From Audit to Action Practical Solution
PMMRC Conference 201
Perinatal and Maternal Mortality in New Zealand: reflections from across the Tasman Chris Wilkinson
Trends of maternal mortality ratios (MMR, maternal deaths per 100 000 live births) – Australia and neighbouring countries Country
MMR 1990
MMR 1995
MMR 2000
MMR 2005
MMR 2013
MMR % change
Annual % change
Australia
7
8
9
6
6
-14 %
- 0.7 %
Indonesia
430
360
310
250
190
- 56 %
- 3.5 %
New Zealand
18
13
12
12
8
- 57 %
- 3.6 %
Papua New Guinea
470
370
340
280
220
- 54%
- 3.3 %
Fiji
89
79
72
69
59
- 34 %
- 1.8 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
Trends of maternal mortality ratios (MMR, maternal deaths per 100 000 live births) – Australia and neighbouring countries Country
MMR 1990
MMR 1995
MMR 2000
MMR 2005
MMR 2013
MMR % change
Annual % change
Australia
7
8
9
6
6
-14 %
- 0.7 %
Indonesia
430
360
310
250
190
- 56 %
- 3.5 %
New Zealand
18
13
12
12
8
- 57 %
- 3.6 %
Papua New Guinea
470
370
340
280
220
- 54%
- 3.3 %
Fiji
89
79
72
69
59
- 34 %
- 1.8 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
Trends of maternal mortality ratios (MMR, maternal deaths per 100 000 live births) – Australia and neighbouring countries Country
MMR 1990
MMR 1995
MMR 2000
MMR 2005
MMR 2013
MMR % change
Annual % change
Australia
7
8
9
6
6
-14 %
- 0.7 %
Indonesia
430
360
310
250
190
- 56 %
- 3.5 %
New Zealand
18
13
12
12
8
- 57 %
- 3.6 %
Papua New Guinea
470
370
340
280
220
- 54%
- 3.3 %
Fiji
89
79
72
69
59
- 34 %
- 1.8 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
Trends of maternal mortality ratios (MMR, maternal deaths per 100 000 live births) – Australia and neighbouring countries Country
MMR 1990
MMR 1995
MMR 2000
MMR 2005
MMR 2013
MMR % change
Annual % change
Australia
7
8
9
6
6
-14 %
- 0.7 %
Indonesia
430
360
310
250
190
- 56 %
- 3.5 %
New Zealand
18
13
12
12
8
- 57 %
- 3.6 %
Papua New Guinea
470
370
340
280
220
- 54%
- 3.3 %
Fiji
89
79
72
69
59
- 34 %
- 1.8 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
Trends of maternal mortality ratios (MMR, maternal deaths per 100 000 live births) – Australia and neighbouring countries Country
MMR 1990
MMR 1995
MMR 2000
MMR 2005
MMR 2013
MMR % change
Annual % change
Australia
7
8
9
6
6
-14 %
- 0.7 %
Indonesia
430
360
310
250
190
- 56 %
- 3.5 %
New Zealand
18
13
12
12
8
- 57 %
- 3.6 %
Papua New Guinea
470
370
340
280
220
- 54%
- 3.3 %
Fiji
89
79
72
69
59
- 34 %
- 1.8 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
Trends of maternal mortality ratios (MMR, maternal deaths per 100 000 live births) – Australia and neighbouring countries Country
MMR 1990
MMR 1995
MMR 2000
MMR 2005
MMR 2013
MMR % change
Annual % change
Australia
7
8
9
6
6
-14 %
- 0.7 %
Indonesia
430
360
310
250
190
- 56 %
- 3.5 %
New Zealand
18
13
12
12
8
- 57 %
- 3.6 %
Papua New Guinea
470
370
340
280
220
- 54%
- 3.3 %
Fiji
89
79
72
69
59
- 34 %
- 1.8 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
Trends of maternal mortality ratios (MMR, maternal deaths per 100 000 live births) – Australia and neighbouring countries Country
MMR 1990
MMR 1995
MMR 2000
MMR 2005
MMR 2013
MMR % change
Annual % change
Australia
7
8
9
6
6
-14 %
- 0.7 %
Indonesia
