Perinatal mortality has decreased in high-resource countries but cause of death, especially for stillbirths, is often unexplained. The Irish National Perinatal Epidemiology Centre (NPEC) established a national clinical audit on perinatal deaths to better identify causes of death and associated risk factors.Methods
After piloting the NPEC Perinatal Death Notification Form and Classification System in three maternity units in 2010, the national audit was initiated and all 20 Irish maternity units have provided anonymised data on perinatal deaths since 2011.Results
For 2011, 491 perinatal deaths were reported – 318 (65%) stillbirths, 138 (28%) early neonatal deaths and 35 (7%) late neonatal deaths – giving a perinatal mortality rate of 6.1/1,000 births, stillbirth rate of 4.3/1,000 births and early neonatal death rate of 1.9/1,000 live births. Fourfold variation in the perinatal mortality rate was observed across the 20 maternity units. The common causes of death in stillbirth were congenital anomaly (26%), placental conditions (17%) and ante/intrapartum haemorrhage (11%), 20% were unexplained. Early neonatal deaths were generally due to congenital anomaly (51%) or respiratory disorder (33%) – primarily severe pulmonary immaturity. Just 4% were unexplained. Low birthweight was common, below normal range for 53% of stillbirths and 40% of early neonatal deaths. In most cases of early neonatal death, spontaneous respiratory activity was absent or ineffective five minutes following delivery (63%) and death occurred within 24 h (62%).Conclusion
This audit enhances clinical interpretation of perinatal deaths which will inform clinical practice, public health interventions and counselling of prospective parents.