The report shows a slight fall in the rates of stillbirth and neonatal death in the UK compared with 2013, continuing the downward trend in rates seen since 2003. However, this 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 takes 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 small numbers of births in some areas.
Led by the MBRRACE-UK collaborators based in the Department of Health Sciences at the University of Leicester, the report also explores the effect of gestational age on perinatal mortality rates in more detail. This shows that around two thirds of stillbirths and neonatal deaths were 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 all women whose pregnancies reach full term. Read the full report.
The purpose of this Supplementary Report is to enable individual Trusts and Health Boards to understand their local stillbirth, neonatal death and extended perinatal death mortality rates and to give local teams an insight into clinical performance based not just on crude mortality rates, but also having taken account of at least some of the important socio-demographic factors that influence pregnancy outcomes.
Importantly the figures for individual Trusts and Health Boards are compared with other Trusts and Health Boards which provide care to women with similarly high or low risk pregnancies. This is based on the highest level of complex neonatal care provision, and for those organisations which do not provide high level complex neonatal care it is based on the number of women who deliver each year in their organisation. NHS Trusts and Health Boards have then been rated within these groups, comparing their mortality rate to the group average using the traffic light system used in the main report published in June. Guidance is provided to Trusts and Health Boards as to the action they should take based on their rating.
“Saving Lives, Improving Mothers’ Care - Surveillance of maternal deaths in the UK 2011-13 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-13”
Led by the MBRRACE-UK team at the National Perinatal Epidemiology Unit at the University of Oxford this report details the findings of maternal mortality surveillance 2011 to 2013 in the UK and the lessons learned from the confidential enquiries into maternal deaths of women with mental health-related problems, substance misuse, cancer and blood clots and women who died by homicide.
Overall, the maternal mortality rate in the UK continues to fall largely as a result of a reduction in deaths from ‘direct’ pregnancy causes. However the rate of deaths from ‘indirect’ causes has not reduced significantly. These are deaths from conditions not directly due to pregnancy but existing conditions which are exacerbated by pregnancy, for example, women with heart problems. More of these deaths will need to be prevented in the future to reach the UK Government target of a 50% reduction in maternal deaths by 2030.
The care of more than 100 women who died by suicide during pregnancy or in the year after giving birth between 2009 and 2013 was reviewed in detail. One in eleven of the women who died during or up to six weeks after pregnancy died from mental health-related causes. However, almost a quarter of all maternal deaths between six weeks and a year after birth are related to mental health problems, and one in seven of the women who died in this period died by suicide. Although severe maternal mental illness is uncommon, it can develop very quickly in women after birth; the woman, her family and mainstream mental health services may not recognise this or move fast enough to take action.
The care for women with substance misuse problems and those living socially complex lives was also reviewed. The messages for future care echoed those for women with mental health problems, including the need for joined up multi-agency care to ensure that these women do not fall through the cracks between services. The report also contains messages for the future care of women with cancer and those at risk of blood clots, which is the primary cause of ‘direct’ maternal deaths.
Led by the MBRRACE-UK team at the University of Leicester, this report details the findings from review of 130 term stillbirths, of which 85 were examined in detail by a panel of clinicians including midwives, obstetricians and pathologists.
The enquiry found that half of all term, singleton, normally-formed, antepartum stillbirths had at least one element of care that required improvement which may have made a difference to the outcome. Opportunities missed in two thirds of cases included: correctly identifying women with risk factors for diabetes and offering them testing; and appropriate screening and monitoring the growth of the baby. Almost half of the women had contacted their maternity units with concerns that their baby’s movements had slowed, changed or stopped. In half of these cases there were missed opportunities to potentially save the baby including a lack of investigation, misinterpretation of the baby’s heart trace or a failure to respond appropriately to other factors. Internal hospital reviews were only documented for a quarter of the deaths and their quality was highly variable. A post-mortem was carried out in only half of the cases, but most were of satisfactory or good quality. A generally good standard of bereavement care was provided for parents immediately following birth, including the offer of the opportunity to create memories of their baby. Read the full report for the detailed findings and the key actions for improving services to help prevent the terrible heartache experienced by three families every day across the UK. Follow us on Twitter @TIMMSleicester@mbrrace