Overview of Perinatal Mortality in Ireland

Paul Corcoranon behalf of the NPEC and the Perinatal Mortality Group

NPEC Study Day, 17 January 2020

HOSPITAL GROUP

Ireland East

Dublin Midlands HOSPITALS BY NUMBER OF

RCSI Hospitals

< 2000

2001–6000

> 6001

Saolta University Health Care

South/South West

UL Hospitals

Definitions

• Live birth: The complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life - e.g. beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles – whether or not the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered live born.

http://www.who.int/healthinfo/statistics/indmaternalmortality/en/

Perinatal deaths

• Stillbirth: A child born weighing ≥500g or having a gestational age of ≥24 weeks who shows no signs of life (Stillbirth Registration Act, 1994)

• Early neonatal death: Death of a live born baby occurring within 7 completed days of birth

• Late neonatal death: Death of a live born baby occurring after the 7th day and within 28 completed days of birth.

Guidance of signs of life<24 gestational weeks

https://leicester.onlinesurveys.ac.uk/signs-of-life

• One in 800 births occur at 22-23wks of gestation (MBRRACE-UK, 2017)

• Across healthcare organisations in England, 20% to 80% of births at 22-23 gestational weeks were registered as live births, a range which is unlikely to reflect real variation (Smith et al, 2012)

• Such variation has been shown to influence perinatal mortality rates (Smith et al, 2012 & 2017; Rysavy et al, 2015).

Guidance of signs of life<24 gestational weeks

Europeancomparison of thestillbirth rate

Euro-Peristat compared the stillbirth rate across countries in Europe in 2004 applying different definitions.

Mohangoo et al, 2011

Europeancomparison of thestillbirth rate

Note: Rate based on stillbirths among births with ≥28 completed weeks of gestation. The Irish stillbirth rate, when corrected by excluding cases due to a congenital malformation, is adjusted to 2.1 per 1,000 births

5.73.7

3.63.5

3.43.2

3.13.13.1

333

2.92.82.8

2.72.7

2.62.52.52.5

2.42.42.42.42.4

2.32.3

2.22.12.1

22

1.4

0 1 2 3 4 5 6

BulgariaHungaryRomaniaSlovakia

LatviaCroatia

BelgiumEstonia

UK: England & WalesGreeceFrance

Sweden, 2014Lithuania

IrelandUK: Scotland

Czech RepublicSpain

UK: Northern IrelandMalta

Poland, 2014Portugal

GermanyItaly

AustriaSlovenia

SwitzerlandLuxembourg

NorwayNetherlands

Ireland (corrected)Finland

DenmarkIcelandCyprus

Stillbirths/1,000 births ≥28 weeks gestation

In 2018, Euro-Peristat reported a comparison based on stillbirth rates in 2015.

Ireland’s stillbirth rate is based on year 2017.

Number of perinatal deaths in Ireland, 2017(Stillbirths and early neonatal deaths)

Definition NPEC

SB 500g+/24wks & any ENND 384

SB 500g+ & any ENND 365

SB & ENND 500g+/24wks 346

SB & ENND 500g+ 325

Other source

264 CSO

310 IMIS

325 HPO

Perinatal mortality numbers and rates

Corrected perinatal deaths exclude deaths due to a congenital anomaly.

Perinatal mortality trend, 2011-2017

PMR=perinatal mortality rate;Corrected PMR excludes deaths due to a congenital anomaly.

In-utero transfer and perinatal deaths, 2017

• Pregnant woman’s care and intended place of delivery transferred from the maternity unit where she had her booking appointment to another unit

• 28 of the 346 perinatal deaths followed in-utero transfer (8.1%)

• IMIS reported 343 in-utero transfers of women admitted into the hospital after being transferred from another hospital in the fetal interest, during the current birth episode.

In-utero transfer and total PMR by unit, 2017

Note: The blue diamond markers indicate the unit-specific PMR that was observed in 2017 and the red square markers the PMR that would have been observed if in utero transfer cases had remained at the unit where the booking appointment had taken place.

Placental histology and autopsy99%,90% in UK93%

60%,45% in UK43%,26% in UK

Stillbirth Early neonatal deathCause of death, 2017

Risk factors - Maternal age and parityIncreased risk for younger women and for older women

Increased risk for women with at least three previous deliveries

Fetal growth restriction (FGR)50% of stillbirths and 45% of ENNDs were SGA (<10th bwt centile)

Antenatal diagnosis of FGR was low201631%27%29%23%

Corrected PMR by birthweight centile

Overall rate, 2011-20174 per 1,000 births

Perinatal death by gestational age(Singleton, not due to congenital anomaly)

Gestational age Births Deaths Rate per 1,000<28 weeks 1,420 545 383.828-31 weeks 2,340 244 104.332-36 weeks 17,766 329 18.537 weeks 21,748 95 4.438 weeks 59,012 120 2.039 weeks 113,128 127 1.140 weeks 138,301 122 0.941 weeks 92,125 77 0.842 weeks+ 11,631 9 0.8

Thank you