TY - JOUR
T1 - Lessons learned from the perinatal audit of uterine rupture in the Netherlands
T2 - A mixed-method study
AU - Rosman, Ageeth N.
AU - van Dillen, Jeroen
AU - Zwart, Joost
AU - Overtoom, Evelien
AU - Schaap, Timme
AU - Bloemenkamp, Kitty
AU - van den Akker, Thomas
N1 - Funding Information:
The authors would like to thank all members of local perinatal cooperation groups and members of local perinatal audit teams for participating in local perinatal audit sessions and for sharing their cases and outcomes in a nationwide database. Perined is funded by the Dutch Ministry of Health, Welfare and Sports. For this specific study, no funding was provided.
Publisher Copyright:
© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.
PY - 2022/9
Y1 - 2022/9
N2 - Background and Aims: To analyze outcomes of nationwide local audits of uterine rupture to draw lessons for clinical care. Methods: Descriptive cohort study. Critical incident audit sessions within all local perinatal cooperation groups in the Netherlands. Women who sustained uterine rupture between January 1st, 2017 and December 31st, 2019. Main Outcome Measures: Improvable factors, recommendations, and lessons learned for clinical care. Women's case histories were discussed in multidisciplinary perinatal audit sessions. Participants evaluated care against national and local clinical guidelines and common professional standards to identify improvable factors. Cases and outcomes were registered in a nationwide database. Results: One hundred and fourteen women who sustained uterine rupture were discussed in local perinatal audit sessions by 40–60 participants on average: A total of 111 (97%) were multiparous of whom 107 (94%) had given birth by cesarean section in a previous pregnancy. The audit revealed 178 improvable factors and 200 recommendations. Six percent (N = 11) of the improvable factors were identified as very likely and 18% (N = 32) as likely to have a relationship with the outcome or occurrence of uterine rupture. Improvable factors were related to inadequate communication, absent, or unclear documentation, delay in diagnosing the rupture, and suboptimal management of labor. Speak up in case a suspicion arises, escalating care by involving specialist obstetricians, addressing the importance of accurate documentation, and improving training related to fetal monitoring were the most frequent recommendations and should be topics for team (skills and drills) training. Conclusions: Through a nationwide incident audit of uterine rupture, we identified improvable factors related to communication, documentation, and organization of care. Lessons learned include “speaking up,” improving the transfer of information and team training are crucial to reduce the incidence of uterine rupture.
AB - Background and Aims: To analyze outcomes of nationwide local audits of uterine rupture to draw lessons for clinical care. Methods: Descriptive cohort study. Critical incident audit sessions within all local perinatal cooperation groups in the Netherlands. Women who sustained uterine rupture between January 1st, 2017 and December 31st, 2019. Main Outcome Measures: Improvable factors, recommendations, and lessons learned for clinical care. Women's case histories were discussed in multidisciplinary perinatal audit sessions. Participants evaluated care against national and local clinical guidelines and common professional standards to identify improvable factors. Cases and outcomes were registered in a nationwide database. Results: One hundred and fourteen women who sustained uterine rupture were discussed in local perinatal audit sessions by 40–60 participants on average: A total of 111 (97%) were multiparous of whom 107 (94%) had given birth by cesarean section in a previous pregnancy. The audit revealed 178 improvable factors and 200 recommendations. Six percent (N = 11) of the improvable factors were identified as very likely and 18% (N = 32) as likely to have a relationship with the outcome or occurrence of uterine rupture. Improvable factors were related to inadequate communication, absent, or unclear documentation, delay in diagnosing the rupture, and suboptimal management of labor. Speak up in case a suspicion arises, escalating care by involving specialist obstetricians, addressing the importance of accurate documentation, and improving training related to fetal monitoring were the most frequent recommendations and should be topics for team (skills and drills) training. Conclusions: Through a nationwide incident audit of uterine rupture, we identified improvable factors related to communication, documentation, and organization of care. Lessons learned include “speaking up,” improving the transfer of information and team training are crucial to reduce the incidence of uterine rupture.
KW - audit
KW - maternal near miss
KW - perinatal mortality
KW - severe maternal morbidity
KW - trial of labor after cesarean section
KW - uterine rupture
UR - http://www.scopus.com/inward/record.url?scp=85138705315&partnerID=8YFLogxK
U2 - 10.1002/hsr2.664
DO - 10.1002/hsr2.664
M3 - Article
C2 - 35949672
AN - SCOPUS:85138705315
VL - 5
SP - 1
EP - 10
JO - Health Science Reports
JF - Health Science Reports
IS - 5
M1 - e664
ER -