Perinatal mortality is an important measure of obstetric and neonatal care. The World Health Organization defines perinatal mortality as the "number of stillbirths and deaths in the first week of life per 1,000 live births, with the perinatal period commencing at 22 completed weeks of gestation and ending seven completed days after birth”. 

Regular audit of perinatal mortality can identify modifiable risk factors which decrease the risk of perinatal death and also inform clinical practice. Over the past decades, the rate of perinatal mortality has decreased substantially in high-resource countries and has been partly attributed to the proliferation of regular perinatal mortality audits.

Thus, given the importance of such audits, the NPEC has provided an annual national assessment of perinatal mortality in Ireland (from a clinical viewpoint) since 2008.  It has done so with the guidance and collaboration of the NPEC Perinatal Mortality National Clinical Audit Group (that is, a specialist multidisciplinary group whose aim is to develop a comprehensive national audit system of perinatal mortality in Ireland). 

The NPEC uses the Perinatal Mortality National Clinical Audit Notification Form to collect its clinical audit data.  The form provides a robust framework for evaluating obstetric and neonatal practices.

For further information on the Perinatal Mortality National Clinical Audit, please contact Edel Manning (e.manning@ucc.ie).

Latest Key Findings for the year 2021

Perinatal Mortality Rate (PMR)

• The perinatal mortality rate (PMR) was 5.87 per 1,000 total births in 2021. While a slight decrease in the PMR was observed in 2021, it is not statistically significant compared to previous years 2020 and 2019. Corrected for Major Congenital Anomaly (MCA), the PMR was 3.78 per 1,000 total births.
• The stillbirth rate associated was 3.91 per 1,000 total births and the early neonatal death rate was 1.96 per 1,000 live births.
• The level of variation in the rate of PMR between maternity units was lower in 2021 compared to 2020. When adjusted for MCA and in-utero transfers, no maternity unit was considered an outlier as defined by NOCA policy. 

Maternal characteristics

• Maternal age (greater than 40 years) and overweight were associated with an increased risk of perinatal mortality.
• While the numbers involved were small, Irish Traveller, Asian and Black ethnicities were overrepresented in the mothers who experienced perinatal deaths in 2021.
•  Twenty percent (20.1%) of mothers experiencing perinatal loss booked into hospital for antenatal care before 12 weeks gestation, and more than seventy percent (70.8%) attended between 12- and 19-weeks gestation.

Infant characteristics

• As in previous reports, low birthweight centiles were associated with perinatal deaths in 2021, particularly stillbirths.
• An increased risk of perinatal mortality with multiple births compared to single pregnancy was again identified in 2021. Perinatal death from multiple births accounted for 13.7% of all perinatal deaths.
• The rate of autopsy uptake continues to be higher in stillbirths compared to neonatal deaths.

Stillbirths

• The stillbirth rate associated was 3.91 per 1,000 total births
• Stillbirths accounted for 66.7% of perinatal deaths in 2021.
• In contrast to previous years, specific placental conditions was the most common cause of death in stillbirths (32.8%) followed by major congenital anomaly (28.6%).
• Intrapartum deaths accounted for 5.9% of stillbirths. This rate is similar to previous years.

Early neonatal deaths 

• The early neonatal death rate was 1.96 per 1,000 live births.
• Early neonatal deaths accounted for 33.3% of perinatal deaths in 2021. 
• Major congenital anomaly was the most common cause of early neonatal death (49.6%) followed by Respiratory disorders (26.1%), primarily due to severe pulmonary immaturity. 
• More than half (53.4%) of early neonatal deaths occurred within 24 hours of delivery.

Late neonatal deaths 

• There were 40 late neonatal deaths reported to the NPEC in 2021.
• Major congenital anomaly was the most cause of late neonatal death (32.5%) followed by Respiratory disorders (17.5%)
• In contrast to previous reports, the proportion of late neonatal deaths was found to increase across the second and third weeks of life in 2021 (i.e., 42.5% in week two and 57.5% in week three).

Early neonatal deaths with a birthweight <500g and a gestational age at delivery <24 weeks

• There were 47 early neonatal deaths with a birthweight < 500g and a gestational age at delivery < 24 weeks in 2021.
• The majority (63.8%) of these babies delivered between 20 and 22 weeks gestation and one quarter (25.5%) delivered at less than 20 weeks gestation.
• The assigned neonatal cause of death was pre-viable for the majority of cases (72.3%) followed by severe pulmonary immaturity (14.9%)