14 - Audit in obstetrics and gynaecology

Summary

Introduction

The basic ideas of ‘Health for All by the Year 2000’ were outlined in 1978 at the Alma Ata Conference organised by the World Health Organisation (WHO) and the United Nations Children's Fund (UNICEF). Subsequently, the WHO Regional Office for Europe devised criteria to monitor some practical ways of implementing the basic ideas and in their document they suggest ‘By 1990, all members states should have built effective mechanisms for ensuring the quality of care within their health care systems’. Medical audit is one way of monitoring the mechanisms implemented to ensure the quality of care and indeed, medical audit is a key part of the UK's White Paper that proposed reconstruction of the National Health Service.

Maternal mortality audit

Maternal mortality audit is not a new phenomenon in the specialty of obstetrics and gynaecology. In Scotland, for example, the first special enquiry into maternal deaths was instituted in 1930 by agreement between the Scottish Board of Health, the local authorities and the medical professional organisations. The perinatal mortality rate was first recorded in Scotland in 1939, when it was 68 per 1000 total births. The information elicited by the first enquiry led directly to the Maternity Services (Scotland) Act of 1937 and laid the foundation for the immeasurably improved hospital services of today.