妊娠と小児の健康に関するジャーナル

抽象的な

The National Quality Plan and More Caesarean Sections, Less Wound Infections,more Gestational Diabetes (GDM) and Fewer Smokers in Northern Norway: A Registry-based Retrospective Study

Jan Norum, Tove Elisabeth Svee, Ingrid Petrikke Olsen, Margit Steinholt, Merethe Kumle and Randi Spørck

Background: The Ministry of Health and Care Service’s plan for improved maternity and delivery care was implemented in Northern Norway in March 2012. Selection criteria were standardized and economic resources allocated. Methods: We explored the effects in a retrospective quality of care study employing data from the Medical Birth Registry of Norway (MBRN). The prior study (2009-11) was compared with the 2012-14 period. The levels of care were Midwife administered maternity units (MAMU), Departments of Obstetrics and Gynaecology (DOG) and Regional Clinics of Obstetrics and Gynaecology (RCOG). National data on post-caesarean surgical wound infection (2009-2014) was added. Quality of care was defined as rate of multiple pregnancies, eclampsia, vacuum or forceps assisted delivery, births during transportation, caesarean section rate, post-caesarean wound infection, perineal rupture, smoking habits, body mass index (BMI), Apgar score <7, birth weight <2.5 kg and stillbirth. There were in total 30,516 and 362,013 births during study period in Northern Norway and Norway, respectively. Results: In Northern Norway, the quality commitment did not affect the balance between levels of care. In the northern region, birth weight<2.5 kg, stillbirth rates and Apgar score <7 was stable and similar to national figures. Caesarean section rate increased in the northern region from 16.1% to 16.9% (P=0.04). It dropped at the MAMUs (2.8% vs. 1.4%, P=0.019), and increased at the RCOGs (17.4% vs. 18.2%, P=0.017). Post-caesarean wound infection rate was reduced both in Northern Norway (10.5% vs. 8.3%, P=0.069) and nationally (7.1% and 4.6%, P<0.001). The use of forceps and vacuum assisted delivery was stable and below national levels. Perineal rupture grade 3 and 4 and eclampsia rates were unchanged. However, gestational diabetes mellitus (GDM) rate increased from 1.7% to 2.9% (P<0.001), but body mass index (BMI) did not change. Number of smokers dropped (11.6% vs. 8.2%, P<0.001). Conclusion: The national commitment did not alter the balance between institutions in Northern Norway. The caesarean section rate increased at the RCOGs and the Apgar score did not improve. GDM rate increased and the number of smokers dropped.