Maternity Patient Safety Statements

Maternity Patient Safety Statements have been published for each of the country’s 19 maternity hospitals and units. Each Hospital Group and Maternity Hospital will publish an updated statement each month.

The objective in publishing these statements is to provide public assurance that maternity services are delivered in an environment that promotes open disclosure.  It is intended that reporting in an honest and open way helps build trust and improves clinical performance and the culture of safety.

The Maternity Patient Safety Statement contains information on 17 metrics covering a range of clinical activities, major obstetric events, modes of delivery and clinical incidents.

While all maternity hospitals collect a large range of information and data on an ongoing basis, these particular metrics have been selected on the basis that they are clinically robust, relevant and underpinned by standardised definitions.

The statements will also inform hospital management in carrying out their role in safety and quality improvement. It is intended that they will act as an early warning mechanism for issues that require local action or any issues that need intervention at Hospital Group or national level.

The statements are also part of the recommendations of the reports:

·        HSE Midland Regional Hospital, Portlaoise Perinatal Deaths, Report to the Minister for Health from Dr. Tony Holohan, Chief Medical Officer, 24 February 2014; and

·        HIQA Report of the Investigation into the Safety, Quality and Standards of Services Provided by the HSE to patients in the Midland Regional Hospital, Portlaoise, 8 May 2015

Like all performance measurements the data should be interpreted with caution particularly when reporting low numbers which may vary naturally from month to month and are influenced by case complexity.

The Statement is set out under a number of headings as follows:

Hospital Activities - information is reported on the number of women delivering babies for the first time, the number who have previously given birth, the number of multiple pregnancies, perinatal mortality rates and transfers in and out to out hospitals.

Major Obstetric Events – information is provided on a range of rare but potentially life threatening events that could occur within maternity services. These include eclampsia, uterine rupture, peripartum hysterectomy and pulmonary embolism. As the numbers for these rare events are small, they will be reported and published as a combined rate per 1,000 mothers delivered.

Modes of Delivery: information is provided on the rate of delivery of babies through induction of labour, instrumental delivery or caesarean section.

Total Number of Clinical Incidents for maternity services reported in the month:  This information relates to the total number of incidents recorded on the National Incident Management System. This system has been rolled out as a joint initiative with the State Claims Agency.

Explanatory notes on Maternity Patient Safety Statement (MPSS) metrics

Summary:

Metrics 1-6 refer to levels of activity in maternity units, including mothers delivered ≥500g, babies born ≥500g, in-utero transfers, and perinatal mortality.

Metrics 7-16 refer to rates of major obstetric events and assisted deliveries.

Metric 17 refers to the number of clinical incidents for maternity services reported to NIMS on a monthly basis

 Detailed explanations:

1.    Total mothers delivered ≥500g: Total number of women delivering a baby weighing 500g or more.  The infant weight of 500g is an internationally recognised weight measurement for counting numbers of mothers delivered.

2.    Multiple pregnancies: Number of mothers delivering more than one baby from a single pregnancy.  This is a count of mothers, not numbers of babies delivered.

3.    Total births ≥500g: Total number of babies born, including live births and stillbirths, weighing 500g or more.  The weight of 500g is an internationally recognised weight measurement for counting numbers of babies born.

4.    Rate of perinatal deaths (i.e., including stillbirths and early neonatal deaths (from delivery to 6 completed days)) weighing ≥2.5kg without a congenital anomaly (i.e. without physiological or structural abnormalities that develop at or before birth and are present at the time of birth).  Rate is calculated per 1,000 total births.

5.    In-utero transfers admitted: Number of pregnant women admitted to a maternity hospital from another hospital prior to delivery for reasons in the foetal interest.

6.    In-utero transfers sent out: Number of pregnant women transferred from a maternity hospital to another hospital prior to delivery for reasons in the foetal interest.

