Many perinatal and maternal deaths avoidable – report

A new report reviewing the leading causes of death among mothers and children in New Zealand has highlighted maternal suicide during, or shortly after, pregnancy as a tragedy that needs to be addressed.

The annual report of the Perinatal and Maternal Mortality Review Committee (PMMRC) shows suicide continues to be the leading cause of maternal deaths. There were 13 maternal deaths from suicide during 2006 to 2010, almost a quarter of the total recorded.

The PMMRC is responsible for reviewing maternal deaths and all deaths of babies from 20 weeks gestation up to 28 days after birth, or weighing at least 400g if gestation is unknown. It advises the Health Quality & Safety Commission on how to reduce these deaths.

PMMRC Chair Professor Cynthia Farquhar says the report has a number of recommendations aimed at reducing maternal suicides.

“These include the setting up of a mother and baby unit in the North Island in addition to the unit based in Christchurch. Another recommendation is the referral of pregnant women and new mothers with a history of mental illness for psychiatric assessment and management even if they are currently well.

“There also needs to be better coordination between existing services in the primary and specialist sectors and processes for sharing information between providers.”

There were 704 perinatal-related deaths in 2010, including 211 due to a congenital abnormality, 111 due to pre-term birth, and 78 due to haemorrhage during pregnancy.

Professor Farquhar says the report found that 124 (one in five) perinatal deaths and 18 (one in three) maternal deaths were potentially avoidable.

Key findings and recommendations  from the report are summarised below. More information is available in a media release, and the full report can be found here.

The report has been widely covered in the media. Examples include: Call for action over maternal suicides

Radio New Zealand: Rise in potentially avoidable baby deaths

Dominion Post: One In Five Baby Deaths may Be Avoidable

NZ Herald News: Many NZ maternal deaths avoidable

Radio New Zealand: Few facilities for new mothers with mental health problems

3 News: Suicide leading cause of maternal deaths

Yahoo! New Zealand News: Lack of support for women through pregnancy


Perinatal related mortality

• In 2010, the perinatal mortality rate was 10.1/1000 births, and the perinatal related mortality rate was 10.8/1000 births, which represents a small non-significant decrease compared to the previous year. This rate is higher than the rate in Australia in 2009 and similar to the United Kingdom in 2009.
• M?ori and Pacific mothers are more likely to have stillbirths and neonatal deaths compared to New Zealand European and non-Indian Asian mothers.
• There is a significantly increased rate of stillbirth and neonatal death among mothers who live in the most deprived areas.
• Teenage mothers are at higher risk of perinatal related mortality, specifically stillbirth and neonatal death, compared to mothers aged 20-39 years. Mothers of 40 years and older are also at increased risk of perinatal related mortality
• Nine percent of mothers reported using alcohol, and 3.4 percent reported using marijuana in pregnancy. Alcohol and marijuana use were associated with perinatal death due to spontaneous preterm birth and deaths due to sudden unexpected deaths in infancy (SUDI). These findings may be confounded by smoking, deprivation and young age.
• Eighteen percent of all perinatal related deaths were thought to be potentially avoidable deaths – 2 percent of late terminations, 15 percent of stillbirths and 19 percent of neonatal deaths.
• Contributory factors were identified in 27.3 percent of all perinatal related deaths – 2.6 percent of late terminations, 20.5 percent of stillbirths and 23.8 percent of neonatal deaths. The most common contributory factors were barriers to accessing or engaging with maternity and health services (19%), personnel (7%) and organisational and management factors (4%).

Maternal mortality

• The maternal mortality ratio for the five-year interval 2006-2010 was 17.8/100,000 maternities.
• The New Zealand maternal mortality ratio is significantly higher than the ratio reported by the United Kingdom for 2006 to 2008.
• There were eight maternal deaths in 2010.
• The most frequent causes of maternal death in New Zealand in the years 2006 to 2010 were suicide (13 cases), maternal pre-existing medical conditions (11 cases) and amniotic fluid embolism (9 cases).
• Thirty-six percent of maternal deaths in New Zealand from 2006-2010 were considered to be potentially avoidable.
• M?ori and Pacific mothers are more likely than New Zealand European mothers to die during pregnancy or in the six weeks postpartum.

Recommendations perinatal-related illness and death

• If a baby is small for gestational age, and this is confirmed by ultrasound at term, timely delivery is recommended.
• Maternal gestational weight gain: Pregnant women should be given an indication of ideal weight gain in pregnancy according to their body mass index.
• Smoking cessation: All health professionals who provide care to pregnant women should offer smoking cessation advice.
• Neonatal encephalopathy: Cord gases should be performed on all babies born with an Apgar

Recommendations maternal illness and death

• Pregnant women who are identified with pre-existing medical disease during pregnancy should be referred appropriately.
• The committee notes the publication of the Ministry of Health’s Healthy Beginnings report in January 2012 and supports the recommendations with particular regard to the establishment of mother and baby units in the North Island and the importance of screening mothers for a history of mental health disorders.
• A comprehensive perinatal and infant mental health service includes screening and assessment, timely intervention, access to respite care and specialist inpatient care for mothers and babies, consultation and liaison services.
• Termination of pregnancy services should undertake holistic screening for maternal mental health and family violence and provide appropriate support and referral.

You can read the SMC’s coverage of last year’s 2011 PMMRC review here.