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for pregnant women and their babies

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Euro-Peristat Perinatal Health Indicators 2010

In our European Perinatal Health Report 2010 (EPHR 2010), we provided summary tables of our 2010 core and recommended perinatal health indicators. You can now gain access to our detailed data tables free of charge after accepting the terms of use and registering by clicking on the links below. Your registration information will only be required once per session.

Definitions for each of the indicators and the methodological issues to keep in mind whilst analyzing them are described in our report.

We ask that you:

  • Carefully read the methodology section of our report as well as the page for each indicator in order to be aware of the strengths and limits of these indicators. If you have any questions, please do not hesitate to contact us.
  • Cite our project in your presentations and publications: "Euro-Peristat project with SCPE and Eurocat. European Perinatal Health Report. The health and care of pregnant women and babies in Europe in 2010. May 2013"
  • Provide feedback on how you use the indicators.

By following these guidelines, you will contribute to the promotion of high quality perinatal health reporting in Europe.

Detailed data tables from EPHR2010

CORE INDICATORS

RECOMMENDED INDICATORS

The EURO-PERISTAT indicators are grouped into four themes: fetal, neonatal, and child health, maternal health, population characteristics and risk factors, and health services. We defined core indicators – those that are essential to monitoring perinatal health – and recommended indicators – those considered desirable for a more complete picture of perinatal health across the member states. We also identified indicators for further development – those that represent important aspects of perinatal health but require further work before they can be implemented within the member states. The list was recently updated in 2012.

  • Download our full list of indicators with definitions here.

EURO-PERISTAT INDICATORS OF PERINATAL HEALTH

(C=core, R=recommended, F=further development)

FETAL, NEONATAL, AND CHILD HEALTH

MATERNAL HEALTH

POPULATION CHARACTERISTICS/RISK FACTORS

HEALTH CARE SERVICES


Euro-Peristat Indicators definitions

click on the indicator to show the definition below

C1. Fetal mortality rate by gestational age, birth weight, and plurality

The number of fetal deaths at or after 22 completed weeks of gestation in a given year per 1000 live and stillbirths in the same year calculated by gestational age, birth weight and plurality. Fetal deaths are differentiated by whether they are spontaneous fetal deaths or result from a termination of pregnancy.

C2. Neonatal mortality rate by gestational age, birth weight, and plurality

The number of neonatal deaths (day 0 through 27) after live birth in a given year per 1000 live births in the same year calculated by gestational age, birth weight and plurality. This rate is presented for all births at or after 22 completed weeks of gestation. This rate is sub-divided by timing of death into early neonatal deaths (0-6 days of life) and late neonatal deaths (7-27 days).

C3. Infant mortality rate by gestational age, birth weight, and plurality

The number of deaths (day 0-364) after live birth in a given year per 1000 live births in the same year calculated by gestational age, birth weight and plurality. This rate is presented for all births at or after 22 completed weeks of gestation. Cohort rates (deaths after live birth in the year, even if the deaths occur in the following year) are also collected by the Euro-Peristat project

C4. Distribution of birth weight by vital status, gestational age, and plurality

Number of births within each 500g weight interval expressed as a proportion of all live and stillbirths calculated by gestational age and vital status at birth for singletons and multiples.

C5. Distribution of gestational age by vital status and plurality

Number of live births and fetal deaths at each completed week of gestation (starting from 22 weeks) expressed as a proportion of all live and stillbirths for singletons and multiples.

Gestational age is defined as the best obstetrical estimate.
This distribution is presented, as follows:
22-36 weeks of gestation (preterm births)
37-41 weeks (term births)
41+ weeks (post-term births)
Preterm births can also be presented as:
22-27 weeks (extremely preterm)
28-31 weeks (very preterm)
32-36 weeks (moderately preterm)

C6. Maternal mortality ratio

The number of maternal deaths (the death of a woman while pregnant or within 42 days of the termination of pregnancy, irrespective of the duration and site of the pregnancy, for any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes) per 100 000 live births.

Euro-Peristat collects data on the maternal mortality ratio from both routine and enhanced systems in countries where the latter exist.

C7. Multiple birth rate by number of fetuses

The number of women in a multiple gestation pregnancy at delivery as a proportion of all women delivering live or stillborn babies by number of fetuses

C8. Distribution of maternal age

Distribution of age in years at delivery for women delivering a live or stillbirth. Recommended presentation, as follows: <15, 15-17, 18-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50+

C9. Distribution of parity

Distribution of parity (number of previous live or stillbirths) of women delivering a live or stillbirth.

