Summary of rapid report
forms 1999 - Chapter 2
(no.of stillbirths/no.of total births) = 5 per 1000
Perinatal mortality rate
(no. of stillbirths + early neonatal deaths/ no.of
total births) = 7.9 per 1000 total births
Neonatal death rate
(no. of deaths within the first 28 days of life/no.
of live births) =3.9 per 1000 live births
Post-neonatal mortality rate
(infants who die between 28 completed days and
1 year/live births)=1.8 per1000 live births
Regional mortality rates
(combined stillbirth, neonatal and post neonatal
mortality rates) range 9.1-13.2per 1000 total births
West Midlands 13.2/1000 total births - Again
the region with the highest mortality rate in the country
Intrapartum related mortality rate = 0.62 per 1000
Enquiry comments on stillbirths - Chapter 3
Stillbirths account for a third of all
deaths reported to CESDI.
The 1 in 10 enquiry (6th annual CESDI
report 1996-97) examined a random sample of the deaths
reported to CESDI excluding babies weighing less than
1000g, major congenital abnormalities and post neonatal
deaths. The majority (422/573) of these deaths were
The majority of stillbirths are classed as “unexplained” (8th annual
report figures: 71% unexplained by Wigglesworth classification
and of those 70% remained unclassified by Aberdeen
However an extensive panel review of the 1in10 enquiry
revealed that 45% of the stillbirths were associated
with grade 2 or 3 suboptimal care.
This suggests that unexplained does not equate to
The 8th annual report included a review
of the comments made in the 1 in 10 enquiry to aim
to identify potentially preventable factors.
Most frequently cited areas of suboptimal care:
Risk assessment- including lack of communication
between GPs and hospital at booking and inappropriate
booking by junior hospital staff
Growth- failure to suspect growth
restriction in a mother with a previous history, failure
to detect it, to act on it and to monitor it.
Fetal movement- failure of mother to report
decrease fetal movements, failure of professionals
to convey importance to mother, failure to act on history
of diminished fetal movements.
Management- delay in instigating management
plan, lack of senior care, failure to investigate infection
and cholestasis, suboptimal management of anaemia,
rhesus disease, hypertension, diabetic control.
Communication - poor documentation, poor oral
and written communication between mother and healthcare
professionals and between health care professionals.
Lifestyle- failure to attend antenatal visits,
failure to stop smoking, failure of healthcare professionals
to advise re smoke cessation.
Post-delivery- Although this did not affect
pregnancy outcome there were several areas of suboptimal
care post delivery that could have added to maternal
distress and suboptimal preparation for future pregnancy.
The majority of comments involved post mortems; failure
to offer them, to counsel correctly and poor quality
of postmortem reports including failure of identification
of IUGR or its cause. Failure to send the placenta
for histology was also criticised.
The 8th annual report includes an “update
on issues surrounding the postmortem” which provides
an overview of the recently published guidelines from
several organisations in view of the recent postmortem
controversies. This is not included in this review-
for more information see www.cemach.org.uk chapter
Other areas that were mentioned were failure to investigate
fully following stillbirth and lack of bereavement
The Euronatal study - Chapter 4
This international audit consisted of a panel of
12 experts reviewing 1619 cases of perinatal death
from 10 European countries. The aim was to identify
areas of suboptimal care and to identify differences
in care between different countries and health systems.
Three groups of babies were considered: antenatal
stillbirths>28 weeks, intrapartum stillbirths >28
weeks and neonatal deaths >34 weeks.
Overall 46.3% of cases had either grade 2 or 3 substandard
care, (a similar number to the 45% substandard care
of the 1 in 10 enquiry). The range of substandard care
between countries was 32-54%.
The most commonly cited reason for substandard care
was failure to detect IUGR, the next most common were;
failure of fetal monitoring, suboptimal management
of IUGR and suboptimal management of hypertension.
The results showed a similarity between the comments
made by the CESDI panels and those across Europe.
Electronic Fetal Monitoring - Chapter 6
The Clinical Effectiveness Support Unit of the Royal
College of Obstetricians and Gynaecologists carried
out an audit on electronic fetal monitoring in response
to CESDIs work on the subject over the past 5 years.
It was also part of the background to the national
evidence based guideline development by the Department
of Health and later the National Institute of Clinical
Assessment of current practice
||Standard Met (% of units)
||Each unit should have at least 2-4 machines per
||There should be an EFM guideline available in
||Continuous EFM should be used in a selection
of high risk pregnancies
||Fetal blood sampling should be available if EFM
||Umbilical cord pH should be performed in situations
of suspected fetal compromise
The availability of guidelines was poor and did not
correspond to the size of unit.
Despite high overall use of EFM for high-risk labours,
the definition of high risk varied considerably between
There has been a doubling of the availability of
FBS facilities over the past 20 years.
Most units sampled cord pH in situations of suspected
fetal compromise but the definition if compromise again
varied between units, for example only 68% of units
routinely samples cord pH after emergency Caesarean
Project 27/28 - Chapter 7
This aimed to provide national and regional survival
rates for babies born between 27+0 and 28+6 weeks during
1998-2000. This data is not routinely collected centrally
despite being recorded on all births.
The overall survival rate was 88% - much better than
expected and double the rate of the mid-1980s.
The type of hospital in which they were born did
not affect survival rate.
Full enquiry findings will be published in the next