A nationwide surveillance system to reduce perinatal death cases in Italy: implementing a population-based pilot project

Abstract

Objectives: to describe the methodology of a pilot perinatal mortality surveillance system (SPItOSS) aimed to improve quality of care and prevent avoidable perinatal severe morbidity and mortality in three Italian regions.

Design: population-based surveillance project monitoring incident cases of stillbirths, born dead ≥ 28 weeks of gestation and live births dying within 7 days. Local multidisciplinary audits in obstetric and neonatal units were conducted to assess causes of each death. A selection of deaths was also discussed by experts in regional and national Confidential Enquiries to assess causes and avoidability. The WHO perinatal mortality definition and the ICD-PM classification were adopted to codify perinatal deaths.

Setting and participants: health professionals working in any obstetric and neonatal unit in Lombardy (Northern Italy), Tuscany (Central Italy), and Sicily (Southern Italy), accounting for 32.3% of births in Italy. Data collection started on 01.07.2017 and ended on 30.06.2019.

Main outcome measures: obstetric and neonatal units' participation rate in the participating regions, facility structural organisation description, health professionals' training course participation, estimate of perinatal death rates, clinical audits and Confidential Enquiries rates.

Results: health professionals from all obstetric and/or neonatal units (N. 138) joined the pilot project. Overall, 830 incident perinatal deaths were reported; 699 underwent a facility-based clinical audit, and 94 selected cases were analysed in detail through regional and national Confidential Enquiries. Among the latter, 16.0% were assessed as avoidable deaths. Interregional differences related to the facility structural organisation were identified.

Conclusions: SPItOSS was efficient in identifying and analysing incident cases of perinatal deaths and detecting improvable aspects of care and avoidable perinatal deaths. The next objective is to extend the surveillance at the national level, considering that stable funding and a higher number of participating healthcare professionals and experts will be needed.

Keywords: clinical audit; perinatal mortality; pregnancy complications; public health surveillance; stillbirth.