MBRRACE-UK Perinatal Mortality Surveillance Report

Published on: 18/10/2019

Who are MBRRACE-UK?

MBRRACE-UK Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK, have released their annual report on Perinatal Mortality Surveillance. This covers UK Perinatal deaths for births from January to December 2017.

It is commissioned by the Healthcare Quality Improvement Partnership to carry out the Maternal, Newborn, and Infant Clinical Outcome Review Programme on behalf of NHS England, the Welsh Government, the Scottish Government Health and Social Care Directorate, the Northern Ireland Department of Health, the States of Guernsey, the States of Jersey, and the Isle of Man Government.

Key findings of the report:

There has been a reduction in the rate of stillbirth and neonatal deaths in the UK in 2017. This represents a 12% reduction in extended perinatal mortality since 2013, equivalent to nearly 500
fewer deaths in 2017.

The stillbirth rate for the UK in 2017 has reduced to 3.74 per 1,000 total births from 4.20 in 2013, which represents 350 fewer stillbirths.

The rate of neonatal mortality for babies born at 24 weeks gestational age or later in the UK continues to show a steady decline over the period 2013 to 2017 from 1.84 to 1.67 deaths per 1,000 live births. This represents a 10% reduction in neonatal mortality over the last five years.

The largest fall in stillbirth and neonatal death rates is seen in term babies (37+0 to 41+6 weeks gestational age), accounting for half of the reduction seen in these rates.

Just over half of deaths were notified within the MBRRACE-UK benchmark time of 30 days (57% of stillbirths and 51% of neonatal deaths). Only 39% of Trusts and Health Boards had an average notification time of less than 30 days for stillbirths and 29% for neonatal deaths.

There has been an increase in the completeness of carbon monoxide monitoring data for both stillbirths and neonatal deaths over the period 2015 to 2017, from 36.4% to 48.3% for stillbirths and 31.4% to 44.5% for neonatal deaths.

Despite overall improvements in mortality, out of 224 commissioning organisations, stabilised mortality rates were more than 5% higher than the overall UK average in 52 organisations for stillbirth and 57 organisations for neonatal death.

Mortality rates remain high for Black or Black British and Asian or Asian British babies. Whilst stillbirth rates for these groups have reduced over the period 2015 to 2017, neonatal mortality rates have unfortunately increased over the same period.

The reduction in both the stillbirth and neonatal death rate ratios associated with twin pregnancies over the period 2014 to 2016 has not been sustained, with small increases in risk seen in 2017 for stillbirths and neonatal deaths.

What has been recommended?

In order to achieve the various UK Governments’ ambitions, efforts need to be focused on implementing existing national initiatives to reduce stillbirths and continue the slow but steady decline in neonatal mortality rates observed since 2013. Particular emphasis should be placed on reducing preterm birth.

Trusts and Health Boards should aim to notify all deaths via the MBRRACE-UK system within 30 days of the death occurring.

Commissioning organisations should review both their crude and stabilised mortality rates alongside their high risk population characteristics (e.g. deprivation and ethnicity) to facilitate the development of public health initiatives and to target focused interventions.

Trust and Health Boards should use the Perinatal Mortality Review Tool multidisciplinary meetings to improve the quality of cause of death coding.

Trusts and Health Boards should also review their policies to ensure that the parents of ALL babies who die are provided with unbiased counselling for post-mortem to enable them to make an informed decision.

Trusts and Health Boards should work to implement fully the National Bereavement Care Pathway to ensure that all parents are offered high quality, individualised bereavement care after the loss of their baby.

Placental histology should be undertaken for all stillbirths and if possible all anticipated neonatal deaths, preferably by a perinatal pathologist.

For further information from MBRRACE-UK or to see the full report please visit MBRRACE REPORTS  where you can also find the full list of info graphics and downloadable tables.