Making Every Baby Count

Annex 1b. Guidance for completing the Stillbirth and
Neonatal Death Case Review Form
Purpose of form: To assist perinatal death review (also known as “perinatal mortality
audit”) meetings/committees in reviewing a perinatal death, to provide information about
the death, and to identify critical delays and modifiable factors that can be targeted with
interventions to prevent future deaths. The form is designed so that the “normal” answers
appear on the left and the “abnormal” answers appear on the right, making it easier to
identify problem areas.
Time of completion: Sections 1–4 should ideally be completed by a committee in advance
of the perinatal death review meeting, for discussion during the meeting. In some settings
it may be completed during the meeting itself. If this is the case, ensure that all relevant
files and patient notes are available at the meeting.
Section 5 should be completed and discussed at the review meeting.
Section 1: Identification
1.1: Mother’s ID: Put an identifier for the mother here. Include ID numbers that are used by
your health-care facility. If there are potential legal ramifications linked to audit records, do
not use this identifier and instead just number the cases discussed sequentially.
1.2: Baby’s ID: Include ID numbers that are used by your health-care facility. If no standard
ID numbers are used, put the baby’s name instead. If the baby has no name, put mother’s
name + “boy” or “girl”. If there are multiple babies for the same mother, add “boy No. 1”
or “girl No. 1” as needed.
1.3: Facility name: Put the name of the facility where the stillbirth or neonatal death took
place. If it is being reviewed at a different facility, add “reviewed at facility: ____” to clarify.
1.4: Type of care available: Circle the type of care available at the time the woman presented
for care.
Type of care is defined according to the World Health Organization classification of basic
emergency obstetric care (BEmOC) and comprehensive emergency obstetric care (CEmOC).
To classify care as “basic”, it must provide all of seven essential interventions:
1. administration of parenteral antibiotics to treat infection
2. administration of magnesium sulfate for treatment of eclampsia and pre-eclampsia
3. administration of oxytocin for postpartum haemorrhage
4. manual removal of the placenta
5. assisted or instrumental vaginal delivery
6. removal of retained products of conception
7. neonatal resuscitation.
74 MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS