TÜV NORD for the quality management system
The entire MHH is certified in accordance with the requirements of DIN EN ISO 9001:2015.
As one of the leading university Facilities or Institutions in northern Germany, we have a pioneering role in patient care. In addition to modern and future-oriented equipment, we strive to provide our patients with high-quality treatment in accordance with guidelines.
This also includes appropriate quality assurance measures, which have already been successfully implemented within the Department of Obstetrics and Gynecology and the Department of Neonatology. Both are successfully certified Clinical Departments in accordance with DIN EN ISO 9001:2015.
periZert® for specialized care
Around 3,000 children are born at the Hannover Medical School Perinatal Centre every year. Over 500 children are born prematurely or require intensive medical and nursing care after a high-risk birth, including around 100 premature babies with a birth weight of less than 1,500 grams and numerous newborns with all kinds of malformations. The independent certification company periZert® has now officially confirmed that the highest quality standards of the highest possible care level (Level 1) apply in the interaction between prenatal medicine, obstetrics and neonatology at the MHH.
In addition to the spatial, technical and personnel requirements, the auditors examined the entire treatment process at the center: from prenatal diagnostics to support during birth, neonatal care and follow-up care for patients. The MHH can therefore boast that the maternity ward, pediatric surgery and neonatal intensive care unit are linked, that there is always a neonatal emergency physician on site and that there are many diagnostic and therapeutic options. Equally important is the professional cooperation between the various specialist disciplines. "The auditor expressly praised us for this," says Professor Dr. Bettina Bohnhorst. The cooperation works excellently at all levels, between the senior physicians of the departments just as well as between the physicians and the nursing staff and midwives.
The award is the only specialist certification that is jointly supported by professional associations such as the German Society for Gynecology and Obstetrics (DGGG), the German Society for Perinatal Medicine (DGPM) and the German Society for Prenatal and Obstetric Medicine (DGPGM). Parents thus receive proof of structured treatment procedures with a high degree of specialization in premature and high-risk births, particularly at the interface between obstetrics and neonatal intensive care medicine.
The MHH's Level 1 Perinatal Centre was successfully certified according to Perizert® for the first time in 2016. This makes it the ninth of more than 150 Perinatal Centres in Germany to undergo this qualification process. The MHH is the second largest Level 1 Perinatal Centre in Lower Saxony. In 2019, the Perizert® certification was again successfully completed.
Peer review by the Lower Saxony Medical Association
The Perinatal Centre at MHH also took part in a peer review process by the Medical Association in 2017 as part of a pilot project.
Quality assurance
Treatment results at the Perinatal Centre of Hannover Medical School
It goes without saying that both the Obstetrics Department and the Neonatology Department take part in the external quality assurance procedure (perinatal survey). This ensures that we can offer you the best possible treatment. Our treatment results are regularly evaluated.
A summary of the quality assurance results is published here, as required by the Joint Federal Committee (G-BA).
The course of pregnancy and birth, including any complications that may occur, as well as the condition of the child immediately after birth of all pregnant women delivered at our clinic are recorded anonymously and statistically evaluated.
The results of our Clinical Department are compared with the quality targets we have set ourselves as well as with other obstetric clinics in the state of Lower Saxony and throughout Germany.
In 2016, our Clinical Department had a total of 3010 births and 3121 children were born.
In 2016, 1012 women were delivered by caesarean section in our Clinical Department, which corresponds to a caesarean section rate of 33.6%. Of these, 12.4% were so-called secondary caesareans, i.e. caesareans in which the birth had already begun and either the waters broke or the mother went into labor. In the comparison group, i.e. in other level 1 perinatal centers, the caesarean section rate averaged 34.5%. Due to the high maternal and infant risk collective, we calculated with a higher number of deliveries by caesarean section and thus achieved this quality target. We were also able to reduce the caesarean section rate from 34.2% in 2016 to 33.6% in 2015 without achieving a deterioration in maternal or child outcomes. The proportion of vaginal-operative deliveries, i.e. deliveries with a suction cup (vacuum) or forceps, amounted to 4.1% in 2016.
