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The United Kingdom's stillbirth rate has stopped declining in recent years, and even current rates of perinatal mortality may be hard to maintain because the average age of British mothers continues to rise, a report from the Confidential Enquiry into Maternal and Child Health says.
The Confidential Enquiry into Maternal and Child Health is a research group mandated by the government to collect confidential statistics from NHS trusts and neonatal networks. Its latest report records stillbirths and perinatal deaths for 2005 in England, Wales, and Northern Ireland.
Slightly more than one in 200 pregnancies ended in a stillbirth, and about one in 300 babies died in the first four weeks of life. These numbers, although low, represent “the tip of an iceberg” of morbidity, the report argues.
The rate of stillbirths, which fell steadily from the 1950s onward, remains at the same level as in the early 1990s, the report has founds. Because stillbirths account for the largest component of perinatal mortality, with over 3600 deaths a year, this represents “a matter of considerable public health concern.”
Overall, the 2005 rate of stillbirths was 5.5 (95% confidence interval 5.3 to 5.6) per 1000 total births, neonatal mortality 3.5 (3.4 to 3.7) per 1000 live births, and perinatal mortality was 8.2 (8.0 to 8.4) per 1000 total births. These figures show little change from the previous four years.
Social deprivation remains closely linked to perinatal risk, with mothers from the most deprived fifth of residential areas about twice as likely as mothers from the richest areas to experience stillbirth or neonatal mortality.
Ethnicity is also a factor. Although the stillbirth rate among white mothers was 4.8 per 1000, among black mothers it was 11.6 per 1000 and among Asian women 8.9 per 1000. Mothers of Chinese origin had the fewest stillbirths, at 4.1 per 1000.
Stillbirth and neonatal mortality were most likely when the mother was aged under 20 or over 40 years. Women older than 40 years accounted for 3.4% of live births in 2005, almost twice the proportion of a decade before.
The report includes the performance of individual trusts on perinatal mortality as dots on a graph, but does not identify trusts. Instead it invites trusts that are statistical outliers to examine local factors that might be contributing to their higher than average rates.
Although perinatal mortality in home births was high (7.1 per 1000), the report cautions that most of the deaths did not involve planned home deliveries but cases of unbooked pregnancies and of failure to reach hospital. Next year's report will try to give a clearer picture of perinatal mortality in planned home deliveries.
The report calls for better reporting of the causes of perinatal death. In 2005 more than half of stillbirths were listed as “unexplained,” and 48% of neonatal deaths were classified as caused by “immaturity.” Only 39% of perinatal deaths were investigated by postmortem examination in 2005, compared with 58% in 1993.
The report, Perinatal Mortality 2005: England, Wales, and Northern Ireland, is at www.cemach.org.uk.