430
360
310
250
190
- 56 %
- 3.5 %
New Zealand
18
13
12
12
8
- 57 %
- 3.6 %
Papua New Guinea
470
370
340
280
220
- 54%
- 3.3 %
Fiji
89
79
72
69
59
- 34 %
- 1.8 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
Trends of maternal mortality ratios (MMR, maternal deaths per 100 000 live births) – Australia and neighbouring countries Country
MMR 1990
MMR 1995
MMR 2000
MMR 2005
MMR 2013
MMR % change
Annual % change
Australia
7
8
9
6
6
-14 %
- 0.7 %
Indonesia
430
360
310
250
190
- 56 %
- 3.5 %
New Zealand
18
13
12
12
8
- 57 %
- 3.6 %
Papua New Guinea
470
370
340
280
220
- 54%
- 3.3 %
Fiji
89
79
72
69
59
- 34 %
- 1.8 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
Trends of maternal mortality ratios (MMR, maternal deaths per 100 000 live births) – Australia and neighbouring countries Country
MMR 1990
MMR 1995
MMR 2000
MMR 2005
MMR 2013
MMR % change
Annual % change
Australia
7
8
9
6
6
-14 %
- 0.7 %
Indonesia
430
360
310
250
190
- 56 %
- 3.5 %
New Zealand
18
13
12
12
8
- 57 %
- 3.6 %
Papua New Guinea
470
370
340
280
220
- 54%
- 3.3 %
Fiji
89
79
72
69
59
- 34 %
- 1.8 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
2013 Estimates of maternal mortality ratio (MMR, maternal deaths per 100 000 live births), number of maternal deaths, lifetime risk (probability of maternal death of a 15 yo woman) Country
MMR
Lower range of MMR certainty
Upper range of MMR certainty
Number of Maternal deaths
Lifetime maternal death risk 1 in …..
PMD (%) % of mat deaths per 15yo
Australia
6
4
10
18
9.000
0.5 %
Indonesia
190
120
300
8,800
220
8.4 %
New Zealand
8
5
12
5
6,600
0.6 %
Papua New Guinea
220
110
450
460
120
7.8 %
Fiji
59
35
95
11
620
2.7 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
2013 Estimates of maternal mortality ratio (MMR, maternal deaths per 100 000 live births), number of maternal deaths, lifetime risk (probability of maternal death of a 15 yo woman) Country
MMR
Lower range of MMR certainty
Upper range of MMR certainty
Number of Maternal deaths
Lifetime maternal death risk 1 in …..
PMD (%) % of mat deaths per 15yo
Australia
6
4
10
18
9.000
0.5 %
Indonesia
190
120
300
8,800
220
8.4 %
New Zealand
8
5
12
5
6,600
0.6 %
Papua New Guinea
220
110
450
460
120
7.8 %
Fiji
59
35
95
11
620
2.7 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
2013 Estimates of maternal mortality ratio (MMR, maternal deaths per 100 000 live births), number of maternal deaths, lifetime risk (probability of maternal death of a 15 yo woman) Country
MMR
Lower range of MMR certainty
Upper range of MMR certainty
Number of Maternal deaths
Lifetime maternal death risk 1 in …..
PMD (%) % of mat deaths per 15yo
Australia
6
4
10
18
9.000
0.5 %
Indonesia
190
120
300
8,800
220
8.4 %
New Zealand
8
5
12
5
6,600
0.6 %
Papua New Guinea
220
110
450
460
120
7.8 %
Fiji
59
35
95
11
620
2.7 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
2013 Estimates of maternal mortality ratio (MMR, maternal deaths per 100 000 live births), number of maternal deaths, lifetime risk (probability of maternal death of a 15 yo woman) Country
MMR
Lower range of MMR certainty
Upper range of MMR certainty
Number of Maternal deaths
Lifetime maternal death risk 1 in …..
