Making Every Baby Count

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• If fetal heart sounds were not auscultated on admission or if this information is not available, circle “unknown”. 3.7: Partograph used: Circle to indicate the appropriate information: • “no” if a partograph was not used during delivery; • “yes” if a partograph was used during delivery, and write any relevant additional comments (e.g., write “incomplete” if it was used for only a portion of delivery or does not include all standard information on a partograph); • “unknown” if this information is not available. 3.8: Mode of delivery: Circle to indicate the appropriate information for the fetus or neonate being discussed. • “CVD” for cephalic vaginal (or normal) delivery • “assisted vaginal delivery” if vacuum and/or forceps were used • “caesarean” if indicated • “other” if indicated, and describe (e.g. breech delivery) • “unknown” if this information is not available. More than one answer can be chosen, as appropriate (e.g. failed use of vacuum or forceps followed by a caesarean section). 3.9: Time between the decision for action and the birth: If mode of delivery was anything other than “CVD”, circle the amount of time it took from making the decision that a normal delivery is not longer possible/appropriate to achieving the actual birth by way of assisted/surgical delivery. If delivery was “CVD”, circle “n/a” for not applicable. 3.10: Apgar score: Record the scores at 1 and at 5 minutes. Next to these, circle “6 or more” or “5 or less” as indicated by the score. If either of these scores is not available, circle “unknown” for that score. 3.11: Circle to indicate actions related to resuscitation: • “not needed” if not indicated by Apgar scores or clinical state; • “bag + mask” if performed; • “not done” if resuscitation was indicated but not performed; • “other” and record whether the following forms of resuscitation were performed: –– stimulation –– suction –– intubation –– CPR –– other forms of resuscitation (record); • “unknown” if this information is not available. 3.12: Sex of baby: Circle “male”, “female” or “unknown” as indicated. 3.13: Birth weight: Record the total birth weight, and circle the appropriate category of birth weight, or “unknown” if birth weight is not available. The acronyms stand for: • LBW: Low birth weight (1500–2499 g) 78 MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS
• VLBW: Very low birth weight (1000–1499 g) • ELBW: Extremely low birth weight (< 1000 g) Section 4: Details of the death 4.1 and 4.1.1: Record the date and time of death. 4.2: Type of death: Circle to indicate the appropriate category based on the following definitions. • “Neonatal death” is the death of a baby born alive but who died within the first 28 days of life. • “Intrapartum stillbirth” is the death of a fetus who was alive at the onset of labour but who died before delivery. This can be determined by the presence of fetal heart sounds (fetal heart tones) on admission or prior to delivery, or by appearance of a “fresh” stillbirth (intact skin and fetus on delivery). • “Antepartum stillbirth” is the death of a fetus before the onset of labour. This can be determined by “macerated” appearance of the fetus upon delivery, in combination with absence of fetal heart sounds on admission. –– Absence of fetal heart sounds on admission does not necessarily indicate an antepartum stillbirth, if the woman was admitted with labour already in progress. –– Presence of fetal heart sounds on admission of a labouring woman does exclude the possibility of an antepartum stillbirth. • “Stillbirth, unknown timing” should be circled if it is not possible to tell the time of death of the fetus. 4.3: Main maternal condition: Enter in writing the main maternal condition followed by the letter and number code corresponding to it, found on the maternal conditions reference page. If unknown circle “unknown”. 4.4: Cause of death: Identify the relevant cause of stillbirth or neonatal death by circling the appropriate letter below this item (a–g). For infections (e), circle the most appropriate response. After choosing a main cause of stillbirth or neonatal death, indicate the maternal condition in the relevant M1–M5 category, using the numbers provided on the accompanying reference page. If the mother was healthy, enter 1 in the M5 column corresponding to the cause of stillbirth or neonatal death. Check “other” if none of the maternal conditions codes fit, and check “unknown” if the mother’s condition is unknown. Section 5: Critical delays and modifiable factors 5.1: Critical delays: Circle any delays in care that are recognized during the review of the case, as described below. • Delay 1: Delay in the decision to seek care (e.g., a woman may labour at home for too long because she and/or her family are afraid to come for care, are concerned about the cost of care, or do not recognize developing problems). MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS 79
