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. 2024 Dec 4;50(1):256.
doi: 10.1186/s13052-024-01811-w.

The Italian Perinatal Surveillance System SPItOSS: insights from Confidential Enquiries

Michele Antonio Salvatore  1 , Silvia Salvi  2   3 , Paola D'Aloja  1 , Patrizia Vergani  4 , Roberto Bellù  5 , Carlo Dani  6 , Federico Mecacci  7 , Maria Rosa D'Anna  8 , Sergio Ferrazzani  9 , Giuseppe Battagliarin  10 , Piermichele Paolillo  11 , Simonetta Picone  11 , Luca Ramenghi  12 , Giovanni Vento  13 , Serena Donati  1 ; Italian Perinatal Surveillance System-SPItOSS Working Group
Collaborators, Affiliations

The Italian Perinatal Surveillance System SPItOSS: insights from Confidential Enquiries

Michele Antonio Salvatore et al. Ital J Pediatr. .

Abstract

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.

Keywords: Active surveillance; Confidential enquiry; Maternal surveillance; Neonatal death; Neonatal surveillance; Perinatal care; Perinatal death; Perinatal mortality review.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Ethics Committee of the INIH evaluated the project and stated its unanimous ethical approval waiving the participants from the request for patient consent statement. The Protocol number is PRE-442/17, Rome 06/06/2017. The project was performed in accordance with the ethical standards as laid down in the Declaration of Helsinki and its later amendments or comparable ethical standards. Consent for publication: Not applicable. Competing interests: Carlo Dani, the editor of the journal, is one of the co-authors. No other competing interests have been declared.

Figures

Fig. 1
Fig. 1
Perinatal deaths revised through Confidential Enquiries
Fig. 2
Fig. 2
Clinical practice recommendations from SPItOSS Confidential Enquiries
See this image and copyright information in PMC

References

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