Royal College of Obstetricians and Gynaecologists

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Royal College ofObstetricians andGynaecologists
Setting standards to improve womens health
Risk Management and Medico-Legal Issues In
Womens Health Joint RCOG/ENTER Meeting
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Audit of Obstetric Near-Misses

• Dr. I ChandraSekaran
• University Hospitals of North Staffordshire

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Aim

• To introduce the concept of severe maternal
  morbidity. Mortalities have declined.
• 11.4/100000 maternities(1997-1999)
• 13.1/100000 maternities(2000-2002)
• To create awareness among obstetric and midwifery
  staff.
• To establish the commonest cause for morbidity.
• To estimate an incidence for these events.
• To calculate a near miss death ratio.

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Aim

• To realise the need for establishing consistency
  in documentation record keeping.
• To inculcate the culture of OUR responsibility
  among junior medical staff.
• To establish standards for future auditing.

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• Scottish Confidential Audit of Severe Maternal
  Morbidity. (SPCERH Publication 2003 2004) 20
  consultant-led maternity units.
• 270 cases studied and analysed.
• MOH 3.5/1000 births
• ITU admissions 1.5/1000 births
• Near miss death ratio 671

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Background

• Total number of deliveries (Labour ward) - 3660
• Total number of maternal deaths - 2

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Methods

• Severe morbidity defined
• Jan Dec 2006
• 10 cases met the inclusion criteria and hence
  were included.
• Retrospective assessment from documentation.
• Quality of care judged by an expert panel.

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Definition of cases

• Obstetric haemorrhage
• Eclampsia
• Rupture uterus
• ITU admissions
• Massive PE
• Acute respiratory dysfunction
• Cardiac arrest
• Pulmonary oedema

• Cerebro vascular event
• Status epilepticus
• Anaphylactic shock
• Septicaemic shock
• Anaesthetic problems
• Coma
• Renal/liver dysfunction

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• MOH with blood loss gt2.5lts 6
• ITU admissions 2 (3
  PPH)
• Eclampsia 1
• Rupture uterus 1
• CVA (Cerebellar bleed) 1
• (not delivered)

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MOH (APHPPH) TTMOH (APHPPH) BF

• Judged Appropriate

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PPH CJPPH SL

• Judged Appropriate

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PPH - SJ

• Judged substandard - Minor

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PPH- NM

• Judged Substandard - Incidental

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ITU Ruptured Cornual Pregnancy-SL

• Judged Substandard Minor

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ITU Sepsis /Abruption-EL

• Judged Appropriate

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Rupture uterus - CH

• Judged Substandard Major

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Eclampsia HELLP -NS

• Judged Appropriate

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RSH

• Total number of LW deliveries 3660
• Incidence of 1332 deliveries
• Total number of maternal deaths 2
• One maternal death - RTA
• Total number of near-misses 11
• Near-miss death ratio of 111

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Quality of Care

• Appropriate 6
• Substandard Incidental 1
• Substandard Minor 2
• Substandard Major 1

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Lessons learnt

• Documentation
• Electronic database
• System errors
• Referral pathway from peripheral units
• Busy shifts
• Treating coagulopathy secondary to abruption
• Treating liver rupture

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Thank you
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Royal College ofObstetricians andGynaecologists
Setting standards to improve womens health
Risk Management and Medico-Legal Issues In
Womens Health Joint RCOG/ENTER Meeting
Please turn off all mobile phones and pagers