PMD (%) % of mat deaths per 15yo
Australia
6
4
10
18
9.000
0.5 %
Indonesia
190
120
300
8,800
220
8.4 %
New Zealand
8
5
12
5
6,600
0.6 %
Papua New Guinea
220
110
450
460
120
7.8 %
Fiji
59
35
95
11
620
2.7 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
2013 Estimates of maternal mortality ratio (MMR, maternal deaths per 100 000 live births), number of maternal deaths, lifetime risk (probability of maternal death of a 15 yo woman) Country
MMR
Lower range of MMR certainty
Upper range of MMR certainty
Number of Maternal deaths
Lifetime maternal death risk 1 in …..
PMD (%) % of mat deaths per 15yo
Australia
6
4
10
18
9,000
0.5 %
Indonesia
190
120
300
8,800
220
8.4 %
New Zealand
8
5
12
5
6,600
0.6 %
Papua New Guinea
220
110
450
460
120
7.8 %
Fiji
59
35
95
11
620
2.7 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
2013 Estimates of maternal mortality ratio (MMR, maternal deaths per 100 000 live births), number of maternal deaths, lifetime risk (probability of maternal death of a 15 yo woman) Country
MMR
Lower range of MMR certainty
Upper range of MMR certainty
Number of Maternal deaths
Lifetime maternal death risk 1 in …..
PMD (%) % of mat deaths per 15yo
Australia
6
4
10
18
9,000
0.5 %
Indonesia
190
120
300
8,800
220
8.4 %
New Zealand
8
5
12
5
6,600
0.6 %
Papua New Guinea
220
110
450
460
120
7.8 %
Fiji
59
35
95
11
620
2.7 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
2013 Estimates of maternal mortality ratio (MMR, maternal deaths per 100 000 live births), number of maternal deaths, lifetime risk (probability of maternal death of a 15 yo woman) Country
MMR
Lower range of MMR certainty
Upper range of MMR certainty
Number of Maternal deaths
Lifetime maternal death risk 1 in …..
PMD (%) % of mat deaths per 15yo
Australia
6
4
10
18
9.000
0.5 %
Indonesia
190
120
300
8,800
220
8.4 %
New Zealand
8
5
12
5
6,600
0.6 %
Papua New Guinea
220
110
450
460
120
7.8 %
Fiji
59
35
95
11
620
2.7 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
2013 Estimates of maternal mortality ratio (MMR, maternal deaths per 100 000 live births), number of maternal deaths, lifetime risk (probability of maternal death of a 15 yo woman) Country
MMR
Lower range of MMR certainty
Upper range of MMR certainty
Number of Maternal deaths
Lifetime maternal death risk 1 in …..
PMD (%) % of mat deaths per 15yo
Australia
6
4
10
18
9.000
0.5 %
Indonesia
190
120
300
8,800
220
8.4 %
New Zealand
8
5
12
5
6,600
0.6 %
Papua New Guinea
220
110
450
460
120
7.8 %
Fiji
59
35
95
11
620
2.7 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
2013 Estimates of maternal mortality ratio (MMR, maternal deaths per 100 000 live births), number of maternal deaths, lifetime risk (probability of maternal death of a 15 yo woman) Country
MMR
Lower range of MMR certainty
Upper range of MMR certainty
Number of Maternal deaths
Lifetime maternal death risk 1 in …..
PMD (%) % of mat deaths per 15yo
Australia
6
4
10
18
9.000
0.5 %
New Zealand
8
5
12
5
6,600
0.6 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
Significance of maternal death • Sensitive indicator of health inequalities between developing and developed countries • In an developed country, it can be a marker of deprivation within a heterogeneous community
Maternal mortality ratio (per 100,000 maternities) by deprivation quintile (NZDep2006) 2006–2012 •
Fig 2.5 p142 PMMRC. 2014. Eighth Annual Report of the Perinatal and Maternal Mortality Review Committee: Reporting mortality 2012.Wellington: Health Quality & Safety Commission.
