National Women's Annual Clinical Report 2010

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10 PERINATAL MORTALITY This chapter provides information on perinatal and maternal deaths. Further data tables can be found in Appendix 9. NW has a Bereavement Team whose members care for women with pregnancy loss, including women with stillbirth and neonatal death and also those who undergo termination for fetal abnormality or other cause. Methods Perinatal mortality data are obtained from the Healthware clinical database and also from a stand alone Access database. These data include classifications of cause of death assigned following multi-disciplinary discussion. The classification of perinatal death uses the Perinatal Society of Australia and New Zealand (PSANZ) system which was first released in May 2003, updated in November 2004 and most recently in March 2009. It includes a classification system by antecedent cause (PSANZ-PDC). In addition neonatal deaths are classified by relevant conditions preceding neonatal death using the PSANZ-NDC. PSANZ-PDC (PSANZ Perinatal Death Classification) is used to identify the single most important factor which led to the chain of events that resulted in the death. PSANZ-NDC (PSANZ Neonatal Death Classification) is applied, in addition to the PSANZ-PDC, to identify the single most important factor in the neonatal period which caused the neonatal death. Two associated factors can also be recorded in each of these systems, but associated factors are not included in the analysis in this report. The PSANZ system was developed because of shortcomings in ICD10 coding alone and in the Whitfield system which classified a high proportion of deaths as unexplained. Perinatal mortality rate is defined as fetal death (stillbirth of a baby of at least 20 weeks of gestation at issue or at least 400 grams birth weight if gestation is unknown) plus early neonatal death (death of a liveborn baby before completion of the first 7 days of life), and expressed as a rate per 1000 total babies born. Perinatal-related mortality rate includes, in addition, late neonatal deaths (death of a liveborn baby of any gestation and weight following 7 days of life but before completion of 28 days of life). Perinatal-related death risk is presented by gestation and in this case is the risk of fetal death or neonatal death per 1000 babies remaining in utero to represent the risk at a specific gestation in pregnancy. Fetal death rate is calculated per 1000 babies born, meaning babies remaining in utero if data are presented by gestation, or meaning total babies born if presented as an overall rate. Neonatal death rate is per 1000 live born babies, except in the perinatal mortality time trends figure where neonatal death rates are per 1000 total babies born. This variation is to demonstrate the contribution of fetal deaths and neonatal deaths to overall perinatal mortality rates. Perinatal mortality rates are also presented excluding deaths of babies with lethal abnormalities and terminations for fetal abnormalities. This is calculated by excluding fetal deaths where the primary PDC classification was congenital abnormality and neonatal deaths where the primary NDC classification was congenital abnormality. All perinatal deaths are reviewed monthly by a multidisciplinary team comprising an obstetrician (MFM subspecialist), neonatologist, midwife, perinatal pathologist and administrator. This group classifies the cause of death and summarises recommendations for management if there is a future pregnancy. There is also a service wide monthly quality meeting. Any issues requiring further investigation in terms of aspects of clinical practice or systems/policies are referred to the Maternal <strong>Clinical</strong> Review Committee. 157
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National Women’s Annual Clinical
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It is my pleasure to present the 20
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7 LABOUR AND BIRTH OUTCOMES .......
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Table 50: Neonatal outcomes followi
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Table 153: Preterm birth and matern
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Table 258: Perinatal mortality rate
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Figure 53: Mode of birth (1991-2010
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Chapter 1 INTRODUCTION 1
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Chapter 8: Postnatal care This chap
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1.5.3 Gynaecologic data quality As
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2 SERVICE PROVISION 2.1 Maternity s
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2.2.4 Antenatal and Postnatal Wards
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The service has access to the ACH L
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2.5.3 University Links There are cl
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Reportable events All incidents (mi
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Chaptern 3 SUMMARY STATISTICS 19
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3.2 Summary of maternal outcomes 20
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Rate Table 7: Perinatal related mor
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Maternal indicator Caesarean sectio
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50 45 40 35 30 25 20 15 10 5 0 % Ep
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4 MATERNAL DEMOGRAPHY This chapter
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4.2.2 Maternal ethnicity When more
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% 60 50 40 30 20 10 0 NZ European M
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4.5 Body mass index Thirty five per
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% 100 80 60 40 20 0 European Maori
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Women booked with a private obstetr
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5 ANTENATAL COMPLICATIONS This chap
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Ethnic differences in rates of pret
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of women under 20 with SGA babies s
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Perinatal deaths in term SGA infant
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The rate of multiple pregnancy rema
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Summary / Implications Multiple pre
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5.4.1 Demographic characteristics o
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5.4.5 Perinatal losses Diabetes Per
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A confirmed placental abruption is
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70 60 50 40 30 20 10 0 % Gestationa