In order to minimize the maternal wound infection rate after caesarean section deliveries, the prophylactic administration of antibiotics during the operation is a quality feature. 96.7% of women delivered by caesarean section received perioperative antibiotic prophylaxis in our Clinical Department, which is within the required reference range of >90%. Reasons against perioperative antibiotic prophylaxis were, for example, multiple allergies to antibiotics.
In life-threatening situations for mother and/or child, an emergency caesarean section may have to be performed. The time between the decision to perform a caesarean section and the development of the child should not exceed 20 minutes. We were able to clearly achieve this quality indicator for all emergency caesarean sections thanks to the close proximity of the delivery rooms to the caesarean section operating room and an established emergency caesarean section training program.
Children with a low pH value are referred to as fetal acidosis. Despite the high risk profile of a university hospital, 0.39% of all babies born at Hannover Medical School in 2016 had such a fetal acidosis with a pH value below 7. We were able to improve on the low rate of 0.45% from 2015.
The number of fetal acidosis cases in premature babies in 2016 was just 0.43%, which is both lower than the previous year's figure of 0.48% and below the reference range of < 5.02%. This means that we provide good care for children in a critical condition.
The fetal lungs are considered mature from 34+0 weeks' gestation. If there is a risk of premature birth < 34+0 weeks' gestation, lung maturation induction with a corticosteroid should be performed in order to prepare the fetus's lungs for better ventilation in the event of a premature birth. Another quality indicator is prenatal corticosteroid therapy for premature births if the expectant mother was hospitalized for at least 2 days before the birth. This was carried out in 78.02% of cases. The lower figure can be explained by a documentation error and has been corrected.
The presence of a pediatrician is equally important for the adequate care of premature babies, i.e. for births before 37+0 weeks' gestation. We were able to achieve this quality target with 90.6% and thus ensure optimal care for premature babies. The remaining 9.4% of premature babies were seen by a pediatrician within a short time of birth due to the very rapid birth process.
Our Clinical Department continues to be characterized by a very low number of high-grade perineal injuries. One aim is to avoid so-called III° and IV° perineal tears, where the intestinal sphincter (III°) or the rectum (IV°) is torn. A higher-grade perineal tear occurred in only 0.44% of all births in our Clinical Department. This means that we have fallen well short of our quality target for high-grade perineal injuries. We are also below the average for the state of Lower Saxony at 0.73% and below the required reference range of <2.09%.
In summary, our obstetrics department meets the quality requirements of the perinatal survey in all areas and is also very well positioned compared to the rest of the state and to other Level 1 perinatal centers.
According to a GBA resolution of 19.02.2009, all perinatal centers are obliged to publish data on the treatment outcomes of premature babies with a very low birth weight (<1500 g). Since 2014, this data has been published centrally at www.perinatalzentren.org.
High-risk pregnant women, some of whom were transferred to the MHH from other Clinical Departments in Lower Saxony before birth, are cared for and delivered at the MHH Perinatal Centre. As a result, a large number of very immature premature babies, multiple births and premature and newborn babies, some with very complex congenital malformations, are treated at the MHH Perinatal Centre.
Furthermore, as a maximum care centre with the possibility of paediatric surgery, neurosurgery, cardiothoracic and vascular surgery and specialization in heart diseases, kidney diseases such as renal replacement therapy and kidney transplantation, liver diseases, tumour diseases and metabolic diseases, patients with such diseases are frequently transferred to the MHH Perinatal Centre from other Clinical Departments after birth.
The lower the gestational age and birth weight, the higher the risk of death. There is also an increased risk of death in the case of births outside the Perinatal Centre and postpartum transfers, multiple births and children with congenital malformations and other serious congenital diseases.