Significance of maternal death • Within a developed country, maternal death may also be a marker of unavailability , inaccessibility or unacceptability of that care. • Within a developed country, compared to a developing country, because of the greater availability of resources, the role of medical misadventure may be responsible for a larger proportion of maternal deaths
Significance of maternal death • Abortion is a significant factor in maternal death. • Where legal abortion is unavailable, it forces women to face direct hazards of the procedure if it is unregulated and performed by incompetent people
Significance of maternal death • A lack of legal abortion forces more women to be exposed to high risk pregnancy, either later in life, after multiple closely spaced pregnancies, or whilst their health or social circumstances are otherwise compromised
Significance of maternal death • The most “unfortunate experiment” supporting this argument is the eight fold increase in maternal mortality rate in Romania, compared to comparable Eastern European states, during the 10 year period when all contraception and abortion services were banned. Stephenson Commentary : the public health consequences of restricted abortion – lessons from Romania. Am J Public Health 1992 82: 1328 - 31
Significance of maternal death • For every woman who dies in pregnancy, another 10 – 15 suffer serious impairment, including infertility, fistula and infectious morbidity
Sai. The need for a reproductive health approach. Int J Obster Gynecol, 1989, S3 103 - 113
The social determinants of maternal death • The most significant social determinant of maternal death is the level of education attained by the woman – logistic regression analyses have demonstrated in developing countries, that it is the most significant factor, followed by improved sanitation, and where the mother is the major wage earner Golding J. Maternal mortality in Jamaica. Socioeconomic factors Acta Obstet Gynecol Scand; 1989; 68(7) 581 - 7
Maternal death definitions controversies • Maternal mortality rate versus maternal mortality ratio – Rate is the number of deaths per 100,000 women of reproductive age – Ratio is the number of deaths per 100,000 births (of greater than 20 weeks gestation)
Maternal death definitions controversies • Maternal mortality rate versus maternal mortality ratio – The ratio will include in the numerator women not in the denominator (such as deaths from ectopic pregnancy or TOP which are not recorded in the number of births after 20 weeks) – This results in significant overstatement of risk – eg. the annual denominator for births over 20 weeks in Australia is approx 250,000. If TOP is included, the annual denominator is approx 400,000
Maternal death definitions controversies • Ascertainment of incidental, as well as direct and indirect deaths – This may result in reclassification of incidental to indirect maternal death
Maternal death definitions controversies • Ascertainment of incidental, as well as direct and indirect deaths – This may result in reclassification of incidental to indirect maternal death for example
Maternal death definitions controversies • An pregnant aboriginal woman, near term with
twins, suffered a snakebite and was brought into a rural hospital. In hospital, she suffered a cardio respiratory arrest. At first, her death was classified as an incidental maternal death, but further investigation, particularly instigated because of the time of alleged envenomation to the cardiac arrest, revealed the probable cause as supine hypotension, as a result of the women not being nursed on her side.
Maternal death definitions controversies • Other examples – Bathtub electrocution – incidental, or secondary to falling from the advanced pregnancy causing her to lose balance – Suicide – incidental, or from severe post partum depression
Maternal mortality ratios (per 100,000 maternities) from routine and mandatory reporting, comparing New Zealand, Australia and the United Kingdom 2003 - 2012
Fig 2.2 p138 PMMRC. 2014. Eighth Annual Report of the Perinatal and Maternal Mortality Review Committee: Reporting mortality 2012.Wellington: Health Quality & Safety Commission.
Confidential enquiry into maternal death • Initiated in 1928 by the RCOG, with local health board audits • The first report on confidential enquiries into maternal deaths covered England and Wales for 1952 – 1954 • It is the longest running and most successful medical audit in history
Maternal Deaths in Australia (NH&MRC, AIHW) • Australia instigated the practice of reviewing and reporting maternal deaths for the triennium 1964–6, based upon the UK confidential enquiries into maternal death. • To date, 13 triennial reports have been published, the most recent covering 2003 2005
Maternal Deaths in Australia (NH&MRC, AIHW) • Each state (individually responsible for health in Australia) has a multidisciplinary Maternal and Infant Perinatal Mortality Committee.
