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RNZ".{ $Selection of pregnancies for enquiry%% Sampled from 3808 pregnancies in descriptive study Multiple pregnancies excluded Four groups of pregnancies sampled 521 pregnanciesP.Pregnancies in enquiry ZAnomalies (127)Major fetal congenital anomaly at any gestationDeaths (95)Deaths excluding anomalies from 20 weeks to 28 days after deliveryControls (220)Random sample of normally-formed babies alive at 28 days Additional type 2 sample (79)Normally-formed babies alive at 28 days resulting from pregnancies to women with type 2 diabetes Z0Z ZCZZ:ZZbZZ0 (:  a       Panel enquiries$ tApril 2004  December 2005143 panel meetings at regional levelNational pool of 521 pregnancies3 or 4 cases reviewed per meeting Assessors independent of case being reviewedP*Panel composition Two each of:ObstetriciansMidwivesDiabetes specialist nursesDiabetes physiciansAdditional invited assessorsObserversPanel Chairs 6F8F8,Panel process  Assessment of careNStructured enquiry pro formaGrading of careOptimal (no issues with care)Adequate (some issues of concern)Poor Adequate and  poor aggregated as  suboptimal care <-ZEZ6Z-E62!Analysis  Audit of careCase control study Analysis of underlying issues identified by panelsComparison of women with type 1 and type 2 diabetesNeonatal enquiry into care of normally-formed term babiesZ/Case control analysis (n=442)0!The women in the enquiry (n=442) "" ^50% had poor pregnancy outcome Similar socio-demographic characteristics to 3808 pregnancies__3"!The babies in the enquiry (n=442)5#&Cause of stillbirth and neonatal death'' 6$ Post mortem 7% Thank you $P/T)   0` 33` Sf3f` 33g` f` www3PP` ZXdbmo` \ғ3y`Ӣ` 3f3ff` 3f3FKf` hk]wwwfܹ` ff>>\`Y{ff` R>&- {p_/̴>?" dd@|?" dd@   " @ ` n?" dd@   @@``PV    @ ` `p>> N(    nAL Y?$dv418111ucPreview_imgMain#" `S  6Pj ,  jT Click to edit Master title style! !  0tSj 'g  jRClick to edit Master text stylesSecond levelThird levelFourth levelFifth level!   S`  C *APicture1"  08Xj &  jTCEMACH Diabetes in Pregnancy National Report Launch, Sheffield, 26th February 2007UUH  0޽h ? 33D<___PPT10..O2  1_Default Design  0 kc(    6 > T Click to edit Master title style! !  0  `  W#Click to edit Master subtitle style$ $  nAL Y?$dv418111ucPreview_imgMain#" `S`  C *APicture1"H  0޽h ? 33D<___PPT10..OO 0 zr< (  < < 0 - P   P*   < 0H2    R*  d < c $ ?   < 05  0 RClick to edit Master text stylesSecond levelThird levelFourth levelFifth level!   S < 6; _P  P*   < 6@ _  R*  H < 0޽h ? 3380___PPT10.8G 0 ^V(  ~  s *Dj/T, j 0  H ?"6@ NNN?NS fp z2Dr Jo ModderCEMACH Clinical Director (Obstetrics)38P23H  0޽h ? 33___PPT10i.P@v+D=' =@B + 0 <(  ~  s *g,  ~  s *g'g   H  0޽h ? 3f3fg___PPT10i.+D=' =@B + 0 x0(  x~ x s *tm,   r x S Ln'gi  H x 0޽h ? 33g___PPT10i.t+D=' =@B + 0 ,0(  ,x , c $} W  x , c $~'g  H , 0޽h ? 33___PPT10i.P+D=' =@B +} 0 0$(  r  S p,   r  S H/'g  H  0޽h ? 33___PPT10i.TX0ݶ+D=' =@B + 0 pV(  p p  6"`,  ~ p s *hzTv  H p 0޽h ? 33g___PPT10i.*+D=' =@B +} 0 $(  r  S ,   r  S l9  H  0޽h ? 33___PPT10i."X0q+D=' =@B +  0  (  r  S j  j   <@j3M\*Pregnancies notified to Regional Managers++  <j2LMedical records requested   <Pjc = ?Panel meeting  <j9=w; Consensus    <jff"`6 &,6 CEnquiry pro formar  BjL"`qw OIrreversible anonymisationr  BjL"`qw`LCases/controls selectedL  c $@ @ 2L @ c $ @ A :L  c $@ @ c   <\jff"`s &,3IPre-pregnancy pro formaH  0޽h ??` 33___PPT10i.$X.+D=' =@B + 0 (0(  (x ( c $,  x ( c $'g  H ( 0޽h ? 33___PPT10i.P+D=' =@B +$ 0 $(  r  S T,   r  S |]'gw  H  0޽h ? 3380___PPT10.X_8,s 0 p '(  f2  0"` r  S ,  l2  6ff"`  ! 0tZ&LMajor congenital anomalies 2 " 0X$@*'8Deaths 2= # 0t( 'ZHPoor pregnancy outcome = A + B + C (222)Anomalies = B + C (127)All deaths including congenital anomalies = A + B (137)Deaths excluding anomalies = A (95)$ 23 $ 0<.? A (n=95) (2  & 0/ ? B (n=42) (2  ' 04 ? C (n=85) (2 H  0޽h ? 33___PPT10i.WX kN+D=' =@B + 0 }m(  r  S D;,   x  c $</'`  ; ~ } #"*II<2H~  v <L2? a ^ 27% (73/273)   @` t <H? a (Body Mass Index e" 30*  @`  <HY ?"