Perinatal & Maternal Mortality Review Committee News & Events

Working towards Safer Beginnings

Thu, 14 Mar 2013 15:26:00 +1300

Perinatal & Maternal Mortality Review Committee

Annual workshop of the Perinatal and Maternal Mortality Review Committee

Wednesday 12 June 2013 - Wellington

Keynote speaker: Professor Marian Knight

A workshop on improving outcomes for New Zealand mothers and babies.

You are invited to register your participation for this one-day workshop. This workshop is being organised by the Perinatal and Maternal Mortality Review Committee and supported by the Health Quality & Safety Commission.

Topics include:

New Zealand perinatal and maternal mortality statistics
The PMMRC’s impact: how have we made a difference?
Congenital abnormalities and perinatal mortality
Preventable perinatal and maternal mortality

Keynote speaker: Professor Marian Knight

NIHR Research Professor and Honorary Consultant in Public Health, National Perinatal Epidemiology Unit, University of Oxford

Marian studied medicine in Cambridge and Edinburgh and qualified in 1992. She did basic training in obstetrics and neonatology before moving to Oxford as a clinical research fellow in 1995. Her research into the pathogenesis of pre-eclampsia led to the award of a DPhil in 1998. During this time Marian became interested in epidemiology and population health, and subsequently moved into public health, becoming a Fellow of the Faculty of Public Health in 2006. She is an Honorary Consultant in Public Health with Oxfordshire PCT. She set up and has led the UK Obstetric Surveillance System (UKOSS) since its inception in 2005 and is the Chief Investigator for a national programme of study into near-miss maternal morbidity, funded by the National Institute for Health Research. She also leads the British Association of Paediatric Surgeons Congenital Anomalies Surveillance System (BAPS-CASS), conducting studies relating to the care of infants requiring early surgery. In February 2012, Marian was awarded one of the UK’s first NIHR Research Professorships, to develop further her work relating to maternal morbidity and care of infants requiring early surgery.

When:	Wednesday 12 June 2013, 9am to 5pm
Where:	Oceania Room, Te Papa Tongarewa, Wellington
Registration:	Registration fee: $175 (incl GST)
	Early bird rate: $140 (incl GST) - this rate applies if registration and payment are received by 15 May 2013.
Website:	To register go to: www.saferbeginnings.co.nz

This meeting has been approached as a RANZCOG Approved O&G meeting and eligible Fellows of this College will earn 7 CPD points for attendance. It is also approved by the Midwifery Council of New Zealand as part of the Recertification Programme for midwives. Those midwives who attend will receive five (5) professional activity points.

The working towards safer beginnings and staying alive after surgery annual workshops of the Perinatal and Maternal and Perioperative mortality review committees has been endorsed by The Royal New Zealand College of General Practitioners (RNZCGP) and has been approved for up to 6 credits for each committee workshop for CME for General Practice Educational Programme Stage 2 (GPEP2) and Maintenance of Professional Standards (MOPS) purposes.

Why not register for both days? This includes Staying Alive After Surgery, the inaugural workshop of the Perioperative Mortality Review Committee on Wednesday 12 June 2013.

Two day registration fee: $260 (GST incl)
Two day early bird rate: $225 (GST incl)

For more information contact the Health Quality & Safety Commission on 04 901 6060.

Download the full informational flyer here.

PMMRC Chair Cynthia Farquhar talks to Radio NZ about the Committee's Sixth Annual Report

Thu, 14 Jun 2012 10:27:00 +1200

Perinatal & Maternal Mortality Review Committee

On 13 June 2012 Radio New Zealand interviewed Perinatal and Maternal Mortality Review Committee chair Professor Cynthia Farquhar about the Committee's sixth annual report. Topics covered included the proposed introduction of special mental health units for new mothers and babies, and new information about babies who are deprived of oxygen at birth.

Click here to listen to the interview.

Report finds suicide remains leading cause of maternal death

Wed, 13 Jun 2012 17:20:00 +1200

Perinatal & Maternal Mortality Review Committee

The annual report of the Perinatal and Maternal Mortality Review Committee (PMMRC) shows suicide continues to be the leading cause of maternal deaths. There were 13 maternal deaths from suicide during 2006 to 2010, almost a quarter of the total recorded. Three maternal suicides were reported in 2010 and three in 2009.

