TY - JOUR
T1 - Antenatal cardiotocography in dutch primary midwife-led care : maternal and perinatal outcomes and serious adverse events : a prospective observational cohort study
AU - Neppelenbroek, E. M.
AU - Verhoeven, C. J. M.
AU - Van der Heijden, O. W. H.
AU - Van der Pijl, M. S. G.
AU - Groenen, C. J. M.
AU - Ganzevoort, W.
AU - Bijvank, B. S. W. A. N.
AU - De Jonge, Ank
PY - 2024/2
Y1 - 2024/2
N2 - Problem: It is yet unknown whether shifting antenatal cardiotocography (aCTG) from obstetrician-led to midwife-led care leads to a safe reduction in referrals. Background: ACTG is used to assess fetal well-being. In the Netherlands, the procedure has until now been performed as part of obstetrician-led care. Developments in E-health facilitates the performance of aCTG outside the hospital in midwife-led care, hereby increasing continuity of care. Aim: To evaluate 1) process outcomes of implementing aCTG for specific indications in primary midwife-led care; 2) maternal and perinatal outcomes of pregnant women receiving aCTG in midwife-led care; 3) serious adverse events (with outcomes, causes, avoidability, and potential prevention strategies) that have occurred during the innovation project ‘aCTG in midwife-led care’. Methods: Prospective observational cohort study and a case series study of serious adverse events. Findings: A total of 1584 pregnant women with a specific aCTG indication were included in this cohort study for whom 1795 aCTGs were performed in midwife-led care. 1591 aCTGs(89.7%) were classified as reassuring. Referral to obstetrician-led care occurred for 234 women(13.0%) after an aCTG in midwife-led care of whom 202(86%) were referred back. Severe neonatal morbidity occurred in 27 neonates (1.7%). In the 5736 aCTGs included in the case series study, one case with a serious neonatal outcome was assessed as a serious adverse event attributable to human factors. Discussion: ACTGs performed in midwife-led care increased continuity of care. In this innovation project, maternal and perinatal outcomes were in the expected range for women in midwife-led care.
AB - Problem: It is yet unknown whether shifting antenatal cardiotocography (aCTG) from obstetrician-led to midwife-led care leads to a safe reduction in referrals. Background: ACTG is used to assess fetal well-being. In the Netherlands, the procedure has until now been performed as part of obstetrician-led care. Developments in E-health facilitates the performance of aCTG outside the hospital in midwife-led care, hereby increasing continuity of care. Aim: To evaluate 1) process outcomes of implementing aCTG for specific indications in primary midwife-led care; 2) maternal and perinatal outcomes of pregnant women receiving aCTG in midwife-led care; 3) serious adverse events (with outcomes, causes, avoidability, and potential prevention strategies) that have occurred during the innovation project ‘aCTG in midwife-led care’. Methods: Prospective observational cohort study and a case series study of serious adverse events. Findings: A total of 1584 pregnant women with a specific aCTG indication were included in this cohort study for whom 1795 aCTGs were performed in midwife-led care. 1591 aCTGs(89.7%) were classified as reassuring. Referral to obstetrician-led care occurred for 234 women(13.0%) after an aCTG in midwife-led care of whom 202(86%) were referred back. Severe neonatal morbidity occurred in 27 neonates (1.7%). In the 5736 aCTGs included in the case series study, one case with a serious neonatal outcome was assessed as a serious adverse event attributable to human factors. Discussion: ACTGs performed in midwife-led care increased continuity of care. In this innovation project, maternal and perinatal outcomes were in the expected range for women in midwife-led care.
UR - https://hdl.handle.net/1959.7/uws:78543
U2 - 10.1016/j.wombi.2023.08.006
DO - 10.1016/j.wombi.2023.08.006
M3 - Article
SN - 1871-5192
SN - 1878-1799
VL - 37
SP - 177
EP - 187
JO - Women and Birth
JF - Women and Birth
IS - 1
ER -