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Making Every Baby Count Audit and r
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Making Every Baby Count Audit and r
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4.3 The six-step mortality audit cy
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Acknowledgements The World Health O
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Foreword Pregnancy is a time of gre
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in the future. The process of routi
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Key messages of this guide • Audi
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1 Getting started
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1.2 Why is this guide important? Co
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Importantly, it is not sufficient t
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2 Definitions and classification Th
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There are also numerous ways to app
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TABLE 2.1. Mortality rate definitio
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application of ICD-10 to deaths dur
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Box 2.1. Background and contextual
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• Family- or patient-related: e.g
Page 34 and 35: 3 Auditing deaths that occur at the
Page 36 and 37: Within each facility, at least two
Page 38 and 39: compared to the actual numbers of r
Page 40 and 41: of events that led to death, text b
Page 42 and 43: • the number of antepartum (or ma
Page 44 and 45: Possible actions include interventi
Page 46 and 47: Step 6: Evaluating and refining The
Page 48 and 49: 4 Auditing deaths that occur in the
Page 50 and 51: (e.g. individuals who conduct routi
Page 52 and 53: The most effective mechanism for in
Page 54 and 55: Step 1.2: Notification and reportin
Page 56 and 57: It may be easier for an information
Page 58 and 59: Geospatial analyses may be very ben
Page 60 and 61: 5 Creating an enabling environment
Page 62 and 63: will help facilitate the process fo
Page 64 and 65: Maternal and Perinatal Death Review
Page 66 and 67: 6 Scaling up audit for quality and
Page 68 and 69: FIGURE 6.1. Dimensions of a phased
Page 70 and 71: FIGURE 6.2. Example of data flow in
Page 72 and 73: References 1. Maternal death survei
Page 74 and 75: 39. Bradshaw D, Chopra M, Kerber K,
Page 76 and 77: Annexes Annex 1 Stillbirth and Neon
Page 78 and 79: 3.6 Fetal heart sounds on admission
Page 80 and 81: Annex 1b. Guidance for completing t
Page 82 and 83: • “unknown” if the total numb
Page 86 and 87: -- If a “delay 1” is present, c
Page 88 and 89: . antepartum complications Annex 2:
Page 92 and 93: 2.1b: Cause of death - intrapartum
Page 94 and 95: Annex 3b. Guidance for collecting t
Page 96 and 97: 3) If there is no gestational age e
Page 98 and 99: Annex 4. Approaches for classifying
Page 100 and 101: There are multiple tools available
Page 102 and 103: to their occurrence - are entered o
Page 104 and 105: Annex 6. Sample mortality audit mee
Page 106 and 107: Annex 8: Stillbirth and Neonatal Mo
Page 110 and 111: Steps 1. Understand the steps of th
Page 112 and 113: INFORMED CONSENT FORM (INTERVIEWEE
Page 114 and 115: SEQUENTIAL NUMBER SECTION 1. INTER
Page 116 and 117: SECTION 3. INFORMATION ON THE DECEA
Page 118 and 119: ASK THE RESPONDENT: What do you thi
Page 120 and 121: 4.4.2 Before the woman became pregn
Page 122 and 123: 4.16.2 During the last 3 months of
Page 124 and 125: 5.5 How many hours or days passed b
Page 126 and 127: 5.18 Would you say the baby’s siz
Page 128 and 129: 5.33 Did the baby ever move, even a
Page 130 and 131: SECTION 6. NEONATAL ILLNESS HISTORY
Page 132 and 133: 6.17 Did the baby have a swollen st
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SECTION 7. HISTORY OF INJURIES/ACCI
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8.7 What were the reasons the baby
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8.15.2 What difficulties did you ha
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SECTION 9. DATA ABSTRACTED FROM REC
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VA Supervisor comments and observat
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