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 audit proved not to be successful because of emotional involvement. A panel of independent experts seemed to be a better instrument to assess the quality of care. In 66 (75%) of all 89 cases complete consensus or near consensus was reached. In this group preventable factors were noticed in 29 cases (44%). In 30 cases (45%) the mortality was judged as inevitable. In 7 cases the information was insufficient. In the 29 cases with preventable factors, 12 cases concerned the skill of the obstetrician, seven cases the skill of the pediatrician, seven cases the skill of the midwife. In two cases the behaviour of the patient and in one case the skill of the general practitioner were blamed. Preventable factors are mainly present in decisions made during the prenatal period by the midwife (or general practitioner) and the obstetrician, and in care during labour and delivery and the postnatal period by the obstetrician and pediatrician. The care of the midwife during labour and delivery had little influence on preventable perinatal mortality. A further decrease of perinatal mortality may be achieved by analysis of the cases and continued education of all workers in perinatal care.