Responding to variations in mortality due to intrapartum asphyxia

The mortality rate due to intrapartum asphyxia is generally considered a good guide to the quality of perinatal care. Using a routine system of surveillance, we identified a six‐fold difference in mortality rate due to intrapartum asphyxia depending on the hospital of birth, with the lowest rate (95 per cent confidence intervals) of 0.25 (0.10, 0.64)/1,000 births and the highest rate of 1.59 (0.77, 3.27)/1,000 births. A framework of internal and external reviews of the clinical services was developed, that is able to tackle such clinical governance issues in a robust but sensitive manner. The outcome included specific improvements in service provision. The model is generally applicable and is thus suitable for use wherever such clinical governance issues are identified.