[Evaluation and validation of a perinatal death audit by means of feedback to the caregivers]. / Evaluatie en validatie van perinatale-sterfte-audit door terugkoppeling naar zorgverleners.

OBJECTIVE: To evaluate a perinatal audit procedure by communicating the results to the caregivers (midwives and obstetricians) involved, in order to determine whether the audit led to specific suggestions for improving practice and whether evaluation of the panel assessments by caregivers leads to a different evaluation of the audit process. DESIGN: Descriptive evaluation study. METHOD: Because of privacy regulations, the results of a recently published audit concerning perinatal mortality were reported at an aggregated level. At their own request, two participating hospitals received panel assessment reports of their own cases. The audit procedure, the 77 panel assessments and the care provided were then evaluated during closed meetings with the caregivers affiliated to the respective hospitals. RESULTS: In two audited cases of mortality the caregivers judged the panel's assessments as being too light and as too severe in one other case (Cohen's kappa: 0.98). Detailed case description was considered essential to the audit procedure. While aggregated reporting of audit results provides a general understanding of substandard factors in the care provided, feedback of results on an individual practice level led to specific suggestions for improvement (in relation to medical aspects, patient-caregiver relationship and collaboration between caregivers). Lack of anonymity appeared not to be an issue for the caregivers. CONCLUSION: The feedback of perinatal audit results to the caregivers involved as well as discussion of these results led to specific starting points in the areas of collaboration, documentation and policymaking at both individual and institutional level.

Urinary excretion rates of calcium and magnesium in normal and complicated pregnancies.

In this cross-sectional study calcium and magnesium metabolism was investigated in normal pregnancies (n = 34) and pregnancies complicated by either fetal growth retardation of hypertension with or without fetal growth retardation (SGA newborns) (n = 30). Special attention has been given to the renal excretion rates of calcium and magnesium and their relationship to creatinine and sodium clearances. No differences were noted in the third trimester of pregnancy between the normal and complicated pregnancies in calcium or magnesium metabolism except for an increased serum magnesium in the SGA group. Comparing the post-partum period to normal pregnancy the following results were observed: (i) serum ionic calcium levels showed no differences; (ii) urinary calcium excretion was increased as a result of increased calcium clearance. A striking feature was the fact that the fractional calcium clearance was not increased, in contrast to the increase in relative calcium clearance. The observed results can be explained by an increased GFR and a possible dissociation between the sodium and calcium handling in the cortical thick ascending Limb of Henle's Loop.