Benchmarking the hypertensive disorders of pregnancy : improving outcomes for mothers and babies via clinical practice change

Western Sydney University thesis: Doctoral thesis

Abstract

An average of one hundred and thirty four mothers and 410 babies die every day around the world as a result of the hypertensive disorders of pregnancy (HDP). This figure, whilst staggering, in no way reflects the degree of morbidity which results from these disorders. Randomised controlled data and isolated hospital specific databases can provide us with snapshots at single points in time within obstetric units and populations, but there is no routinely collected or mandatory dataset which accurately reflects the type and severity of complications which occur. Eclampsia, acute renal failure (ARF), acute pulmonary oedema (APO) and growth restriction are well documented complications of the HDPs, yet there is considerable variation in the literature in describing their incidence. There is currently no consensus on treatment modalities which will optimise outcomes. Without accurate data, obstetric care providers and obstetric units are unable to be confident that the care they provide is optimal if they have no standard or benchmark against which to compare. The aim of the study herein, was to establish a database across obstetric units and countries to determine if accurate rates of morbidity could be obtained, and if this data could be the basis for the establishment of 'best achievable outcomes'. Further, the utility of the audit and feedback process was tested as the means by which clinical practice change could be instituted.
Date of Award2010
Original languageEnglish

Keywords

  • eclampsia
  • preeclampsia
  • mothers
  • mortality
  • morbidity
  • perinatal death
  • acute renal failure
  • acute pulmonary oedema
  • hypertension in pregnancy
  • benchmarking (management)

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