The PMMRC is responsible for reviewing maternal deaths and all deaths of babies from 20 weeks gestation up to 28 days after birth, or weighing at least 400g if gestation is unknown. It advises the Health Quality & Safety Commission on how to reduce these deaths.

PMMRC Chair Professor Cynthia Farquhar says the report has a number of recommendations aimed at reducing maternal suicides.

“These include the setting up of a mother and baby unit in the North Island in addition to the unit based in Christchurch. Another recommendation is the referral of pregnant women and new mothers with a history of mental illness for psychiatric assessment and management even if they are currently well.

“There also needs to be better coordination between existing services in the primary and specialist sectors and processes for sharing information between providers.

“It is encouraging to this Committee that the Ministry of Health’s report Healthy Beginnings, released earlier this year, supports the establishment of new specialist inpatient facilities for mothers and babies.”

The most frequent causes of maternal death in New Zealand in the years 2006 to 2010 were suicide (13 cases), maternal pre-existing medical conditions (11 cases) and amniotic fluid embolism (9 cases).

New Zealand’s maternal mortality rate – the death of a mother while pregnant or up to six weeks after birth – is significantly higher than that in the United Kingdom. Our perinatal mortality rate – the death of a baby from 20 weeks gestation up to 28 days after birth – is comparable with that in the United Kingdom.

There were 704 perinatal-related deaths in 2010, including 211 due to a congenital abnormality, 111 due to pre-term birth, and 78 due to haemorrhage during pregnancy.

Professor Farquhar says the report found that 124 (one in five) perinatal deaths and 18 (one in three) maternal deaths were potentially avoidable.

“Every one of these deaths is a tragedy. While some were not preventable, we can learn from others to help reduce deaths in the future. The report aims to identify where maternity and neonatal services should focus to make the greatest difference.

“New Zealand has very good maternity services, but there is always scope to learn and improve.”

She says the most common factors contributing to the potentially avoidable deaths of babies and mothers are not being able to access the necessary health services – such as not booking for pregnancy care, issues with the skills of health care professionals, and organisational factors such as a lack of protocols or delays in procedures.

“Maternity providers need to consider the recommendations from this report and seek to implement them.”

This year’s report contains new information on babies diagnosed with neonatal encephalopathy, where a term baby is born in poor condition requiring resuscitation and ongoing care. In 2010, there were 82 babies diagnosed with neonatal encephalopathy, of whom 59 survived. This is the initial analysis of data and more comprehensive analysis of two years of data will be reported in 2013.

Background

A maternal death is the death of a woman while pregnant or within 42 days of the end of pregnancy, from any cause related to or aggravated by the pregnancy or its management. It does not include accidental or incidental causes of death of a pregnant woman.
Perinatal mortality is fetal and early neonatal deaths from 20 weeks gestation until less than seven days of age or weighing at least 400g if gestation was unknown.
Perinatal related mortality is fetal deaths and early and late neonatal deaths from 20 weeks gestation up to 28 days after birth or weighing at least 400g if gestation is unknown.

KEY POINTS FROM THE REPORT

Perinatal related mortality

In 2010, the perinatal mortality rate was 10.1/1000 births, and the perinatal related mortality rate was 10.8/1000 births, which represents a small non-significant decrease compared to the previous year. This rate is higher than the rate in Australia in 2009 and similar to the United Kingdom in 2009.
Māori and Pacific mothers are more likely to have stillbirths and neonatal deaths compared to New Zealand European and non-Indian Asian mothers.
There is a significantly increased rate of stillbirth and neonatal death among mothers who live in the most deprived areas.
Teenage mothers are at higher risk of perinatal related mortality, specifically stillbirth and neonatal death, compared to mothers aged 20–39 years. Mothers of 40 years and older are also at increased risk of perinatal related mortality
Nine percent of mothers reported using alcohol, and 3.4 percent reported using marijuana in pregnancy. Alcohol and marijuana use were associated with perinatal death due to spontaneous preterm birth and deaths due to sudden unexpected deaths in infancy (SUDI). These findings may be confounded by smoking, deprivation and young age.
Eighteen percent of all perinatal related deaths were thought to be potentially avoidable deaths – 2 percent of late terminations, 15 percent of stillbirths and 19 percent of neonatal deaths.
Contributory factors were identified in 27.3 percent of all perinatal related deaths – 2.6 percent of late terminations, 20.5 percent of stillbirths and 23.8 percent of neonatal deaths. The most common contributory factors were barriers to accessing or engaging with maternity and health services (19%), personnel (7%) and organisational and management factors (4%).

