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74 Maternity and Obstetrics 2020 | NMH Annual Rep t Leah Byrne, Midwife. Labour and Delivery Audit pregnancy, single breech pregnancy, single oblique or transverse lie, or multiple pregnancy) course of labour and delivery (spontaneous labour, induced labour or pre labour caesarean) and gestational age in completed weeks at the time of delivery. Within this structure all perinatal events and outcomes, satisfaction and complications can be analysed. It is useful to remember that within homogenous groups of women (classification) the incidence of events, outcomes and complications are relatively consistent and are helpful in validating data. It is also important to remember in analysing events and outcomes it is unusual to over record (possibly due to change in data definition or application) but not unusual to under record (usually then due to inaccurate collection). It is easier to assess this the more years of data you have for comparison. This is the third Clinical Report after the introduction of the MN-CMS and many of the same challenges remain and new ones develop but the amount of information contained in this chapter continues to increase. Significant efforts are made to improve data quality and reporting. Validation of information collected takes place on a daily basis with continuous training and feedback to clinicians. I n January 2018, The National Maternity Hospital went live with the Maternal and Newborn Clinical Management System (MN-CMS). Effectively this is an electronic patient record for mother and baby which tells the story of their care but also collects all events, outcomes and complications. It also includes laboratory ordering and medication prescribing so that all care is digitally recorded. It now communicates with general practitioners and will eventually include a patient portal. It has the potential to be the most significant change to the way we provide healthcare in the future. Routine data collection is a challenge to any organisation. The first measure of quality is knowing your results and the second is being able to interpret them. It helps when there is standardisation so you can compare and learn from others. The National Maternity Hospital has a long history of producing detailed Annual Clinical Reports and has lead the way in perinatal audit. It has now a unique opportunity to continue this tradition. A commitment both in terms of resources and leadership is required but this investment will be rewarded in the future. The principle that has been applied to data collection in the MN-CMS is that if you do something then you record it in MN-CMS. The Electronic Patient Record vendors have a responsibility to make it as easy as possible to record the information and analyse the results. Clinicians and administrative staff have a responsibility to document accurately and in a disciplined manner. The interpretation of a clinical report will depend on three variables. Data quality (disciplined data collection using consistent definitions), significant epidemiological characteristics and lastly clinical practice. A good report will enable the reader to hypothesise which of these variables singularly or together contribute to the results recorded. Comments made in this chapter will attempt to demonstrate this. Audit of maternal and fetal outcome following labour and delivery in this chapter is based on a standardised prospective framework consisting of the four obstetric concepts within which there are different parameters. The obstetric concepts are previous record of the pregnancy (nulliparous, multiparous without a uterine scar, multiparous with a uterine scar) category of pregnancy (single cephalic