MBRRACE-UK Perinatal Mortality Surveillance Report for births in 2020 (13 October 2022)

Summary

MBRRACE-UK is commissioned by the Healthcare Quality Improvement Partnership (HQIP) to undertake the Maternal, Newborn and Infant Clinical Outcome Review Programme (MNI-CORP). The aims of the MNI-CORP are to collect, analyse and report national surveillance data and conduct national confidential enquiries in order to stimulate and evaluate improvements in health care for mothers and babies. This report focuses on the surveillance of perinatal deaths from 22+0 weeks’ gestational age (including late fetal losses, stillbirths, and neonatal deaths) of babies born between 1 January and 31 December 2020.

Content

New recommendations

1. Commission a review of evidence in order to enhance perinatal services for disadvantaged populations to reduce inequitable outcomes.

2. Continue to evaluate and implement the national initiatives to reduce stillbirth and neonatal deaths and monitor their impact on reducing preterm birth, particularly the most extreme preterm group.

3. Develop UK-wide harmonised indicators to identify high risk groups, including ethnicity and deprivation measures, to facilitate direct population comparisons.

4. Improve the availability and accessibility of initiatives and policies to reduce stillbirth and neonatal mortality across the UK for health professionals, policy makers, academics, health service researchers and the public. Provide regular updates on progress towards publicised ambitions and targets.

5. Investigate the characteristics of stillbirths and neonatal deaths in twin pregnancies, particularly with regard to gestation at delivery, in order to understand the reasons for increasing mortality rates.

6. Ensure cause of death coding is undertaken by a suitably qualified clinician following PMRT review, and MBRRACE UK surveillance data updated accordingly.

Recommendations from previous reports requiring improved implementation

• Enhance current programmes in order to accelerate the reduction of stillbirths and neonatal deaths to meet national targets, with an emphasis on reducing rates of preterm birth, particularly the most extreme preterm group.
• Use the MBRRACE-UK real-time data monitoring tool as part of regular mortality meetings to help identify why an organisation’s stabilised & adjusted stillbirth, neonatal mortality or extended perinatal mortality rate falls into the red or amber band.
• Investigate potential modifiable factors in the treatment of neonates when an organisation’s stabilised & adjusted neonatal mortality rate falls into the red or amber bands after exclusion of deaths due to congenital anomalies. Ensure that this encompasses both local population characteristics and quality of care provision.
• Use the MBRRACE-UK guidance for the assessment of signs of life in births before 24+0 weeks’ gestational age.
• Ensure that there is a multi-agency targeted approach affecting people living in areas of high socio-economic deprivation across all points of the reproductive, pregnancy and neonatal healthcare pathway.
• Identify the specific needs of Black and Asian populations and ensure that these are addressed as part of their reproductive and pregnancy healthcare provision.
• Initiate a research programme to inform the development of effective interventions to address health inequalities and reduce stillbirth and neonatal mortality rates.
• Develop focused initiatives to reduce stillbirths and neonatal deaths among those at the highest risk, informed by the multidimensional effects of ethnicity, deprivation and age.
• Emphasise the importance of pre-conception health as a routine part of every health professional’s interaction with people who have risk factors for congenital anomaly.
• Undertake placental histology for all babies admitted to a neonatal unit, preferably by a specialist perinatal pathologist.