TY - JOUR
T1 - Antenatal cardiotocography in dutch primary midwife-led care
T2 - Maternal and perinatal outcomes and serious adverse events. A prospective observational cohort study
AU - Neppelenbroek, Elise M.
AU - Verhoeven, Corine J. M.
AU - van der Heijden, Olivier W. H.
AU - van der Pijl, Marit S. G.
AU - Groenen, Carola J. M.
AU - Ganzevoort, Wessel
AU - Bijvank, Bas S. W. A. Nij
AU - de Jonge, Ank
N1 - Funding Information: This study was supported by a grant from the National Agency for Practice-Oriented Research (SIA) , part of NWO (grant number RAAK.MKB09.009 ). This funding source had no role in study design, data collection, data analysis, data interpretation, writing of the scientific article, or the decision to submit the paper for publication. There was no additional external funding received for this study. Publisher Copyright: © 2023 The Authors
PY - 2023/8/28
Y1 - 2023/8/28
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.
KW - Antenatal cardiotocography
KW - Antepartum fetal monitoring
KW - Midwife-led care
KW - Task shifting
UR - http://www.scopus.com/inward/record.url?scp=85171473937&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.wombi.2023.08.006
DO - https://doi.org/10.1016/j.wombi.2023.08.006
M3 - Article
C2 - 37648620
SN - 1871-5192
JO - Women and birth
JF - Women and birth
ER -