Article

The value of incorporating avoidable factors into perinatal audits

Department of Obstetrics and Gynaecology, Kalafong Hospital, University of Pretoria.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde (Impact Factor: 1.71). 04/1995; 85(3):145-7.
Source: PubMed

ABSTRACT To assess whether incorporating a system of identifying, classifying and grading avoidable factors into a perinatal audit can be useful in identifying problem areas.
Descriptive study.
Black urban population, Pretoria, South Africa.
All perinatal deaths of infants weighing more than 1,000 g from urban areas served by Kalafong Hospital between August 1991 and July 1992.
All perinatal deaths were classified according to the primary obstetric cause of death and neonatal cause of death, and whether any avoidable factors were present which could have contributed to the death.
The perinatal mortality rate was 26/1,000 deliveries. Avoidable factors occurred in 58% of perinatal deaths. Our problem areas which were immediately remedial were identified as labour management-related problems, administrative problems in obtaining syphilis results, and estimation of fetal weight. Other problem areas which need to be solved are patient education, early attendance at clinics, improved documentation and continuing education of medical personnel.
The use of this classification of avoidable factors has enabled the detection of problem areas that can be improved immediately at very little cost.

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    • "Maternal syphilis in pregnancy continues to be an important and avoidable cause of pregnancy loss in developing countries (Guinness et al. 1988; Lindstrand et al. 1993; Pattinson et al. 1995). The risk of perinatal mortality among women with syphilis is at least twice that amongst those without (Bam et al. 1994). "
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    ABSTRACT: To demonstrate the impact on perinatal mortality of inadequate treatment for maternal syphilis despite adequate screening. In 12 clinics providing antenatal care in Hlabisa, South Africa 1783 pregnant women were screened for syphilis at their first antenatal visit between June and October 1998. Pregnancy outcome was determined among those with syphilis. A total of 158 women were diagnosed with syphilis: prevalence 9% (95% CI 8-10%). Mean gestation at first antenatal visit was 24 weeks. Thirty women (19%) received no treatment and 96 (61%) received all three recommended doses of penicillin. Among those receiving at least one dose, mean delay to the first dose was 20 days. Among those fully treated mean delay to treatment completion was 34 days. Pregnancy outcome was known for 142 women (90%) and there were 17 perinatal deaths among 15 women (11%). Eleven of 43 women (26%) who received one or fewer doses of penicillin experienced a perinatal death whilst only four of 99 women (4%) who received two or more doses of penicillin did so (P = 0.0001). Protection from perinatal death increased with the number of doses of penicillin: linear modelling suggests that one dose reduced the risk by 41%, two doses by 65% and three doses by 79%, compared with no doses. A dose-specific, categorical model confirmed reduction in risk by 79% for all three doses. Despite effective screening, many pregnant women with syphilis remain inadequately treated, resulting in avoidable perinatal mortality. Delays in starting and finishing treatment, as well as incomplete treatment occur. Near-patient syphilis testing in the antenatal clinic with early treatment could improve treatment of syphilis and reduce perinatal mortality, and a randomized trial to test this is underway.
    Tropical Medicine & International Health 12/2000; 5(11):800-4. · 2.30 Impact Factor
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    • "Maternal syphilis in pregnancy continues to be an important and avoidable cause of pregnancy loss in developing countries (Guinness et al. 1988; Lindstrand et al. 1993; Pattinson et al. 1995). The risk of perinatal mortality among women with syphilis is at least twice that amongst those without (Bam et al. 1994). "
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    ABSTRACT: Summaryobjective To demonstrate the impact on perinatal mortality of inadequate treatment for maternal syphilis despite adequate screening. method In 12 clinics providing antenatal care in Hlabisa, South Africa 1783 pregnant women were screened for syphilis at their first antenatal visit between June and October 1998. Pregnancy outcome was determined among those with syphilis. results A total of 158 women were diagnosed with syphilis: prevalence 9% (95% CI 8–10%). Mean gestation at first antenatal visit was 24 weeks. Thirty women (19%) received no treatment and 96 (61%) received all three recommended doses of penicillin. Among those receiving at least one dose, mean delay to the first dose was 20 days. Among those fully treated mean delay to treatment completion was 34 days. Pregnancy outcome was known for 142 women (90%) and there were 17 perinatal deaths among 15 women (11%). Eleven of 43 women (26%) who received one or fewer doses of penicillin experienced a perinatal death whilst only four of 99 women (4%) who received two or more doses of penicillin did so (P = 0.0001). Protection from perinatal death increased with the number of doses of penicillin: linear modelling suggests that one dose reduced the risk by 41%, two doses by 65% and three doses by 79%, compared with no doses. A dose-specific, categorical model confirmed reduction in risk by 79% for all three doses. conclusion Despite effective screening, many pregnant women with syphilis remain inadequately treated, resulting in avoidable perinatal mortality. Delays in starting and finishing treatment, as well as incomplete treatment occur. Near-patient syphilis testing in the antenatal clinic with early treatment could improve treatment of syphilis and reduce perinatal mortality, and a randomized trial to test this is underway.
    Tropical Medicine & International Health 10/2000; 5(11):800 - 804. DOI:10.1046/j.1365-3156.2000.00636.x · 2.30 Impact Factor
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