Organization of Perinatal Care in Czech Republic

  • 371 views
Uploaded on

International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)

International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
371
On Slideshare
0
From Embeds
0
Number of Embeds
1

Actions

Shares
Downloads
0
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Organization of Perinatal Care in Czech Republic Zbynek Stranak, Petr VelebilInstitute for the Care of Mother and Child, Prague 3rd Medical Faculty, Charles University, Prague Czech Republic
  • 2. Perinatal mortality (per 1000 births)10 9 8 7 Czech Republic 6 France Germany Ireland 5 Netherlands Norway 4 Sweden United Kingdom 3 2 1 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Source: WHO Euro
  • 3. Early neonatal mortality per 1000 live births 6 5 4 Czech Republic France Germany Ireland 3 Netherlands Norway Sweden United Kingdom 2 1 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Source: WHO Euro
  • 4. Infant mortality per 1000 live births765 Czech Republic France4 Germany Ireland Netherlands3 Norway Sweden United Kingdom210 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Source: WHO Euro
  • 5. System of perinatal care in the Czech Republic Perinatal services are provided by obstetricians and gynaecologists and midwives together with neonatologists Approximately 1000 OB/GYN offices 96 hospital facilities 12 Regional Perinatal Centres Perinatal Centres of Intermediary Care High coverage (98 % receiving prenatal care) Early registration (80 % in Ist trimester) Extensive number of visits (96 % 6 visits and more) Hospital deliveries (99.8 % of all births) Frequency of LBW 8-8.5 %
  • 6. Newborn Care in Institute for the Care of Mother and Child LEVEL III LEVEL II LEVEL I Level III: 20 beds Level II: 30 beds Level I: 70 beds
  • 7. Data sources Facility-based aggregated perinatal data  From all 96 obstetrical units in the CR  Provided on annual basis during January for the previous year  Analyzed by the Czech Society of Perinatal Medicine Individual perinatal data  On all births and newborns in the CR (since 1991)  Separately on mothers and newborns with possibility to link  Analyzed centrally by the Czech Institute for Health Statistics and Information
  • 8. Czech Republic - Practical measures prevention of preterm deliveries prenatal diagnosis with early detection of nonviable malformations followed by termination of pregnancy, if desired transport in utero to Perinatal Centers pre- and intranatal clinical management to achieve the optimal start of extrauterine life improved organization and quality of neonatal care and some changes of indications for cesarean section
  • 9. Network of perinatal centers Before 1995 – a „natural“ network of „perinatal“ centers In 1995 official establishment of 12 Regional Perinatal Centers In 1998 official establishement of 17 Intermediary Perinatal Centers In 2002 reduction of number of intermediary centers (only five are included in the National Perinatology Program)
  • 10. Goals of the Czech Society of Perinatal Medicine• Evaluation of health status of • pregnant women • mothers • newborns• Risk identification • health, social, economical • priorities• Design of solutions – strategy • in perinatal care (medical, organisation) • other sectors (social, economic, legislation)
  • 11. Perinatal data forms
  • 12. Perinatal data forms Perinatologická sekce
  • 13. Age of pregnant women in the Czech Republic6000050000 30-3440000 25-293000020000 20-2410000 35 + 15-19 0 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08
  • 14. Proportion of multiple deliveries during 1995-2009 2 ,1 2 1 ,9 1 ,8 1 ,7% 1 ,6 1 ,5 1 ,4 1 ,3 1 ,2 1 ,1 1 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
  • 15. Specific ENMR of newborns in regional PCs in the Czech Republic in 2009 Early Neonatal Mortality 500-749 750-999 1000-1499 1500-1999Inborn 124.2 21.5 18.4 5.2Outborn 178.6 48.8 28.6 6.9Not centralized 526.3 97.6 36.1 1.4 Total 168.6 31.3 21.6 3.7
  • 16. Specific ENMR of newborns in regional PCs in the Czech Republic in 2009 Early Neonatal Mortality 500-749 750-999 1000-1499 1500-1999Inborn 124.2 21.5 18.4 5.2Outborn 178.6 48.8 28.6 6.9Not centralized 526.3 97.6 36.1 1.4 Total 168.6 31.3 21.6 3.7
  • 17. Inborns (born in a centre) Czech Republic 2009 Live born babies Perinatal 500-749 g 750-999 g 1000-1499 1500-1999 Centre n % n % n % n % Intensive 153 88.9 279 87.2 762 82.1 1155 61.4 Intermediary 5 2.9 12 3.8 80 8.6 445 23.6Not centralized 14 8.2 29 9.0 86 9.3 282 15.0 Total 167 100.0 316 100.0 856 100.0 1907 100.0
  • 18. Inborns (born in a centre) Czech Republic 2009 Live born babies Perinatal 500-749 g 750-999 g 1000-1499 1500-1999 Centre n % n % n % n % Intensive 153 88.9 279 87.2 762 82.1 1155 61.4 Intermediary 5 2.9 12 3.8 80 8.6 445 23.6Not centralized 14 8.2 29 9.0 86 9.3 282 15.0 Total 167 100.0 316 100.0 856 100.0 1907 100.0