C10. Mode of delivery by parity, plurality, presentation of the fetus, previous caesarean section and gestational age

For a population of women and year: the number of births associated with each of the following modes:

- Vaginal, non instrumental
- Vaginal: forceps
- Vaginal: ventouse
- Vaginal (other, Thierry’s spatula, etc..)
- Caesarean: before or at onset of labour/elective
- Caesarean: during labour/emergency

as a proportion of all still and live births. Computed by parity, plurality, presentation and previous caesarean section and gestational age ( 22-27, 28-31, 32-36, 37, 38, 39, 40, 41, 42+)

R1. Prevalence of selected congenital anomalies

The number of neural tube defects, oral clefts, and Down’s syndrome as a proportion of all live births, fetal deaths and induced abortions collected in the following categories:

Anencephaly and similar anomalies (ICD10-Q00) Spina bifida (ICD10-Q05) All congenital anomalies of the central nervous system (ICD10-Q00-Q07) Down's syndrome (ICD10-Q90) Cleft lip (ICD10-Q36) Cleft palate with cleft lip (ICD10-Q37) Cleft palate (without cleft lip) (ICD10-Q35)

Data are collected for three years.

R2. Distribution of APGAR score at 5 minutes

Distribution of APGAR score at 5 minutes (0-10) for live births

R3. Fetal and neonatal deaths due to congenital anomalies

The number of deaths in the fetal and neonatal period, subdivided into those attributed to congenital anomalies and those attributed to remaining causes.

R4. Prevalence of Cerebral Palsy

For this indicator, we use the SCPE (Surveillance of Cerebral Palsy in Europe) definition. Data on this indicator are collected and provided by the SCPE network.

R5. Maternal mortality ratio by cause of death 

Number of maternal deaths (during pregnancy or within 42 days following the end of pregnancy) per 100,000 live births by the following causes:

Cause of death ICD-10 codes
Ectopic pregnancy O00
Pregnancy with abortive outcome (excluding ectopic) O01 - O08
Hypertensive disorders O10 - O16
Haemorrhage O20 O44.1 O45 O46 O67 O72
Chorioamnionitis/sepsis O75.2 O75.3 O85 O86 O41.1
Other thromboembolic causes O22.2 O22.3 O22.5 O22.8 O22.9, O87.0 O87.1 O87.3 O87.8 O87.9 O88 (excl. O88.1)
Amniotic fluid embolism O88.1
Complications of anaesthesia O29 O74 O89
Uterine rupture O71.0, O71.2
Other direct causes All direct causes in O chapter that are not listed above
Indirect causes: diseases of the circulatory system O99.4
Indirect causes: other O98, O99.1-3, 5-9
unspecified obstetric cause/Unknown O95

R6. Incidence of severe maternal morbidity

Severe Maternal Morbidity: Severe acute morbidity resulting during pregnancy, delivery or the puerperium period (<42 days) as a proportion of all women delivering live or stillborn births:
Eclampsia (includes convulsion following specified or unspecified hypertensive disorders (that are not due to unknown epilepsy) during pregnancy, delivery or the puerperium. Corresponds to ICD-10 code O150)
Hysterectomy (surgical remove of the uterus (partial or total, body and/or cervix) for stopping the untreatable post partum haemorrhage) or embolisation (the process by which a blood vessel is obstructed by the lodgement of a material mass (or an embolus) to stop severe obstetric haemorrhage).
Blood transfusion (all acts or processes of transferring blood into the vein, including transfusion of red blood cells, platelets (thrombocytes) and fresh frozen plasma). Collected by units of blood (3 units or more, 5 units or more, other amount, no units specified) ICU >24 hours (admission during pregnancy, delivery or the puerperium to any facility or unit providing intensive or acute care or resuscitation-whether inside or outside of the maternity unit- for greater than 24 hours).

R7. Incidence of tears to the perineum

The number of women who had a first-, second-, third-, or fourth-degree tear of the perineum expressed as a proportion of all women who had a vaginal delivery. Presented for all vaginal deliveries and then for non-instrumental and instrumental separately.

Categories as follows (ICD10)
1st degree tear (ICD O70.0) involves the fourchette, perineal skin and vaginal membrane.
2nd degree tear (ICD O70.1) includes the skin and mucous membrane, and the fascia and muscles of the perineal body.
3rd degree tear (ICD O70.2) extends through skin, mucous membrane and perineal body and involves the muscle of the anal sphincter.
4th degree tear (ICD O70.3) extends through the rectal mucosa to expose the lumen of the rectum.