Maternal mortality

The maternal mortality ratio for the five-year interval 2006–2010 was 17.8/100,000 maternities.
The New Zealand maternal mortality ratio is significantly higher than the ratio reported by the United Kingdom for 2006 to 2008.
There were eight maternal deaths in 2010.
The most frequent causes of maternal death in New Zealand in the years 2006 to 2010 were suicide (13 cases), maternal pre-existing medical conditions (11 cases) and amniotic fluid embolism (9 cases).
Thirty-six percent of maternal deaths in New Zealand from 2006–2010 were considered to be potentially avoidable.
Māori and Pacific mothers are more likely than New Zealand European mothers to die during pregnancy or in the six weeks postpartum.

Recommendations perinatal-related illness and death

If a baby is small for gestational age, and this is confirmed by ultrasound at term, timely delivery is recommended.
Maternal gestational weight gain: Pregnant women should be given an indication of ideal weight gain in pregnancy according to their body mass index.
Smoking cessation: All health professionals who provide care to pregnant women should offer smoking cessation advice.
Neonatal encephalopathy: Cord gases should be performed on all babies born with an Apgar <7 at one minute. If neonatal encephalopathy is clinically suspected in the immediate hours after birth, early consultation with a neonatal paediatrician is recommended in order to avoid a delay in commencing cooling. All babies with moderate or severe neonatal encephalopathy should undergo a formal neurological examination and have the findings clearly documented prior to discharge.

Recommendations maternal illness and death

Pregnant women who are identified with pre-existing medical disease during pregnancy should be referred appropriately.
The committee notes the publication of the Ministry of Health’s Healthy Beginnings report in January 2012 and supports the recommendations with particular regard to the establishment of mother and baby units in the North Island and the importance of screening mothers for a history of mental health disorders.
A comprehensive perinatal and infant mental health service includes screening and assessment, timely intervention, access to respite care and specialist inpatient care for mothers and babies, consultation and liaison services.
Termination of pregnancy services should undertake holistic screening for maternal mental health and family violence and provide appropriate support and referral.

Report finds suicide remains leading cause of maternal death

Wed, 13 Jun 2012 14:02:00 +1200

Perinatal & Maternal Mortality Review Committee

PMMRC Chair Professor Cynthia Farquhar says the report has a number of recommendations aimed at reducing maternal suicides.

“There also needs to be better coordination between existing services in the primary and specialist sectors and processes for sharing information between providers.

The most frequent causes of maternal death in New Zealand in the years 2006 to 2010 were suicide (13 cases), maternal pre-existing medical conditions (11 cases) and amniotic fluid embolism (9 cases).

There were 704 perinatal-related deaths in 2010, including 211 due to a congenital abnormality, 111 due to pre-term birth, and 78 due to haemorrhage during pregnancy.

Professor Farquhar says the report found that 124 (one in five) perinatal deaths and 18 (one in three) maternal deaths were potentially avoidable.

“New Zealand has very good maternity services, but there is always scope to learn and improve.”

“Maternity providers need to consider the recommendations from this report and seek to implement them.”

Background

A maternal death is the death of a woman while pregnant or within 42 days of the end of pregnancy, from any cause related to or aggravated by the pregnancy or its management. It does not include accidental or incidental causes of death of a pregnant woman.
Perinatal mortality is fetal and early neonatal deaths from 20 weeks gestation until less than seven days of age or weighing at least 400g if gestation was unknown.
Perinatal related mortality is fetal deaths and early and late neonatal deaths from 20 weeks gestation up to 28 days after birth or weighing at least 400g if gestation is unknown.

