MBRRACE-UK have published their latest Perinatal Mortality Surveillance Report. The “State of the Nation” report analyses statistical information from reported perinatal deaths of babies who were born in the UK during 2021. These include: late fetal losses, where the baby was born between 22 and 23 completed weeks of pregnancy (gestation) showing no signs of life; stillbirths, where the baby was born at or after 24 weeks’ gestation showing no signs of life; and neonatal deaths, where the baby was born alive at 20 weeks’ gestation or later and died within 28 days of birth. The figures in this report do not include terminations of pregnancy. MBRRACE-UK’s State of the Nation report finds that in the UK in 2021, perinatal mortality rates increased for the first time in seven years. The report also highlights continued and increasing inequalities in the numbers of stillbirths and neonatal deaths suffered by mothers and babies from ethnic minorities and areas of deprivation. How many babies were stillborn or died soon after birth in the UK in 2021? MBRRACE-UK’s latest report shows that in 2021 a total of 698,909 babies were born at 24 or more completed weeks of pregnancy. This was an increase of 1.5% compared with 2020. Since 2013, there had been a reduction each year in the numbers of stillbirths and neonatal (newborn) deaths, but in 2021 the numbers of stillbirths and neonatal deaths increased. There were 2,473 stillbirths in 2021, compared to 2,292 in 2020, and 1,151 neonatal deaths, up from 1,051 in 2020. The UK’s perinatal mortality rate as a whole in 2021 was 5.19 per 1,000 total births. The stillbirth rate was 3.54 per 1,000 total births, and the neonatal mortality rate was 1.65 per 1,000 total births. The rates were lowest in England, compared with the other UK nations, for both types of injury, with wide variation in the rates between different NHS trusts and health boards. Which babes were at highest risk of stillbirth or death in 2021? Three quarters (75%) of stillbirths and late fetal losses, and 73% of neonatal deaths related to babies who were born preterm (prematurely) before 37 completed weeks of pregnancy. Late fetal loss and stillbirth rates increased in 2021 for babies of all gestational ages, except for those born at term between 37 and 41 completed weeks of pregnancy. Neonatal mortality also increased for all gestational age groups. Including babies born at 22 to 23 weeks’ gestational age, 36% of stillbirths and 46% of neonatal deaths in 2021 related to babies who were born extremely preterm (less than 28 weeks’ gestational age). In 2021, the stillbirth rate for babies born to mothers from the most deprived areas increased to 4.69 per 1,000 total births, up from 4.29 in 2020, and compared with 2.37 per 1,000 total births in the least deprived areas. The stillbirth rate for babies of Black ethnicity also increased to 7.52 per 1,000 total births from 6.42 in 2020. Amongst Asian babies the stillbirth rate was 5.15 per 1,000 total births. The stillbirth rate for babies of White ethnicity was 3.30 per 1,000 total births. The stillbirth rate increased disproportionately for babies of Black ethnicity, compared with the increases for White and Asian babies, further widening the inequalities. The neonatal mortality rate for babies of Black ethnicity increased to 2.94 per 1,000 live births, meaning this group now has the highest rates of stillbirth and neonatal death. There was a slight increase in the neonatal mortality rate for White babies (1.68 per 1,000 births) and a drop in the neonatal mortality rate for Asian babies to 2.22 per 1,000 births. As higher proportions of babies of Black African, Black Caribbean, Pakistani and Bangladeshi ethnicity are born to mothers living in more deprived areas, these babies are disproportionately affected by impact of deprivation on the stillbirth and neonatal death rates. MBRRACE-UK noted, however, that mortality rates for babies of Black and Asian ethnicity were still higher than for White babies across all levels of deprivation. What were the most common causes of stillbirth or neonatal death in 2021? The most commonly reported causes of stillbirth were placental problems (33.2%), congenital (developmental) anomalies (9.3%), problems with the umbilical cord (4.7%), and infection (4.5%). A third (33.3%) of all stillbirths had an unknown cause of death. The most commonly reported causes of neonatal death were congenital anomalies (32.6%), extreme prematurity (14.2%), neurological (14%), cardio-respiratory (9%) and infection (7.7%), with increased numbers in every category. MBRRACE-UK noted that although around 7% of all stillbirths occurred during labour and birth (intrapartum), only 10% of intrapartum stillbirths were reported as having an intrapartum cause of death. Only 2.2% of newborn deaths were attributed to intrapartum (during labour and birth) causes, but an additional 11.1% of neonatal deaths suffered by babies born at 32 weeks gestation or over were attributed to hypoxic ischaemic encephalopathy (HIE). HIE brain injury is caused by a lack of oxygen to the baby’s brain around the time of birth. Parents were offered a post-mortem after 98.1% of stillbirths and 87.4% of neonatal deaths, and full or limited consent was given for 52.1% of stillbirths and 28.4% of newborn deaths. The coroner or procurator fiscal arranged for examinations in a further 2.6% of the neonatal deaths. The placenta was examined in 95% of stillbirths and 84% of intrapartum (birth-related) or neonatal deaths. In 2021, a total of 11.9% of stillbirths coincided with known COVID-19 infection. 351 mothers of stillborn babies had a positive COVID-19 test, and one stillborn baby tested positive without the mother having a positive test. 57 mothers of babies who died as newborns had a positive COVID-19 test, representing 4.8% out of the total number of neonatal deaths of babies born after 24 weeks gestation. MBRRACE-UK could not calculate the risk of stillbirth and neonatal death associated with COVID-19 infection from the available data. What happens next? Professor Elizabeth Draper, Professor of Perinatal and Paediatric Epidemiology at the University of Leicester and MBRRACE-UK perinatal lead, has called for the government, the Royal Colleges and health commissioners to support rigorous reviews of all stillbirths and neonatal deaths, so that common themes can be identified which may lead to improvements in maternity and neonatal healthcare services, and reduce the need for further inquiries. The State of the Nation report also recommended that UK governments and national organisations should prioritise targeted action at national and organisational levels to reduce inequalities and review perinatal pathology services to address the unknown causes of stillbirths and provide equal access to post-mortem examinations. The report also recommended that healthcare providers adopt the British Association for Perinatal Medicine (BAPM) Perinatal Optimisation pathway to improve outcomes for pre-term babies. MBRRACE-UK advise that a full confidential enquiry into the deaths of babies born to Black and Asian mothers in the UK will be published in December 2023. If you have suffered severe injury as a result of medical negligence or have been contacted by HSIB/HSSIB/MNSI/CQC or NHS Resolution, you can talk to a solicitor, free and confidentially, for advice about how to respond or make a claim by contacting us.