R8. Percentage of women who smoked during pregnancy

The number of women who smoke during the third trimester of pregnancy expressed as a proportion of all women delivering live or stillborn babies. When data are not available for the third trimester of pregnancy, data are requested for another time point during pregnancy.

R9. Distribution of mother’s educational level

The distribution of education level of women delivering live or stillborn babies, expressed as highest level of education of the mother. Data is collected using most detailed educational groupings in national systems and recoded by Euro-Peristat using the international standard classification of education (ISCED - UNESCO, 1997)
- Primary not complete or none
- Primary complete
- Lower secondary (up to 3 or 4 years)
- (Upper) secondary (up to 6 or 7 years)
- Post secondary non tertiary (6 months to 2 years)
- First stage of tertiary education (Bachelor)
- Second stage of tertiary education (Master, doctorate or more)
- Unknown

R10. Distribution of parents' occupational classification

The distribution of the mother’s and father’s occupation for mothers and fathers of live or stillborn babies using the International Standard Classification of Occupations (ISCO-08) major groups:
1-Managers
2-Professionals
3-Technicians and associate professionals
4-Clerical support workers
5-Service and sales workers
6-Skilled agricultural, forestry and fishery workers
7-Craft and related trades workers
8-Plant and machine operators, and assemblers
9-Elementary occupations
0-Armed forces occupations
99 – no profession
88 – student
If countries cannot use this classification, data are provided using local classifications used to report on occupation in your system.

R11. Distribution of mother’s country of birth

Distribution of the countries of birth of women delivering live or stillborn babies.These data will be presented by:
1. Geographic regions (as per UN World Regionsa and components with Europe further sub-divided into EU27b and non-EU27b)
2. Regions grouped by income level (as per World Bankc or UNDPd,
using regions defined by income distribution rather than solely gross national income)
a. United Nations
b. European Union
c. World Bank
d. United Nations Development Programme.

R12. Distribution of mothers’ prepregnancy body mass index (BMI)

Distribution of pre-pregnancy body mass index for women delivering live or stillborn babies before pregnancy or at the first antenatal visit. BMI is defined as the pre-pregnancy weight in kilograms divided by the square of the height in meters (kg/m2) and is classified as follows:

Underweight <18.50
Normal range 18.50-24.99
Overweight 25.00-29.99
Obese =30.00
- Obese class I 30.00-34.99
- Obese class II 35.00-39.99
- Obese class III =40.00

R12. Distribution of mothers’ pre-pregnancy body mass index (BMI)

Distribution of pre-pregnancy body mass index for women delivering live or stillborn babies before pregnancy or at the first antenatal visit. BMI is defined as the pre-pregnancy weight in kilograms divided by the square of the height in meters (kg/m2) and is classified as follows:

Underweight <18.50
Normal range 18.50-24.99
Overweight 25.00-29.99
Obese =30.00
- Obese class I 30.00-34.99
- Obese class II 35.00-39.99
- Obese class III =40.00

R13. Percentage of all pregnancies following treatment for subfertility

The number of women delivering live or stillborn babies after the following fertility treatments divided by the total number of women delivering live or stillborn babies.
Induction of Ovulation only
IntraUterine Insemination (IUI) with or without OI
InVitro Fertilisation (IVF), IntraCytoplasmatic Sperm Injection (ICSI), InVitro Maturation (IVM); including frozen embryo transfers
Unknown

R14. Distribution of timing of first antenatal visit

Definition: Distribution of timing of first antenatal visit regardless of provider by trimester of pregnancy for all women delivering live or stillborn babies. Trimesters are defined as follows (by completed weeks of gestation):
1st trimester = < 15 weeks
2nd trimester = 15 – 27 weeks
3rd trimester = 28 weeks or more

R15. Distribution of births by mode of onset of labour

Definition: The number of deliveries associated with each of the following modes of labour onset, as a proportion of deliveries resulting in a live or stillbirth:
- Spontaneous onset
- Caesarean section prior to the onset of labour
- Labour induction (initiation of uterine contractions) by medical or surgical means prior to the onset of labour.
For all births and by gestational age, using the following groups:
22-27, 28-31, 32-36, 37, 38, 39, 40, 41, 42+

R16. Distribution of place of birth by volume of deliveries

Number of births occurring at home or in maternity units defined by the number of annual births, with the following groups: home, <300, 300-499, 500-999, 1000-1499, 1500-1999, 2000-2999, 3000-3999, 4000-4999, 5000+)

R17. Percentage of very preterm babies delivered in units without a neonatal intensive care unit (NICU)

The percentage of preterm live and stillbirths less than 32 completed weeks of gestation that are born in a maternity unit without an on-site neonatal intensive care unit. The place of birth of very preterm birth should be presented by level of neonatal intensive care unit using local official or, if no official definitions exist, unofficial definitions with the units without a NICU highlighted.

