Tommy's news, 15/06/2018
Today, the fourth annual Perinatal Mortality Surveillance data report (2018) was released.
This report aims to collect, analyse and report national surveillance data and conduct national confidential enquiries in order to stimulate and evaluate improvements in health care for mothers and babies. Statistics are focused on rates of stillbirth and neonatal death across the UK for babies born at 24 weeks of gestation or more.
While this report presents important statistics and trends in stillbirth and neonatal deaths across the UK, it is important to remember that these numbers also represents the real life tragic death of a much wanted baby, two bereaved parents, other grieving family members, and a future life full of promise never realised.
Tommy’s welcomes this report because we believe that parents need, and deserve, answers when their babies die. Tommy's exists to answer these questions. Sadly, many of these questions will go unanswered as medical science has not yet found out why some babies make it and some do not, why some babies are born early and why some make it to full term.
Which is why we fund four research centres across the UK that investigate causes and find treatments for miscarriage, stillbirth and premature birth. Our target is to halve the number of babies that die during pregnancy or birth by 2030 and this report will provide valuable learning and point us in the direction of improvements in health care for mothers and babies.
The report's recommendation that we need to focus on public health initiatives also renews and focuses our drive to reach every pregnant woman in the UK with evidence-based pregnancy information to give them the best chance of having a safe and healthy pregnancy.
Campaigns such as Movements Matter and Sleep on Side continue to inform women about modifiable risk factors for stillbirth, and our pregnancy information website now reaches around 700k women a month with information on the risks of smoking and high BMI in pregnancy.
- There has been little change in the rate of extended perinatal mortality in the UK in 2016: 5.64 per 1,000 total births for babies born at 24+0 weeks gestational age or later compared with 5.61 in 2015. However this represents an overall fall from 6.04 deaths per 1,000 total births in 2013.
- The stillbirth rate for the UK in 2016 has remained fairly static at 4 percent per 1,000 births. This follows a three year period of reduction from 4.20 to 3.87 stillbirths per 1,000 total births (2013 to 2015)
- The rate of neonatal mortality in the UK has shown a slow but steady decline over the period 2013 to 2016 from 1.84 to 1.72 deaths per 1,000 live births.
- There has been a small increase in the rate of consent for post-mortem for stillbirth from 47.2% to 49.4% (2014 to 2016) and a small decrease for neonatal deaths from 29.1% to 28.6% over the same period. However, the offer of a post-mortem to parents was reported in almost all stillbirths (97.8%) and for 81.3% of neonatal deaths.
- Relative to singletons there has been a significant reduction in both the stillbirth and neonatal death rate ratios associated with twin pregnancies over the period 2014 to 2016, reducing from 2.8 to 1.6 for stillbirths and from 4.91 to 3.33 for neonatal deaths.
It is important to note that these overall national rates do not take into account the increasing clinical and social complexity of the women and babies for whom our maternity and neonatal services provide care.
What do these findings mean?
The stillbirth rate showed little change from 2015 – 2016, meaning that stillbirth still affects 1:250 births after 24 weeks. This is disappointing as it followed a three year period where the stillbirth rate fell from 4.20 to 3.87 stillbirths per 1,000 live births. Overall there has been a fall of 2.4% per year since 2010. This is substantially less than the 4% per year fall we need to achieve the National Maternity Ambition.
Clinical Director of the Tommy's stillbirth research centre in St Mary's Hospital, Professor Alex Heazell notes:
The National Perinatal Mortality Surveillance report released today by MBRRACE has shown that stillbirth affects 1 in 250 babies born after 24 weeks of pregnancy, sadly this year we did not see the decline in stillbirth rates that was evident between 2012-2015. To achieve the national maternity ambition we need to increase the rate of reduction in stillbirth from 2.4% per year to 4% per year. This demonstrates the need to translate research findings into clinical practice so that we can reduce the number of preventable stillbirths.
As such it is heartening to see that since 2014 there has been nearly a halving in the rate of stillbirths in twins and although the reduction in neonatal deaths is smaller at 30% both represent a statistically significant decrease, indicating this is unlikely to be a chance finding.
The figures in this report also highlight that in order to make substantial inroads into the overall perinatal mortality rate and meet the various national ambitions, stretch aims and aspirations, there will need to be a greater focus on preterm mortality.
About 70% of all extended perinatal deaths occur before term and nearly 40% occur extremely preterm at less than 28 weeks’ gestation.
Compared with babies who die at term, the circumstances of care and the train of events prior to death are likely to be different for the majority of deaths preterm. So whilst the improvements in care designed to prevent deaths at term are likely to have some an impact on preterm deaths, other strategies will also be required to prevent births and deaths earlier in pregnancy.
Important to note
Importantly, we also need to acknowledge the contribution of congenital anomalies at 1 in 6 of all extended perinatal deaths, recognising that for the majority of babies with anomalies who die, their deaths are likely to be inevitable.
Furthermore, we need to remember that for some Trusts and Health Boards, particularly the tertiary centres with neonatal surgical provision, and in Northern Ireland where termination of pregnancy is only legal in exceptional circumstances, the proportion of their deaths associated with congenital anomalies will be much higher than 1 in 6 and this will be reflected in higher neonatal mortality rates in particular. The best that maternity and neonatal services can provide in these circumstances is high quality compassionate and empathetic care.
Nevertheless, despite this reduction UK stillbirth rates still remain high compared to many similar European countries and there remains significant variation across the UK that is not solely explained by some of the important factors that influence the rate of death such as poverty, mothers age, multiple birth and ethnicity.
- In order to achieve the various UK Governments’ ambitions renewed efforts need to be focused on reducing stillbirths and continuing the slow but steady decline in neonatal mortality rates observed since 2013.
- Trusts and Health Boards with a stabilised & adjusted stillbirth, neonatal mortality or extended perinatal mortality rate that falls into the red or amber band should carry out an initial investigation of their data quality and possible contributing local factors.
- Public health initiatives should continue to be developed to reduce the impact of known risk factors for stillbirth and neonatal death; for example, smoking and obesity.
- All parents of babies who die should be provided with unbiased counselling for post-mortem to enable them to make an informed decision.
- Placental histology should be undertaken for all stillbirths and if possible all anticipated neonatal deaths, preferably by a perinatal pathologist.
What this report means for parents
This report demonstrates a growing awareness for the importance of identifying key areas where improvements in health care for mothers and babies can be made. It also demonstrates a national resolve to find answers for parents who sorely need them.
What this report means for Research
This report serves to show us both how far we have come, but also how far we have yet to go.
There is no single solution to reduce the number of babies dying, but together we can continue to work towards a goal of service quality improvements to ensure that every potentially preventable death is indeed prevented. This in addition to ensuring we have a clear understanding of where improvements in care can be made and for what areas we require further research.
The plateau of the stillbirth rate reflected in this report, demonstrates the need to translate research findings into clinical practice so that we can reduce the number of preventable stillbirths.
Tommy’s is the largest UK charity funding research to prevent stillbirth. We carry out vital research to find out why stillbirths happen, and how we can prevent them. Our research is helping us understand the causes of stillbirth, so we can find the babies at risk in time to help them.
Find out how Tommy's research is helping to change this:
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