Maternal Deaths in Australia (NH&MRC, AIHW) • Confidential enquiry is conducted with each maternal death, with a report issued annually (usually in combination with perinatal and infant deaths)
Maternal Deaths in Australia (NH&MRC, AIHW) Scheil W, Scott J, Catcheside B, Sage L. Pregnancy Outcome in South Australia 2010. Adelaide: Pregnancy Outcome Unit, SA Health, Government of South Australia, 2012. Maternal, Perinatal and Infant Mortality Committee. Maternal, Perinatal and Infant Mortality in South Australia 2010. Adelaide: SA Health, Government of South Australia, 2012.
Epidemiology Branch, ACT Health 2011. Maternal and perinatal health in the ACT, 1999– 2008. Canberra: ACT Health.
Thompson F, Zhang X, Dempsey KE. Northern Territory Midwives’ Collection. Mothers and Babies 2007.Department of Health, Darwin, 2012
Joyce A, Hutchinson M (2012). Western Australia’s Mothers and Babies, 2010: Twenty-eighth Annual Report of the Western Australian Midwives’ Notification System, Department ofHealth, Western Australia.
Maternal Deaths in Australia (NH&MRC, AIHW)
Ascertainment • The most common form of identification is direct notification by health professionals and hospitals involved in a death.
Ascertainment • In other cases, deaths may be reported by the coroner or the Registrar of Births, Deaths and Marriages.
Ascertainment • Ascertainment is facilitated by use of the ‘pregnancy tick box’ at death registration (which indicates if a woman has been pregnant within the year preceding her death).
Ascertainment • Some jurisdictions search for maternal deaths using hospital administrative data collections.
Ascertainment • This has been found to be particularly effective in improving ascertainment of late maternal deaths.
Cliffe etal. ANZJOG 2008: 48, 255 - 260
Ascertainment • “Word of mouth” and systematic surveillance of media is also used by individual state comittees to improve ascertainment
Ascertainment
Ascertainment
Atrash atal. Obstet Gynecol 1995 86, 700 - 705
Ascertainment
Atrash atal. Obstet Gynecol 1995 86, 700 - 705
Ascertainment
Atrash atal. Obstet Gynecol 1995 86, 700 - 705
Ascertainment
Atrash atal. Obstet Gynecol 1995 86, 700 - 705
Ascertainment
Atrash atal. Obstet Gynecol 1995 86, 700 - 705
Ascertainment
Atrash atal. Obstet Gynecol 1995 86, 700 - 705
Ascertainment
Atrash atal. Obstet Gynecol 1995 86, 700 - 705
Adjustment factor to account for misclassification of maternal deaths in civil registration, literature review of reports and articles Country
Period / year
Adjustment Factor
Australia1
1994-1996
1.23
Australia2
1997-1999
1.80
Australia3
2000-2002
1.97
Australia4
2003-2005
2.03
1-4 NH&MRC and AIHW triennial Reports
Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division
Australia has not issues a maternal mortality report since 2005 – Why? • The Australian mortality review process, as well as the UK CEMD process, have been questioned, with review of national funding.
Australia has not issues a maternal mortality report since 2005 – Why? • Critics argue that it deals with “anecdote” • It does not fulfill audit criteria • It involves “expert” opinion on the data collected, rather than formal peer review
Australia has not issues a maternal mortality report since 2005 – Why? • Epidemiologists argue that it lacks denominators, is expensive and has scanty evidence of benefit
Arguments for continuing the confidential enquiry into maternal death • Proponents argue that evidence does not always lead itself to formal scientific evaluation, and its recommendations are drawn from multiple sources
Arguments for continuing the confidential enquiry into maternal death • The traditional ethos of the confidential enquiry is that worthwhile clinical lessons can be drawn from attending to the detail of an individual tragedy
Arguments for continuing the confidential enquiry into maternal death • Careful unpicking of the circumstances surrounding avoidable deaths, far from being voyeuristic, requires the engagement of front line clinicians who deliver care
Arguments for continuing the confidential enquiry into maternal death • This may also improve ascertainment
Arguments for continuing the confidential enquiry into maternal death • Expert opinion, peer opinion, and subjective judgment of substandard care – passed on through powerful narratives (for example, through requesting relatives interviews) may still have a place in motivating best practice alongside more quantifiable outcomes.
