Health Quality & Safety Commission | Reduction in New Zealand’s perinatal-related death rate
New Zealand’s perinatal-related death rate has shown a significant reduction for the first time since the Perinatal and Maternal Mortality Review Committee (PMMRC) began analysing perinatal mortality data in 2007. The annual report of the PMMRC says there were 3 deaths per 1000 births in New Zealand in 2011, using the World Health Organization’s (WHO’s) international measure of perinatal mortality. In 2007, there were 3.6 deaths per 1000 births.
The PMMRC reviews all maternal deaths and deaths of babies up to 28 days after birth. It advises the Health Quality & Safety Commission on how to reduce the number of deaths.
The PMMRC believes the reduction in the perinatal mortality rate is likely to be due to a reduction in the rate of babies dying during labour, and dying from oxygen deprivation around the time of birth.
The rate of still born babies dropped significantly. For babies at term, there were nine deaths during labour in 2011 (a rate of 0.16 per 1000) and 26 deaths during labour in 2007 (a rate of 0.43 per 1000). There were also significantly fewer babies dying around the time of birth from oxygen deprivation. There were 4 deaths in 2011 (a rate of 0.07 per thousand) and 16 deaths in 2007 (a rate of 0.26 per thousand births) around the time of birth from oxygen deprivation.
PMMRC chair Prof Cynthia Farquhar says the improvements are good news. "It’s extremely encouraging to see a reduction for the first time in the number of babies who are dying during labour, and dying from insufficient oxygen around the time of birth."
There were eight maternal deaths in 2011. There has been no statistically significant change in the maternal death rate since PMMRC began analysing maternal mortality data in 2006.
"We’re also pleased to see no increase in the number of women dying during pregnancy and birth," she says. "However, there are still areas of concern."
Between 2010 and 2011, 149 babies were identified as having neonatal encephalopathy, a syndrome usually resulting from lack of oxygen to the brain around the time of birth. In 16 percent of cases, inadequate neonatal resuscitation was a contributing factor to the baby’s illness. The PMMRC has recommended continual improvement in the standard of neonatal resuscitation by all health professionals caring for newborn babies.
The death rate for babies born in multiple births has increased, from 32 per 1000 births in 2007 to 53 per 1000 births in 2011. The PMMRC has recommended all women having assisted reproduction, such as IVF, be offered transfer of a single embryo, rather than two or more.
In 2011, mortality reviews carried out by DHBs reported that 19 percent of perinatal deaths were potentially avoidable. The most common contributing factors to these deaths were barriers to access or engagement with care – most commonly, late or infrequent access to antenatal care. These were followed by personnel factors – most commonly, failure to follow recommended best practice.
Māori, Pacific and Indian mothers, and women from areas of socioeconomic deprivation, were significantly more likely to experience a perinatal death. The risks of losing a baby from potentially avoidable causes were higher for Māori and Pacific mothers, and for women from areas of socioeconomic deprivation.
An audit of babies who died in 2010 with identifiable congenital abnormalities found that one in four women who sought care with a primary health care provider before 20 weeks gestation was not offered first or second trimester antenatal screening. The PMMRC has recommended that all GPs and midwives should be adequately informed to be able to offer antenatal screening. This screens for chromosomal abnormalities, such as Down syndrome, and can detect some major congenital abnormalities, such as spina bifida.
While there was poor documentation of whether women took folic acid around the start of pregnancy, it appears not all pregnant women are taking folic acid to prevent birth defects. The PMMRC data suggests that as many as 15 deaths in one year associated with neural tube defects such as spina bifida could be prevented with folic acid.
The PMMRC has recommended New Zealand starts fortifying bread with folic acid. This is because unplanned pregnancies are common, and folic acid should be taken before conception and for the first 12 weeks of pregnancy.
Background and definitions
- The 2013 PMMRC report includes the latest available data, from 2011, along with a comparison of perinatal mortality data from 2007 to 2011 and maternal mortality data from 2006 to 2011.
- A maternal death is the death of a woman while pregnant or within 42 days of the end of pregnancy, from any cause related to or aggravated by the pregnancy or its management. It does not include accidental or incidental causes of death of a pregnant woman.
- Perinatal mortality is fetal and early neonatal deaths from 20 weeks gestation until less than seven days of age or weighing at least 400g if gestation was unknown.
- Perinatal-related mortality is fetal deaths and early and late neonatal deaths from 20 weeks gestation up to 28 days after birth or weighing less than 400g if gestation is unknown.
Read the frequently asked questions for the PMMRC report here.