The 2010 PMMRC Report: an overview

Perinatal Mortality 2007-2010Maternal Mortality 2006-2010

Methodology

Perinatal Maternal

Definition of cases > 20 wks< 28 days

Direct, indirect to 6wks (Co-incidental)

Ascertainment of cases Clinicians; LMCs; Local coordinatorsBDM; NMDS; Coroners; media

Data sources LMCs; hospitals; GPs; Coroners; Police

Review of cases, classification of cause, contributory factors, and potentially avoidable death

Localmultidisciplinary

Nationalmultidisciplinary

Denominator data Registered births - BDM

Definitions

• Perinatal related mortality rate - /1,000• Maternal mortality ratio - /100,000• Ethnicity – prioritised maternal• DHB of maternal residence at birth registration• Deprivation quintile (NZDep 2006)• Contributory factors - including organisation and

management, personnel, equipment and technology, environment, and barriers to access/engagement factors that contributed to the death

• Potentially avoidable death – defined when the absence of a factor may have prevented the death

Perinatal related mortality NZ 2007-2010

Perinatal related mortality NZ and UK 2007-2010

0

2

4

6

8

10

2007 2008 2009 2010

Peri

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talit

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er 1

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NZ (CMACE defn) perinatal mortality UK perinatal mortality

Perinatal related mortality NZ and Australia 2007-2010

*excludes Victoria

0

2

4

6

8

10

12

2007 2008 2009 2010

Mor

talit

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NZ Perinatal related mortality Australia Perinatal related mortality

*excludes Victoria

Perinatal Death Classification (PDC) among all perinatal

related deaths 2007-2010

Figure 16 pg 31

NDC among neonatal deaths

(excluding FA) by gestation 2007-2010

Figure 18 pg 35

Ethnic specific perinatal related mortality 2007-2010

Figure 22 pg 42

Ethnic specific neonatal death rate by gestation group

2007-2010

Figure 19 pg 36

PDC specific perinatal related mortality rate by ethnicity 2007-2010

Figure 24 pg 45

Age specific perinatal related mortality 2007-2010

Figure 20 pg 39

PDC specific perinatal related death rates by age 2007-2010

Figure 21 pg 40

Deprivation quintile specific perinatal related mortality 2007-2010

Figure 26 pg 47

Figure 27 pg 48

DHB of residence and perinatal related mortality 2007-2010

Figure 28 pg 49

DHB of residence and Ethnicity 2010

Figure 13 pg 25

DHB of residence and Deprivation Quintile 2010

Figure 14 pg 26

Ethnicity and deprivation quintile standardised perinatal related mortality CMDHB 2007-2010

CMDHB NZ

Crude 13.1 10.8

Adjusted 10.9 10.5

Smoking, drug and alcohol use among mothers of babies who

died 2010

• Smoking 29%• Alcohol at least 8.8%• Marijuanaat least 3.4%

*16% missing data

• Other drugs <1%

Among perinatal deaths, alcohol and marijuana were associated with death from spontaneous preterm birth and SUDI

Contributory factors and potentially avoidable perinatal

related deaths 2010

Figure 33 pg 67

Contributory factors by ethnicity among perinatal related deaths

’09-’10

Figure 32 pg 72

Contributory factors by cause of perinatal related death ’09-’10

Figure 29 pg 70

Maternal mortality: ‘06-’10

Figure 35 pg 77

Maternal mortality: international data

• 2006-2008 UK 11.4/100,000

• 2006-2008 NZ 18.3/100,000

Maternal mortality: international data

Maternal mortality and maternal age 2006-2010

Figure 33 pg 80

Maternal mortality and maternal ethnicity 2006-2010

Figure 34 pg 80

Maternal mortality 2006-2010

• Contributory factors 53% of maternal deaths– Organisation and management 32%– Personnel 30%– Barriers 37%

• Potentially avoidable 32% of maternal deaths

• CMACE 2006-2008 61% substandard care; 36% significantly contributing to death

Recommendations 2010:perinatal mortality

• Timely delivery is recommended for confirmed SGA at term

• Women should be given guidelines for ideal maternal gestational weight gain

• Smoking cessation advice is the responsibility of all health professionals

Recommendations 2010:Maternal mortality

• Identifying women with medical problems and referring early

• Support for the Health Beginnings report on maternal and perinatal mental health services in NZ, in particular

• A mother and baby unit should be established in the Auckland region

• Composition of comprehensive mental health services

• MMH screening in termination of pregnancy services