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Indicators for Monitoring and Evaluating Perinatal Health in Europe (PERISTAT). Béatrice BLONDEL, Jennifer ZEITLIN, INSERM, FRANCE. PERISTAT.

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indicators for monitoring and evaluating perinatal health in europe peristat

Indicators for Monitoring and Evaluating Perinatal Health in Europe (PERISTAT)

Béatrice BLONDEL, Jennifer ZEITLIN, INSERM, FRANCE

peristat
PERISTAT

The overall project aim is to develop valid and reliable indicators which can be used for monitoring and evaluating perinatal health in the European Union

perinatal health and its determinants
Perinatal Health and its ‘Determinants’

health outcomes : maternal mortality, morbidity, fetal and neonatal mortality, neonatal morbidity and long term measures of perinatal outcome

clinical practice and the organization and quality of health care provision : during pregnancy, delivery and the postpartum period which influence perinatal health

medical, demographic and social risk factors which influence perinatal health.

coordination
Coordination
  • Epidemiological Research Unit on Perinatal and Women’s Health, U.149 INSERM, Paris.
    • Gérard Bréart
    • Jennifer Zeitlin
    • Katherine Wildman
steering committee
Steering Committee
  • Sophie Alexander, Brussels, BELGIUM
  • Mika Gissler, Helsinki, FINLAND.
  • Béatrice Blondel, Villejuif, FRANCE.
  • Simone Buitendijk, Leiden, THE NETHERLANDS
  • Henrique Barros, Porto, PORTUGAL
  • Alison Macfarlane, London, UK
scientific advisory committee
Scientific advisory committee
  • One clinician (neonatologist, obstetrician, midwife) from each country
  • One epidemiologist/statistician from each country
slide7

Existing recommendations

(from European experts)

Methods

Steering committee review

List of recommended indicators

SAC formalized consensus

Process : DELPHI

PERISTAT indicator set

Midwives’ DELPHI

Survey of statistical

Offices to assess feasibility

Final indicator set

review of existing recommendations
Review of existing recommendations

Indicators reported on International/European level

EUROSTAT, WHO/HFA, OECD

Recommendations by international collaborations

ECHI, WHO – OBSQUID, WHO – Reproductive Health Working Group, EAPM, FIGO, EUROPET.

Recommendations from countries/groups of countries

slide9

Existing recommendations

(from European experts)

Methods

Steering committee review

List of recommended indicators

SAC formalized consensus

Process : DELPHI

PERISTAT indicator set

Midwives’ DELPHI

Survey of statistical

Offices to assess feasibility

Final indicator set

delphi process two successive questionnaires with a list of indicators
DELPHI processtwo successive questionnaires with a list of indicators
  • 1st round :to rank each indicatorto select the ‘top 10’ indicators
  • 2nd round :with a smaller list of indicatorsto select 10 to 15 essential indicatorsto select 20 recommended indicators
slide11

Existing recommendations

(from European experts)

Methods

Steering committee review

List of recommended indicators

SAC formalized consensus

Process : DELPHI

PERISTAT indicator set

Midwives’ DELPHI

Survey of statistical

Offices to assess feasibility

Final indicator set

development of indicator set
Development of indicator set
  • Core indicators: 10routinely published indicators on perinatal health
  • Recommended indicators: 23 necessary for a more complete review of perinatal health status
    • Available
    • Further development needed
peristat core indicators
PERISTAT Core indicators

FETAL/NEONATAL HEALTH

  • Fetal mortality rate
  • Neonatal mortality rate
  • Infant mortality rate
  • Birthweight distribution
  • Gestational age distributionby vital status, birthweight, gestational age, plurality
peristat core indicators14
PERISTAT Core indicators

MATERNAL HEALTH

  • Maternal mortality ratio by age and mode of deliveryPOPULATION CHARACTERISTICS
  • Multiple birth rate
  • Distribution of maternal age
  • Distribution of parityHEALTH CARE SERVICES
  • Distribution of mode of delivery
peristat recommended indicators
PERISTAT Recommended indicators

INFANT/FETAL HEALTH

  • Distribution of APGAR score at 5 minutes
  • Prevalence of congenital anomalies
  • Causes of perinatal death
  • Prevalence of hypoxic-ischemic encephalophathy
  • Prevalence of cerebral palsy
peristat recommended indicators16
PERISTAT recommended indicators

MATERNAL HEALTH

  • Maternal mortality ratio by cause of death
  • Indicator of severe maternal morbidity
  • Prevalence of trauma to the perineum (includes episiotomy)
  • Prevalence of faecal incontinence
  • Postpartum depression
peristat recommended indicators17
PERISTAT Recommended indicators

POPULATION CHARACTERISTICS

  • Percent of pregnant women who smoke during pregnancy
  • Distribution of mother’s education
  • Mother’s country of origin
peristat recommended indicators18
PERISTAT Recommended indicators

HEALTH SERVICES

  • % pregnancies after fertility treatment
  • Distribution of the timing of 1st antenatal visit
  • Distribution of mode of onset of labour
  • Distribution of place of birth (% home births & by size of maternity unit)
  • % of infants breast-feeding at birth
  • % very preterm births delivered in units without a NICU
peristat recommended indicators19
PERISTAT Recommended indicators

HEALTH SERVICES CONTINUED

  • Indicator of support to women
  • Indicator of maternal satisfaction
  • Births attended by midwives
  • Births without medical intervention
core indicators delphi results
Core indicators, DELPHI results

Stillbirth/fetal mortality rate 96%

Neonatal mortality rate 96%

Maternal mortality rate 93%

Maternal age 93%

Births by birthweight group 80%

Births by gestational age 89%

Multiple birth rate 85%

Mode of delivery 85%

Parity 81%

Infant mortality rate 78%

midwives consensus
Midwives Consensus
  • Perinatal mortality rate
  • Maternal mortality ratio (by cause)
  • Mode of delivery
  • Proportion of babies breastfeeding
  • Distribution of gestational age
  • APGAR 5 minute
  • Fetal growth restriction
  • Births without medical intervention
  • Post-partum depression
  • Maternal satisfaction
  • Births attended by midwives
sub group analyses
Sub-group analyses
  • Stillbirth rate by gestational age, birthweight and plurality
  • Neonatal mortality rate by timing of death, gestational age, birthweight, plurality
  • Distribution of birthweight by plurality, vital status at birth, gestational age
  • Distribution of gestational age by plurality, vital status at birth