1. Making pregnancy safer: can we do better? A PMMRC workshop on improving outcomes for New Zealand mothers and babies

2. 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

3. 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

4. The 2009 report

5. What’s new in this report? Contributory factors and potentially avoidable deaths Focus on teenage mothers

6. 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

7. 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

8. Young mothers 2007-2009 p35

9. 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

10. 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

11. 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 1 st January 2010 with notification of cases through the PSU

12. 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 1 st January 2010

13. 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

14. Current structure of PMMRC Perinatal and Maternal Mortality Review Committee Health Quality and Safety Commission Maori Caucus POMRC CYMRC FVRC Local Coordinators Network AMOSS WG Neonatal Encephalopathy WG Maternal MWG Secretariat/ National Coordinator

15. Finally Thank you to all midwives, nurses, doctors, analysts, epidemiologists and managers who have worked to collect this data and produce this report

16. PMMRC www.pmmrc.health.govt.nz