MMBRACE 2018

Question 1

How many maternal deaths were reported in 3014_2016

Answer 1

9.8 per 100 000
During or end of pregnancy
or 6 weeks after childbirth

Question 2

Preterm deaths_ how many

Answer 2

About 70% of all extended
perinatal deaths occur before term and
nearly 40% occur extremely preterm at
less than 28 weeks’ gestation

Question 3

What is the rate of congenital anomslies in prrterm deaths

Answer 3

congenital anomalies at 1 in 6 of all
extended perinatal deaths
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 in6

Question 4

What is the death rate reduction in twins

Answer 4

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

Question 5

What is the PMRT

Answer 5

national Perinatal Mortality
Review Tool (PMRT) earlier this year is
designed to support high quality,
multidisciplinary local review of the care
provided at all stages of the maternity and
neonatal pathway on the basis of “review
once, review well”.

Question 6

Late fetal loss

Answer 6

delivered between 22+0 and 23+6
weeks gestational age showing no
signs of life, irrespective of when the
death occurred.

Question 7

Stillbirth

Answer 7

delivered at or after 24+0 weeks
gestational age showing no signs of
life, irrespective of when the death
occurred.

Question 8

Intrapartum stillbirth

Answer 8

A baby delivered at 
or after 24+0 weeks gestational age 
showing no signs of 
life and known to have been alive at the 
onset of care in labour.

Question 9

Neonatal death

Answer 9

liveborn baby (born 
at 20+0 weeks gestational age or later,
 or with a 
birthweight of 400g or more where an 
accurate estimate of gestation is not 
available), who died before 28 completed 
days after birth.

Question 10

Early neonatal death

Answer 10

A liveborn baby
(born at 20+0 weeks gestational age
or later, or with a weight of 400g or more

Question 11

Perinatal death

Answer 11

A stillbirth or

early neonatal death.

Question 12

Extended perinatal death

Answer 12

A stillbirth or

neonatal death.

Question 13

Any change in extended perinatal mortality

Answer 13

No
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.

Question 14

Still birth rate in uk

Answer 14

The stillbirth rate for the UK in 2016
has remained fairly static at 3.93 per 1,
000 total birth

Question 15

neonatal mortality

Answer 15

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.

Question 16

Variation in neonstal mortality rated

Answer 16

the
reported neonatal mortality rates show a
wide variation, with rates of between 1.
78 and 3.52 per 1,000 live births in those
with level 3 Neonatal Intensive Care
Units (NICUs) and surgical provision and
significantly lower rates in the small units
delivering less than 2,000 births per
annum (0.97 to 1.18).

Question 17

What are the stabilised & adjusted

extended perinatal mortality rates

Answer 17

for
commissioning organisations ranging from
5.32 to 6.29 deaths per 1,000 total birth

Question 18

Consent for post mortems

Answer 18

small increase in
the rate of consent for post-mortem for
stillbirth from 47.2% to
49.4% (2014 to 2016)

Question 19

Neonatal deaths

Answer 19

decrease for neonatal deaths from 29.1%

to 28.6%

Question 20

perceng of placental histology

Answer 20

which placental histology is carried out: 89.

9% in 2016 compared to 88.8% in 2015.

Question 21

Reduction in twin deaths

Answer 21

2014 to
2016, reducing from 2.8 (95% CI, 2.47 to
3.17) to 1.6 (95% CI, 1.36 to 1.88) for
stillbirths and from 4.91 (95% CI, 4.20 to
5.73) to 3.33 (95% CI, 2.80 to 3.98) for
neonatal deaths.

Question 22

Key recommendation

Answer 22

1need to be focused on
reducing stillbirths and continuing the
decreased mortality rates

Question 23

key recommendation 2

Answer 23

facilitate the close 
working between MBRRACE-UK and the 
Perinatal Mortality Review 
Tool (PMRT), within Trusts and Health 
Boards all stillbirths and neonatal deaths 
should be notified to MBRRACE-UK via 
the joint web-based system as soon as 
possible following the death.

Question 24

Key recommendation 3

Answer 24

Commissioning organisations should
review both their crude and their stabilised
& adjusted mortality
rates to facilitate the identification of
high risk populations and to target
interventions for known inequalities.

Question 25

Key recommendation 4

Answer 25

Trusts and Health Boards with a stabilised & adjusted stillbirth, neonatal mortality or extended

Question 26

KR5

Answer 26

``` Irrespective of where they fall in the spectrum of national performance all Trusts and Health Boards should use the national PMRT to review all their stillbirths and neonatal deaths. ```

Question 27

KR6

Answer 27

Trusts and Health Boards should ensure that the data provided to MBRRACE-UK is of the highest quality. T

Question 28

KR7

Answer 28

National health forum

Question 29

KR8

Answer 29

``` 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 ```

Question 30

KR9

Answer 30

Trust and Health Board Perinatal Review groups should focus on the quality of cause of death coding.

Question 31

KR10

Answer 31

Parents provided with unbiased counselling for post-mortem to enable them to make an informed decision

Question 32

KR12

Answer 32

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

Question 33

KR13,

Answer 33

``` Trusts and Health Boards should endeavour to improve the quality and completeness of data reported to MBRRACE-UK and for routine inpatient, and birth and death registration purpose ```

Question 34

preterm stillbirths

Answer 34

among babies born preterm to nearly 50% of stillbirths and late fetal losses and 55% of neonatal deaths. Government initiatives to reduce stillbirth and neonatal death rates, if they are to succeed, will need to focus on ways of reducing the number of preterm births.

Question 35

What should organisations do

Answer 35

However, as a first step for any commissioning organisation, Trust or Health Board whose performance falls in the red band a more detailed local review of their data quality and investigation of local factors should be carried out to identify if these issues explain the high rate. For example, data quality might not be sufficiently good to allow for the effect of the proportion of mothers who for legal, cultural or religious reasons choose to continue with a pregnancy affected by a severe congenital anomaly