Making Every Baby Count

• the number of antepartum (or macerated) and intrapartum (or fresh) stillbirths and
early neonatal deaths; and
• in-facility stillbirth (intrapartum and antepartum) and neonatal mortality rates.
The number of major complications during labour and birth, and the reasons for caesarean
section (fetal distress, obstructed labour, failed induction, placental abruptions,
postpartum haemorrhage, postpartum infection, severe preeclampsia or eclampsia, etc.)
may also be collated and presented. Audit committees, facility administrators or local policy-makers
may want to pick one particular indicator to focus on and follow over time to
see if outcomes improve after implementing audit recommendations.
Computer programs, such as the Perinatal Information System (50), can be designed to
run analyses and produce standardized tables, graphs and maps, which may enhance the
use and reporting of data (Annex 7). Although the set-up of an automated system requires
an initial investment, it will save time and money in the long run. Program maintenance
and plans for updating source data and program codes should be integrated into the data
management plan, as well as checks within the system to avoid erroneous data entry,
where possible.
Indicator tallies over time are simple and quick to prepare, but more detail could be gained
from geographically mapping key details related to specific indicators – for example, if a
number of women presenting with obstructed labour come from a specific area, there may
be a transport or other issue affecting access to the health-care facility. Mapping cases may
be time-consuming but can provide more information about the population’s care-seeking
behaviour, existing social and health services and the natural environment.
For each individual case, a death case review form with key details should be completed
ahead of the meeting (see Annex 1: Stillbirth and Neonatal Death Case Review Form),
by compiling data from multiple sources. While the form is concise, it should include all
relevant information, both medical and non-medical, as well as some standard demographic
data. Although it is more efficient for a designated individual or small group to
complete the whole form – including the direct causes of death, related maternal conditions
and modifiable factors – before the mortality audit meeting, these sections may also
be discussed and completed during the meeting itself until the designated individuals are
comfortable with completing the process independently.
The review team should remain open to considering all possible problems and factors
revealed by the data. Different methods of classifying modifiable factors are detailed in
Chapter 2 and Annex 4. The combined quantitative and qualitative analysis will allow identification
of patterns and trends of problems, both non-medical and medical, that lead to
deaths. The interpretation of and action in response to the results of the quantitative analysis
– i.e. information about the most common problems contributing to stillbirths and
neonatal deaths – will be the job of the health-care facility staff, management and local
leaders who are members of the mortality audit committee.
Additional analyses that could be helpful include the approximate number of deliveries
and deaths and their distribution by place of occurrence (home, health centre, public hospital,
private hospital or other level/type of hospital). Where more detailed demographic
36 MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS