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At least 19 recordsLinked to original sources
PubMed1995

Towards improved perinatal care--perinatal audit.

Perinatal audit is a measure of quality of care given in pregnancy and it gives an idea as to how the resources need to be allocated for better outcome. The perinatal mortality data in the National University Hospital over a 7-year period (1986-1992) were compiled and compared with that of the year 1982. The perinatal mortality rate (PNMR) of 14.6/1000 in 1982 declined to 8.9/1000 for the period 1986 to 1992 and the reduction was noticeable in all ethnic groups, particularly in the Malays. When lethal congenital malformations (LCMs) were excluded, the PNMR decreased to 5.7/1000. Such reduction is due to easy availability and acceptance of antenatal care, improvement in antenatal and intrapartum fetal surveillance and advances in neonatal care. Neonatal audit was extended beyond the first 7 days of birth which showed that the majority (65%) of deaths occurred in the first week and 15% occurred after the first month. The fear that intensive neonatal care serves to postpone death is not entirely substantiated. There was nearly a ten-fold rise in PNMR between the non-low birthweight and low birthweight groups. The important causes of perinatal mortality during the review period were LCMs (35.7%), complications of prematurity (17.9%) and asphyxia (15.3%). No cause was identifiable in 28.5%. Detailed analysis revealed that the standard of care could have been improved in a third of the cases (83/235) which could have led to further reduction of perinatal mortality rate.

Asphyxia Neonatorum↗
PubMed1999

From public health to population health: epidemiological yardsticks for perinatal care.

Perinatal epidemiology and health services research have focused on specific health outcomes or disease states ("key" indicators and/or sentinel events), clients of public programs, and clinical service populations. In this paper, the concept of "population health" is defined and operationalized for the broad perinatal healthcare context within the framework of population health informatics. Traditional indicators and outcome measures for perinatal health are compared with some newer measures and assessed for their relevance to population health. A hypothetical model for the implementation of population health informatics for maternal and child health is described; in addition, and some obstacles to the practice of population health are identified, with strategies to overcome these obstacles.

Child↗
PubMed1996

Influence of obstetric and perinatal care on perinatal mortality.

OBJECTIVE: Cases of perinatal death attributed to suboptimal perinatal care between 1979 and 1992 inclusive at a large, tertiary care center are reviewed. STUDY DESIGN: The study compared two periods: 1979-1985 and 1986-1992. The perinatal morbidity-mortality committee analyzed patient records for the mothers and neonates, delivery room records, the results of fetal autopsy, and histological sections of the placenta. RESULTS: In the first period, 21.5% of the deaths were found to have received suboptimal care; this figure declined 13.5% in the second period (P < 0.05). During the second period, antenatal, intranatal and postnatal care improved, as shown by the lower suboptimal care rate for antepartum (15.8% versus 9.8%; P < 0.05), intrapartum (49.2% versus 22.1%; P < 0.001) and postpartum death (19.9% versus 8.1%; P < 0.001). During both periods, fetal death during pregnancy made up the largest proportion of deaths attributed to suboptimal care, with 44 cases (43.1%) during 1979-1985, and 36 cases (64.3%) during 1986-1992 (P < 0.01). Of these cases, fetuses with intrauterine growth retardation were the most frequent recipients of suboptimal care (20 cases (45.5%) during the first period; 18 cases (50%) during the second period). CONCLUSION: Despite better prenatal care, the highest suboptimal care rate was due to suboptimal care during pregnancy, when some high risk situations were overlooked by the obstetrician.

Cesarean Section↗
PubMed2004

Development of regionalized perinatal care.

Regionalized perinatal care was first advocated in Canada 35 years ago. Its development in the United States of America (from 1971), United Kingdom (from 1972) and Australia (from 1978), has been described. In all instances, the efforts and perseverance of visionary individuals were crucial in introducing the concepts to the medical profession, and in bringing the principles to national consciousness at a governmental level. Official endorsement of regionalized perinatal care by both the national professional bodies and the central and regional governments was necessary. An important milestone along the path of regionalized perinatal care was the establishment of national training programmes, and the recognition of maternal-fetal medicine and neonatal-perinatal medicine as respective subspecialties for obstetricians and paediatricians. The developmental process requires close collaboration among all three groups (individuals, professional bodies and government) to improve both the quality and availability of perinatal services to a geographically defined region.

Australia↗
PubMed2001

WHO principles of perinatal care: the essential antenatal, perinatal, and postpartum care course.

World Health Organization (WHO) recommendations and meta-analyses of controlled trials have concluded that inappropriate perinatal care and technology continue to be practiced widely throughout the world, despite the acceptance of evidence-based principles and care. The WHO Regional Office for Europe, in consultation with policy makers and reproductive health experts recently proposed ten "Principles of Perinatal Care," which have been endorsed by the reproductive health units of most member states. A comprehensive training program, based on the principles, is now being offered throughout the European region. This paper describes the development of the WHO principles and the WHO training course "Essential Antenatal, Perinatal and Postpartum Care." Together they provide an innovative model of evidence-based and psychosocially sensitive care for the future guidance of perinatal policy makers and caregivers worldwide.

Female↗
PubMed1977

Specialized perinatal care: impact on perinatal mortality.

A neonatal intensive care unit was established at one hospital in 1972 when the neonatal mortality was 7.6 and the perinatal mortality 20.9 per 1000 deliveries. In 1973, with full operation of that unit and partial introduction of a high-risk pregnancy unit for fetal monitoring, the rates decreased to 6.4 and 14.9, respectively. With full operation of both units the rates decreased further, to 3.4 and 9.0 in 1974 and 3.8 and 8.9 in 1975. The frequency of cesarean section was 10.1% in 1972-73 and 11.6% in 1974-75. It is concluded that the centralization of obstetric and neonatal care, together with the development of qualified medical and nursing teams, had a major impact in reducing perinatal mortality, and that the frequency of cesarean section was not affected by the introduction of fetal monitoring, although the indications for this precedure became more specific.

Birth Weight↗
PubMed2004

[Prognosis of the reproduction health care in the Czech Republic until 2010. I. Perinatal care].

OBJECTIVE: A prognosis of the development of perinatal care in the Czech Republic until 2010 DESIGN: An epidemiological study to be used as a basis for the prognosis. SETTING: Mother and Child Care Institute, Prague. METHODS: The primary source data on the indicators of the level of perinatal care as well as on some circumstances under which this care is being developed and on which their prognosis is based were drawn from the information obtained from their annual nationwide analysis. RESULTS: The prognosis of the development of perinatal care until 2010 builds on the previous prognosis from the period 1980-2000, whose results, when analysed retrospectively, proved a significant dependence of professional development on political, demographic, social and economic circumstances. Increase of the level of perinatal care, evaluated according to internationally recognised criteria, resulted in decreasing the maternal, perinatal and infant mortality rates to levels reported by a few countries in the world. The fact that these levels have been stagnating since 2000 is a result of two conflicting processes. On one hand, there is the improvement in the standard of care; on the other hand, there is deterioration in some of the above-mentioned circumstances. The fact that the reserves for further decrease in professional care have been used up and, conversely, the risk that some of the above-mentioned circumstances will deteriorate have raised concerns that some of the indicators of this care will deteriorate as shown by the extrapolation of the trend in these indicators prevalent in the last years carried out for the period until 2010. Two prognoses with differently serious impacts were formulated on the basis of this extrapolation. CONCLUSION: The development of perinatal care is dependent on the circumstances under which it is being developed. The fact that the reserves in development and organisation of this specific field have been used up, which resulted in decreasing the maternal, perinatal and infant mortality rates to levels, which are among the lowest ones in the world, and, conversely, the deterioration in some of the above-mentioned circumstances have raised concerns that the internationally recognised indicators of this care will deteriorate.

Czech Republic↗
PubMed1985

Objectives and outcome of perinatal care.

Great advances in perinatal care during the past two decades have been accompanied by reduced mortality rates in progressively lower birthweight groups. Continuing effort may be warranted by these improved results or by the need to preserve human life, yet rising costs in terms of disability, stress on parents and attendants, and financial resources raise questions about the value and justification of such effort. If rational policies are to be formulated for the future, accurate data based on planned population studies are essential. Perinatal care is only one of the determinants of outcome--environmental influences are also important and must be taken into account. Resources should be directed to improving the sociocultural environment as well as the standards of perinatal care.

Critical Care↗
PubMed1991

Ambulatory care in the public sector: perinatal care in Los Angeles County.

In planning its response to the increasing demand for perinatal services and the increasing rate of infant mortality and low-birthweight infants the Los Angeles County Department of Health Services faces a formidable set of tasks. Initiatives already in place are attempting to deal with some of the most pressing problems. However, increased services must be made available to enable the increasing number of women to access the system of care, and further outreach is necessary to encourage more women to begin prenatal care early in pregnancy. The county needs to increase the availability of perinatal care services, and these services must respond to the cultural and socioeconomic needs of pregnant women. Financial barriers to care must be eased, and the process of qualifying for Medi-Cal must be simplified. Additional private providers need to be brought into the system, and alternative care providers--such as birthing centers and delivery by midwives--should be expanded for low-risk pregnancies. The DHS has been forced to respond to staggering increases in demands for perinatal care services, and the population pressures and the widening socioeconomic gaps are unlikely to decrease in the near future. These same forces also require the DHS to respond to the increased demand for other health services. The DHS is being required to develop and maintain a complex program of health services without adequate financial resources. The solution to the perinatal care crisis in Los Angeles County and other localities with high rates of poverty cannot be found solely within local governments. It is unrealistic to expect that local taxation can support an increase of this magnitude in the need for care, and increased state and federal support is essential. Other nations, spending far less for health care, produce significantly better results: how much longer will it take this nation to recognize its responsibilities to its most vulnerable citizens?

Adolescent↗
PubMed1983

Effect of delivery method on outcomes in the very low-birth weight breech infant: is the improved survival related to cesarean section or other perinatal care maneuvers?