  • 19. Proportion of multiple birthsof all newborns novorozenců and their contribution to perinatal deaths CR 2004 - 2009 (all newborns from 500 grams) Multiples Multiples Proportion of newborns Proportion of perinatal deaths 15 15 10 10 5 5 0 0 2004 2005 2006 2007 2008 2009 2004 2005 2006 2007 2008 2009 Proportion of newborns = 4.05 % Proportion of perinatal deaths = 8.0 % Velebil 2010
  • 20. Perinatal mortality among singleton and multiple births Czech Republic 2004 - 2009 (all babies from 500 grams) Singletons Multiples20 2015 1510 10 5 5 0 0 2004 2005 2006 2007 2008 2009 2004 2005 2006 2007 2008 2009 ENMR = 0.7 ENMR ENMR = 4.2 SBR = 4.3 SBR SBR = 6.2 Velebil 2010
  • 21. Low birthweight among singleton and multiple births Czech Republic 2004 - 2009 (all babies from 500 grams) Singletons Multiples90 9060 6030 30 0 0 2004 2005 2006 2007 2008 2009 2004 2005 2006 2007 2008 2009 LBW = 5.7 % LBW = 61.5 % Velebil 2010
  • 22. Caesarean sections among singleton and multiple births Czech Republic 2004 - 2009 (all babies from 500 grams) Singletons Multiples90 9060 6030 30 0 0 2004 2005 2006 2007 2008 2009 2004 2005 2006 2007 2008 2009 SC = 21.0 % SC = 78.0 % Velebil 2010
  • 23. Caesarean sections CR 2002-2008 100% 90% 80% Planned in pregnancy 70%% 60% Planned in labour 50% 40% Emergency in pregnancy 30% 20% Emergency in labour 10% 0% 2002 2003 2004 2005 2006 2007 2008
  • 24. Frequency of using VEX and forceps1510 5 0 Czech France Germany Ireland Netherlands Norway Sweden UK: England Republic European Perinatal Health Report, 2008
  • 25. Perinatal Centre - Selected Characteristics Structure Prenatal Outpatient Department  4 outpatient offices Prenatal Diagnosis Department  3 examining offices  Invasive diagnostic room  Genetists office High-Risk Pregnancy Department  2 intensive care rooms + 7 (20 beds) Labour and Delivery Department  Admittion  Preparatory  8 delivery rooms  Emergency CS OR Post-partum Department  3 wards (67 beds) Neonatology Department Complement (including ICU)
  • 26. Perinatal Centre - Selected Characteristics Performance Prenatal Outpatient Department  21,869 outpatient prenatal care visits (7,485 pregnant patients) Prenatal Diagnosis Department  16,693 ultrasound exams  326 AMC, 29 CVS, 3 cordocenteses,  11 other procedures (IUT, AI, reductions)  1,897 genetic consultations High-Risk Pregnancy Department  2,223 hospitalizations Labour and Delivery Department  5,071 deliveries (5,238 newborns)  1,707 caesarean sections  43 forceps deliveries  1 post-partum hysterectomy  No maternal death
  • 27. Perinatal Mortality (‰) – CR and our PC 8 PM of all CR 6 4 PM of our PC 2 0 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 19 19 19 19 19 19 20 20 20 20 20 20 20 20 20 20
  • 28. Proportion of LBW, VLBW, and ELBW and Perinatal Mortality PC of the Institute Czech RepublicNewborns< 2500 grams 10.0 % 7.9 %< 1500 grams 2.6 % 1.4 %< 1000 grams 1.0 % 0.6 % twins 6.3 % 4.0 %Perinatal mortalitySingletons 3.82 ‰ 4.99 ‰Multiples 6.17 ‰ 10.36 ‰Total 3.97 ‰ 5.21 ‰
  • 29. Perinatal Centre - Selected Characteristics Current Activities• Important role in the network od perinatal centers• Site of analysis of perinatal data from all obstetrical units in the Czech Republic• Close collaboration with WHO (since 1988 repeatedly CC) and other international institutions• Important educational place for pre and postgraduate training
  • 30. Newborn CareInstitute for the Care of Mother and Child Level III: 20 beds Level II: 30 beds Level I: 70 beds
  • 31. Hospital-Based Newborn Services Basic neonatal care (level I)  Well-newborn nursery, evaluation and postnatal care of healthy newborns Specialty neonatal care (level II)  Special care nursery Specialty neonatal intensive care (level III)  No restrictions on type or duration of mechanical ventilation  Major surgery performed on site (except surgical repair of serious congenital heart anomalies that require cardiopulmonary bypass)
  • 32. Early Cleft Recovery Programme 1st Day 2nd Day - Surgery6th Day -Discharge 3 Months Later
  • 33. Neonatal Department Health Care Activity Genetics Perinatal Fetal Medicine Medicine Surgery Pediatric Follow up
  • 34. Neonatal Department Educational ActivityPregraduate Training - Medical Faculty Postgraduate Training Continuing Medical Education Theoretical background Practice, Skills
  • 35. Neonatal Department Research ActivityBasic Research: FDA, NIH RCT: International Collaboration (CURPAP trial, Motavizumab trial) Grants: IGA MH CZ, EU Grant (HIP Trial)
  • 36. Perinatal Centre - Selected Characteristics Planned Activities• Perinatal data related activities • National (aggregated and individual databases) • Europeristat (data collection and analysis) • Participation on the EPICE project (Effective Perinatal Intensive Care in Europe for very preterm babies)• WHO collaboration• Establishment of Fetal Medicine Centre• Establishment of Simulation Training Centre for OB/GYN
  • 37. Thank you for your attention