R18. Episiotomy rate

The number of women who had an episiotomy expressed as a proportion of all women who had a vaginal delivery. Presented for all vaginal deliveries and then for non-instrumental and instrumental separately.

R19. Births without obstetric intervention

Number of deliveries without selected obstetric interventions as a proportion of all deliveries resulting in a live birth or stillbirth
Births without obstetric intervention are defined as births to women whose labour starts spontaneously, progresses spontaneously without drugs, and who give birth spontaneously; To compute this indicators, we collect information on women who experience any one or more of the following:
- induction of labour (with prostaglandins, oxytocic’s or ARM),
- epidural or spinal or general anaesthetic,
- forceps or ventouse,
- caesarean section
- episiotomy

R20. Percentage of infants breast fed at birth

The number of babies who are partially breastfed (infant receives breast milk and the infant is allowed any food or liquid including non-human milk) and the number who are exclusively breastfed (infant receives breast milk and is allowed to receive drops and syrups) throughout the first 48 hrs of age as a proportion of all newborn babies. (Definitions from WHO Indicators for Assessing Breastfeeding Practices. Report from meeting 11-12 June 1991. Geneva, 1991.)

F1**. Severe neonatal morbidity among babies at high risk

definition to be developed

F2**. Prevalence of neonatal encephalopathy

definition to be developed

F3**. Causes of fetal and neonatal death other than CA

Definition to be developed

F4**. Neonatal screening policies

definition to be developed

F5**. Content of antenatal care

definition to be developed

 

Contact us

For more information about our project, please contact:

Project Leader

Jennifer Zeitlin / jennifer.zetilin[at]inserm.fr

Inserm UMR 1153
Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé)
Center for Epidemiology and Statistics Sorbonne Paris Cité
DHU Risks in pregnancy
Paris Descartes University

Project Manager

Melanie Durox / melanie.durox[at]inserm.fr

Inserm UMR 1153
Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé)
Center for Epidemiology and Statistics Sorbonne Paris Cité
DHU Risks in pregnancy
Paris Descartes University

For country-specific information please contact your country's team 

 

Our Mission

The EURO-PERISTAT project’s goal has been to develop valid and reliable indicators that can be used for monitoring and evaluating perinatal health in the EU. The project began in 1999 as part of the Health Monitoring Programme and has continued into a third phase, with the ultimate aim of producing a European Perinatal Health Report and establishing a sustainable system for reporting perinatal health indicators.

Our Experts

EURO-PERISTAT collaborators meeting in WarsawThe EURO-PERISTAT Action project has enlisted the assistance of perinatal health professionals (clinicians, epidemiologists, and statisticians) from EU member states and Norway and has consulted with members of other networks including SCPE to help develop and test a recommended indicator list. Using a multi-stage formal method called DELPHI, we were able to achieve consensus on a list of 10 core and 24 recommended indicators of perinatal health. Learn more about our contributing experts here.

In addition to the time contributed by our experts and their institutions, EURO-PERISTAT has received generous support from the European Commission Directorate General for Health and Consumers (DG-SANCO), and is currently funded by the European Commission Executive Agency for Health & Consumers (EAHC).

EURO-PERISTAT is coordinated in Paris through a partnership between Assistance Publique Hôpitaux de Paris (AP-HP) and the Institut national de la santé et de la recherche médicale (INSERM). Scientific work is led by a Steering Committee who meet regularly and work with representatives from each member state on the Scientific Committee.

Our Indicators

The EURO-PERISTAT indicators are grouped into four themes: fetal, neonatal, and child health, maternal health, population characteristics and risk factors, and health services. We defined core indicators – those that are essential to monitoring perinatal health – and recommended indicators – those considered desirable for a more complete picture of perinatal health across the member states. We also identified indicators for further development – those that represent important aspects of perinatal health but require further work before they can be implemented within the member states. You can learn more about our indicator development or download our full list of indicators here.

A study using data for the year 2000 was conducted to assess the feasibility of the EURO-PERISTAT indicators; the results were published in a special issue of the European Journal of Obstetrics & Gynecology and Reproductive Biology and used for detailed analyses of health indicators in Europe. These articles can be downloaded here for no charge.

