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NOSS – NOSS –

more than surveillancemore than surveillance

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To develop a Nordic Obstetric Surveillance System to describe the epidemiology of a variety of serious complications at delivery.

Objective:

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Why collect data on rare serious obstetric complications?

• Hypothesis raised that there is an increase in rare serious obstetric complications due to the increasing rate of caeserean section worldwide.

• The low incidence imply that risk factors, treatment modalities and consequences are not well described.

•The rare serious complications can be considered “near-miss events” for maternal death.

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Inspiration from UKOSS

• Acute fatty liver• Amniotic fluid embolism• Antenatal pulmonary embolism• Eclampsia• Peripartum hysterectomy• TB• Uterine rupture

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What do we want to know?

•The incidence in the Nordic countries?

•The characteristics of the women?

•The impact of mode of delivery and previous caesarean section?

•Treatment modalities?

•The associated maternal and perinatal mortality and morbidity?

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Why not use the Nordic Medical Birth registries?

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0

20.000

40.000

60.000

80.000

100.000

120.000

140.000

1975 1980 1985 1990 1995 2000 2005 2010

Denmark

Finland

Iceland

Norway

Sweden

Live born 1975-2008

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0,0

0,5

1,0

1,5

2,0

2,5

3,0

1975 1980 1985 1990 1995 2000 2005 2010

Denmark

Finland

Iceland

Norway

Sweden

Total fertility rate 1975-2008

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0

5

10

15

20

25

1975 1980 1985 1990 1995 2000 2005 2010

Denmark

Finland

Iceland

Norway

Sweden

Caesarean section 1975-2008

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The Nordic Medical Birth registries

• Appropriate when complications are frequent and well defined – and with record linkage they also offer fantastic opportunities for longitudinal studies.

• Less useful when complications are rare, less well defined and especially when codes are lacking.

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Collaboration:

• NOSS Team: Birth registers – Obstetricians

• Nordic countries

• Midwives and obstetricians participate

• UKOSS Team: Marian Knight and Peter Brocklehurst

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Rare serious obstetric complications:

• Uterine rupture - Complete - Incomplete

• Placenta accreta/percretaVaginal deliveries with incomplete or difficult removal of placenta and blood transfusion within 48 hours OR caesarean section where placenta was difficult to remove and was considered accrete or percrete

• Postpartum Hysterectomy (within 7 days after delivery)

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• Workshops - Hven, September 2008 - Skanör, Sweden, March 2009

• Webpage (www.noss.nu)

• Data collection forms (paper based and electronic)

• Nordic pilot study started 1. April 2009

Preparation:

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Continued preparation:

• Workshop Bergen April 2010

• Inclusion of ”Postpartum Haemorrhage” – Blood transfusion ≥ 6 units (DK Transfusion Database)

• Start of the official study 1. September 2010

• Controls from the Nordic Birth Registers using routine data and – when specific questions arise that cannot be solved by register data – by ”control questionnaires”

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Status – Nordic countries:

• All obstetric departments in four of five countries already participate and report prospectively

• Each department have appointed a contact person

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• All 28 obstetric departments participate and report prospectively

• Each department have appointed a contact person - Obstetrician or Midwife

• Data from Medical Birth Registry every 3. month (last update may 2010) –> request to obstetric department

Status – Denmark:

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Data from Denmark so far:

55 Uterine ruptures

7 Postpartum Hysterectomies

25 Placenta accreta/percreta

Status – Denmark:

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Average Blood transfusions:

Uterine ruptures: 0,44 (0-11)

Postpartum Hysterectomies: 13,3 (0-30)

Placenta accreta/percreta: 3,72 (0-20)

Status – Denmark:

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Future events:

• INOSS workshop Oxford, July 2010

• NOSS workshop Helsinki Finland, April 2011

• NFOG Congress, June 2012 – ”Hardcore data”

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THANK YOUTHANK YOUIt looks so easy...