PMMRC 8th report • Overcomes some of these criticisms of the Australian and CEMD reports – A detailed description of methodology of perinatal mortality collection, including crosschecking of sources, data validation and audit of inconsistencies, feedback to local co-ordinators, a description of the strengths and weaknesses of denominator data, incorporation of newly designed data collections into the methodology, whilst recognising their limitations.
PMMRC 8th report • Overcomes some of these criticisms of the Australian and CEMD reports – Attempts to initiate audit cycles, with recommendations based on current data, but importantly, reviews previous recommendations and comments on progress or otherwise made, using current data.
Maternal mortality ratios (per 100,000 maternities) from routine and mandatory reporting, comparing New Zealand, Australia and the United Kingdom 2003 - 2012
Fig 2.2 p138 PMMRC. 2014. Eighth Annual Report of the Perinatal and Maternal Mortality Review Committee: Reporting mortality 2012.Wellington: Health Quality & Safety Commission.
Maternal Deaths, Maternal Mortality Rate by prioritised ethnic group. NZ 2006 - 2012
•
Maternal Deaths, Maternal Mortality Rate and Risk ratios by place of birth / ethnic group. NSW (Australia) 1981 - 1990 Place of birth / ethnic group
Maternal deaths
Maternal mortality ratio
Risk ratio
95% CI
Aust born (non aboriginal)
35
6.2
Referent
European born
5
6.4
1.02
0.40 – 2.61
Asian born (not 6 ME)
13.2
2.13
0.90 – 5.07
Middle eastern
4
14.7
2.38
0.85 – 6.70
Australian Aboriginal
7
58.4
9.42
4.19 – 21.22
Other
2
8.7
1.40
0.34 – 5.84
Wilkinson C 1995 Masters of Public Health Thesis Sydney University
Maternal Deaths, Maternal Mortality Rate and Risk ratios by place of birth / ethnic group. NSW (Australia) 1981 - 1990 Place of birth / ethnic group
Maternal deaths
Maternal mortality ratio
Risk ratio
95% CI
Aust born (non aboriginal)
35
6.2
Referent
European born
5
6.4
1.02
0.40 – 2.61
Asian born (not 6 ME)
13.2
2.13
0.90 – 5.07
Middle eastern
4
14.7
2.38
0.85 – 6.70
Australian Aboriginal
7
58.4
9.42
4.19 – 21.22
Other
2
8.7
1.40
0.34 – 5.84
Wilkinson C 1995 Masters of Public Health Thesis Sydney University
2013 Estimates of maternal mortality ratio (MMR, maternal deaths per 100 000 live births), number of maternal deaths, lifetime risk (probability of maternal death of a 15 yo woman) Country
MMR
Lower range of MMR certainty
Upper range of MMR certainty
Number of Maternal deaths
Lifetime maternal death risk 1 in …..
PMD (%) % of mat deaths per 15yo
Australia
6
4
10
18
9.000
0.5 %
Indonesia
190
120
300
8,800
220
8.4 %
New Zealand
8
5
12
5
6,600
0.6 %
Papua New Guinea
220
110
450
460
120
7.8 %
Fiji
59
35
95
11
620
2.7 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
2013 Estimates of maternal mortality ratio (MMR, maternal deaths per 100 000 live births), number of maternal deaths, lifetime risk (probability of maternal death of a 15 yo woman) Country
MMR
Lower range of MMR certainty
Upper range of MMR certainty
Number of Maternal deaths
Lifetime maternal death risk 1 in …..
