While we welcome the reported decrease in perinatal mortality for 2008, there is no room for complacency about stillbirths and neonatal deaths in the UK.
Janet Scott, Research Manager, Sands comments: “The reported fall in stillbirth rates is too small to give much cause for optimism; the neonatal mortality rates continue to fall, which is welcome, but much more can be done to bring the rates down further. Meanwhile the actual numbers of babies dying each year are tragically as high as ever due to the UK’s rising birth rate, with 4,000 babies stillborn every year, and a further 2,500 babies dying shortly after birth.”
The number of babies that start labour apparently healthy and then die (intrapartum related deaths) remains stubbornly consistent with around 500 babies dying each year, some of which stem from untoward incidences during delivery. Sands supports CMACE’s call for each of these baby deaths to be fully investigated and lessons learnt to prevent avoidable tragedies for babies and their parents in the future.
We are also very concerned that the rising birth rate and increasingly at risk maternal population (the risk factors for stillbirth and premature births including obesity, smoking, social deprivation, teenage pregnancies and older mothers are all rising) means pressure on maternity services is growing.
Janet Scott continues: “Maternity services must be designed to meet needs without compromising on safety yet Sands is already hearing alarming stories of cuts to maternity services, when the numbers of babies dying is still not being properly addressed. It is therefore more important than ever to ensure the deaths of babies are not sidelined but treated with the same priority as any other death. The wide variation in the stillbirth and neonatal death rates across the regions also raises questions as to whether there are regional variations in the quality of maternity care being offered. We would like to see further work to understand fully what is behind the figures.”
A new system for recording the cause of deaths has been introduced which brings an improvement in the breakdown of the clinical causes of stillbirths and in particular highlights the importance of identifying babies who are not growing well in the womb or who are at risk of placental failure. These are babies who are normally formed and whose deaths, with improved monitoring and intervention, could potentially be avoided.
Nevertheless, 23% of stillbirths still remain unexplained and we are still very far from having a proper understanding of what is causing many stillbirths, nor how to accurately predict and intervene in pregnancies which are at risk. Research funding is urgently needed if we are to answer these questions.
Please see below the press release issued by CMACE on the Perinatal Mortality Report 2008:
CMACE release: UK stillbirth rate is improving – 21 July 2010
The Centre for Maternal and Child Enquiries (CMACE) publishes its Perinatal Mortality 2008 report today. The key findings are:
- The perinatal mortality rate in the UK continues to fall from 8.3 per 1,000 total births in 2000 to 7.5 per 1,000 in 2008
- For the second consecutive year, the trend in the stillbirth rate since 2000 has shown a significant decrease, from 5.4 (2000) to 5.1 (2008) per 1,000 total births
- The stillbirth and neonatal mortality rates for twin births have also fallen
- There is wide variation in the stillbirth and neonatal mortality rates across the regions
- There is also variation in stillbirths and neonatal mortality rates from congenital anomalies, linked to region.
It is unclear why some regions have a higher perinatal mortality rate over others. Possible reasons include reporting differences and variations in the risk profiles of women and babies cared for.
As with previous reports, the socio-demographic trends from the data collected show that:
- The incidence of stillbirths and neonatal deaths is higher in younger (<25 years old) and older (>40 years old) mothers
- Mothers living in the most deprived areas are more likely to have a stillbirth (1.7 times more likely) or neonatal (2.5 times more likely) death compared to mothers in the least deprived areas
- Mothers of ethnic origin are more likely to have stillbirths and neonatal deaths.
The clinical characteristics show that:
- A quarter of mothers who had a stillbirth or neonatal death had a BMI of 30 or more
- 54% of stillbirths and 57% of neonatal deaths occurred even though the mothers had booked their antenatal care before 12 weeks
- A fifth of stillbirths and neonatal deaths occurred in mothers who smoked during pregnancy
- The common previous pregnancy problems associated with stillbirths for mothers were identified as: pre-term birth or third trimester loss (6%), pre-eclampsia (6%) and recurrent miscarriage (4%)
- The pre-existing medical conditions for mothers with previous pregnancies who had stillbirths were identified as: psychiatric disorders (4%), diabetes (3%) and endocrine disorders (2%)
- These problems and conditions are similar for multiparous mothers whose babies died during the neonatal period.
This current report marks the use of a new classification system to record all conditions that arose during the pregnancy that caused or was associated with death. The main causes/associated factors of stillbirth were:
- Antepartum or intrapartum haemorrhage (13%), intra-uterine growth restriction (IUGR – 10%) and specific placental conditions (9%).
As a result of this new system of recording the cause of deaths, CMACE is now collecting better data which will help doctors detect emerging patterns and understand why stillbirths occur. For example, this is the first year which CMACE has reported on whether the placenta was sent to the histology department for pathological examination. There was also a slight increase in the number of post-mortem examinations offered and consented. In previous reports, 50% of stillbirths were classified as ‘unexplained’. The figure has fallen to 23% due to the change in the classification.
CMACE have developed recommendations for the report in response to these findings. The purpose of providing these recommendations is to highlight areas requiring better clinical practice. Two are mentioned below:
- The practice of reporting neonatal deaths of pre-viable babies born before 22 weeks varies from hospital to hospital and this shows up in regionally reported neonatal mortality rates. This is because assessments are done differently and this effects the classification and recording of births. CMACE recommends that national guidelines are developed so that greater consistency occurs.
- There are around 500 intrapartum deaths each year, some of which stem from untoward incidences occurring during delivery. CMACE recommends that term intrapartum deaths which are not attributed to congenital anomaly are fully investigated locally so that lessons can be learned.
CMACE provides perinatal mortality reports to all UK nations, English SHAs and maternity providers with specific datasets that are localised to a region or catchment area. This is to enable maternity units to review and monitor their own rates so that processes and procedures can be put in place quickly to improve services.
Dr Jon Dorling, co-author of the CMACE report said “This year’s report shows conclusive evidence of improving stillbirth and neonatal mortality rates. The new classification of cause of death now gives us more information especially for intrapartum deaths. However, there remains the need to explore in more detail variations in death rates and risk factors with the hope of continuing these improvements in stillbirths and neonatal deaths.”
Richard Congdon, CMACE Chief Executive said “Although there is encouraging progress in reducing perinatal mortality in the UK, the substantial variations between the different parts of the UK and between people depending on factors such as lifestyle and ethnicity, show that significant further improvement is possible.”
Professor Sir Sabaratnam Arulkumaran, President of the Royal College of Obstetricians and Gynaecologists (RCOG) said “Perinatal deaths are difficult for women and their families to come to terms with because of the grief that follows such deaths. The new recommendations developed by CMACE, if followed by Trusts, will help healthcare professionals to build a clearer picture as to why such tragic deaths sometimes occur. We will work with CMACE and our healthcare colleagues to ensure that medical problems are identified so that appropriate care can be provided to women. In the meantime, these recommendations will also help us to chart progress made as we work together to lower the stillbirth rates.”
To view the report, please click here.
To speak to Jon Dorling, Richard Congdon or Professor Sir Arulkumaran, please call 020 7772 6446.