KEY POINTS FROM THE REPORT

Perinatal related mortality

In 2010, the perinatal mortality rate was 10.1/1000 births, and the perinatal related mortality rate was 10.8/1000 births, which represents a small non-significant decrease compared to the previous year. This rate is higher than the rate in Australia in 2009 and similar to the United Kingdom in 2009.
Māori and Pacific mothers are more likely to have stillbirths and neonatal deaths compared to New Zealand European and non-Indian Asian mothers.
There is a significantly increased rate of stillbirth and neonatal death among mothers who live in the most deprived areas.
Teenage mothers are at higher risk of perinatal related mortality, specifically stillbirth and neonatal death, compared to mothers aged 20–39 years. Mothers of 40 years and older are also at increased risk of perinatal related mortality
Nine percent of mothers reported using alcohol, and 3.4 percent reported using marijuana in pregnancy. Alcohol and marijuana use were associated with perinatal death due to spontaneous preterm birth and deaths due to sudden unexpected deaths in infancy (SUDI). These findings may be confounded by smoking, deprivation and young age.
Eighteen percent of all perinatal related deaths were thought to be potentially avoidable deaths – 2 percent of late terminations, 15 percent of stillbirths and 19 percent of neonatal deaths.
Contributory factors were identified in 27.3 percent of all perinatal related deaths – 2.6 percent of late terminations, 20.5 percent of stillbirths and 23.8 percent of neonatal deaths. The most common contributory factors were barriers to accessing or engaging with maternity and health services (19%), personnel (7%) and organisational and management factors (4%).

Maternal mortality

The maternal mortality ratio for the five-year interval 2006–2010 was 17.8/100,000 maternities.
The New Zealand maternal mortality ratio is significantly higher than the ratio reported by the United Kingdom for 2006 to 2008.
There were eight maternal deaths in 2010.
The most frequent causes of maternal death in New Zealand in the years 2006 to 2010 were suicide (13 cases), maternal pre-existing medical conditions (11 cases) and amniotic fluid embolism (9 cases).
Thirty-six percent of maternal deaths in New Zealand from 2006–2010 were considered to be potentially avoidable.
Māori and Pacific mothers are more likely than New Zealand European mothers to die during pregnancy or in the six weeks postpartum.

Recommendations perinatal-related illness and death

If a baby is small for gestational age, and this is confirmed by ultrasound at term, timely delivery is recommended.
Maternal gestational weight gain: Pregnant women should be given an indication of ideal weight gain in pregnancy according to their body mass index.
Smoking cessation: All health professionals who provide care to pregnant women should offer smoking cessation advice.
Neonatal encephalopathy: Cord gases should be performed on all babies born with an Apgar <7 at one minute. If neonatal encephalopathy is clinically suspected in the immediate hours after birth, early consultation with a neonatal paediatrician is recommended in order to avoid a delay in commencing cooling. All babies with moderate or severe neonatal encephalopathy should undergo a formal neurological examination and have the findings clearly documented prior to discharge.

Recommendations maternal illness and death

Pregnant women who are identified with pre-existing medical disease during pregnancy should be referred appropriately.
The committee notes the publication of the Ministry of Health’s Healthy Beginnings report in January 2012 and supports the recommendations with particular regard to the establishment of mother and baby units in the North Island and the importance of screening mothers for a history of mental health disorders.
A comprehensive perinatal and infant mental health service includes screening and assessment, timely intervention, access to respite care and specialist inpatient care for mothers and babies, consultation and liaison services.
Termination of pregnancy services should undertake holistic screening for maternal mental health and family violence and provide appropriate support and referral.

PMMRC member Sue Bree receives Queen's Birthday honour

Fri, 08 Jun 2012 11:06:53 +1200

Perinatal & Maternal Mortality Review Committee

Perinatal and Maternal Mortality Review Committee member Ms Sue Bree has been recognised for her services to midwifery in the Queen's Birthday and Diamond Jubilee Honours. The Commission congratulates Ms Bree on being made a Member of the New Zealand Order of Merit. Ms Bree has worked as a midwife for 30 years in the Northland region.

Read more on this story in The Northern Advocate.

