Territory-wide Obstetrics and Gynaecology Audit (1999)

Background

Five years after the 1994 Territory-wide Audit, the College had organized a second audit exercise in 1999. Twenty-two hospitals providing obstetric and/or gynaecological services in Hong Kong joined the program. The “Minimal Data Set” was revised with addition of fields concerning with the use of tocolytic, use of steroid and external cephalic version in the obstetric side, and various endoscopic surgeries in the gynaecology database. A desktop database program was designed by Dr. Yuen Pong Mo for the gynaecological data entry. It was used by the public hospitals. Obstetric data of the public hospitals were extracted from the Clinical Management System of the Hospital Authority. (Data conversion was done for the databases from two public hospitals where the system was not installed at that time.) For private hospitals, audit forms were filled in and sent to the College for centralized data entry.

Data processing

After pooling of all the data for the year of 1999, the hospital names were replaced by codes. Hence the hospitals would not be identified. Duplicated records were eliminated if known. A combined report of factual description was produced and some topics of interest were analyzed. The vital statistics were checked against the data available from the Hong Kong Government and discrepancies in the number of stillbirths and neonatal deaths were noted.

Obstetric report

According to the government statistics, the total number of both live births and stillbirths in Hong Kong in 1999 was 50,513. In this exercise, the College received 48,924 obstetric returns, making a return rate of 96.9% (c.f. 94.6% in 1994). Out of the 79 neonatal deaths registered, 72 (91.1%) were included in the analysis. The percentage of neonatal deaths analyzed in 1994 was 85%. Out of the 228 registered stillbirths, 169 (74.1%) were analyzed. The figure in 1994 was 67.6%.

The format of the 1999 report was made similar to that of 1994 for ease of comparison. The report was based on the data collected. Some of the data were well-defined and should be accurate but some need interpretation with caution. Similar to the previous report, data on fetal outcomes and neonatal complications, might not reflect the real situation. The accuracy would depend on the effort of information tracing by the obstetricians and feedback from the paediatric colleagues.

Compared to 1994 figures, there was a drop of 28.1% in the number of parturients. There was a two fold increase in the proportion of parturients aged ≥ 35(22.9% versus 13.9%) and a 3.4 fold increase in those aged ≥ 40 (5.1% vs. 1.5%). The incidence of elderly primigravidae (≥ 35 years) increased from 4.0% to 9.5% but that of grand multiparae (parity ≥ 4) remained less than 1%. While the incidence of preterm delivery (< 37 weeks) remained unchanged, that of post-term delivery (≥ 42 weeks) was halved (2.5% vs. 5.3%).

The incidence of Caesarean section increased from 22.5% to 27.6%. Social reason had become the sixth commonest indication for Caesarean section.

The incidence of parturients with previous uterine scar was significantly increased from 7.5% to 9.2%. There were no significant changes in the other medical or obstetric complications. The maternal mortality rate was increased from 11.8 to 12.4 per 100000 deliveries.

The mean birth weight of the term babies (≥ 37 weeks) remained unchanged (3224 versus 3220 gm). The incidences of birth asphyxia, birth trauma and major neonatal complication were similar, however the survival rate appeared to have improved and the neonatal mortality rate was reduced by 40% (1.5 versus 2.5/1000 livebirths). The stillbirth rate and perinatal mortality rate remained around 3.5 /1000 total births and 5.0/1000 births.

Gynaecolgical report

The data in this part were admission-based. It is important to note that each admission might be associated with multiple diagnoses and treatments, and a patient might have multiple admissions. The default value of various complications was set to “Nil” and hence the possibility of under-reporting should always be considered.

The order of the ten commonest diagnoses was similar to 1994 except for cervical intra-epithelial neoplaisa which ranked 7th compared to 14th in 1994.The actual numbers increased by 3 folds (from 856 to 2,725), suggesting that there was either an actually increase in the number of cases or a shift from outpatient to inpatient and/or day case management. Compared to 1994 figures, “Non-obstetric diseases complicating pregnancy” increased by 55.3%, “Genital displacement/urinary disorders” increased by 42.1% and “Diseases of the cervix” increase by 39.8%.

There were minor changes in the ranking of the top ten most common procedure/treatment modailites in 1999. Diagnostic hysteroscopy increased from 2.9% to 7.1% and ranked the 4th most common procedures. D&C/polypectomy dropped from 10.9% to 6.9%, while endometrial biopsy (not coded in 1994) accounted for 2.2% of the cases. There was a significant increase in endoscopic procedures in the 5-year interval. It increased from 7.7% to 14.1%. The proportion of laparoscopy to hysteroscopy had also changed from about 60:40 to 50:50. The endoscopic procedures were performed for diagnostic purposes in 60.7% (64.6% in 1994). For the therapeutic laparoscopic procedures, laparoscopic sterilization accounted for 32.1% (50.1% in 1994) of cases and was the most popular method for permanent female sterilization

The overall complication rate increased from 0.88% to 1.02% of all admissions. This was mainly attributed by the increase in other unspecified complications which increased from 0.15% to 0.69%. Fever and urinary tract infection remained the two most common complications while inadvertent organ injury occurred in 0.01-0.05%.

Clinical Audit Subcommittee (1999-2000)

Dr NG Tai Keung (Chairman)
Dr CHAN Yuk May May
Prof NGAN Yuen Sheung Hextan
Dr PUN Tin Chung
Dr SO Kon Ping
Dr TSANG Sing Wing
Dr YUEN Pong Mo

List of participating hospitals (1999-2000)

Alice Ho Miu Ling Nethersole Hospital
Canossa Hospital
Caritas Medical Centre
Evangel Hospital
Hong Kong Adventist Hospital
Hong Kong Baptist Hospital
Hong Kong Central Hospital
Hong Kong Santorium & Hospital Ltd.
Kwong Wah Hospital
Matilda & War Memorial Hospital
Our Lady of Maryknoll Hospital
Pamela Youde Nethersole Eastern Hospital
Pok Oi Hospital
Precious Blood Hospital
Prince of Wales Hospital
Princess Margaret Hospital
Queen Elizabeth Hospital
Queen Mary/TsanYukHospital
St Paul's Hospital
St Teresa's Hospital
TsuenWan Adventist Hospital
Tuen Mum Hospital
United Christian Hospital
Union Hospital