Euro-Peristat

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.

In our first phase, we developed a set of indicators with members from the then 15 member states.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 respond 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.

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. A study using data for the year 2000 was conducted to assess the feasibility of the EUROPERISTAT 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.

EURO-PERISTAT INDICATORS OF PERINATAL HEALTH

(C=core, R=recommended, R**= recommended for further development)

FETAL, NEONATAL, AND CHILD HEALTH                                              

C: Fetal mortality rate by gestational age, birth weight, plurality

C: Neonatal mortality rate by gestational age, birth weight, plurality

C: Infant mortality rate by gestational age, birth weight, plurality

C: Birth weight distribution by vital status, gestational age, plurality

C: Gestational age distribution by vital status, plurality

R: Prevalence of selected congenital anomalies

R: Distribution of Apgar score at 5 minutes

R: Causes of perinatal deaths due to congenital anomalies

R: Prevalence of cerebral palsy

R**: Prevalence of hypoxic-ischemic encephalopathy

R**: Prevalence of late induced abortions

R**: Severe neonatal morbidity among babies at high risk

MATERNAL HEALTH

C: Maternal mortality ratio by age, mode of delivery

R: Maternal mortality ratio by cause of death

R: Prevalence of severe maternal morbidity

R**: Prevalence of trauma to the perineum

R**: Prevalence of faecal incontinence

R**: Postpartum depression

POPULATION CHARACTERISTICS/RISK FACTORS

C: Multiple birth rate by number of fetuses

C: Distribution of maternal age

C: Distribution of parity

R: Percentage of women who smoke during pregnancy

R: Distribution of mother’s education

R**: Distribution of mother’s country of origin

HEALTH CARE SERVICES

C: Mode of delivery by parity, plurality, presentation, previous caesarean section

R: Percentage of all pregnancies following fertility treatment

R: Distribution of timing of first antenatal visit

R: Distribution of births by mode of onset of labour

R: Distribution of place of birth (according to number of annual deliveries in the maternity unit)

R: Percentage of infants breast fed at birth

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

R**: Positive outcomes of pregnancy (births without medical intervention)

R**: Neonatal screening policies

R**: Content of antenatal care