Royal College of Obstetricians and Gynaecologists

1. Setting standards to improve women’s health Royal College ofObstetricians andGynaecologists Risk Management and Medico-Legal Issues In Women’s Health Joint RCOG/ENTER Meeting Please turn off all mobile phones and pagers

2. Audit of Obstetric Near-Misses Dr. I ChandraSekaran University Hospitals of North Staffordshire RCOG

3. Aim • To introduce the concept of severe maternal morbidity. Mortalities have declined. • 11.4/100000 maternities(1997-1999) • 13.1/100000 maternities(2000-2002) • To create awareness among obstetric and midwifery staff. • To establish the commonest cause for morbidity. • To estimate an incidence for these events. • To calculate a near miss: death ratio. RCOG

4. Aim • To realise the need for establishing consistency in documentation & record keeping. • To inculcate the culture of ‘OUR’ responsibility among junior medical staff. • To establish standards for future auditing. RCOG

5. Scottish Confidential Audit of Severe Maternal Morbidity. (SPCERH Publication 2003 & 2004) 20 consultant-led maternity units. • 270 cases studied and analysed. • MOH 3.5/1000 births • ITU admissions 1.5/1000 births • Near miss: death ratio = 67:1 RCOG

6. Background • Total number of deliveries (Labour ward) - 3660 • Total number of maternal deaths - 2 RCOG

7. Methods • Severe morbidity – defined • Jan – Dec 2006 • 10 cases met the inclusion criteria and hence were included. • Retrospective assessment from documentation. • Quality of care judged by an expert panel. RCOG

8. Obstetric haemorrhage Eclampsia Rupture uterus ITU admissions Massive PE Acute respiratory dysfunction Cardiac arrest Pulmonary oedema Cerebro vascular event Status epilepticus Anaphylactic shock Septicaemic shock Anaesthetic problems Coma Renal/liver dysfunction Definition of cases

9. MOH with blood loss >2.5lts : 6 • ITU admissions : 2 (+3 PPH) • Eclampsia : 1 • Rupture uterus : 1 • CVA (Cerebellar bleed) : 1 (not delivered) RCOG

10. MOH (APH+PPH) – TTMOH (APH+PPH) – BF Judged Appropriate RCOG

11. PPH – CJPPH – SL Judged Appropriate RCOG

12. PPH - SJ Judged substandard - Minor RCOG

13. PPH- NM Judged Substandard - Incidental RCOG

14. ITU – Ruptured Cornual Pregnancy-SL Judged Substandard Minor RCOG

15. ITU – Sepsis /Abruption-EL Judged Appropriate RCOG

16. Rupture uterus - CH Judged Substandard Major RCOG

17. Eclampsia + HELLP -NS Judged Appropriate RCOG

18. RSH • Total number of LW deliveries : 3660 • Incidence of 1:332 deliveries • Total number of maternal deaths : 2 • One maternal death - RTA • Total number of near-misses : 11 • Near-miss: death ratio of 11:1 RCOG

19. Quality of Care • Appropriate : 6 • Substandard – Incidental : 1 • Substandard – Minor : 2 • Substandard – Major : 1 RCOG

20. Lessons learnt… • Documentation • Electronic database • System errors • Referral pathway from peripheral units • Busy shifts • Treating coagulopathy secondary to abruption • Treating liver rupture RCOG

21. Thank you

22. Setting standards to improve women’s health Royal College ofObstetricians andGynaecologists Risk Management and Medico-Legal Issues In Women’s Health Joint RCOG/ENTER Meeting Please turn off all mobile phones and pagers