Antenatal cardiotocography in dutch primary midwife-led care: Maternal and perinatal outcomes and serious adverse events. A prospective observational cohort study.

Antenatal cardiotocography Antepartum fetal monitoring Midwife-led care Task shifting

Journal

Women and birth : journal of the Australian College of Midwives
ISSN: 1878-1799
Titre abrégé: Women Birth
Pays: Netherlands
ID NLM: 101266131

Informations de publication

Date de publication:
28 Aug 2023
Historique:
received: 05 06 2023
revised: 27 07 2023
accepted: 21 08 2023
medline: 31 8 2023
pubmed: 31 8 2023
entrez: 30 8 2023
Statut: aheadofprint

Résumé

It is yet unknown whether shifting antenatal cardiotocography (aCTG) from obstetrician-led to midwife-led care leads to a safe reduction in referrals. ACTG is used to assess fetal well-being. In the Netherlands, the procedure has until now been performed as part of obstetrician-led care. Developments in E-health facilitates the performance of aCTG outside the hospital in midwife-led care, hereby increasing continuity of care. To evaluate 1) process outcomes of implementing aCTG for specific indications in primary midwife-led care; 2) maternal and perinatal outcomes of pregnant women receiving aCTG in midwife-led care; 3) serious adverse events (with outcomes, causes, avoidability, and potential prevention strategies) that have occurred during the innovation project 'aCTG in midwife-led care'. Prospective observational cohort study and a case series study of serious adverse events. A total of 1584 pregnant women with a specific aCTG indication were included in this cohort study for whom 1795 aCTGs were performed in midwife-led care. 1591 aCTGs(89.7%) were classified as reassuring. Referral to obstetrician-led care occurred for 234 women(13.0%) after an aCTG in midwife-led care of whom 202(86%) were referred back. Severe neonatal morbidity occurred in 27 neonates (1.7%). In the 5736 aCTGs included in the case series study, one case with a serious neonatal outcome was assessed as a serious adverse event attributable to human factors. ACTGs performed in midwife-led care increased continuity of care. In this innovation project, maternal and perinatal outcomes were in the expected range for women in midwife-led care.

Sections du résumé

PROBLEM OBJECTIVE
It is yet unknown whether shifting antenatal cardiotocography (aCTG) from obstetrician-led to midwife-led care leads to a safe reduction in referrals.
BACKGROUND BACKGROUND
ACTG is used to assess fetal well-being. In the Netherlands, the procedure has until now been performed as part of obstetrician-led care. Developments in E-health facilitates the performance of aCTG outside the hospital in midwife-led care, hereby increasing continuity of care.
AIM OBJECTIVE
To evaluate 1) process outcomes of implementing aCTG for specific indications in primary midwife-led care; 2) maternal and perinatal outcomes of pregnant women receiving aCTG in midwife-led care; 3) serious adverse events (with outcomes, causes, avoidability, and potential prevention strategies) that have occurred during the innovation project 'aCTG in midwife-led care'.
METHODS METHODS
Prospective observational cohort study and a case series study of serious adverse events.
FINDINGS RESULTS
A total of 1584 pregnant women with a specific aCTG indication were included in this cohort study for whom 1795 aCTGs were performed in midwife-led care. 1591 aCTGs(89.7%) were classified as reassuring. Referral to obstetrician-led care occurred for 234 women(13.0%) after an aCTG in midwife-led care of whom 202(86%) were referred back. Severe neonatal morbidity occurred in 27 neonates (1.7%). In the 5736 aCTGs included in the case series study, one case with a serious neonatal outcome was assessed as a serious adverse event attributable to human factors.
DISCUSSION CONCLUSIONS
ACTGs performed in midwife-led care increased continuity of care. In this innovation project, maternal and perinatal outcomes were in the expected range for women in midwife-led care.

Identifiants

DOI: 10.1016/j.wombi.2023.08.006 PMID: 37648620
pubmed: 37648620
pii: S1871-5192(23)00260-3
doi: 10.1016/j.wombi.2023.08.006
pii:
doi:

Types de publication

Journal Article

Langues

eng

Informations de copyright

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors report no conflicts of interest.

Auteurs

Elise M Neppelenbroek (EM)

Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, Netherlands. Electronic address: e.m.neppelenbroek@amsterdamumc.nl.

Corine J M Verhoeven (CJM)

Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, Netherlands; University of Nottingham, Department of Midwifery, School of Health Sciences, Nottingham, United Kingdom; Maxima Medical Centre, Department of Obstetrics and Gynaecology, Veldhoven, Netherlands.

Olivier W H van der Heijden (OWH)

Amalia Children's Hospital, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands.

Marit S G van der Pijl (MSG)

Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, Netherlands.

Carola J M Groenen (CJM)

Amalia Children's Hospital, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands.

Wessel Ganzevoort (W)

Amsterdam University Medical Centres, Universiteit van Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands.

Bas S W A Nij Bijvank (BSWAN)

Department of Obstetrics and Gynecology, Isala Women and Children's hospital, Zwolle, Netherlands.

Ank de Jonge (A)

Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands.

Classifications MeSH