` ` 51% (203/400)   @`  <a ?"` ]Recurrent hypoglycaemia @`  <k ?"`  ^ 20% (63/311)   @`  <u ?"`  ZSevere hypoglycaemia @`   < ~ ?"`6~` 9% (29/316)   @`   <v ?"`6~UNew retinopathy @`  < ?"` 6^ 12% (42/359)   @`  < ?"` 6Q Nephropathy   @`  <|?a  ^ 23% (73/316)   @`  <?a  ^Pre-existing retinopathy @`ZB  s *1 ?  ZB  s *1 ?66ZB  s *1 ?~ZB  s *1 ?  ZB  s *1 ?  `B  01 ?`B  01 ?~`B  01 ?~`B  01 ?~~ZB u s *1 ?a a H  0޽h ? 33___PPT10i.\Xpx+D=' !=@B +Y 0 ph (  r  S $,    0 ZA ? ?E0    0xMJ45286 2  0F - 419 2  0 M 439 2  0 3g 477 2  0s Z 413 2  0 c 38 2H  0޽h ? 33___PPT10i.Xh+D=' !=@B + 0  'U}(  r  S t,{   U U #"*|{|U  9 <? tQP-value @` 7 <? tfGeneral maternity(N=5756) @` 5 <? tZEnquiry(N=98) @` 3 <? tn$Extended Wigglesworth classification%% @` 0 <? ^  T<0.0013 @` . < ?^  Q18%3 @` , <0? ^  P4%3 @` * <x"?^ R Immaturity   @` ' <h+?  UN0.10 @` % < 4? UL4% @` # <P=? UL1% @` ! <`F? UQ Infection   @`  <pO?  ^ N0.30 @`  <$X? ^ L8% @`  <a? ^ M10% @`  <k? ^ eDeath from intrapartum causes @`   <Le?  S0.0023 @`   <m?  Q44%3 @`   <?  Q59%3 @`   <? dUnexplained antepartum death @`  <? tN0.68 @`  <?t M19% @`  <8? tM18% @`  <?t YCongenital defect @``B  0o ?ZB  s *1 ?ZB  s *1 ?  ZB  s *1 ?^ ^ `B  0o ?UU`B  0o ?UZB  s *1 ?  UZB  s *1 ?UZB  s *1 ?  U`B  0o ?UZB + s *1 ?  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RNZ".{ $Selection of pregnancies for enquiry%% Sampled from 3808 pregnancies in descriptive study Multiple pregnancies excluded Four groups of pregnancies sampled 521 pregnanciesP.Pregnancies in enquiry ZAnomalies (127)Major fetal congenital anomaly at any gestationDeaths (95)Deaths excluding anomalies from 20 weeks to 28 days after deliveryControls (220)Random sample of normally-formed babies alive at 28 days Additional type 2 sample (79)Normally-formed babies alive at 28 days resulting from pregnancies to women with type 2 diabetes Z0Z ZCZZ:ZZbZZ0 (:  a       Panel enquiries$ tApril 2004  December 2005143 panel meetings at regional levelNational pool of 521 pregnancies3 or 4 cases reviewed per meeting Assessors independent of case being reviewedP*Panel composition Two each of:ObstetriciansMidwivesDiabetes specialist nursesDiabetes physiciansAdditional invited assessorsObserversPanel Chairs 6F8F8,Panel process  Assessment of careNStructured enquiry pro formaGrading of careOptimal (no issues with care)Adequate (some issues of concern)Poor Adequate and  poor aggregated as  suboptimal care <-ZEZ6Z-E62!Analysis  Audit of careCase control study Analysis of underlying issues identified by panelsComparison of women with type 1 and type 2 diabetesNeonatal enquiry into care of normally-formed term babiesZ/Case control analysis (n=442)0!The women in the enquiry (n=442) "" ^50% had poor pregnancy outcome Similar socio-demographic characteristics to 3808 pregnancies__3"!The babies in the enquiry (n=442)5#&Cause of stillbirth and neonatal death'' 6$ Post mortem 7% Thank you $P/T)   0` 33` Sf3f` 33g` f` www3PP` ZXdbmo` \ғ3y`Ӣ` 3f3ff` 3f3FKf` hk]wwwfܹ` ff>>\`Y{ff` R>&- {p_/̴>?" dd@|?" dd@   " @ ` n?" dd@   @@``PV    @ ` `p>> N(    nAL Y?$dv418111ucPreview_imgMain#" `S  6l ,  T Click to edit Master title style! !  0 'g  RClick to edit Master text stylesSecond levelThird levelFourth levelFifth level!   S`  C *APicture1"  0~ &  TCEMACH Diabetes in Pregnancy National Report Launch, Sheffield, 26th February 2007UU H  0޽h ? 33D<___PPT10..O2  1_Default Designr˳&e71 ՜.+,0   On-screen ShowCEMACHM Arial1_Default DesignMicrosoft Graph Chart+ Aims and methods of the national enquiry"Modules of the Diabetes ProgrammeAims of enquiry module%Selection of pregnancies for enquiryPregnancies in enquiry  Panel enquiriesPanel compositionPanel processAssessment of care AnalysisCase control analysis (n=442)"The women in the enquiry (n=442) "The babies in the enquiry (n=442)'Cause of stillbirth and neonatal deathPost mortem Thank you  Fonts UsedDesign TemplateEmbedded OLE ServersSlide Titles