In addition the programme will also include a series of themed topic-based confidential clinical reviews of serious maternal and infant morbidity, and stillbirths. As near-miss events and cases of serious morbidity are more numerous than deaths, lessons can be learned quickly and improvements in care can be instituted more rapidly following their investigation.
The first two topics for themed review have been selected by the MBRRACE-UK Independent Advisory Group. The maternal themed review topic is sepsis and the perinatal topic is infants with congenital diaphragmatic hernia. The confidential case review methods are currently being finalised; we will be working with professional organisations to develop selection criteria for case assessors who may be members of review panels, and further information for potential panel members will be available on the MBRRACE-UK website later in the year. We will be seeking ideas for future review topics shortly and information about this will be available on the MBRRACE-UK website shortly along with details of the selection process which will be used to agree on topics from those suggested.
The programme of work – maternal deaths
The MBRRACE-UK programme of work will involve continuing the national Confidential Enquiry into Maternal Deaths (CEMD).
The most recent CEMD report issued in March 2011 reported deaths of women which occurred in the triennium 2006-2008. MBRRACE-UK regards safeguarding the continuity of CEMD as having the highest priority. For this reason our first task since taking responsibility for CEMD has been to evaluate the work needed to begin the confidential case reviews for women who died from January 2009 onwards including all late maternal deaths. Please note that this is change from the most recent data collection undertaken by CMACE and all deaths from 43 days to one year after delivery will now be included.
We estimate that for 2009-2011 85% of maternal deaths have been identified although complete information is only available for about 52%. We will be in touch with Trusts shortly to confirm that they have reported all the maternal deaths which occurred in women who delivered in their Units since January 2009 and to start to collect the detailed clinical information and anonymised copies of case notes in preparation for confidential reviews which will begin in 2013. We aim to report on these deaths in 2014.
The programme of work – stillbirths and infant deaths
The MBRRACE-UK programme of work will involve national surveillance of late fetal losses, stillbirths and infant deaths. Evaluation of the data relating to perinatal deaths in England which occurred during 2011 and were notified via the MPMN portals has indicated that there is about a 30% shortfall in the number of cases notified. The funding bodies have therefore made the decision that MBRRACE-UK should concentrate on data collection in 2012 and for the future rather than trying to retrospectively identify missing cases and collect the missing information for 2011. Importantly, however, the information about the babies who died in 2011 will be used to identify those babies whose deaths will be included in the topic-based confidential case reviews.
A report on perinatal deaths in 2011 which occurred in Wales will be issued by the All Wales Perinatal Survey in October 2012 and will be available at: http://medicine.cf.ac.uk/awps/
Regional structures have been maintained in Northern Ireland to support the collection of perinatal and maternal mortality data through the NI Maternal and Child Health Office (NIMACH) which sits in the NI Public Health Agency. A complete perinatal mortality dataset has been maintained since 2009 and a Northern Ireland report on perinatal mortality for 2010 and 2011 will be finalised by the end of 2012.