MBRRACE-UK: Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK

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THIS IS NOT THE MBRRACE-UK ONLINE REPORTING SYSTEM. IF YOU WISH TO REPORT A CASE PLEASE GO TO: www.mbrrace.ox.ac.uk

MBRRACE-UK release “Saving Lives, Improving Mothers’ Care - Surveillance of maternal deaths in the UK 2012-14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-14” 

The most recent MBRRACE-UK confidential enquiry report into maternal deaths was launched on the 7th December 2016. The report presents the findings of maternal mortality surveillance 2012 to 2014 in the UK and the lessons learned from the confidential enquiries into maternal deaths from cardiovascular causes, blood pressure disorders of pregnancy, early pregnancy causes together with messages for critical care.

For women in the United Kingdom, giving birth remains safer than ever - less than 9 in every 100,000 women die in pregnancy and around childbirth. Overall the maternal mortality rate in the UK continues to fall although the reduction reported this year is smaller than previously. Deaths from ‘indirect’ causes remain the largest group of deaths; these are deaths from conditions not directly due to pregnancy but existing conditions which are exacerbated by pregnancy, for example, women with heart problems. Given the very gradual rate of decline and the complexity of medical conditions now experienced by women during pregnancy, achieving the Government’s ambition to reduce maternal deaths by 20% by 2020 and 50% by 2030 presents a major challenge for the health service which will require co-ordination of care across multiple specialities.   

The care of more than 150 women who died from heart disease during pregnancy or in the year after giving birth between 2009 and 2014 was reviewed in detail. Heart disease is the leading cause of maternal death during or up to six weeks after the end of pregnancy. The enquiry found that in some cases diagnosis of heart disease in young women was overlooked and for others who knew they had heart disease, care was fragmented. Preventing women from dying from heart disease is essential to efforts to continue to reduce the number of women dying.  

Despite blood pressure problems – pre-eclampsia and related complications – being very common in pregnancy, maternal deaths from these conditions are at their lowest rate ever. Now in the UK less than one woman in every million women dies from a blood pressure disorder of pregnancy. This is less than one woman every year compared with more than one woman every hour globally who dies from this condition. This is a great success of maternity care in the UK.

The report also contains messages for the future care of women with early pregnancy conditions including ectopic pregnancy and those women in pregnancy or soon after who require critical care.

Clear pointers for improving services and care by individual practitioners were identified and these are discussed in detail alongside the findings in the full report which can be downloaded here.

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Call for topic proposals for the ‘maternal morbidity’ confidential enquiry in 2018 – now open

In addition to carrying out confidential enquiries into maternal deaths, we are undertaking confidential enquiries into a rolling programme of selected maternal morbidity topics.

We would like to invite new topic proposals from individuals and organisations for the maternal morbidity confidential enquiry which will run during 2018 and report in 2019. This invitation will be open from now until 31st December 2016.

More information is available on the topic proposal page.

MBRRACE-UK release “Perinatal mortality Surveillance Report – UK Perinatal Deaths for Births from January to December 2014”

There has been slight fall in the rates of stillbirths and neonatal deaths in the UK compared with rates in 2013 which continues the downward trend in rates from 2003 onwards. However, the overall trend masks variations in rates across the UK. These variations remain despite the fact that a novel method of analysis introduced by MBRRACE-UK has been used to take into account aspects of case-mix to allow ‘fairer’ comparisons of mortality rates between services provided for high risk and low risk pregnancies. The new analytical method which divides the figures for Trusts and Health Boards into five groups based on the services they deliver, also takes into account the random variation in rates which can occur because of the small number of births which occur in some areas.

The effect of gestational age on perinatal mortality rates was also explored in more detail in this report. This shows that around two thirds of stillbirths and neonatal deaths were of babies born preterm indicating that initiatives to reduce stillbirth and neonatal deaths must include a focus on reducing preterm birth as well as ensuring high quality care for women whose pregnancies reach full term. These findings are reported in the second perinatal mortality surveillance report published by the MBRRACE-UK team on the 17th May 2016 and launched at a meeting at the Royal College of Obstetricians and Gynaecologists in London.

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Download the report

'MBRRACE-UK' is the collaboration appointed by the Healthcare Quality Improvement Partnership (HQIP) to continue the national programme of work investigating maternal deaths, stillbirths and infant deaths, including the Confidential Enquiry into Maternal Deaths (CEMD). The programme of work is now called the Maternal, Newborn and Infant Clinical Outcome Review Programme (MNI-CORP).