Registrations still open for workshop on improving outcomes for mothers and babies

Fri, 01 Jun 2012 15:17:00 +1200

Perinatal & Maternal Mortality Review Committee

Registrations are still open for the Beyond The Numbers workshop on maternal deaths and neonatal mortality. The one-day workshop is being held at Te Papa Tongarewa, Wellington on 14 June.

Topics include:

Understanding potentially avoidable deaths and approaches to prevent them
Midwifery challenges in preventing maternal mortality
Interventions to prevent maternal deaths
Neonatal mortality and encephalopathy

Click here to find out more.

The workshop is being organised by the Perinatal and Maternal Mortality Review Committee and is supported by the Health Quality & Safety Commission.

Born too soon – a new report looks at the increasing number of preterm births

Mon, 07 May 2012 13:21:00 +1200

Perinatal & Maternal Mortality Review Committee

A new report, Born Too Soon: The Global Action Report on Preterm Birth, highlights the increasing number of babies being born too early and the risks they face.

Preterm birth is responsible for nearly half of all new-born deaths and is the second leading cause of death for children under five; the first is pneumonia.

Globally more than one in 10 babies are born too early equating to over 15 million preterm births and more than one million new-born deaths. Many of those who survive will have a permanent disability.

While the preterm birth rate is highest in areas with low incomes, the number of babies being born at 37 weeks or less is increasing globally in all but three countries. In New Zealand, nearly 8 out of 100 babies are born preterm and that number has been increasing annually by 2.1 per cent over the last 20 years.

The increasing preterm birth rate in high income countries is linked to the growing number of women choosing to have their families later and the increasing use of fertility drugs leading to multiple pregnancies. A recent trend in some countries to arrange inductions and caesareans which are not medically necessary is also noted as a cause of preterm births.

The authors of the report, which is the result of a joint effort of almost 50 organisations, are keen to improve neonatal health by reducing the number of babies born preterm. They’re calling for further research on risk factors, such as obesity, diabetes, hypertension and smoking, and on the interactions between these factors. Improving the ability to identify and screen women at risk will enable providers to work towards preventing health problems before they arise.

The full report can be viewed here.

American Journal of Obstetrics & Gynecology: Maternal Mortality

Tue, 13 Dec 2011 00:00:00 +1300

Perinatal & Maternal Mortality Review Committee

The reduction in maternal deaths in high-income countries is one of the greatest achievements of modern medicine. This article in the American Journal of Obstetrics and Gynecology looks at the reduction of maternal deaths over the last 100 years.

American Journal of Obstetrics & Gynecology: October 2011

Classifying contributory factors and potentially avoidable maternal deaths in NZ

Tue, 13 Dec 2011 00:00:00 +1300

Perinatal & Maternal Mortality Review Committee

Beyond the numbers: classifying contributory factors and potentially avoidable maternal deaths in New Zealand, 2006 - 2009. Cynthia Farquhar, Lynn Sadler, Vicki Masson, Gillian Bohm, Alastair Haslam.

This American Journal of Obstetrics and Gynecology article considers a new classification system for contributory factors in, and potential avoidability of, maternal deaths and to determine the contributory factors and potential avoidability among four years of maternal deaths in New Zealand.

It concludes that almost one-third of maternal deaths in New Zealand can be considered to be potentially avoidable. This methodology has the potential to develop areas for improvement in the quality of maternity care.

The article is attached below.

Call for nominations: Perinatal and Maternal Mortality Review Committee

Sat, 10 Dec 2011 00:00:00 +1300

Perinatal & Maternal Mortality Review Committee

The Health Quality & Safety Commission Board is seeking new member(s) for the Perinatal and Maternal Mortality Review Committee. There are up to four vacancies available.

The Perinatal and Maternal Mortality Review Committee is a mortality review committee established under Section 59e of the New Zealand Public Health and Disability Act 2000. The Committee is required to review and report on perinatal and maternal mortality and morbidity as directed by the Commission Board, for the purpose of improving quality and safety and saving lives.

If you would like to nominate any suitable candidates or apply directly, without nomination, please complete the Application Form following and provide a current curriculum vitae, to Deon York. Nominations close on Monday 13^th February at 5pm.

See the attached document for further information and an application form.

Call for nominations

New RCOG guideline on Antepartum Haemorrhage released

Fri, 09 Dec 2011 00:00:00 +1300

Perinatal & Maternal Mortality Review Committee

Click here to read the new guideline.

