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NOSS – more than surveillance

NOSS – more than surveillance. Objective:. To develop a Nordic Obstetric Surveillance System to describe the epidemiology of a variety of serious complications at delivery. Why collect data on rare serious obstetric complications?.

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NOSS – more than surveillance

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  1. NOSS – more than surveillance KBP 06/10

  2. Objective: To develop a Nordic Obstetric Surveillance System to describe the epidemiology of a variety of serious complications at delivery. KBP 06/10

  3. Why collect data on rare serious obstetric complications? • Hypothesis raised that there is an increase in rare serious obstetric complications due to the increasing rate of caeserean section worldwide. • The low incidence imply that risk factors, treatment modalities and consequences are not well described. • The rare serious complications can be considered “near-miss events” for maternal death. KBP 06/10

  4. Inspiration from UKOSS • Acute fatty liver • Amniotic fluid embolism • Antenatal pulmonary embolism • Eclampsia • Peripartum hysterectomy • TB • Uterine rupture KBP 06/10

  5. What do we want to know? • The incidence in the Nordic countries? • The characteristics of the women? • The impact of mode of delivery and previous caesarean section? • Treatment modalities? • The associated maternal and perinatal mortality and morbidity? KBP 06/10

  6. Why not use the Nordic Medical Birth registries? KBP 06/10

  7. Live born 1975-2008 KBP 06/10

  8. Total fertility rate 1975-2008 KBP 06/10

  9. Caesarean section 1975-2008 KBP 06/10

  10. The Nordic Medical Birth registries • Appropriate when complications are frequent and well defined – and with record linkage they also offer fantastic opportunities for longitudinal studies. • Less useful when complications are rare, less well defined and especially when codes are lacking. KBP 06/10

  11. KBP 06/10

  12. Collaboration: • NOSS Team: • Birth registers – Obstetricians • Nordic countries • Midwives and obstetricians participate • UKOSS Team: • Marian Knight and Peter Brocklehurst KBP 06/10

  13. Rare serious obstetric complications: • Uterine rupture • - Complete • - Incomplete • Placenta accreta/percreta • Vaginal deliveries with incomplete or difficult removal of placenta and blood transfusion within 48 hours OR caesarean section where placenta was difficult to remove and was considered accrete or percrete • Postpartum Hysterectomy • (within 7 days after delivery) KBP 06/10

  14. Preparation: • Workshops • - Hven, September 2008 • - Skanör, Sweden, March 2009 • Webpage (www.noss.nu) • Data collection forms • (paper based and electronic) • Nordic pilot study started 1. April 2009 KBP 06/10

  15. Continued preparation: • Workshop Bergen April 2010 • Inclusion of ”Postpartum Haemorrhage” – • Blood transfusion ≥ 6 units (DK Transfusion Database) • Start of the official study 1. September 2010 • Controls from the Nordic Birth Registers using routine data and – when specific questions arise that cannot be solved by register data – by ”control questionnaires” KBP 06/10

  16. Status – Nordic countries: • All obstetric departments in four of five countries already participate and report prospectively • Each department have appointed a contact person KBP 06/10

  17. Status – Denmark: • All 28 obstetric departments participate and report prospectively • Each department have appointed a contact person • - Obstetrician or Midwife • Data from Medical Birth Registry every 3. month • (last update may 2010) –> request to obstetric • department KBP 06/10

  18. Status – Denmark: Data from Denmark so far: 55 Uterine ruptures 7 Postpartum Hysterectomies 25 Placenta accreta/percreta KBP 06/10

  19. Status – Denmark: Average Blood transfusions: Uterine ruptures: 0,44 (0-11) Postpartum Hysterectomies: 13,3 (0-30) Placenta accreta/percreta: 3,72 (0-20) KBP 06/10

  20. Future events: • INOSS workshop Oxford, July 2010 • NOSS workshop Helsinki Finland, April 2011 • NFOG Congress, June 2012 – ”Hardcore data” KBP 06/10

  21. THANK YOU It looks so easy... KBP 06/10

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