The perinatal mortality rate among very low-birth weight infants has been decreased by 20% during the last 4 years of the 1973 to 1980 period here reported. The concurrent increase in the cesarean section rate from 11.9% to 49.1% during the same time frames has been assumed to be responsible for the improved outcome. The changes were most marked in the extremely low-birth weight group (less than 1,000 gm). The survival rates and cesarean section rates were examined among infants of similar birth weight and gestational age in the vertex presentation, in the same time frames. A similar or greater reduction in mortality rate (from 85% to 45%) was noted in the very low-birth weight vertex infants, whereas the cesarean section rate remained minimally and not significantly increased (14.2% to 22.2%). The interpretation of this finding is by no means clear but must include the hypothesis that the increased cesarean section rate may be incidental and in no way related to the improved outcome. The most statistically significant determinants of outcome remain birth weight and gestational age strata, with no significant difference in outcomes when the extremely low-birth weight group is analyzed separately from the entire very low-birth weight group. As yet unidentified perinatal care practices, other than cesarean section, may be more likely to affect outcome in this high-risk group.

Birth Weight↗
PubMed2004

Regionalized perinatal care in developing countries.

Neonatal-perinatal ill health and mortality are overwhelmingly a burden of the developing world. As many as 90% of births, 98% of fetal deaths and 98% of neonatal deaths occur in less developed countries. Regionalized perinatal services were introduced in developed countries when most neonatal mortality was confined to very-low-birthweight babies who required intensive perinatal care to survive. A large proportion of newborn morbidity and mortality in developing countries, however, continues to occur among full-term and moderate-sized low-birthweight neonates who can be managed well in the community and at small hospitals. The model of regionalized perinatal care as practiced in developed countries is, at present, neither affordable nor relevant to the needs of many developing countries. It is possible to achieve considerably lower neonatal mortality rates in resource-poor settings by implementing home-based newborn care delivered by community health workers, and by promoting institutional perinatal care at simple facilities provided by trained midwives.

Developing Countries↗
PubMed2004

America's Health Centers: reducing racial and ethnic disparities in perinatal care and birth outcomes.

OBJECTIVE: To examine whether community health centers (CHCs) reduce racial/ethnic disparities in perinatal care and birth outcomes, and to identify CHC characteristics associated with better outcomes. BACKGROUND: Despite great national wealth, the U.S. continues to rank poorly relative to other industrialized nations on infant mortality and other birth outcomes, and with wide inequities by race/ethnicity. Disparities in primary care (including perinatal care) may contribute to disparities in birth outcomes, which may be addressed by CHCs that provide safety-net medical services to vulnerable populations. METHODS: Data are from annual Uniform Data System reports submitted to the Bureau of Primary Health Care over six years (1996-2001) by about 700 CHCs each year. RESULTS: Across all years, about 60% of CHC mothers received first-trimester prenatal care and more than 70% received postpartum and newborn care. In 2001, Asian mothers were the most likely to receive both postpartum and newborn care (81.7% and 80.3%), followed by Hispanics (75.0% and 76.3%), blacks (70.8% and 69.9%), and whites (70.7% and 66.7%). In 2001, blacks had higher rates of low birth weight (LBW) babies (10.4%), but the disparity in rates for blacks and whites was smaller in CHCs (3.3 percentage points) compared to national disparities for low-socioeconomic status mothers (5.8 percentage points) and the total population (6.2 percentage points). In CHCs, greater perinatal care capacity was associated with higher rates of first-trimester prenatal care, which was associated with a lower LBW rate. CONCLUSION: Racial/ethnic disparities in certain prenatal services and birth outcomes may be lower in CHCs compared to the general population, despite serving higher-risk groups. Within CHCs, increasing first-trimester prenatal care use through perinatal care capacity may lead to further improvement in birth outcomes for the underserved.

Adult↗
PubMed2000

Perinatal care: cultural and technical differences between China and the United States.

A comparison of perinatal care in the U.S. and China is presented. Perinatal care has made tremendous achievements in both countries since mid-century. However, the outcomes in the two cultures are different due to the different focus on caring concepts, the strengths of a nursing philosophy, and the emphasis on the nursing role in maternal care. Perinatal family in the U.S. will have advantages in perinatal education physical facilities, and a philosophy of care. North American women have greater access to early prenatal and continuing care, and less infant mortality. Chinese women have less access to qualified nursing services, higher infant mortality rates, and limited perinatal education. Overall, Chinese perinatal care is far behind that which is found in the U.S. This comparison analyzes the strengths and weaknesses in both cultures with a focus on change that will produce healthier and more consistent optimal outcomes.

China↗
PubMed2006

Regionalization reigns--but is care being delivered accordingly? An evaluation of perinatal care delivery in a regionalized child health network.

The Child Health Network for the Greater Toronto Area (CHN), a network of 20 hospitals and 9 community care access centres, assessed one component of its early progress in building a regionalized system of perinatal care. Focusing on the relationship between hospital level of care and gestational age, the study showed that most births occurred at appropriately designated facilities. However, a quarter of newborns of gestational age <32 weeks were delivered at a lower level of care than is considered optimal. CHN's ongoing research will offer opportunities to assess the impact of regional models on their foremost goal--quality clinical care.

Cooperative Behavior↗