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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.

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

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

  2. 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

  3. 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.

  4. Coordination • Epidemiological Research Unit on Perinatal and Women’s Health, U.149 INSERM, Paris. • Gérard Bréart • Jennifer Zeitlin • Katherine Wildman

  5. 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

  6. Scientific advisory committee • One clinician (neonatologist, obstetrician, midwife) from each country • One epidemiologist/statistician from each country

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. PERISTAT Recommended indicators POPULATION CHARACTERISTICS • Percent of pregnant women who smoke during pregnancy • Distribution of mother’s education • Mother’s country of origin

  18. 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

  19. PERISTAT Recommended indicators HEALTH SERVICES CONTINUED • Indicator of support to women • Indicator of maternal satisfaction • Births attended by midwives • Births without medical intervention

  20. 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%

  21. 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

  22. 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

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