We present the twenty third Annual Report of the All Wales Perinatal Survey (AWPS). Through the AWPS, we have been able to provide an accurate and complete surveillance of stillbirth, neonatal and infant mortality in Wales since 1993. The views in this report are entirely those of the All Wales Perinatal Survey.
This year, as last year, we present the majority of data tables in the Appendices. In addition, we report post neonatal deaths and infant deaths for all livebirths for 2014; hence post neonatal and infant mortality rates are presented in separate tables. Infant mortality for results for 2015 will be presented in the 2016 report. Later this year we will be publishing a commentary which has been produced in collaboration with the Congenital Anomaly Register and information Service (CARIS).
The report presents data on stillbirths and infant deaths by the seven Health Boards in Wales by residency of the mother, and by individual hospitals. The majority of the mortality rates are presented unadjusted for variables, such as social deprivation and case mix, which are known to influence mortality rates, therefore, caution is needed when interpreting the data. Any increases noted in mortality rates, either at Health Board level or at individual hospital level, should be further explored locally. MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) recommends that local reviews should be carried out where stabilised and adjusted stillbirth, neonatal or extended perinatal rates fall in the red band, (more than 10% higher than the UK average). Local reviews should be considered where rates fall in the amber band, (up to 10% higher than the UK average), and perhaps even for those in the yellow, (up to 10% lower than the UK average), and green bands, (more than 10% lower than the UK average or lower than the aspirational target), if local aspiration is to simply not be average for the UK. We agree and indeed recommend that a robust system to assess stillbirth and neonatal death is needed throughout Wales. To facilitate this, we can provide hospitals and birth units with their own data relating to stillbirths and infant deaths upon request as well as collated Wales-wide data for comparison so local reviews can take place. For the second year, we also present the data for the seven Health Boards adjusted for the available variables known to influence mortality rates, including maternal age, deprivation quintile, multiple births, gestation and gender.
MBRRACE-UK 1 were appointed by HQIP (Healthcare Quality Improvement Partnership) to conduct the National Maternal, Newborn and Infant Clinical Outcome Review Programme. MBRRACE-UK will continue the work investigating maternal deaths, stillbirths and neonatal deaths carried out in the past by the Centre for Maternal and Child Enquiries (CMACE), including the Confidential Enquiry into Maternal Deaths. MBRRACE-UK is a collaboration led by the National Perinatal Epidemiology Unit, University of Oxford (NPEU). AWPS and MBRRACE-UK work closely to improve ascertainment and quality of Welsh data. There are small differences between MBRRACE-UK data and AWPS data due to different methods. These differences were discussed in more detail in the AWPS Annual Report for 2014 which can be accessed via http://awpsonline.uk/. The MBRRACE_UK reports can be found at https://www.npeu.ox.ac.uk/MBRRACE-UK/reports.
Over the last year, there have been some changes in the AWPS team. Mrs Kim Rolfe, Dr John Watkins and Dr Verity Bennett have left the AWPS. We thank them all for their hard work. In particular, we would like to note the contribution of Mrs Kim Rolfe, who has been a core member of the AWPS since the inception in 1993. The remaining members of the AWPS team have had to significantly increase their time commitment, as well as having excellent input from Mrs Leah Inkin, to ensure a timely report and the continuing acquisition of high quality data,. We would in particular like to welcome Dr Natasha Kalebic as the Project Manager and Mrs Saranya Ulaganathan as administrator for AWPS. We are also extremely grateful for the ongoing input and support from the steering committee members.
We are extremely grateful for the continued support of the unit coordinators, neonatologists, obstetricians, midwives, other health professionals and administrative staff throughout Wales who are involved with the data collection for the survey.
We would like to invite interested individuals to become involved by joining our steering committee and review any future AWPS reports. If interested, please contact the AWPS office (029 20 74 4499 or firstname.lastname@example.org). We also would like to welcome comments from readers on this report, and any suggestions to improve it further in the future.
Professor Sailesh Kotecha Dr Mallinath Chakraborty 17 November 2016
1.MBRRACE-UK. Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK ‘Available at:’ https://www.npeu.ox.ac.uk/MBRRACE-UK. Accessed 2013.