An official inquiry into stillbirths and neonatal deaths should be considered in order to enhance lessons that could improve care, according to the national body that prepares statistics on such deaths.
The inquiry could specifically review multiple pregnancies, unexpected death during birth and stillbirths in full-term, normally formed babies, according to the National Perinatal Epidemiology Centre (NPEC) in its latest report on perinatal deaths.
Consideration should be given to the establishment of a national working group of medical specialists to look at the problem of preterm birth in Ireland at a national level and how it is best addressed, the report also recommends.
The overall rate of perinatal mortality has remained flat for a number of years, NPEC’s eighth report notes, whereas it was declining in the years up to 2012. “While reductions in perinatal mortality rates are not easy to achieve, other countries have made significant reductions, particularly for stillbirths, in recent years.”
Publication of the report, which covers 2018 and 2019, was delayed by staffing issues and the Covid-19 pandemic.
Deaths of babies
Over the two years, the perinatal mortality rate increased by 17 per cent between 2018 and 2019, but this is not regarded as statistically significant.
In 2019, there were 59,574 births in Ireland, 242 stillbirths and 150 neonatal deaths. This gave a perinatal mortality rate of one for every 166 births.
Perinatal mortality relates to the deaths of babies weighing at least 500 grams and of at least 24 weeks’ gestation.
Thirty of the perinatal deaths in 2019 resulted from a termination of pregnancy, according to the reports, and most of these occurred between 22 and 27 weeks. Stillbirths accounted for 23 of these cases, all related to major congenital anomaly, while seven cases involved neonatal death.
For the first time, the report lists mortality rates for each maternity unit; the level of variation across units was greater in 2019 than in 2018.
The mortality rate for large maternity units appears greater than average, but when adjusted for congenital anomalies and “in utero transfers” from smaller units is similar to the national rate.
Body mass index
One unit – Mayo General Hospital – was above the corrected rate in 2018, but none of the 19 units met the criteria of "outlier" in 2018 or 2019, the report states.
Older or unemployed women, and those from ethnic minorities or with high body-mass index, were more likely to suffer perinatal mortality.
In 2018, women aged over 40 had a 66 per cent higher rate of perinatal mortality; in 2019, it was 35 per cent.
Obese women had more than twice the risk of perinatal mortality compared to women who gave birth in 2019 with a healthy BMI.
Twin and other multiple births were also over-represented. While the birth rate is declining year on year, Ireland has one of the highest multiple pregnancy birth rates in Europe. Perinatal deaths from multiple births accounts for 12.9 per cent of all perinatal deaths in 2018 and 9.7 per cent in 2018.
This is over 3.85 times the proportion of multiples among all births in 2018 and 2.85 the number in 2019.
Two out of every three perinatal deaths is accounted for by stillbirth, with major congenital anomaly the most common cause of death, followed by specific placental conditions.