The aim of the MBRRACE-UK programme is to provide robust information to support the delivery of safe, equitable, high quality, patient-centred maternal, newborn and infant health services.

Notifications of maternal deaths should be made by ringing the Oxford MBRRACE-UK office on 01865 289715.

Reporting of stillbirths, perinatal deaths and infant deaths is via the MBRRACE-UK online reporting system available here: www.mbrrace.ox.ac.uk. Guidelines for using the system can be downloaded here: MBRRACE online data entry guidebook (release April 2013 v101) .

Units are asked to review their access to the internet to ensure that the web browser they are using meets the specifications required to enter data via the MBRRACE-UK system; older versions of software are not suitable as they do not meet NHS data security requirements. Please view the IT specification page to check this for your Unit.

Please also view the MBRRACE-UK IT deployment page which outlines more information about the deployment of the MBRRACE-UK data collection system and may be helpful for IT staff in Units.

Information about why we are collecting non-anonymised information and details about the approvals we have to collect this information is provided on the 'Why we need identifiers' page.

The topics selected for future confidential enquiries are available on the Topic Proposals page.

Information about the new MBRRACE-UK surveillance data collection system

  • The new MBRRACE-UK system applies to England, Wales and Scotland; modified arrangements are in place for Northern Ireland.
  • Every Unit should have nominated staff responsible for notifying deaths via the new MBRRACE-UK system. Nominated staff members need to be authorised by senior staff in their Unit by completing the MBRRACE-UK registration form .
  • Maternal deaths can be notified by ringing the Oxford MBRRACE-UK office on 01865 289715 – this arrangement does not apply to any perinatal or infant deaths.
  • Maternal deaths eligible for notification are:
    • All deaths of pregnant women and women up to one year following the end of the pregnancy (regardless of the place and circumstances of the death).
  • Perinatal deaths and infant deaths should be reported via the online data collection system available here: www.mbrrace.ox.ac.uk
  • Deaths eligible for notification from 1stJanuary 2013 onwards are:
    • Late fetal losses – the baby is delivered between 22+0 and 23+6weeks of pregnancy showing no signs of life, irrespective of when the death occurred.
    • Terminations of pregnancy - resulting in a pregnancy outcome from 22+0 weeks gestation onwards.
    • Stillbirths – the baby is delivered from 24+0 weeks gestation showing no signs of life.
    • Early neonatal deaths – death of a live born baby (born at 20 weeks gestation of pregnancy or later or 400g where an accurate estimate of gestation is not available) occurring before 7 completed days after birth.
    • Late neonatal deaths – death of a live born baby (born at 20 weeks gestation of pregnancy or later or 400g where an accurate estimate of gestation is not available) occurring between 7 and 28 completed days after birth.
    • Post-neonatal deaths – We are no longer collecting information for post-neonatal deaths because of the difficulty in ensuring complete data collection from the wide variety of places of death for these cases.
    • Note: Terminations of pregnancy: We are only interested in collecting information about terminations of pregnancy that are cases of late fetal loss, stillbirth or neonatal death. Therefore ALL terminations from 22+0 weeks are cases which should be notified plus any terminations of pregnancy from 20+0 weeks which resulted in a live birth ending in neonatal death.
    • Note: Births showing no signs of life (stillbirths and late fetal losses): All births delivered from 22+0 showing no signs of life are eligible for notification irrespective of when the death occurred. Please ensure that both date of delivery and date of confirmation of death are reported for these cases. Recently there has been considerable discussion about these births by the RCOG and other professional bodies. In an effort to ensure complete data collection in line with the World Health Organisation guidelines and to allow international comparisons, the eligibility criteria for MBRRACE-UK Perinatal Death Surveillance System is based on gestation at delivery irrespective of when the death occurred.

Please also see our Frequently Asked Questions page.

Assessors for the Confidential Enquiries into Maternal and Infant Deaths

With the exception of a small number of specific specialties we have recruited most assessors for the Confidential Enquiries into Maternal Death. Any future positions will be advertised here.

Contact details

  • Brenda Strohm  (brenda.strohm@npeu.ox.ac.uk) Maternal Programme Manager, Oxford MBRRACE-UK office
  • Tel: 01865 617771
  • Pauline Hyman-Taylor (pht4@leicester.ac.uk) Perinatal Programme Manager, Leicester MBRRACE-UK office
  • Tel: 0116 252 5425