7.    Major obstetrics events: This metric combines four major obstetric events: eclampsia, uterine rupture, peripartum hysterectomy, and pulmonary embolism.  Typically, these events are rare and involve small numbers of cases annually.  But they are dangerous, potentially life-threatening conditions.  The rate is calculated per 1,000 total mothers delivering babies weighing 500g or more and the four major obstetric events are defined as follows:

Eclampsia : Eclampsia is a condition in which one or more convulsions occur in a pregnant woman suffering from high blood pressure, often followed by coma and posing a threat to the health of mother and baby.  The metric includes women diagnosed with eclampsia during any antenatal hospital event or at delivery, including eclampsia in pregnancy, in labour, in the puerperium, and eclampsia unspecified as to time period. It does not count cases of severe pre-eclampsia.

Uterine rupture: The complete rupture of uterus (i.e., involving the full thickness of the uterine wall) before onset of labour or during labour.  Include cases that may not be diagnosed until after delivery.  The main risk factors for uterine rupture are previous caesarean section or induction of labour (using prostaglandins).

Peripartum hysterectomy: Surgical removal of the uterus, may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures.  Peripartum hysterectomy is a rare procedure, usually only performed in circumstances of emergency, life-threatening haemorrhage, but it is a life-saving procedure in cases of severe haemorrhage. This metric counts the number of hysterectomy procedures completed during the birth episode of care, usually following a caesarean section, including hysterectomies performed during pregnancy and/or procedures within seven completed days after delivery. 

-Pulmonary embolism: A blockage of the lung’s main artery or one of its branches   by a substance that travels from elsewhere in the body through the bloodstream.  PE results from a deep vein thrombosis (commonly a blood clot in a leg) that breaks off and migrates to the lung, a process termed venous thromboembolism (VTE). 

8.     Instrumental delivery: Percentage of ‘Mothers delivered ≥500g’ who require instrumental assistance during delivery.  Instrumental assistance includes forceps delivery and vacuum extraction, excluding failed forceps and failed vacuum extraction.  Also includes assisted breech delivery with forceps to after-coming head and breech extraction with forceps to after-coming head.

          Metrics 9 and 10 indicate the rate of nulliparas with instrumental delivery (i.e., Percentage of women who have never had a previous pregnancy resulting in a live birth or stillbirth ≥ 500g who require instrumental assistance during delivery) and the rate of multiparas with instrumental delivery (i.e., Percentage of women who have had at least one previous delivery resulting in a live birth or stillbirth ≥ 500g who require instrumental assistance during delivery).

11.   Induction of labour: Percentage of ‘Mothers delivered ≥500g’ who require induction of labour.  Induction of labour includesmedical induction using oxytocin, prostaglandin, or other medical means, or whose labour was assisted surgically by artificial rupture of membranes or other surgical procedure; also includes women who undergo both medical and surgical induction of labour.

Metrics 12 and 13

Indicate the rate of nulliparas with induction of labour (i.e., Percentage of women who have never had a previous pregnancy resulting in a live birth or stillbirth ≥ 500g who require induction of labour) and the rate of multiparas with induction of labour (i.e., Percentage of women who have had at least one previous delivery resulting in a live birth or stillbirth ≥ 500g who require induction of labour).

14.   Caesarean sections: Percentage of ‘Mothers delivered ≥500g’ by caesarean section, including elective and emergency classical caesarean section and elective and emergency lower segment caesarean section.

Metrics 15 and 16

Indicate the rate of nulliparas with caesarean section (i.e., women who have never had a previous pregnancy resulting in a live birth or stillbirth ≥ 500g who require an elective or emergency caesarean section) and the rate of multiparas with caesarean section (i.e., women who have had at least one previous delivery resulting in a live birth or stillbirth ≥ 500g who require an elective or emergency caesarean section).

17.  Total number of clinical incidents in the hospital that are reported monthly to the National Incident Management System. A Clinical incident is an event or circumstance that could have resulted, or did result, in unnecessary harm to a patient.