Data sources used by the NMPA. 24. Selection of audit measures for the NMPA. 26. Outlier indicators. 27. Case ascertainm
National Maternity and Perinatal Audit Clinical report 2017
Based on births in NHS maternity services between 1st April 2015 and 31st March 2016
National Maternity and Perinatal Audit Clinical report 2017
Based on births in NHS maternity services between 1st April 2015 and 31st March 2016
Some of the figures in this report are in the process of being updated. A revised version will be issued in early 2018. Further information is available at: http://www.maternityaudit.org.uk/Audit/Charting/Clinical
The National Maternity and Perinatal Audit is led by the Royal College of Obstetricians and Gynaecologists (RCOG) in partnership with the Royal College of Midwives (RCM), the Royal College of Paediatrics and Child Health (RCPCH) and the London School of Hygiene and Tropical Medicine (LSHTM) Copyright Healthcare Quality Improvement Partnership (HQIP) This report was prepared by the NMPA project team: Ms Andrea Blotkamp, NMPA Clinical Fellow (Midwifery) Dr Fran Carroll, NMPA Research Fellow Dr David Cromwell, NMPA Senior Methodological Advisor Dr Ipek Gurol-Urganci, NMPA Senior Methodological Advisor Dr Tina Harris, NMPA Senior Clinical Lead (Midwifery) Dr Jane Hawdon, NMPA Senior Clinical Lead (Neonatology) Dr Jen Jardine, NMPA Clinical Fellow (Obstetrics) Ms Hannah Knight, NMPA Audit Lead Dr Lindsey Macdougall, NMPA Data Manager Ms Natalie Moitt, NMPA Statistician Dr Dharmintra Pasupathy, NMPA Senior Clinical Lead (Obstetrics) Prof Jan van der Meulen, NMPA Senior Methodologist (Chair) Please cite as: NMPA Project Team. National Maternity and Perinatal Audit: Clinical Report 2017. RCOG London, 2017.
Contents Tables and figures
5
Foreword
8
Acknowledgements
Executive summary Introduction Methods Key messages Clinical findings Data quality Recommendations
Abbreviations and glossary
Introduction The National Maternity and Perinatal Audit Why was the NMPA commissioned? The overall aims of the continuous clinical audit What does this report cover?
7
10 10 10 12 12 14 15
18
21 21 21 22 23
Methods The NMPA approach to data collection Data sources used by the NMPA Selection of audit measures for the NMPA Outlier indicators Case ascertainment Analysis Construction of audit measures Case mix adjustment Presentation of data using funnel plots Levels of reporting Suppression of small numbers
24 24 24 26 27 27 27 27 28 28 29 30
Findings Key findings Characteristics of women and their babies Maternal age Ethnic background Deprivation
37 37 38 38 39 40
Data quality Key findings How does the NMPA assess data quality? Country level differences Results of data quality assessments How does poor data quality affect our ability to derive nationally important measures? Recommendations
31 31 31 32 33 34 35
National Maternity and Perinatal Audit – Clinical Report 2017 Parity Pre-existing medical conditions, obstetric history and current pregnancy-related problems Body mass index Smoking Gestational age at birth Birth weight Discussion Place of birth Measures of care before, during and after birth Smoking at booking and birth Induction of labour Elective deliveries between 37+0 and 38+6 weeks gestation without a documented clinical indication Babies born small Modes of birth Vaginal birth after caesarean section Episiotomy Third and fourth degree tears Obstetric haemorrhage of 1500ml or more Five minute Apgar score Skin to skin contact within one hour of birth Breast milk at first feed and at discharge Unplanned maternal readmission Discussion Recommendations
Stakeholder perspectives
Appendices 1 Contributors 2 Site level results
40 40 41 42 43 44 45 45 46 47 48 49 50 52 55 56 58 59 61 62 63 65 66 67
69
73 76
References
87
4
Tables and figures Tables
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
17 18 19 20 21 22 23 24 25 26 27
Estimated case ascertainment Results of data quality assessment Quality of data items required to construct a ‘birth without intervention’ measure Number of records in the NMPA clinical dataset Ethnic background Index of multiple deprivation Parity Pre-existing medical conditions, obstetric history and current pregnancy-related problems Body mass index at booking Birth weight Birth weight centiles Place of birth by site Place of birth by unit/birth setting Proportion of women who stop smoking during pregnancy Proportion of women with a singleton, cephalic pregnancy at term receiving induction of labour Proportion of elective deliveries between 37+0 and 38+6 weeks gestation without a documented clinical indication Proportion of term babies born small for gestational age Proportion of women giving birth to a singleton, cephalic baby at term, by mode of birth Proportion of women who had their first baby by caesarean section and who give birth to their second baby vaginally at term Proportion of women who have a vaginal birth of a singleton, cephalic baby at term and who have an episiotomy Proportion of women who have a vaginal birth of a singleton, cephalic baby at term and who sustain a third or fourth degree perineal tear Proportion of women who have a singleton, cephalic baby at term and who have an obstetric haemorrhage of 1500ml or more Apgar scoring system Proportion of singleton babies born at term who are assigned an Apgar score of
