This is the fourth report of the national clinical audit on perinatal mortality in Ireland using the NPEC data collection tool and classification system. Anonymised data were reported by the Irish maternity units on a total of 504 deaths occurring in 2014 arising from 67,663 births of at least 500g birthweight or at least 24 weeks gestation. Stillbirths, early neonatal and late neonatal deaths accounted for 330 (65.5%), 141 (28.0%) and 33 (6.5%) of the 504 deaths, respectively.
NOCA provides assisted governance for all of the NPEC’s audits.
- The perinatal mortality rate was 7.0 deaths per 1,000 births; corrected for congenital malformation, the rate was 4.7 per 1,000 births; the stillbirth rate was 4.9 per 1,000 births; and, the early neonatal death rate was 2.1 per 1,000 live births.
- Similar to 2013, major congenital anomaly was the primary cause of death in one in four of the 330 stillbirths that occurred in 2014.
- In Ireland in 2014, an autopsy was undertaken following 52.0% of stillbirths and 39.1% of early neonatal deaths.
- There were 33 late neonatal deaths in 2014 reported to the NPEC.
- Monitoring the socio-economic status of the pregnant population in Ireland is challenging as these data are not routinely captured in Irish maternity records, but further efforts must be made if we are to better understand how social disadvantage impacts on perinatal outcomes.
- The establishment of a confidential enquiry for stillbirth and neonatal death should be considered in order to enhance the lessons which may improve care. An initial step would be the establishment of a standardised review of a case series of unexpected perinatal deaths associated with intrapartum events.
- A public health education programme on perinatal deaths and modifiable risk factors should be developed.
- Anonymised placental histology reports on perinatal death should be submitted to the NPEC as part of this audit: this would facilitate standardised interpretation and classification of placental conditions.
- Resourcing of perinatal pathology services on a regional and national basis, as recommended by the Faculty of Pathology.
- Further research exploring factors impacting on autopsy rates, particularly in the case of neonatal deaths, is warranted.
- All maternity units should continue to collect and submit data on perinatal deaths to inform the maternity services through the NPEC national audit on perinatal mortality. This should include all neonatal deaths regardless of gestational age or weight at birth. In the case of stillbirths, all babies from 24 weeks gestation or with a birthweight of ≥500g should continue to be reported to the NPEC.
The findings of this national clinical audit of perinatal mortality highlight the inherent need for on-going audit in order to identify key factors impacting on adverse perinatal outcomes. Perinatal mortality is a potential pregnancy outcome with a significant mortality burden. The need for prevention extends beyond the maternity services: there is requirement for a public awareness programme. Potential parents must also be made aware of the modifiable risk factors for perinatal mortality, with a view to improving their health and lifestyle prior to pregnancy.
The report is available to download from the NPEC website.
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