Our Publications

In addition to the articles published in the special issue of the European Journal of Obstetrics & Gynecology and Reproductive Biology, we recently released the European Perinatal Health Report. This 280-page publication is the most comprehensive report on fetal, infant and maternal health in Europe to date. The report can be downloaded here for no charge.

Why Monitor Perinatal Health in Europe?

Aldo RisolvoPromoting healthy pregnancy and safe childbirth is a goal of all European health care systems. Despite significant improvements in recent decades, mothers and their babies are still at risk during the perinatal period, which covers pregnancy, delivery, and the postpartum. Babies born too early are more likely to die than those born at term. They are also more likely to have neurological and developmental disorders that carry long-term consequences for their quality of life, their families, and for health and social services. The same is true for babies born with severe congenital anomalies. Many of them have important medical, social, and educational needs. Stillbirths have not decreased to the same extent as neonatal deaths, and their causes remain largely unknown. Maternal deaths are rare but tragic events, particularly because a significant proportion of these deaths are associated with substandard care.

In recent years research has also found connections between perinatal health and chronic diseases of adulthood. Babies born too small as a consequence of fetal growth restriction are more likely than others to develop diabetes and metabolic syndrome as adults. Other implications for adult health of adverse events during pregnancy are currently being explored. These relations make the monitoring of perinatal health outcomes more important than ever.

Reporting on EURO-PERISTAT Indicators of Perinatal Health

To improve outcomes, we need the right tools to assess perinatal health problems and their causes. We also need to monitor the impact of policy initiatives over time. As a first step towards providing Europe with such a tool, EURO-PERISTAT has released several European Perinatal Health Report. These reports bring together statistical information on the characteristics, health, and health care of pregnant women and their newborn babies in countries participating in our network.

Building a Sustainable Network for Perinatal Health Monitoring

To improve perinatal health, we need the right tools to assess problems and their causes. We also need to monitor the impact of policy initiatives over time. The European Perinatal Health Report is a first step towards providing Europe with such a tool, as are our many publications on our perinatal health indicators.

Data to construct the Euro-Peristat core indicators are available in almost all countries, but there are still many gaps. Many countries need to improve the range and quality of the data they collect. Many countries have little or no data on maternal morbidity, care during pregnancy, and the associations between social factors and health outcomes.

To build up a picture of changes over time, reports need to be repeated. Euro-Peristat aims to develop sustainable perinatal health reporting. The full value of having common and comparable indicators in Europe will be realised when this exercise becomes continuous and assessment of progress is possible.

INDICATOR DEVELOPMENT

To develop and test a list of perinatal health indicators, EURO-PERISTAT enlisted the assistance of perinatal health professionals (clinicians, epidemiologists, and statisticians) from EU member states and Norway, and consulted with other networks like SCPE, Eurocat, and Euroneonet.

This indicator set was developed by a procedure that began with an extensive review of existing perinatal health indicators. The resulting list was used as the basis of a DELPHI consensus process, a formalised method in which a panel of experts responds to a successive series of questionnaires with the aim of achieving a consensus on key principles or proposals. Our first panel in 2002 was composed of clinicians, epidemiologists, and statisticians from the then 15 member states. We also invited the Surveillance of Cerebral Palsy in Europe (SCPE) Network to assist with the indicator on cerebral palsy. A second DELPHI process was also conducted in 2002, with a panel of midwives to ensure that their perspectives on perinatal health were represented. Finally, a third DELPHI process was conducted in 2006 with a panel of 2 participants (clinicians, epidemiologists, and statisticians) from each of the ten new member states. A study using data for the year 2000 was conducted to assess the feasibility of the EURO-PERISTAT indicators; the results were published in a special issue of the European Journal of  Obstetrics & Gynecology and Reproductive Biology 2003 and used for detailed analyses of health indicators in Europe. These articles can be downloaded here.

In 2012, the EURO-PERISTAT indicators were updated based on our experiences with the European Perinatal Health Report and the assessments of our Scientific Committee (SC) about the continued relevance of the indicators. The SC reviewed each indicator and commented on its utility and its definition. SC members could also propose new indicators. This process led to several modifications of our list. A new indicator, “R12. Distribution of mothers’ pre-pregnancy body mass index (BMI)” was added, to reflect concerns with the rise of obesity among women in Europe. Two indicators for further development were removed from the list (fecal incontinence and postpartum depression) because the group considered that data from routine systems were not sufficient for producing these indicators routinely.

For other indicators, definitions were refined or expanded.

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