Perinatal Mortality in Ireland Annual Report
The first Irish national audit into the death of babies in the weeks before or after birth (known as perinatal mortality) was launched today (Tuesday 22 October).
This national audit was carried out by the National Perinatal Epidemiology Centre (NPEC) based in the Department of Obstetrics and Gynaecology at University College Cork for the calendar year 2011 in collaboration with the medical and midwifery staff from the individual maternity units around the country.
Perinatal mortality refers to the death of babies in the weeks before or after birth. Perinatal mortality includes stillbirths (babies born with no signs of life after 24 weeks of pregnancy or weighing at least 500 grams) and the deaths of babies within 28 days of being born. Perinatal mortality is an important indicator of the quality of obstetric and neonatal care. Measurement of the outcome of care is central to the development of safe and high quality healthcare services. In recent years, the National Perinatal Epidemiology Centre (NPEC) has worked with colleagues in all 20 Irish maternity units in developing an in-depth clinical audit of perinatal mortality.
The Perinatal Mortality in Ireland Annual Report 2011 is the first report from this in-depth clinical audit. Reporting to the NPEC is not a statutory requirement but all Irish maternity units voluntarily provided data relating to perinatal deaths that occurred in 2011, demonstrating their commitment to improving the service and outcomes for their patients.
- A total of 491 perinatal deaths in 2011 were recorded, arising from 74,265 births of at least 24 weeks gestation or at least 500 grams in birthweight.
- Stillbirths, deaths within the first seven days of life (early neonatal deaths) and deaths within the first 8-28 days of life (late neonatal deaths) accounted for 318 (65%), 138(28%) and 35 (7%) of the 491 deaths respectively.
- The perinatal mortality rate was 6.1 per 1,000 births. Irish perinatal mortality rates have decreased by approximately 10% in the four years for which the NPEC has reported national figures and they compare favourably with UK and European rates.
- Major congenital anomaly was the most common cause of death – 26% of stillbirths, 51% of babies who died within 7 days and 57% of babies who died within 8-28 days.
- The NPEC classification system limited the proportion of unexplained stillbirths to 13% whereas approximately 50% have been reported as unexplained using other classification systems. This has positive implications for the identification of modifiable factors that may prevent stillbirth.
- Of the women with previous pregnancies, 4% of the women had experienced a previous perinatal death and 7% had experienced three or more miscarriages.
- 13% of the perinatal deaths arose from multiple birth deliveries. In contrast, multiple births accounted for just 4% of all births in 2011.
- Approximately 70% of the deaths arose from pre-term births (i.e. births before 37 weeks gestation).
- Low birth weight was highly prevalent - 53% of stillbirths and 40% of babies who died within 7 days were below the normal range for birthweight.
- 6% of mothers were admitted to the high dependency unit following the delivery and 2% were admitted to the intensive care unit.
This national clinical audit highlights efforts made in Ireland to investigate key adverse outcomes for mothers and babies. The report also emphasised the need for continued support from the 20 Irish maternity units in submitting data on perinatal mortality. Some key recommendations from this report:
- A detailed placental examination should be performed by a specialist pathologist in all cases of perinatal death. To achieve this, the feasibility of providing access to specialist perinatal pathology in all health services regions needs to be assessed.
- More complete data are required on a range of factors, such as smoking and body mass index, for all pregnant women in order to establish their role in increasing risk of perinatal mortality.
“This report is evidence of the commitment of the staff of the maternity services to assess their work and outcomes for mothers and babies. It shows a mature approach to reflect on care and look for improvements. The maternity services are leaders in the area of clinical review and audit.” Professor Richard Greene, Director, NPEC.