MMBRACE 2018 Flashcards
The full report
How many maternal deaths were reported in 3014_2016
9.8 per 100 000
During or end of pregnancy
or 6 weeks after childbirth
Preterm deaths_ how many
About 70% of all extended
perinatal deaths occur before term and
nearly 40% occur extremely preterm at
less than 28 weeks’ gestation
What is the rate of congenital anomslies in prrterm deaths
congenital anomalies at 1 in 6 of all
extended perinatal deaths
for some Trusts and
Health Boards, particularly the tertiary
centres with neonatal surgical provision,
and in Northern Ireland where termination
of pregnancy is only legal in exceptional
circumstances, the proportion of their
deaths associated with congenital
anomalies will be much higher than 1 in6
What is the death rate reduction in twins
halving in the rate of stillbirths in twins and although the reduction in neonatal deaths is smaller at 30% both represent a statistically significant decrease
What is the PMRT
national Perinatal Mortality
Review Tool (PMRT) earlier this year is
designed to support high quality,
multidisciplinary local review of the care
provided at all stages of the maternity and
neonatal pathway on the basis of “review
once, review well”.
Late fetal loss
delivered between 22+0 and 23+6
weeks gestational age showing no
signs of life, irrespective of when the
death occurred.
Stillbirth
delivered at or after 24+0 weeks
gestational age showing no signs of
life, irrespective of when the death
occurred.
Intrapartum stillbirth
A baby delivered at or after 24+0 weeks gestational age showing no signs of life and known to have been alive at the onset of care in labour.
Neonatal death
liveborn baby (born at 20+0 weeks gestational age or later, or with a birthweight of 400g or more where an accurate estimate of gestation is not available), who died before 28 completed days after birth.
Early neonatal death
A liveborn baby
(born at 20+0 weeks gestational age
or later, or with a weight of 400g or more
Perinatal death
A stillbirth or
early neonatal death.
Extended perinatal death
A stillbirth or
neonatal death.
Any change in extended perinatal mortality
No
There has been little change in the
rate of extended perinatal mortality in the
UK in 2016: 5.64 per
1,000 total births for babies born at 24+0
weeks gestational age or later compared
with 5.61 in 2015. However this
represents an overall fall from 6.04 deaths
per 1,000 total births in 2013.
Still birth rate in uk
The stillbirth rate for the UK in 2016
has remained fairly static at 3.93 per 1,
000 total birth
neonatal mortality
neonatal mortality in the UK has shown a slow but steady decline over the period 2013 to 2016 from 1.84 to 1.72 deaths per 1, 000 live births.
Variation in neonstal mortality rated
the
reported neonatal mortality rates show a
wide variation, with rates of between 1.
78 and 3.52 per 1,000 live births in those
with level 3 Neonatal Intensive Care
Units (NICUs) and surgical provision and
significantly lower rates in the small units
delivering less than 2,000 births per
annum (0.97 to 1.18).
What are the stabilised & adjusted
extended perinatal mortality rates
for
commissioning organisations ranging from
5.32 to 6.29 deaths per 1,000 total birth
Consent for post mortems
small increase in
the rate of consent for post-mortem for
stillbirth from 47.2% to
49.4% (2014 to 2016)
Neonatal deaths
decrease for neonatal deaths from 29.1%
to 28.6%
perceng of placental histology
which placental histology is carried out: 89.
9% in 2016 compared to 88.8% in 2015.
Reduction in twin deaths
2014 to
2016, reducing from 2.8 (95% CI, 2.47 to
3.17) to 1.6 (95% CI, 1.36 to 1.88) for
stillbirths and from 4.91 (95% CI, 4.20 to
5.73) to 3.33 (95% CI, 2.80 to 3.98) for
neonatal deaths.
Key recommendation
1need to be focused on
reducing stillbirths and continuing the
decreased mortality rates
key recommendation 2
facilitate the close working between MBRRACE-UK and the Perinatal Mortality Review Tool (PMRT), within Trusts and Health Boards all stillbirths and neonatal deaths should be notified to MBRRACE-UK via the joint web-based system as soon as possible following the death.
Key recommendation 3
Commissioning organisations should
review both their crude and their stabilised
& adjusted mortality
rates to facilitate the identification of
high risk populations and to target
interventions for known inequalities.
Key recommendation 4
Trusts and Health Boards with a
stabilised & adjusted stillbirth, neonatal
mortality or extended
KR5
Irrespective of where they fall in the spectrum of national performance all Trusts and Health Boards should use the national PMRT to review all their stillbirths and neonatal deaths.
KR6
Trusts and Health Boards should
ensure that the data provided to
MBRRACE-UK is of the highest
quality. T
KR7
National health forum
KR8
Public health initiatives should continue to be developed to reduce the impact of known risk factors for stillbirth and neonatal death; for example, smoking and obesity
KR9
Trust and Health Board Perinatal
Review groups should focus on the quality
of cause of death coding.
KR10
Parents provided with unbiased counselling for
post-mortem to enable
them to make an informed decision
KR12
Placental histology should be undertaken for all stillbirths and if possible all anticipated neonatal deaths, preferably by a perinatal pathologist.
KR13,
Trusts and Health Boards should endeavour to improve the quality and completeness of data reported to MBRRACE-UK and for routine inpatient, and birth and death registration purpose
preterm stillbirths
among babies born preterm to nearly
50% of stillbirths and late fetal losses
and 55% of neonatal deaths.
Government initiatives to reduce stillbirth
and neonatal death rates, if they are to
succeed, will need to focus on ways of
reducing the number of preterm births.
What should organisations do
However, as a
first step for any commissioning
organisation, Trust or Health Board
whose performance falls in the red band
a more detailed local review of their data
quality and investigation of local factors
should be carried out to identify if these
issues explain the high rate. For
example, data quality might not be
sufficiently good to allow for the effect of
the proportion of mothers who for legal,
cultural or religious reasons choose to
continue with a pregnancy affected by a
severe congenital anomaly
