British Journal of Obstetrics and Gynaecology December 1992, Vol. 99, pp. 955-958
OBSTETRICS
A comparison of perinatal outcome, antenatal and intraparturn care between England and Wales, and France L. M A S C A R E N H A S Registrar B. W. E L I O T Consultant Northampton General Hospital Northampton NN1 SBD, UK I. Z . M A C K E N Z I E Clinical Reader Nuffield Department of Obstetrics and Gynaecology John Radcliffe Maternity Hospital Oxford OX3 9DU, UK
ABSTRACT Objective To compare the national statistics of England and Wales with the national statistics of France, and see if there are significant differences in obstetric care resulting in a significantly different perinatal outcome. Design Retrospective analysis of national statistics 1970-1989 (latest available figures) relating to perinatal outcome, antenatal and intrapartum care. Setting HIPE and DOH statistics (England and Wales); INSERM statistics (France). Subjects Pregnant women residents of England and Wales, and of France. Interventions Different aspects of obstetric care for which comparable data were available from national statistics. Main outcome measures Perinatal mortality rate, incidence of low birth weight and preterm delivery; type of antenatal care, number of antenatal visits and inpatient admission rate; induction of labour rate, incidence of acceleration of labour with oxytocin, incidence of spontaneous and operative deliveries and person undertaking delivery; episiotomy rate and postnatal in-patient stay. Results More antenatal intervention and marginally less intrapartum intervention in England and Wales as compared with France. No significant difference in the perinatal mortality rate, in the incidence of low birth weight or preterm delivery, with similar trends being observed over the two decades. Conclusion Significant differences in obstetric practices between the two countries without a major difference in perinatal outcome.
Obstetricians agree about the need for providing effective care during pregnancy and childbirth. However, there are wide variations in obstetric practice at regional and national levels as well as over a period of time. Highlighting these differences constitutes a screening test for methods of care requiring evaluation (Enkin et al. 1989). A comparison of obstetric practice of England and Wales with that of France has several advantages. Both countries possess reliable national statistics and use the same definitions of obstetric outcome (perinatal mortality rate, low birth weight, preterm delivery). The population, number of births per annum and life expectancy for women are similar (OMS 1988), (Table 1) and, the training of obstetricians and midwives is similar. It is therefore of immense interest to highlight differences in obstetric care between these populations of similar demographic characteristics and see if they result in a different perinatal outcome. There are, however, a few limits to this comparison. National statistics are limited by the scarcity of detail about the various procedures and by the different measures of outcome. Obstetric care in England and Wales is mainly confined to the public sector whereas the private sector in France
represents 47% of the total number of maternity beds (DOH 1990; Ministere de la Sante 1989) (Table 2). Finally, patients are referred via general practitioners to specialists in England and Wales, whereas patients are self referred in France (Blonde1 & Schmidt 1984).
Methods The data are derived from National Statistics, when available, or from surveys on national samples in both countries. For England and Wales, these are mainly HIPE Maternity Statistics (1970-198s) and DOH statistics (after 1985); for France, these are statistics produced by INSERM (French Institute for Health and Medical Research) (1972-1989). The latest available figures have been used. HIPE statistics are based on a one in ten sample of inpatient records for NHS hospitals. INSERM statistics are based on birth records of all births in ten French regions during 2 separate weeks in 1 year (autumn and spring). In both cases validation checks are performed on the data so that any anomalies present can only represent a tiny part of the material included.
955
956
L. M A S C A R E N H A S ET AL
25 20 15 10
5 0 Year
Fig. 1. Perinatal mortality rate.
Year
England and Wales;
France.
Fig. 2. Low birth weight (
OBSTETRICS
A comparison of perinatal outcome, antenatal and intraparturn care between England and Wales, and France L. M A S C A R E N H A S Registrar B. W. E L I O T Consultant Northampton General Hospital Northampton NN1 SBD, UK I. Z . M A C K E N Z I E Clinical Reader Nuffield Department of Obstetrics and Gynaecology John Radcliffe Maternity Hospital Oxford OX3 9DU, UK
ABSTRACT Objective To compare the national statistics of England and Wales with the national statistics of France, and see if there are significant differences in obstetric care resulting in a significantly different perinatal outcome. Design Retrospective analysis of national statistics 1970-1989 (latest available figures) relating to perinatal outcome, antenatal and intrapartum care. Setting HIPE and DOH statistics (England and Wales); INSERM statistics (France). Subjects Pregnant women residents of England and Wales, and of France. Interventions Different aspects of obstetric care for which comparable data were available from national statistics. Main outcome measures Perinatal mortality rate, incidence of low birth weight and preterm delivery; type of antenatal care, number of antenatal visits and inpatient admission rate; induction of labour rate, incidence of acceleration of labour with oxytocin, incidence of spontaneous and operative deliveries and person undertaking delivery; episiotomy rate and postnatal in-patient stay. Results More antenatal intervention and marginally less intrapartum intervention in England and Wales as compared with France. No significant difference in the perinatal mortality rate, in the incidence of low birth weight or preterm delivery, with similar trends being observed over the two decades. Conclusion Significant differences in obstetric practices between the two countries without a major difference in perinatal outcome.
Obstetricians agree about the need for providing effective care during pregnancy and childbirth. However, there are wide variations in obstetric practice at regional and national levels as well as over a period of time. Highlighting these differences constitutes a screening test for methods of care requiring evaluation (Enkin et al. 1989). A comparison of obstetric practice of England and Wales with that of France has several advantages. Both countries possess reliable national statistics and use the same definitions of obstetric outcome (perinatal mortality rate, low birth weight, preterm delivery). The population, number of births per annum and life expectancy for women are similar (OMS 1988), (Table 1) and, the training of obstetricians and midwives is similar. It is therefore of immense interest to highlight differences in obstetric care between these populations of similar demographic characteristics and see if they result in a different perinatal outcome. There are, however, a few limits to this comparison. National statistics are limited by the scarcity of detail about the various procedures and by the different measures of outcome. Obstetric care in England and Wales is mainly confined to the public sector whereas the private sector in France
represents 47% of the total number of maternity beds (DOH 1990; Ministere de la Sante 1989) (Table 2). Finally, patients are referred via general practitioners to specialists in England and Wales, whereas patients are self referred in France (Blonde1 & Schmidt 1984).
Methods The data are derived from National Statistics, when available, or from surveys on national samples in both countries. For England and Wales, these are mainly HIPE Maternity Statistics (1970-198s) and DOH statistics (after 1985); for France, these are statistics produced by INSERM (French Institute for Health and Medical Research) (1972-1989). The latest available figures have been used. HIPE statistics are based on a one in ten sample of inpatient records for NHS hospitals. INSERM statistics are based on birth records of all births in ten French regions during 2 separate weeks in 1 year (autumn and spring). In both cases validation checks are performed on the data so that any anomalies present can only represent a tiny part of the material included.
955
956
L. M A S C A R E N H A S ET AL
25 20 15 10
5 0 Year
Fig. 1. Perinatal mortality rate.
Year
England and Wales;
France.
Fig. 2. Low birth weight (
