National systems, reviews and audits

Perinatal mortality is one of many key indicators of the quality of health care in pregnancy and childbirth. An estimated 5.3 million perinatal deaths occur worldwide each year. In Ireland, there were 335 perinatal deaths reported in 2019; the perinatal mortality rate was 6.25 per 1,000 births in 2020. These deaths are devastating for the parents, families and, if unexpected, for the healthcare staff involved, with long-lasting emotional consequences. Some of these deaths are unavoidable, but many are preventable.

While other European countries have successfully reduced their perinatal mortality rate over the last decade, the perinatal mortality rate in Ireland has largely remained at the same level. There is evidence to show that a robust perinatal death review system has the potential to improve the perinatal mortality rate while also providing opportunities for learning and improvements to clinical care.

While local and national reviews of perinatal deaths occur in Ireland, the reviews lack standardisation, transparency, or adequate depth to fully elucidate the lessons for the prevention of perinatal deaths. Importantly, parents are frequently not involved in the review process and have little opportunity to offer their opinion or concerns.

Our research in this area

Confidential inquiries into perinatal deaths
Developing and evaluating a national perinatal mortality review tool
Initiatives addressing recommendations from national perinatal mortality audits
Involving bereaved parents in hospital-based reviews
Lived experiences
National perinatal mortality audits and reviews
Role of the Coroner

Key publications

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Category	Category	Keywords	Year	Title	Abstract	Actions
Journal Article	Journal Article	Audit / Service evaluation, Neonatal death, Perinatal mortality, Stillbirth	2024	A systematic review of standardised tools used in perinatal death review programmes	Our review found that there is little standardisation when it comes to perinatal mortality review tools. Guidance on structuring such tools in a standardised way is needed as part of efforts to reduce preventable perinatal deaths.	More details Read publication
Journal Article	Journal Article	Audit / Service evaluation, Neonatal death, Perinatal mortality, Stillbirth	2023	A protocol for a systematic review of standardised tools used in perinatal death review programmes [version 2; peer review: 2 approved]	A protocol for a systematic review of standardised tools or frameworks used to audit perinatal deaths in middle- to high-income countries.	More details Read publication
Journal Article	Journal Article	Bereavement care, Experience, Impact, Neonatal death, Perinatal mortality, Stillbirth	2023	Bereaved parents involvement in maternity hospital perinatal death review processes: ‘Nobody even thought to ask us anything’	A respectful, flexible system that allows bereaved parents involvement in their baby's perinatal death review, and is tailored to their needs, is essential. A collaborative process can highlight clinical areas in need of change, enhance lessons learned, improve bereavement services and may prevent future deaths.	More details Read publication
Journal Article	Journal Article	Audit / Service evaluation, Neonatal death, Perinatal mortality, Stillbirth	2022	Perinatal mortality audits and reporting of perinatal deaths: Systematic review of outcomes and barriers	Incomplete data, lack of standardised methods &classifications, inadequate training - identified as main barriers for perinatal mortality audit. To reduce perinatal mortalities, audit cycles must be completed, implementing recommendations with continuous re-evaluation of changes.	More details Read publication
Journal Article	Journal Article	Audit / Service evaluation, Neonatal death, Perinatal mortality, Stillbirth	2021	National perinatal mortality audits and resultant initiatives in four countries	Challenges are common to high-income countries’ perinatal mortality audits, highlighting the need for shared learning of successful initiatives.	More details Read publication
Journal Article	Journal Article	Bereavement care, Neonatal death, Perinatal mortality, Stillbirth	2021	Governance of maternity services: Effects on the management of perinatal deaths and bereavement services	To be effective and initiate positive changes in clinical services, documents such as incident reviews, national strategies and national reports including inquiries, need to include realistic recommendations with clear timelines and responsibilities for implementation.	More details Read publication
Journal Article	Journal Article	Bereavement care, Impact, Neonatal death, Perinatal mortality, Stillbirth	2020	Impact of bereavement care and pregnancy loss services on families: Findings and recommendations from Irish inquiry reports	Personalised perinatal bereavement care helps families to cope with their loss. Immediate bereavement support must be offered to families by expert maternity staff. Families and relevant clinical staff should be involved in perinatal inquiries.	More details Read publication
Journal Article	Journal Article	Neonatal death, Perinatal mortality, Pregnancy loss, Stillbirth	2020	Irish inquiry reports relating to perinatal deaths and pregnancy loss services	A collaborative and standardised inquiry process ensures that all relevant issues are identified, recommendations are implemented and essential lessons are learned.	More details Read publication

Pregnancy Loss Research Group

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National systems, reviews and audits