Background: The purpose of this analysis was to find whether the quality indicators of perinatal care in Slovenia change. Methods: We used the same quality indicators which are used in the European ...project Europeristat1 to compare the quality of perinatal care among the countries of the European Union. We used two 5-year periods, from 1998 to 2002 (reference period) and from 2003 to 2008 (observed period). Data for perinatal quality were collected from the National Perinatal Information System of the Republic of Slovenia.2 Statistical significance was tested using the Pearson’s chi-square test. Results: Between 1998 and 2002, there were 87.679 labours ending in the delivery of 88.678 new- borns, and between 2003 and 2008, there were 90.662 labours ending in the delivery of 91.736 babies. In the observed period (2003 do 2008) mothers had statistically significantly higher educational level, a higher percentage came to their first pregnancy examination before the 12th week of gestation (84.0 % vs. 75.3 %), a higher percentage conceived after assisted reproductive techniques (2.0 % vs. 1.7 %), and the incidence of multiple pregnancies was higher (1.7 % vs. 1.6 %). Significantly lower were the percentages of labours without medical interventions (34.7 % vs. 41.9 %) and of spontaneous onset of labour (74.0 % vs. 92.6 %). The percentages of induced labours and of elective cesarean sections increased dramatically (20.1 % vs. 6.6 % and 6.0 % vs. 0.9 %). The increase in the overall percentage of cesarean sections (14.8 % vs. 11.0 %) is mainly due to increased incidence of elective cesarean sections, but the percentage of operative termination of vaginal labour increased as well (3.1 % vs. 2.6 %). The incidence of episiotomies was lower (48.7 % vs. 51.0 %) and so was the incidence of 2nd degree perineal lacerations (4.5 % vs. 5.4 %), while the incidence of 3rd–4th degree lacerations was higher (0.3 % vs. 0.2 %). Transfusion was required in a lower percentage (0.3 % vs. 1.0 %), but the percentage of hysterectomies increased (0.1 % vs. 0.03 %). The incidence of eclampsia was the same in the two time periods (0.1 %). Among preterm deliveries, the higher percentage occurred between 32 and 36 gestational weeks (5.9 % vs. 5.5 %), while there were no differences among the deliveries between the 22nd and 31st gestational week. Stillbirths after the 22nd gestational week was the same in both periods, 5 per 1000 of all newborns, whereas early (2 per 1000 vs. 3 per 1000) and late (0.04 per 1000 vs. 0.4 per 1000) neonatal mortality rates were lower. In both time periods lethal malformations were the cause of death in 1/3 of stillborn babies 1/3 of neonates. Conclusions: Over the last years, an increase in operative deliveries and a decrease in deliveries without medical interventions have been observed in Slovenia. Despite the fact that mothers come to their first prenatal examination earlier in pregnancy than before and that they are more educated, i.e. they have a better socio-economic status, the incidence of preterm deliveries increases, while the mother’s health and the incidence of stillbirths have not changed sig- nificantly. The decrease in neonatal mortality rate should be highlighted.
Bacground: The quality of work has been increasingly given more emphasis in all areas of life, the health care being no exception. Without appropriate measures or indicators of health care outcomes, ...a health care system cannot be improved. The results of quality of work are of utmost importance as they serve as the basis for various comparisons, e.g.among units, department, individual doctors. The aim of this analysis was to establish the results of work in tertiary and secondary centres, and with individual doctors, and compare them in order to approve the good ones and to find those that need be improved. Methods: The analysis involved 32 parameters concerning the results of work, the same parameters as used elsewhere in Europe, with all deliveries and newborns in Slovenia in the time period 2003–2007. We established the differences in the work of tertiary and secondary centres and used them in various comparisons. Results: We found no significant differences among the Slovene maternity hospitals in the incidence of eclampsia during labour, hysterectomy and in the incidence of lethal malformations among early neonatal deaths. We did find numerous significant differences in the manage- ment of labour, termination of labour and in the newborn's condition after birth. Conclusions: Slovenian perinatal information system is unique in Europe for as long as 22 years it has enabled a steady gathering of a large number of perinatal data for every woman who has given birth in Slovenia. Annual analyses that are done on the basis of the collected data for selected quality indicators within the project »Quality of Health Care in Slovenia« make it possible for every maternity hospital in Slovenia or every obstetrician to get an insight into the quality of their work and to compare it with the work of other maternity departments and individual doctors. The system gives the professional bodies and individual doctors an opportunity to improve the results of their professional work which deviate negatively from Slovenian standards.
