Conference told smaller maternity units ‘safe’

Variations in infant death rates within acceptable limits, says NPEC

 

The rate of baby deaths in smaller maternity units in the State is in line with national averages and compares well internationally, according to the head of the agency charged with compiling figures.

Neo-natal death rates in smaller units “move up and down” from year to year but are always within accepted limits, Prof Richard Greene, director of the National Perinatal Epidemiology Centre.

Last week’s critical report on Portlaoise hospital and the death this week of an infant in the maternity unit of Cavan General Hospital have provoked concern about safety standards in smaller units.

Prof Greene, speaking at a conference on obstetrics insisted “in terms of outcomes, Irish maternity services are safe. However, maintaining safety requires expenditure on services.”

Thirty-nine maternal deaths were reported in a three-year period between 2010 and 2012, the conference heard. Of the 39 maternal mortalities, 10 had direct obstetric causes while 21 were indirect deaths, ie, as a result of other conditions, often pre-existing, such as heart disease.

Maternal mortality is defined as the death of a woman while pregnancy or within 42 days after it ends, from any cause related to or aggravated by pregnancy.

The rate of maternal mortality has increased from 9.6 per 100,000 live births in the years 2009-2011 to 10.5 for the years 2010-2012, but this rise is not considered statistically significant.

The Irish rate is similar to that of the UK, where it is 10.1, where deaths from direct obstetric causes have halved in the past decade.

With almost one-quarter of deaths involving women who had sepsis, the centre is recommending a more active identification of the source of identification that leads to this condition.

Almost half of the indirect maternal deaths were due to influenza, NPEC’s Edel Manning said. Influenza was not considered when the majority of women presented with respiratory illnesses, even though the period included the height of the H1Ni flu epidemic.

Where obstetric haemorrhage was involved, it was found that often cases of antenatal anaemia were not diagnosed, and the amount of blood loss was sometimes underestimated.

Ms Manning said there was a need for training of staff in the management and resuscitation of collapsed pregnant women. There was evidence of poor interdisciplinary communication which needed to be tackled. The fact that two-thirds of women who died had a pre-existing medical or psychiatric condition pointed to the need for more pre-pregnancy counselling.

Dr Paul Corcoran said there were about 300 stillbirths and 150 early neonatal deaths a year, out of over 71,000 births. Older mothers, ethnic minorities and women having multiple births were over-represented in the figures for neonatal deaths.

Dr Corcoran said data on women giving birth in Ireland was lacking and more consistent information was needed to analyse the risk involved for different groups.

One problem was a “diminishing” rate of autopsy following early neonatal death, where some geographical bias was involved. While the rate of autopsy was higher than average in larger maternity hospitals, it ranged as low as 10 per cent in smaller units. About one in five women whose baby had died were not offered an autopsy, it was found.

Dr Corcoran said the number of baby deaths could be reduced by addressing factors restricting the growth of the foetus.