The Italian Perinatal Surveillance System SPItOSS: insights from Confidential Enquiries

期刊论文
出版模式：

开放获取
发表日期：

2024年12月4日

查看全文

Michele Antonio Salvatore,
Silvia Salvi,
Paola D’Aloja,
Patrizia Vergani,
Roberto Bellù,
Carlo Dani,
Federico Mecacci,
Maria Rosa D’Anna,
Sergio Ferrazzani,
Giuseppe Battagliarin,
Piermichele Paolillo,
Simonetta Picone,
Luca Ramenghi,
Giovanni Vento,
Serena Donati,
Sara Albolino,
Flavia Alessandra Rossi,
Gaetano Bulfamante,
Nicola Cassata,
Francesca Castiglione,
Giulia Dagliana,
Gabriella Dardanoni,
Giuseppe Ettore,
Giuseppe Ferlazzo,
Sebastiana Ferraro,
Luigi Gagliardi,
Eloisa Gitto,
Paola Goretti,
Giuseppe Gramaglia,
Ester Grismondi,
Laura Iannuzzi,
Faustina Lalatta,
Lucia Lo,
Tommaso Mannone,
Anna Maria Marconi,
Emiliano Maresi,
Massimo Micaglio,
Alessandra Moretto,
Fabio Mosca,
Giuseppe Murolo,
Elisabetta Pelo,
Maria Piccione,
Simone Pratesi,
Emanuele Scarpuzza,
Caterina Serena,
Filiberto Maria Severi,
Francesca Strigini,
Nicola Strobelt,
Paolo Emilio Tagliabue,
Rosaria Taverna,
Barbara Tomasini,
Marcello Vitaliti,
Fabio Voller,
Giovanni Bartoloni

摘要

Background

An effective strategy to reduce perinatal mortality requires an active surveillance system. This includes monitoring cases, organizing multidisciplinary local audits, conducting Confidential Enquiries, identifying avoidable factors, and facilitating changes in the healthcare system. In 2017, the Italian Obstetric Surveillance System launched the SPItOSS pilot Perinatal Surveillance System. The aim of this paper is to describe the results of the SPItOSS Confidential Enquiries on perinatal deaths focusing on the emergent critical aspects in obstetric and neonatal care, as well as on the healthcare facilities organization.

Methods

SPItOSS, a population-based surveillance system, collected and analysed incident perinatal deaths from July 2017 to June 2019 in three Regions encompassing 32.3% of Italian births. Cases were defined according to WHO definition as fetuses born dead ≥ 28 weeks of gestation and live newborn died within 7 days from birth. The International Statistical Classification of Diseases and related Health Problem-Perinatal Mortality was adopted for coding causes of death and contributing maternal and placenta-related conditions. Confidential Enquiries, prioritized according to perinatal deaths preventability, were conducted by expert committees at Regional and National level.

Results

A total of 830 incident perinatal deaths were notified, with 58.3% classified as antepartum, 4.3% as intrapartum, and 37.3% as neonatal deaths. According to the SPItOSS protocol, Confidential Enquiries evaluated only the most preventable deaths, including 19 intrapartum and 70 neonatal deaths. Of these, 43.8% were assessed as unavoidable with appropriate care; 29.2% as unavoidable with improvable care, and 15.7% as avoidable due to inappropriate care. Most intrapartum deaths were attributed to intrauterine hypoxia, while neonatal deaths recognized a multifactorial aetiology. Different aspects of inappropriate care were highlighted, such as failure to recognise maternal or fetal problems before labour, delayed or inappropriate neonatal resuscitation, and poor or suboptimal neonatal monitoring.

Conclusions

The SPItOSS Confidential Enquires provided insights for improving maternity and perinatal services. By targeting key areas of obstetric and neonatal care, the surveillance can generate recommendations and actions to prevent avoidable perinatal deaths.