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

2. 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

3. 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

4. Perinatal related mortality NZ 2007-2010

5. Perinatal related mortality NZ and UK 2007-2010

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

7. Perinatal Death Classification (PDC) among all perinatal related deaths 2007-2010 Figure 16 pg 31

8. NDC among neonatal deaths (excluding FA) by gestation 2007-2010 Figure 18 pg 35

9. Ethnic specific perinatal related mortality 2007-2010 Figure 22 pg 42

10. Ethnic specific neonatal death rate by gestation group 2007-2010 Figure 19 pg 36

11. PDC specific perinatal related mortality rate by ethnicity 2007-2010 Figure 24 pg 45

12. Age specific perinatal related mortality 2007-2010 Figure 20 pg 39

13. PDC specific perinatal related death rates by age 2007-2010 Figure 21 pg 40

14. Deprivation quintile specific perinatal related mortality 2007-2010 Figure 26 pg 47

15. Figure 27 pg 48

16. DHB of residence and perinatal related mortality 2007-2010 Figure 28 pg 49

17. DHB of residence and Ethnicity 2010 Figure 13 pg 25

18. DHB of residence and Deprivation Quintile 2010 Figure 14 pg 26

19. Ethnicity and deprivation quintile standardised perinatal related mortality CMDHB 2007-2010 CMDHBNZ Crude13.110.8 Adjusted10.910.5

20. 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

21. Contributory factors and potentially avoidable perinatal related deaths 2010 Figure 33 pg 67

22. Contributory factors by ethnicity among perinatal related deaths ’09-’10 Figure 32 pg 72

23. Contributory factors by cause of perinatal related death ’09-’10 Figure 29 pg 70

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

25. Maternal mortality: international data 2006-2008 UK 11.4/100,000 2006-2008 NZ 18.3/100,000

26. Maternal mortality: international data

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

28. Maternal mortality and maternal ethnicity 2006-2010 Figure 34 pg 80

29. 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

30. 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

31. 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