The 2010 PMMRC Report: an overview Perinatal Mortality Maternal Mortality

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

Perinatal related mortality NZ and UK

Perinatal related mortality NZ and Australia *excludes Victoria

Perinatal Death Classification (PDC) among all perinatal related deaths Figure 16 pg 31

NDC among neonatal deaths (excluding FA) by gestation Figure 18 pg 35

Ethnic specific perinatal related mortality Figure 22 pg 42

Ethnic specific neonatal death rate by gestation group Figure 19 pg 36

PDC specific perinatal related mortality rate by ethnicity Figure 24 pg 45

Age specific perinatal related mortality Figure 20 pg 39

PDC specific perinatal related death rates by age Figure 21 pg 40

Deprivation quintile specific perinatal related mortality Figure 26 pg 47

Figure 27 pg 48

DHB of residence and perinatal related mortality 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 CMDHBNZ Crude Adjusted

Smoking, drug and alcohol use among mothers of babies who died 2010 Smoking29% Alcoholat 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 UK 11.4/100, NZ 18.3/100,000

Maternal mortality: international data

Maternal mortality and maternal age Figure 33 pg 80

Maternal mortality and maternal ethnicity Figure 34 pg 80

Maternal mortality Contributory factors 53% of maternal deaths –Organisation and management 32% –Personnel 30% –Barriers 37% Potentially avoidable 32% of maternal deaths CMACE % 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