Australasian Maternity Outcomes Surveillance System (AMOSS) October 2011 newsletter

Sat, 29 Oct 2011 00:00:00 +1300

Perinatal & Maternal Mortality Review Committee

The Australasian Maternity Outcomes Surveillance System (AMOSS) studies rare and serious conditions in pregnancy. Maternity units throughout Australia and New Zealand (> 50 births/year) participate by completion of web surveys on specified conditions. Data from these incidence and case-control studies are then analysed to describe the diagnosis, management and outcomes of severe morbidity in pregnancy, and the associated burden of these events.

Click here for the AMOSS October newsletter.

Baby loss awareness week

Wed, 12 Oct 2011 00:00:00 +1300

Perinatal & Maternal Mortality Review Committee

This week is Baby Loss Awareness Week.

It takes place from 9th to 15th October every year, ending with International Pregnancy and Infant Loss Day on October 15th. It provides an opportunity for parents, families and whanau around New Zealand to come together and remember the lives of their babies who have died.

The lives and deaths of all babies, no matter what their gestation, length of life or how they died are acknowledged. For more information click here.

PMMRC newsletter for clinicians - issue 8

Sun, 04 Sep 2011 00:00:00 +1200

Perinatal & Maternal Mortality Review Committee

Attached is the PMMRC Newsletter Issue 8 for clinicians.

The newsletter discusses the 5^th PMMRC Annual Report, the PMMRC Annual Workshop, the work of the Maternal Mortality Review Working Group, Australasian Maternity Outcomes Surveillance Survey AMOSS Working Group, the Neonatal Encephalopathy Working Group and Sands.

There is also information on upcoming events and recent publications.

Presentations from the PMMRC workshop now available

Fri, 19 Aug 2011 00:00:00 +1200

Perinatal & Maternal Mortality Review Committee

The Perinatal and Maternal Mortality Review Committee workshop was held in Wellington on Thursday 11 August. Workshop topics included:

New Zealand perinatal and maternal mortality statistics
perinatal mortality and young mothers
early booking
potentially avoidable deaths - what can the sector do?

Presentations from the conference are now available to download.

Perinatal and Maternal Mortality in 2009

Thu, 28 Jul 2011 00:00:00 +1200

Perinatal & Maternal Mortality Review Committee

The Perinatal and Maternal Mortality Review Committee (PMMRC) has published its fifth annual report on the deaths of babies and their mothers in New Zealand.

PMMRC advises the Health Quality & Safety Commission on how to reduce these deaths.

The PMMRC report shows that perinatal mortality rates in 2009 were comparable with rates in Australia and the United Kingdom but also highlights the increased risks of stillbirth facing mothers who are young, poor, or Maori or Pacific.

“For the first time we are reporting that a number of perinatal deaths were potentially avoidable,” says PMMRC Chair, Professor Cynthia Farquhar. “Of all perinatal deaths 14 percent were thought to be potentially avoidable. That amounts to 98 lives that could have potentially been saved.

“We can also see that some groups of women and babies are particularly at risk – for example, teenage mothers – and more needs to be done to meet their specific needs during pregnancy and the period immediately afterwards.”

Professor Farquhar says New Zealand has very good maternity services but there is always room for improvement.

“This report aims to identify what maternity and neonatal services should focus on if we want to reduce perinatal and maternal deaths.”

Key findings of the report include:

In 2009 the perinatal related mortality rate was 11.3 per 1000 births, comparable with rates in Australia and the United Kingdom.
Teenage mothers (aged under 20) are at higher risk of stillbirth and neonatal death than mothers aged 20 to 39.
The stillbirth rate in 2009 was 6.3 per 1000 births. One quarter of stillbirths continue to be unexplained, and half of these occur at term.
Maori and Pacific mothers are more likely to have stillbirths and neonatal deaths than New Zealand European and non-Indian Asian mothers.
The maternal mortality rate in 2009 was 22 per 100,000 maternities. The 2009 rate was increased by four pandemic influenza A H1N1 maternal deaths in that year.
The most frequent causes of maternal death in New Zealand from 2006 to 2009 were suicide, pre-existing medical conditions, and amniotic fluid embolism.

