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Report shows significant reduction in stillbirths

Perinatal & Maternal Mortality Review Committee
23 June 2015

The rate of babies dying from 20 weeks of pregnancy to 28 days old (perinatal mortality rate) has fallen to the lowest number since reporting began in New Zealand in 2007.

The Perinatal and Maternal Mortality Review Committee’s (PMMRC’s) ninth annual report shows there was one death for every 100 babies born in New Zealand in 2013.

“Although the overall reduction in perinatal mortality is not statistically significant, any reduction is encouraging,” says PMMRC chair Dr Sue Belgrave.

The overall reduction in perinatal mortality included a significant reduction in stillbirths at term (after 37 weeks of pregnancy) from 117 in 2007 to 69 in 2013.

The greatest reduction in stillbirths came from fewer babies dying due to a lack of oxygen at birth (hypoxic peripartum deaths), with an 80 percent fall compared to the 2007-2009 period. There was also a 30 percent reduction in unexplained antepartum deaths (babies dying before birth without a known cause).

Dr Belgrave says spontaneous preterm births are the second highest cause of perinatal death in New Zealand and a special focus of this year’s report.

“These deaths are more common among smokers, mothers living with socioeconomic deprivation, young mothers, Māori and Pacific mothers and in multiple pregnancies,” she says.

“It may be possible to reduce the risk of preterm birth for some women. For example, 34 percent of mothers whose babies died after a spontaneous preterm birth were smokers. This is higher than the rate of smoking for New Zealand mothers overall (15.3 percent). These mothers need to receive as much help and support as possible to stop smoking.”

The PMMRC has recommended all maternity care providers identify women with modifiable risk factors for perinatal-related death and work with them to address these.

This includes taking folic acid prior to and during early pregnancy and appropriate care pre-pregnancy for known medical diseases such as diabetes.

“Early access to antenatal care is important so women get appropriate pregnancy care including advice on smoking cessation, ideal weight gain and awareness of risk factors such as bleeding and decreased fetal movements,” says Dr Belgrave.

The PMMRC has consistently found the leading cause of maternal death directly related to pregnancy is as a result of amniotic fluid embolism. The rate in New Zealand is 5.6 times higher than the rate reported in the United Kingdom.

“This finding is of concern and the committee plans to further review all cases of amniotic fluid embolism reported to the PMMRC – both deaths and women who survived – with a particular focus on identifying areas for improvement in care,” says Dr Belgrave.

Some DHBs have undertaken work recommended by the committee in previous reports, and future reductions in their mortality rates may be a reflection of this.

Two Auckland-based DHBs – Counties Manukau and Auckland DHB – have instituted measures within the past year aimed at helping mothers and babies.

“The PMMRC is encouraged to see implementation of previous recommendations within several DHBs,” says Dr Belgrave.

“Auckland DHB has commissioned a mother baby unit and Counties is implementing recommendations from its external review.”

The PMMRC’s ninth annual report is available to download below.

The report recommendations include:

  • As a matter of urgency, the Ministry of Health update the National Maternity Collection, including the ethnicity data as identified by the parents in the birth registration process.
  • That all maternity care providers identify women with modifiable risk factors for perinatal related death and work individually and collectively to address these.
  • Offer education to all clinicians so they are proficient at screening women, and are aware of local services and pathways to care, for the following:
    • family violence
    • smoking
    • alcohol and other substance use.
  • That multi-disciplinary fetal surveillance training be mandatory for all clinicians involved in intrapartum care.
  • There is observational evidence that improved detection of fetal growth restriction, accompanied by timely delivery, reduces perinatal morbidity and mortality. The PMMRC recommends that assessment of fetal growth should incorporate a range of strategies.
  • Seasonal or pandemic influenza vaccination is recommended for all pregnant women any time in pregnancy and for women planning to be pregnant during the influenza season.
  • All pregnant women with epilepsy on medication should be referred to a physician.
  • Widespread multidisciplinary education is required on the recognition of neonatal encephalopathy with a particular emphasis on babies with evidence of intrapartum asphyxia (eg, babies who required resuscitation) for all providers of care for babies in the immediate postpartum period.
  • That all DHBs review local cases of neonatal encephalopathy.

Each year, the Perinatal and Maternal Mortality Review Committee (PMMRC) releases a report on maternal and perinatal deaths. It advises the Health Quality & Safety Commission on how to reduce these deaths.

  • A perinatal death is the death of a baby from 20 weeks gestation (pregnancy) up to 28 days after birth, or weighing a least 400g if gestation is unknown.
  • A neonatal death is the death of a baby from live birth to 27 days of age.
  • A stillbirth is a baby who dies in the womb and is born from 20 weeks of pregnancy without any signs of life.
  • An antepartum death is a baby dying at any time before birth, without a known cause.
  • A death associated with a spontaneous preterm birth is a baby born too early to survive.
  • A maternal death is the death of a woman while pregnant or within 42 days of the end of pregnancy.

Download the Ninth PMMRC report questions & answers.

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