The latest figures from the Confidential Enquiry into Maternal and Child Health (CEMACH) Perinatal Mortality Surveillance Report 2007 show improvements in the stillbirth and neonatal death rates in the UK.

The main findings are:

- For the first time since 2000, a significant fall in the stillbirth rate from 5.7 per 1,000 births in 2002 - 2004 to 5.2 per 1, 000 births in 2007.

- The lowest neonatal death rate since 2000 (3.3 per 1, 000 live births).

- Similar improvements in the stillbirth and neonatal death rates among twins.

- A higher proportion of post mortem examinations being offered for stillbirths and neonatal deaths compared to previous years, although this has been offset by a higher proportion of parents/guardians refusing to have an examination. Information obtained from a post mortem examination can contribute to understanding the possible cause of a perinatal death which may help to inform future care.

Maternal age was noted to be a significant risk factor for stillbirths, perinatal and neonatal death and the figures also show an increasing trend of later motherhood:

- Teenage mothers (< 20 years old) had the highest neonatal mortality rate (4.4 per 1,000 live births) when compared to other maternal age groups. Teenage maternities contributed to 9.5% of the overall neonatal mortality rate in England, Wales and Northern Ireland. Researchers suggest that the high rate may be a result of other associated risk factors such as social deprivation and a higher preterm delivery rate amongst this group.

- Older mothers (40+ years old) were found to have an increased risk of having a stillbirth (7.7 per 1, 000 births) when compared to younger mothers. Pregnancy complications such as pre-eclampsia, gestational diabetes and placental abruption (all risk factors for stillbirth) are higher in older mothers and may be contributory factors. From 2008, CEMACH has been collecting information on maternal risk factors in all cases of perinatal death which will help to further understand the reasons underlying these differences.

This year's report reflects further developments in CEMACH's data collection. Researchers were able to review and compare regional variations in mortality rates through examining data drawn from individual SHAs, NHS Trusts, Neonatal Networks and neonatal units. The new report also provides information about hospital-to-hospital transfer patterns for babies dying in the first month of life who booked at level 1 or 2 units that were then transferred on to level 3.

Dr Jo Modder, Clinical Director (Obstetrics) of CEMACH said "The findings from this year's report indicate an improvement in the perinatal mortality rate for both singleton and twin births in the UK, which is very much welcome.

"However, it will be important to continue to monitor the figures to determine if this downward trend is sustained."

Professor Sabaratnam Arulkumaran, RCOG President said, "These new findings show an overall improvement in the perinatal and neonatal death rates in 2007. This is good news but we must remain vigilant over the common maternal risk factors and identify women who may require extra support.

"The increasing number of older mothers is a trend which we will need to monitor closely since there are long-term consequences involved which impact on society and the NHS."

Health Minister, Ann Keen said, "This report shows significant falls in the numbers of stillbirths and babies dying in the weeks immediately after birth. We will continue to work with the NHS towards decreasing these rates still further through high quality maternity services.

"We've increased funding for maternity services by £330 million over the three years 2008/09 - 2010/11 and we are pleased to say there are more maternity staff than ever before and thank the RCOG and RCM for working with us.

"For the best health outcomes, women should access maternity services at an early stage. This is why we say that all women should have their personal needs and risks assessed by a healthcare professional by the twelfth week of pregnancy."

Notes

To view a pdf of the Fifth Annual Perinatal Mortality Report, please click here.

This is the first time CEMACH has provided perinatal mortality statistics for the whole of the UK, allowing for benchmarking between Trusts. Previous reports held data on all stillbirths and neonatal deaths in England, Wales and Northern Ireland, the Channel Islands and the Isle of Man, provided by the Office for National Statistics. This new report includes data from Scotland, gathered in collaboration with NHS Quality Improvement Scotland.

CEMACH will become an independent charity on 1 July 2009 with the new name Centre for Maternal and Child Enquiries (CMACE). The RCOG will continue to support the work of CMACE. For more information, please click here.

Source
Confidential Enquiry into Maternal and Child Health