PMD (%) % of mat deaths per 15yo
Australia
6
4
10
18
9.000
0.5 %
Indonesia
190
120
300
8,800
220
8.4 %
New Zealand
8
5
12
5
6,600
0.6 %
Papua New Guinea
220
110
450
460
120
7.8 %
Fiji
59
35
95
11
620
2.7 %
WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division estimates
Why the difference in maternal mortality – Aust compared to NZ? • Australian indigenous population – 1.7% (2.6% of births) • NZ indigenous Maori and Pacific islander – 20% (but 30% of births)
Term intrapartum deaths • This category is of particular interest by proponents of medically led obstetric care, which is the dominant system in Australia • Such proponents argue that a medical care lead will have a lower threshold of intervention, with the aim of achieving better perinatal mortality, particularly in term intrapartum death and lesser hypoxaemic ischaemic encephalopathy.
NZ Term Intrapartum Deaths
Fig 1.56 p118 PMMRC. 2014. Eighth Annual Report of the Perinatal and Maternal Mortality Review Committee: Reporting mortality 2012.Wellington: Health Quality & Safety Commission.
NZ Term Intrapartum Deaths
Fig 1.56 p118 PMMRC. 2014. Eighth Annual Report of the Perinatal and Maternal Mortality Review Committee: Reporting mortality 2012.Wellington: Health Quality & Safety Commission.
NZ Term Hypoxaemic Peripartum Deaths
NZ
Fig 1.56 p118 PMMRC. 2014. Eighth Annual Report of the Perinatal and Maternal Mortality Review Committee: Reporting mortality 2012.Wellington: Health Quality & Safety Commission.
Australian Term Intrapartum Deaths
Table 5.4 p 95 Li Z, Zeki R, Hilder L & Sullivan EA 2013. Australia’s mothers and babies 2011. Perinatal statistics series no. 28. Cat. no. PER 59. Canberra: AIHW National Perinatal Epidemiology and Statistics Unit..
Australian Term Intrapartum Deaths
Table 5.4 p 93 Li Z, Zeki R, Hilder L & Sullivan EA 2012. Australia’s mothers and babies 2010. Perinatal statistics series no. 28. Cat. no. PER 59. Canberra: AIHW National Perinatal Epidemiology and Statistics Unit..
Australian Term Intrapartum Deaths
Table 5.4 p 90 Li Z, Zeki R, Hilder L & Sullivan EA 2011. Australia’s mothers and babies 2009. Perinatal statistics series no. 25. Cat. no. PER 59. Canberra: AIHW National Perinatal Epidemiology and Statistics Unit..
Australian Term Intrapartum Deaths
Table 6.4 p 97 Li Z, Zeki R, Hilder L & Sullivan EA 2010. Australia’s mothers and babies 2008. Perinatal statistics series no. 24. Cat. no. PER 59. Canberra: AIHW National Perinatal Epidemiology and Statistics Unit..
Australian Term Intrapartum Deaths
Table 6.4 p 91 Laws P & Sullivan EA 2009. Australia’s mothers and babies 2007. Perinatal statistics series no. 23. Cat. no. PER 48. Sydney: AIHW National Perinatal Statistics Unit.
NZ Term Hypoxaemic Peripartum Deaths
NZ
Fig 1.56 p118 PMMRC. 2014. Eighth Annual Report of the Perinatal and Maternal Mortality Review Committee: Reporting mortality 2012.Wellington: Health Quality & Safety Commission.
NZ compared to Aust Term Hypoxaemic Peripartum Deaths
NZ
Australia
Fig 1.56 p118 PMMRC. 2014. Eighth Annual Report of the Perinatal and Maternal Mortality Review Committee: Reporting mortality 2012.Wellington: Health Quality & Safety Commission.
Eight Annual Report of the Perinatal and Maternal Mortality Review Comittee • Perinatal mortality and morbidity are comparable between Australia and New Zealand – In particular, there appear to be no significant differences in fetal and neonatal deaths from intrapartum hypoxia.
