RCOG statement: MBRRACE-UK report on stillbirths and neonatal deaths

RCOG statement: MBRRACE-UK report on stillbirths and neonatal deaths

MBRRACE-UK published its annual perinatal mortality surveillance report in May 2016, which examines the deaths of babies from 24 weeks of pregnancy. There were 3,252 stillbirths and 1,381 neonatal deaths in 2014, which means almost 6 deaths per 1,000 births.

The report also found significant variation across the UK that is not solely explained by factors that influence the rate of death such as poverty, mother’s age, multiple birth and ethnicity.

Other key findings from the report include:

• Two thirds of stillbirths and neonatal deaths were in preterm babies (between 24-37 weeks’ gestation)
• The causes of  46 per cent of stillbirths and 5 per cent of neonatal deaths are unknown
• Geographical variation in mortality rates ranged from 4.7 to 7.1 per 1,000 births
• One area of unexplained variation is in the proportion of deaths coded as being due to major congenital anomalies
• Over 90 per cent of parents whose baby died were offered a post-mortem, but only 40 per cent consented

Dr David Richmond, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said: “Although the findings of the report show an overall improvement in the rates of stillbirth and neonatal deaths in the context of the increasing medical complexity of the maternal population, rates are still higher than many other high income countries. It is clear that we still face a challenge of further reducing these deaths, as well as addressing the existing variation of perinatal mortality rates across the UK.

“Sadly, much is still unknown about the causes of almost half of stillbirths and 5 per cent of neonatal deaths. In addition, two thirds of all stillbirths and neonatal deaths were in preterm babies, so any future initiatives must also include a focus on reducing premature birth and the recently published NICE guideline provides healthcare professionals with clear guidance on reducing the risks of preterm birth and delaying early labour. As and when new evidence emerges, the RCOG’s role is to translate this research into changes to practice in the UK.

“Our current focus is on the implementation of interventions which are already known to reduce stillbirths – particularly those that occur at full term, after 37 weeks’ gestation. These include the diagnosis and management of gestational diabetes, measuring and recording of growth and fetal movements, improving multi-disciplinary training packages and promoting more effective team working to help doctors and midwives pick up potential complications.

“Promotion of messages which may help women reduce the risk of stillbirth – such as maintaining a healthy weight prior to conception, stopping smoking and attending antenatal appointments – are also essential components to help end preventable stillbirths.

“Although an extremely difficult time for grieving parents, post-mortems are vital in order to gain more of an understanding into why these deaths are occurring and families need skilled and highly trained professional support through this process.”

“Along with the MBRRACE-UK team, we have also identified that local reviews following a stillbirth or early neonatal death remain an area in need of clear improvement. Standards of care can vary considerably across the country and frustratingly not all deaths are reviewed rigorously to ensure lessons are learned when mistakes do happen. Through the RCOG’s Each Baby Counts initiative, we are undertaking a structured review to help identify common risk factors for perinatal deaths and enable us to learn from what went wrong and apply the lessons in maternity units across the country. It’s time to ensure that every mother receives the best quality of care and avoidable deaths are prevented.”

Source: Royal College of Obstetricians and Gynaecologists

Staff Writer