The 2010 PMMRC Report an overview Perinatal Mortality

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The 2010 PMMRC Report: an overview Perinatal Mortality 2007 -2010 Maternal Mortality 2006 -2010 The 2010 PMMRC Report: an overview Perinatal Mortality 2007 -2010 Maternal Mortality 2006 -2010

Methodology Perinatal Definition of cases Ascertainment of cases Data sources Maternal > 20 wks Methodology Perinatal Definition of cases Ascertainment of cases Data sources Maternal > 20 wks Direct, indirect to < 28 days 6 wks (Co-incidental) Clinicians; LMCs; Local coordinators BDM; NMDS; Coroners; media LMCs; hospitals; GPs; Coroners; Police Review of cases, Local National classification of cause, multidisciplinary contributory factors, and potentially avoidable death Denominator data Registered births - BDM

Definitions • • • Perinatal related mortality rate - /1, 000 Maternal mortality ratio 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 2007 -2010

Perinatal related mortality NZ and UK 2007 -2010 Perinatal related mortality NZ and UK 2007 -2010

Perinatal related mortality NZ and Australia 2007 -2010 *excludes Victoria Perinatal related mortality NZ and Australia 2007 -2010 *excludes Victoria

Perinatal Death Classification (PDC) among all perinatal related deaths 2007 -2010 Figure 16 pg 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 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 perinatal related mortality 2007 -2010 Figure 22 pg 42

Ethnic specific neonatal death rate by gestation group 2007 -2010 Figure 19 pg 36 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 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 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 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 Deprivation quintile specific perinatal related mortality 2007 -2010 Figure 26 pg 47

Figure 27 pg 48 Figure 27 pg 48

DHB of residence and perinatal related mortality 2007 -2010 Figure 28 pg 49 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 Ethnicity 2010 Figure 13 pg 25

DHB of residence and Deprivation Quintile 2010 Figure 14 pg 26 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 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 Smoking, drug and alcohol use among mothers of babies who died 2010 • Smoking • Alcohol • Marijuana 29% at least 8. 8% at 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 and potentially avoidable perinatal related deaths 2010 Figure 33 pg 67

Contributory factors by ethnicity among perinatal related deaths ’ 09 -’ 10 Figure 32 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 Contributory factors by cause of perinatal related death ’ 09 -’ 10 Figure 29 pg 70

Maternal mortality: ‘ 06 -’ 10 Figure 35 pg 77 Maternal mortality: ‘ 06 -’ 10 Figure 35 pg 77

Maternal mortality: international data • 2006 -2008 UK 11. 4/100, 000 • 2006 -2008 Maternal mortality: international data • 2006 -2008 UK 11. 4/100, 000 • 2006 -2008 NZ 18. 3/100, 000

Maternal mortality: international data Maternal mortality: international data

Maternal mortality and maternal age 2006 -2010 Figure 33 pg 80 Maternal mortality and maternal age 2006 -2010 Figure 33 pg 80

Maternal mortality and maternal ethnicity 2006 -2010 Figure 34 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 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 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 • 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




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