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5.7 Body Mass Index Methods BMI is
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% European Maori Pacific Other Asia
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50 45 40 35 30 25 20 15 10 5 0 % Eu
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16 % 40 14 12 10 8 6 4 2 0 Iatrogen
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Table 38: Mothers with babies diagn
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6 LABOUR AND BIRTH This chapter inc
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Table 39: Maternal demographic char
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Table 40: Gestation at birth among
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Women given syntocinon prior to 3 c
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70 60 50 40 30 20 10 0 % NZ Europea
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6.5 Caesarean section WHA Maternity
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Caesarean section rate 60 50 40 30
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Sixty percent of para 1 women with
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6.6 Instrumental vaginal birth WHA
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Table 52: Neonatal outcomes followi
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6.10 Obstetric analgesia WHA Matern
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Table 56: GA use and mode of birth
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Table 58: Interventions and outcome
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Chaptern 7 LABOUR and BIRTH OUTCOME
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Page 121 and 122: 7.2 Third stage management Methods:
Page 123 and 124: Table 61: Postpartum haemorrhage ra
Page 125 and 126: 7.4 Emergency peripartum hysterecto
Page 127 and 128: Chaptern 8 POSTNATAL CARE 113
Page 129 and 130: 8 POSTNATAL CARE This chapter provi
Page 131 and 132: % 90 85 80 75 70 65 60 55 50 45 40
Page 133 and 134: 8.2 Postnatal admissions Methods Pr
Page 135 and 136: Table 70: Reason for admission to N
Page 137 and 138: Chaptern 9 NEWBORN SERVICES 123
Page 139 and 140: 9 NEWBORN SERVICES This chapter pro
Page 141 and 142: 9.2 NICU occupancy For 2010 the ver
Page 143 and 144: Number 700 600 500 400 300 200 100
Page 145 and 146: 9.3.4 Reasons for admission to NICU
Page 147 and 148: 9.4.3 Intraventricular haemorrhage
Page 149 and 150: 246 for 2010. This number is higher
Page 151 and 152: 9.4.8 Trends in the use of assisted
Page 153 and 154: 9.4.10 Positive pressure ventilatio
Page 155 and 156: 9.4.12 Term/post-term infants on as
Page 157 and 158: 9.5.2 Survival of inborn babies (23
Page 159 and 160: 20% 18% 16% 14% 12% 10% 8% 6% 4% AN
Page 161 and 162: 9.5.10 Postnatal corticosteroids (A
Page 163 and 164: express milk for many weeks before
Page 165 and 166: 9.9 Child Development Unit 9.9.1 Fo
Page 167 and 168: 9.9.2 Development at 4 years of chi
Page 169: Chapter 10 PERINATAL MORTALITY 155
Page 173 and 174: Table 87: Perinatal related loss an
Page 175 and 176: 10.5 Causes of perinatal-related de
Page 177 and 178: Chapter 11 SEVERE MATERNAL MORBIDIT
Page 179 and 180: 11 SEVERE MATERNAL MORBIDITY This c
Page 181 and 182: Chapter 12 GYNAECOLOGY 167
Page 183 and 184: 12 GYNAECOLOGY This chapter provide
Page 185 and 186: 12.2 Termination of pregnancy Epsom
Page 187 and 188: 12.3 Second trimester Termination o
Page 189 and 190: 12.4 Gynaecology inpatient surgery
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Page 193 and 194: ACHS Gynaecology Indicators: Injury
Page 195 and 196: 12.5 Gynaecologic laparoscopic proc
Page 197 and 198: 12.6 Hysterectomy Methods See Gynae
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Page 203 and 204: Table 113: Complications of surgery
Page 205 and 206: 12.8 Colposcopy Methods: The data p
Page 207 and 208: Referral smear cytology Table 117:
Page 209 and 210: The number of treatments and percen
Page 211 and 212: Number of patients 4.5 4 3.5 3 2.5
Page 213 and 214: 12.9 Gynaecologic oncology surgical
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Page 219 and 220: Antenatal Summary screen; Reason fo
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Postnatal Mothers Destination to Wa
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APPENDIX 2. SUMMARY STATISTICS Tabl
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Table 135: Time trends in nullipari
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Table 141: Rates of smoking at book
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Table 149: LMC at birth and materna
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APPENDIX 4. ANTENATAL COMPLICATIONS
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Table 157: Demographic characterist
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4.4 Hypertensive disease Table 160:
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Table 164: LMC at birth and BMI (20
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APPENDIX 5. LABOUR AND BIRTH 5.1 In
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5.2 Outcomes following induction Ta
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Table 180: Mode of birth by LMC at
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5.5 Operative births Table 189: Pri
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Table 196: Referral for ECV (women
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APPENDIX 6. LABOUR and BIRTH OUTCOM
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APPENDIX 7. POSTNATAL CARE 7.1 Infa
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Table 213: Maternal destination fol
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Table 220: Admissions of inborn bab
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Table 224: Admissions of outborn ba
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8.2.5 Antenatal corticosteroids Tab
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8.3.2 Intraventricular haemorrhage
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8.4.1 Survival Table 240: Numbers o
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8.5.4 Patent Ductus Arteriosus Tabl
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Table 252: Inborn babies receiving
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APPENDIX 9. PERINATAL MORTALITY Tab
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Table 260: Cause of perinatal-relat
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10.2 Gynaecology Inpatient Surgery
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APPENDIX 11. GLOSSARY OF ABBREVIATI
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APPENDIX 12. DEFINITIONS Antepartum
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Lead Maternity Carer (LMC) The Lead
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Standard primipara A woman with no
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