Diabetes in pregnancy: are we providing the best care ... - HQIP

the pregnancies meeting this defi nition (see 4. above) after exclusion of the type 2 pregnancies which had
already been sampled as controls.
All the chapters in this report apart from Chapters 5, 10, 11 and 12 refer to the cases and controls
described above.
The additional sample of type 2 pregnancies was used only in the analysis examining differences between
women with type 1 and type 2 diabetes, and the methodology for this analysis is described separately in
Chapter 11.
In total, 590 pregnancies were sampled for enquiry. Notes were requested from the unit of delivery and
followed up on three occasions over the subsequent three months. Notes were unable to be retrieved for
12% of all notes requested giving a fi nal total of 521 pregnancies going for enquiry (table 4.1).
Table 4.1
Summary of notes requested and received
Type of pregnancy Total requested Notes not
available
Notes received
Control 245 25 220
Death 110 15 95
Anomaly 138 11 127
Additional Type 2 97 18 79
Total 590 69 521
4.3 Panel process
Medical records of all pregnancies in the enquiry module were reviewed by multidisciplinary enquiry panels
of senior health care professionals, held at regional level. Panels reviewed three or four cases per meeting.
Cases reviewed were selected from a national pool excluding the region of the assessing panel, to ensure
an independent assessment of the care provided.
In total, 143 panel meetings were convened between April 2004 and December 2005 in the CEMACH
regions throughout England, Wales and Northern Ireland. Panel meetings did not take place in the West
Midlands region but any pregnancy to a woman delivering in the West Midlands that was selected for
enquiry was included in the national pool and reviewed by enquiry panels outside of the West Midlands.
4.3.1 Panel chairs
Two or three panel chairs were appointed per region by a central selection committee. The specifi c remit
of the panel chairs was to ensure that an equitable process was followed to reach consensus on each of
the specifi c questions asked in the enquiry pro forma. Panel chairs were invited to attend a training day
before the commencement of the panel process. This allowed an opportunity to discuss various challenges
likely to be faced by a panel chair and to develop mechanisms of working that would ensure a consistent
approach to panel enquiry meetings across the regions.
11