MBRRACE-UK have published their latest report on the numbers of babies who died around the time of birth in the UK in 2020.
MBRRACE-UK is an acronym for ‘Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK’. MBRRACE-UK is a national programme which collects, analyses and reports national surveillance data, and carries out national confidential enquiries to encourage and evaluate improvements in health care for mothers and babies.
What does MBRRACE-UK’s report into perinatal deaths for babies born during 2020 cover?
The latest report, MBRRACE-UK Perinatal Mortality Surveillance Report: UK Perinatal Deaths for Births from January to December 2020, focuses on perinatal deaths of babies from 22 weeks’ gestational age (22 weeks of pregnancy). This includes:
- late fetal losses – where the baby is born with no signs of life between 22 and 24 weeks of pregnancy;
- stillbirths – where the baby is born at or after 24 weeks of pregnancy showing no signs of life. Stillbirth can take place:
- antepartum - when the baby is born at or after 24 weeks of pregnancy showing no signs of life and is known to have died before the onset of care in labour;
- intrapartum – where the baby is born at or after 24 week of pregnancy showing no signs of life but was known to have been alive at the start of care in labour.
- neonatal death – where the baby was born alive at or after 20 weeks of pregnancy but within the first 28 days after birth. Neonatal deaths may be classed as:
- early neonatal death - if the newborn baby dies within the first seven days of life;
- late neonatal death – where the newborn baby dies between seven and 28 days of life.
Key findings from MBRRACE-UK’s report into perinatal deaths for babies born during 2020
Unlike many other maternity safety reports, MBRRACE-UK’s latest report, MBRRACE-UK Perinatal Mortality Surveillance Report: UK Perinatal Deaths for Births from January to December 2020, examines the increase or reduction in the rates of perinatal deaths, based on data reported to them, rather than the causes of death or the standard of maternity and neonatal healthcare that the mothers and babies received.
MBRRACE-UK’s findings included:
- The rate of stillbirths and neonatal deaths (collectively known as extended perinatal mortality) reduced by 20% over seven years, meaning that there were around 820 fewer deaths in 2020 than in 2013.
- Stillbirth rates reduced by 21% in the same period, meaning there were approximately 605 fewer stillbirths in 2020 than in 2013. This is largely owing to a 19% reduction in stillbirths of babies who were born at full term.
- The neonatal death rate reduced by 17% in the same period, meaning there were approximately 215 fewer neonatal deaths in 2020 than 2013. The biggest improvement in neonatal mortality was a 14% mortality rate reduction for extremely preterm births of babies between 24 and 28 weeks gestation. However, the neonatal mortality rate for very preterm births (between 28 and 32 weeks gestational age) slightly increased.
- Almost three-quarters of stillbirths (73%) and neonatal deaths (71%) were preterm births where the baby was born before 37 weeks of pregnancy.
- 34% of stillbirths and late fetal losses and 43% of neonatal deaths affected babies who were born extremely preterm between 22 and 28 weeks of pregnancy.
- There is still a wide variation in the perinatal death rates between different trusts, even after taking into account differences in risk factors and unit size.
MBRRACE-UK’s findings echoed the conclusions of other reports, highlighting that ethnicity and social deprivation increase the mortality rate for babies during pregnancy and immediately after birth (perinatal mortality). In 2020:
- The rates of stillbirth and newborn deaths increased with deprivation across all ethnic groups.
- Stillbirth and neonatal mortality rates were lowest for White babies from the least deprived areas, with 2.78 stillbirths per 1,000 total births and 1.26 neonatal deaths per 1,000 live births.
- The combined impact of ethnicity and deprivation increased the stillbirth rate to 8.10 per 1,000 total births for Black African babies and 7.96 per 1,000 Black Caribbean babies from the most deprived areas.
- Neonatal mortality rates were also significantly higher (3 per 1,000 live births) for babies of Pakistani and Black African ethnicity from the most deprived areas.
- As considerably higher proportions of Black African, Black Caribbean, Pakistani and Bangladeshi families live in deprived areas, they are disproportionately affected by the higher rates of stillbirth and neonatal death associated with deprivation.
MBRRACE-UK also found that twins were more likely than singleton babies to suffer stillbirth or neonatal death. Despite an overall 12% reduction in the number of births (including singleton and twins) in the period from 2016 to 2020:
- The rates of stillbirth and neonatal mortality for twins has increased between 2016 and 2020.
- The gap between singleton and twin stillbirth and neonatal mortality rates is widening.
- In 2020 the risk of stillbirth was over 2.25 times higher for twins than for singletons, and the risk of twin neonatal death was almost 3.5 times higher than for single babies.
The report did not examine in detail the causes of perinatal death, but highlighted that one third (33%) of stillbirths in 2020 were categorised as having an unknown cause, with a further third (35%) attributed to placental causes. Around 40% of neonatal deaths were attributed to neonatal causes. Congenital anomalies featured in around one third of all neonatal deaths and nearly one-tenth of stillbirths.
MBRRACE-UK report says more work needed to reduce the numbers of stillbirth and neonatal deaths
MBRRACE-UK’s report recognises that on the reported figures, the Department of Health and Social Care’s (DHSC) ambition to reduce mortality rates by 20% by 2020 has been met for stillbirths, with a 21% reduction in the rate of stillbirths since the start of MBRRACE-UK’s perinatal surveillance programme in 2013. Neonatal mortality rates have also shown a 17% reduction in 2020. However, MBRRACE-UK’s report warns that significant improvement is still needed if the UK is to keep up with similar high income countries and achieve the DHSC’s revised ambition of a 50% reduction in mortality rates by 2025.
At Boyes Turner we welcome the valuable work that MBRRACE-UK carries out to monitor and understand these tragic incidents. Improvements should be acknowledged and welcomed, whilst recognising that each death has left a family grieving the loss of their child. However, whilst many of the known risks, such as ethnicity, deprivation and multiple births have yet to be addressed, this is no time for complacency. As MBRRACE-UK points out, there is still much work to be done.
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