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Making pregnancy safer: can we do better?
A PMMRC workshop on improving outcomesfor New Zealand mothers and babies
Purpose of the PMMRC
• To review and report to the Health Quality and Safety Commission on perinatal and maternal deaths with a view to reducing the numbers
• To support quality improvement through local
lperinatal and maternal mortality review meetings
• To develop strategic plans and methodologies to reduce morbidity and mortality
PMMRC annual reporting
• Annual reports– November 2009
• Reported on perinatal and maternal data for 2007
– October 2010• Reported on perinatal and maternal data for 2008
– July 2011• Reported on perinatal and maternal data for 2009
The 2009 report
What’s new in this report?
• Contributory factors and potentially avoidable deaths
• Focus on teenage mothers
Contributory factors and potentially avoidability
– 721 perinatal deaths for 2009 pp60• 23.5% had contributory factors
– Barriers to accessing and engaging in care – Personnel factors– Organisation and management factors
• 13.6% were classified as potentially avoidable – 98 perinatal deaths
– 49 maternal deaths from 2006-2009 p72• 14 in 2009
– 4 were from H1N1
• In 2009 5 had contributory factors and 3 were potentially avoidable
Recommendations• Key stakeholders should work together to identify existing
research on • reasons for barriers to accessing maternity care
• interventions to address barriers to engagement with maternity care
• Clinical services and clinicians have a responsibility to ensure the following:
• CME – focus on personnel and best practice• Policies /guidelines -up to date, implemented and audited • A culture of teamwork• A culture of practice reflection on patient outcomes with a link to
quality improvement • Staffing arrangements that ensure timely access to specialists
Young mothers2007-2009 p35
Recommendations• All LMCs should be aware that teenage mothers are at
increased risk – preterm birth, fetal growth restriction and perinatal infection
• Maternity services for teenager mothers need to address this increased risk – provision of services that specifically meet their needs
• Research on the best model of care for teenage pregnant mothers – view to reducing perinatal deaths
• Engagement with MoE – appropriate education and maternity care in the school setting
Other work of the PMMRC
Neonatal Encephalopathy Working Group p78• Investigating morbidity in newborn
Australasian Maternity Outcomes Surveillance System p79 (AMOSS)
• Investigating morbidity in mothers
Neonatal Encephalopathy Working Group p79
• The PMMRC asked to identify ways to reduce morbidity as well as mortality
• The outcome for affected infants may include mortality and long-term neurodevelopmental morbidity
• Aim to investigate the size of the problem in New Zealand and to explore ways of
improving outcomes • Collection of data began 1st January 2010 with
notification of cases through the PSU
Australasian Maternity Outcomes Surveillance System p79
• Maximise the safety & quality of maternity care and outcomes in Australasia
• Described severe morbidity and mortality from these conditions
• Quantify the burden on the healthcare sector
• Address the lack of robust evidence for clinical practice
• Data collection commenced 1st January 2010
AMOSS – conditions
Current conditions • Antenatal pulmonary embolism• Amniotic fluid embolism• Eclampsia• Placenta accreta• Peripartum hysterectomy
Completed surveys• ICU admission with Influenza• Morbid obesity (BMI>50) * numbers only/no
data
Current structure of PMMRC
Finally
• Thank you to all midwives, nurses, doctors, analysts, epidemiologists and managers who have worked to collect this data and produce this report
PMMRC
www.pmmrc.health.govt.nz
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