Summary

Global estimates from the World Health Organization indicate that in 2010 there were 2.6 million stillbirths, with at least half of all stillbirths occurring during labour and birth, and a further 2.8 million newborn deaths occurring in the first week of life. The majority of these deaths occurred in low to middle income countries.

In the years 2013 and 2014, 622,037 babies were born in Australia and 6,037 of those babies died in the perinatal period (4,419 stillbirths and 1,618 neonatal deaths). The perinatal mortality rate was 9.7 per 1,000 births; the stillbirth (fetal mortality) rate was 7.1 per 1,000 births, and the neonatal mortality rate 2.6 per 1,000 live births. Between 1995 and 2014 there has been some reduction in the neonatal mortality rate, but the stillbirth rate has remained relatively unchanged.

The incidence of perinatal death in Australia was higher for a number of demographic factors, including low birthweight, prematurity, low birthweight for gestational age, babies of women who are of Aboriginal and/or Torres Strait Islander status, have multiple pregnancy, are older or younger, use tobacco in pregnancy, have poor attendance or access to antenatal care, live in more remote areas and are at socio-economic disadvantage. It is beyond the scope of this report to understand the interaction of these various risk factors, but the marked excess of perinatal deaths in babies of women who had little or no antenatal care should be noted in future maternity care policy reviews.

The most common causes of perinatal death were congenital anomaly, unexplained antepartum death and spontaneous preterm birth. Stillbirths were most frequently classified as being related to congenital anomaly, unexplained antepartum death and various maternal conditions that affect the fetus within the intra-uterine environment. Extreme prematurity, congenital anomaly and various neurological conditions were the most frequent causes of neonatal deaths. Extremely pre-term birth was a more prominent cause of perinatal death in Aboriginal and/or Torres Strait Islander babies, while congenital anomaly was less prominent.

This report highlights, in particular, perinatal deaths of singleton mature (37 or more weeks of pregnancy) babies without a congenital anomaly causing death. The most frequent cause of perinatal death in these babies, across all birthweight groups, was unexplained antepartum death. However, it must be noted that the level of investigations performed to be able to determine cause of death is likely to be insufficient. There is no placental assessment in a significant proportion of all perinatal deaths, and no post mortem in more than 50% of such deaths.

This report is limited by incomplete information regarding babies who died in the perinatal period. Of the 397 babies whose birthweight was not recorded in 2013–2014, 139 (35%) were perinatal deaths. Equally, recording of Indigenous status, gestational age, and age at neonatal death was noticeably incomplete.

When considering plans aimed at ending preventable perinatal deaths in Australia, focussed high quality review of stillbirths is a priority. Review of instances where the baby died during labour (intrapartum deaths), and perinatal deaths in singleton births where the baby did not have a lethal congenital anomaly and birth occurred at a mature gestation, are particularly important (RCOG 2017). It is likely that appropriate investigations and careful institutional review of these perinatal deaths may lead to the most effective reviews of policy and practice in maternity and neonatal care (Flenady et al. 2016; RCOG 2017).

 

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