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Perinatale sterfte Verloskundig Samenwerkingsverband Martini Ziekenhuis 2010-2016 - Kan de zorg beter?

(2017) Dam, W.H.J. van

Introduction Perinatal mortality is an important indicator for the health of pregnant women and their children, as well as health care quality, and was significantly different per province in the Netherlands from 2000 till 2006. Highest mortality rates were found in the province of Groningen with an uncorrected mortality rate of 1,13 (95%-CI: 1,02-1,26).
Objective To examine whether there were additional, antenatal risk factors besides the standard risk factors that could be correlated to perinatal mortality in the VSV Martini from 2010 till 2016.
Material and Methods A total of 57 cases of perinatal mortality were included. As a control group, each case was matched with three cases of women with similar parity that gave birth to a living child in the same period. Study groups were compared based on medical, biological, behavioural and environmental factors.
Results Smoking (18% versus 8,0%, p = 0,048), pregnancy counselling from a health care worker with a solo practice (14% versus 5,0%, p = 0,049), and foetal growth restriction (FGR) (26% versus 8,0%, p ≤ 0,001) each correlated significantly to perinatal mortality. Of the cases with FGR, no biometry was performed in 39% of cases in the perinatal mortality group versus 8,0% in the control group. Perinatal mortality occurred more frequently in non-Western women who started prenatal care after the 12th week of their pregnancy. Socio-economic status and travel distance were not different between groups.
Conclusion In agreement with previous studies, this study shows that smoking increases the risk of perinatal mortality. Additionally, identification of FGR might be essential in the prevention of perinatal mortality. It is desirable to limit the number of obstetric health care workers per case (while maintaining at least two) to ensure quality and continuity of health care.





ID 3557
Moeder ID 3463
Volgorde Dam, W.H.J. van
Naam DamWHJvan
Publiceren yes
OAI-naam Student_thesis
Path root/geneeskunde/2017/DamWHJvan/
Gemaakt op: 2017-08-22 09:52:15
Gemodificeerd op: 2017-08-22 09:52:15
Digitaal ID 599bfed0baeab
Afstudeerrichting opleiding/afstudeerrichting 1
Studierichting Studierichting 1
Titel Perinatale sterfte Verloskundig Samenwerkingsverband Martini Ziekenhuis 2010-2016 - Kan de zorg beter?
Ruilverkeer mogelijk no
Printen in opdracht no
Aantal pagina's 29
Publicatiejaar 2017
Taal nl
Engelse samenvatting Introduction Perinatal mortality is an important indicator for the health of pregnant women and their children, as well as health care quality, and was significantly different per province in the Netherlands from 2000 till 2006. Highest mortality rates were found in the province of Groningen with an uncorrected mortality rate of 1,13 (95%-CI: 1,02-1,26).
Objective To examine whether there were additional, antenatal risk factors besides the standard risk factors that could be correlated to perinatal mortality in the VSV Martini from 2010 till 2016.
Material and Methods A total of 57 cases of perinatal mortality were included. As a control group, each case was matched with three cases of women with similar parity that gave birth to a living child in the same period. Study groups were compared based on medical, biological, behavioural and environmental factors.
Results Smoking (18% versus 8,0%, p = 0,048), pregnancy counselling from a health care worker with a solo practice (14% versus 5,0%, p = 0,049), and foetal growth restriction (FGR) (26% versus 8,0%, p ≤ 0,001) each correlated significantly to perinatal mortality. Of the cases with FGR, no biometry was performed in 39% of cases in the perinatal mortality group versus 8,0% in the control group. Perinatal mortality occurred more frequently in non-Western women who started prenatal care after the 12th week of their pregnancy. Socio-economic status and travel distance were not different between groups.
Conclusion In agreement with previous studies, this study shows that smoking increases the risk of perinatal mortality. Additionally, identification of FGR might be essential in the prevention of perinatal mortality. It is desirable to limit the number of obstetric health care workers per case (while maintaining at least two) to ensure quality and continuity of health care.
Nederlandse samenvatting Introductie Perinatale sterfte is een belangrijke indicator voor de gezondheid van zwangere vrouwen en hun kinderen en van de kwaliteit van de zorgverlening. De totale perinatale sterfte in Nederland verschilde in de periode 2000-2006 significant per provincie. De provincie Groningen scoorde het hoogst met een ongecorrigeerde sterftekans van 1,13 (95%-BI: 1,02-1,26).
Vraagstelling Zijn er naast de bekende risicofactoren voor perinatale sterfte nog andere (sub-standaard) factoren die antenataal geïdentificeerd kunnen worden en een relatie hebben met de perinatale sterfte binnen het VSV Martini in de periode 2010-2016?
Materiaal en methode 57 cases van perinatale sterfte werden gematcht met 3 andere vrouwen op basis van een levend geboren kind, geboorte in dezelfde periode en met een overeenkomstige pariteit. Beide onderzoeksgroepen zijn vergeleken op basis van medisch-biologische, gedrag- en omgeving-gerelateerde factoren.
Resultaten Roken (18% versus 8,0%, p = 0,048), zwangerschapsbegeleiding door een verloskundig hulpverlener met een solopraktijk (14% versus 5,0%, p = 0,049) en foetale groeirestrictie (FGR) (26% versus 8,0%, p < 0,001) bleken significant gerelateerd te zijn aan perinatale sterfte. Van de perinatale sterftegevallen, waarbij er sprake was van een FGR, had 39% geen biometrie gehad tegenover 8,0% in de controlegroep. Bij niet-westerse vrouwen die laat (> 12 weken zwangerschap) met prenatale zorg startten, trad vaker perinatale sterfte op. In sociaaleconomische status en reisafstand werd geen verschil aangetoond.
Conclusie Opnieuw toont dit onderzoek aan dat roken het risico op perinatale sterfte verhoogt. Daarnaast lijkt het identificeren van FGR essentieel. Betrokkenheid van een beperkt aantal (maar mogelijk meer dan één) verloskundig hulpverleners is wenselijk, om de kwaliteit en continuïteit van zorg te waarborgen.
Onderwijsinstelling Medical Sciences
Type embargo abstract openbaar, scriptie op aanvraag
Auteur(s) Dam, W.H.J. van
Begeleider(s) opleidingsinstelling Hoofdbegeleider Dr. D.P. van der Ham, gynaecoloog; Medebegeleider E. Mañé y – Oostinga, verloskundige; Disciplinegroep Gynaecologie & Obstetrie,; Martini Ziekenhuis Groningen
Auteur(s) Dam, W.H.J. van


 
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