Professor Farquhar says PMMRC is recommending a number of practical measures which it believes will help reduce the number of deaths of babies and mothers.

For example, it suggests establishing a national intersectoral working group to consider the best way of providing services to young mothers in order to better meet their needs.

It is also recommending measures to improve the recognition of women at increased risk of perinatal mortality, assessment of maternal mental health at the point of first contact with health services, and regular training in managing obstetric emergencies for all staff involved in the care of pregnant women.

Other key findings and recommendations can be found in the PMMRC report, available on the Health Quality & Safety Commission’s website.

“The death of a baby or mother is a tragedy and we need to learn from these deaths to make improvements that will, ultimately, save lives,” says Professor Farquhar.

“I’m confident this report makes a significant contribution to the sector’s understanding of why women and babies die, and PMMRC looks forward to discussing the issues raised here with clinical leaders and health managers.”

Mortality Definitions:

PMMRC reviews maternal deaths and all deaths of infants from 20 weeks gestation to 28 completed days after birth, or weighing at least 400g if gestation is unknown.

A maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management. It does not include accidental or incidental causes of death of a pregnant woman.

Maternities are all live births and all fetal deaths at 20 weeks or beyond, or weighing at least 400g if gestation was unknown. In 2009 the maternal mortality rate was calculated per 100,000 maternities.

Perinatal mortality is fetal and early neonatal deaths, from 20 weeks gestation until less than seven days of age or weighing at least 400g if gestation was unknown.

The perinatal-related mortality rate is fetal deaths (including terminations of pregnancy and stillbirths) and neonatal deaths (up to 28 days) per 1000 total babies born at 20 weeks or beyond, or weighing at least 400g if gestation is unknown.

Neonatal mortality is all infant deaths from live birth to 27 days of age inclusive.

Closing the gap: The Safe Childbirth Checklist from WHO

Fri, 04 Feb 2011 00:00:00 +1300

Perinatal & Maternal Mortality Review Committee

Globally, nearly half a million mothers are still dying in childbirth, almost 4 million newborns die in the neonatal period, and 1 million stillbirths occur each year despite the fact that most maternal and newborn deaths and a large percentage of stillbirths, are avoidable. These figures indicate that a majority of high-risk countries have achieved insufficient progress towards MDG 4 (reducing child mortality rates) and 5 (reducing the maternal mortality ratio), according to a recently released report on progress towards achieving the Millennium Development Goals.

Gaps in maternal and perinatal care practices at birthing sites worldwide are well-recognized and documented, yet there are no universally applied practice tools which clearly define minimum care standards and support their effective delivery. Proven interventions are relatively inexpensive and easy to perform but the unfortunate disparity between knowledge and practice has constituted a major barrier to improving outcomes associated with childbirth in parts of the world where mortality rates are highest.

Closing the gap: The Safe Childbirth Checklist

To address this, WHO Patient Safety has, over the past two years, worked with a broad network of stakeholders and international experts in maternal-newborn health to develop a transformative checklist tool that defines facility-based standards of care at the time of childbirth and supports their effective delivery. The Safe Childbirth Checklist Programme aims to help frontline health workers prevent avoidable childbirth-related mortality and morbidity.

This programme contains two main components:

Safe Childbirth Checklist with essential aspects of safe maternal and perinatal care, based on current guidelines published by WHO and others, data-driven literature and expert consensus; and
quality improvement programme, with the Safe Childbirth Checklist at its core, designed to maximize the likelihood of successful checklist implementation.

Results from pilot testing

The Safe Childbirth Checklist Programme is currently being pilot tested in a large community health centre in Karnataka, India, to assess how health-care workers adhere to critical safety practices and to see which factors influence the implementation of the checklist in this particular setting. Preliminary analyses suggest that health-care workers are more likely to successfully complete essential clinical care practices if they use the Safe Childbirth Checklist. WHO Patient Safety is exploring options for a larger trial to evaluate the impact of the Safe Childbirth Checklist on maternal and perinatal survival in high-risk settings.

Source of this article: http://www.who.int/patientsafety/news_events/news/childbirth_checklist/en/index.html