional involvement. A pane l of independent experts seemed to be a better instrument to assess th e quality of care. In 66 (75%) of all 89 cases complete consensus or n ear consensus was reached. In this group preventable factors were noti ced in 29 cases (44%). In 30 cases (45%) the mortality was judged as i nevitable. In 7 cases the information was insufficient. In the 29 case s with preventable factors, 12 cases concerned the skill of the obstet rician, seven cases the skill of the pediatrician, seven cases the ski ll of the midwife. In two cases the behaviour of the patient and in on e case the skill of the general practitioner were blamed. Preventable factors are mainly present in decisions made during the prenatal perio d by the midwife (or general practitioner) and the obstetrician, and i n care during labour and delivery and the postnatal period by the obst etrician and pediatrician. The care of the midwife during labour and d elivery had little influence on preventable perinatal mortality. A fur ther decrease of perinatal mortality may be achieved by analysis of th e cases and continued education of all workers in perinatal care.