THE MAIN TOOLS OF THE CONFIDENTIAL AUDIT OF PERINATAL MORTALITY: A REVIEW

Abstract

Introduction. Perinatal mortality audits and reviews are conducted to identify preventable factors in mortality, identify weaknesses in health services, and make recommendations to improve the quality of neonatal care. This study aimed to assess the effectiveness of confidential audit of perinatal mortality through a content analysis of the use of different confidential audit tools in various countries. Research Strategy. Data were searched in medical databases such as Scopus, Cohrane Library, PubMed, and Embase. 50 relevant articles on the topic were selected, in addition, data from WHO and UNICEF manuals and reports. Results. The main methods of confidential audit are verbal and social autopsy, analysis and expert evaluation of medical history and clinical cases, classification of suboptimal help, and a combination of these methods. Identification of modifiable factors is widely and effectively used in many countries. The involvement of bereaved parents in the audit process has benefits and value for parents and healthcare providers, and it has gradually been introduced into the audit process in some countries. In the Netherlands, a decrease in perinatal mortality from 2.3 to 2.0/1000 births (p<0.00001) was observed during the audit between 2010 and 2012 [15]. A meta-analysis of 7 studies also found that perinatal mortality decreased by an average of 30% (95% confidence interval, 21 to 38%) in low- and middle-income countries following perinatal audits [42]. In Uganda, the perinatal mortality rate was 47.9 deaths per 1000 births in 2008 after the introduction of the audit, compared to 52.8 per 1000 births in 2007 [37]. Conclusions. Based on the review, it can be concluded that the main tools of confidential audit, such as identification of suboptimal care, modifiable factors, and expert assessment, are used quite effectively in different countries. According to the meta-analysis and systematic review, perinatal mortality is reduced by audits in both developed and developing countries. Perinatal mortality reviews should be continued to better understand the effectiveness of audit.