Perinatal and Maternal Mortality Review Committee (PMMRC) Annual Report
Frequently Asked Questions
What is New Zealand’s perinatal death rate?
In 2015, there were 578 deaths of babies aged from 20 weeks’ gestation to less than 28 days old (or weighing at least 400g if gestation was unknown). The perinatal related mortality rate in 2015 was 9.7 per 1000 births.
This was the lowest rate since the PMMRC started collecting data on baby deaths, but not yet low enough to be sure that the apparent reduction is not due to chance.
What is the main cause of perinatal death in New Zealand?
In 2015, the main cause of perinatal death in New Zealand was congenital abnormality, which accounted for 27.3 percent of deaths. The second most common cause of death was unexplained antepartum death (babies dying before birth without a known cause) which accounted for 15.1 percent of deaths, followed by antepartum haemorrhage at 13.7 percent.
How does New Zealand’s perinatal death rate compare internationally?
The perinatal related mortality rate in New Zealand in 2015 is similar to the rate reported by in Scandinavian countries in 2014, lower than the UK and but higher than Australia. The neonatal death rate has not changed in New Zealand from 2007 to 2015; meanwhile there have been reductions in neonatal mortality in the UK (from 2004 to 2014), Australia, and Scandinavia. This will be investigated in detail by the PMMRC in 2017–2018.
How many deaths were potentially avoidable?
In 81 cases, or 14 percent of perinatal-related deaths in 2015, deaths were determined to be potentially avoidable. This means that if at least one of the factors identified as contributing to the death had been absent, the death may not have occurred.
Why were there an unusually high number of deaths of babies at 41 weeks’ gestation, and what can be done about this?
A further review of these deaths has highlighted the importance of risk assessment leading up to term, and inducing labour where appropriate. This is a topic for discussion at the PMMRC annual conference and has led to a recommendation for the development of an interdisciplinary consensus guideline on induction of labour.
Are there any groups more at risk of losing a baby?
Women who smoke in pregnancy, who are overweight or obese, live in areas of high socioeconomic deprivation and who are of Māori, Pacific and Indian ethnicity are more at risk of losing a baby.
There has been a decrease in the rate of perinatal death of babies among mothers under 20 years old; there has also been a continued reduction in births generally among mothers under 20 years of age.
What can women do to reduce their likelihood of losing a baby during pregnancy or shortly after birth?
There are a number of things women can do before they get pregnant, to ensure they and their baby has the best chance at a healthy birth.
Talking to a doctor about pre-existing medical conditions, quitting smoking, not drinking alcohol, eating healthy food and exercising regularly, taking folic acid and iodine are all proven methods to keep both mother and baby healthy.
If you are already pregnant, find a lead maternity carer (LMC), usually a midwife, as soon as you can, and have regular check-ups.
How many babies had neonatal encephalopathy?
In 2015, 70 babies were reported as having moderate or severe neonatal encephalopathy (NE), a syndrome usually resulting from lack of oxygen to the brain around the time of birth. There is a downward trend in the rate of NE.
The incidence of NE is significantly higher among Pacific mothers than among New Zealand European mothers, and the incidence increases with increasing socioeconomic deprivation.
How many maternal deaths were there?
In 2015, there were 11 maternal deaths. A maternal death is the death of a woman while pregnant or within 42 days of the end of pregnancy. There has been no statistically significant change in the maternal death rate since PMMRC began analysing maternal mortality data in 2006.
The three most frequent causes of maternal death were pre-existing medical diseases 28 percent, suicide 26 percent, and amniotic fluid embolism 12 percent.
Were any of the maternal deaths preventable?
Between 2006 and 2015, 39 percent of maternal deaths were identified as potentially avoidable. Contributory factors were identified in 62 percent of deaths, these factors included lack of policies, guidelines, lack of recognition of complexity or seriousness of the condition by the caregiver or woman, and no (or limited) antenatal care.
How many maternal suicides were there, and what is being done to prevent these?
Between 2006 and 2015 there were 27 maternal suicides, 26% of all maternal deaths. Many women who died had a number of complex stressors in their lives, including issues relating to alcohol and drug abuse, and a history of mental illness.
In its previous report, the PMMRC included a special chapter on maternal suicide, which emphasised the importance of all clinicians involved in a woman’s care having knowledge of her mental health history, so they are able to provide the best care. The PMMRC also recommended a perinatal and infant mental health network be established to provide a forum to discuss perinatal mental health issues.
Maternal mental health screening should be included as part of standard maternity care, followed by appropriate referral.
Strategies are required to improve communication and coordination between the full range of primary maternity providers (e.g. LMC, GP) and secondary providers (e.g. mental health services, maternal mental health services, and maternity, including termination of pregnancy services).
The Ministry of Health and PMMRC are working towards the establishment of a national Perinatal and Infant Mental Health Network; this includes ensuring supportive links with pre-existing regional perinatal and infant mental health networks.
Why are Māori over-represented in maternal suicides?
Māori mothers were almost three times likely to die from suicide than NZ European mothers.
The Mortality Review Committees’ Māori Caucus has explored the reasons behind this inequity and found most of the Māori women who died from suicide experienced multiple risk factors.
Early recognition of these risk factors, particularly where there are multiple factors, will assist health services and professionals to provide better services for these women. This is reported in the Māori perinatal and maternal mortality chapter.
What is the reason behind the reduction in stillbirths and what does it mean for people expecting a baby?
In 2007, there was one stillbirth for every 178 births; in 2015 there was one stillbirth for every 196 births, which is a small but significant improvement. Fewer families are experiencing the death of their baby prior to birth.
There is a significant reduction in stillbirths at 37–40 weeks from 2007 to 2015, in part due to a significant reduction in stillbirths due to babies dying from lack of oxygen around the time of birth and fewer babies dying from growth restriction.
A number of initiatives to improve pregnancy care and/or to reduce perinatal death may be responsible for these reductions. Some changes in demography and the distribution of risk factors may also have had a small effect. Possible explanations for the observed reduction in perinatal mortality include:
• reduced births among teenage women
• reduced rates of smoking among pregnant women
• reduced births at 40 weeks and beyond (presumably associated with increased rates of iatrogenic birth by induction or elective caesarean for at-risk pregnancies)
• structured review and reporting of perinatal deaths at all New Zealand DHBs
• increased education around the risks of being small for gestational age (SGA)
• introduction of the Growth Assessment Protocol (GAP) for recognition of reduced fetal growth and the Maternal Fetal Network guideline for management of SGA from 34 weeks gestation http://www.perinatal.org.uk/FetalGrowth/GAP/GAP.aspx
• the work of the Maternity Quality and Safety Programme, such as introduction of learning from the maternal sleep position studies suggesting that left-sided sleep is associated with reduced odds of late stillbirth