Section B: Mortality Statistics in Wales – Perinatal

  1. Perinatal mortality rate in Wales
  2. Perinatal mortality by deprivation quintile
  3. Cause of perinatal death in Wales
  4. References
Perinatal mortality in Wales

Perinatal mortality includes stillbirths and early neonatal deaths. The perinatal mortality rate to women usually resident in Wales (excluding late terminations) in 2015 was 5.88 (95% CI 5.11, 6.75) per 1,000 registrable births (Table A9(2)). The perinatal mortality rate including late terminations in 2015 was 6.7 (95% CI 5.9, 7.6) per 1,000 registrable births. There is a slight decline in the rates (Figure 4).

Figure 4  Perinatal deaths (excluding late terminations): 3 year rolling average rates in Wales (1995-1997 to 2013-2015)

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Source: NCCHD and AWPS/MBRRACE-UK

For each three-year rolling period between 1993-2015, there was on average a decrease of 0.09 per 1,000 registrable births for the Perinatal Mortality Rate (R-squared=0.92, p<0.0001).

For mothers usually resident in Wales between Health Boards, perinatal mortality rates (excluding late terminations) for 2015 ranged from 4.37 (95% CI 2.65, 7.19) at Cwm Taf Health Board to 8.34 (95% CI 6.31, 11.01) at Cardiff and Vale University Health Board. Regionally, perinatal mortality rates (excluding late terminations) for 2015 were 5.79 (95% CI 4.27, 7.85) in North Wales, 5.22 (95% CI 4.01, 6.81) in Mid and West Wales and 6.41 (95% CI 5.29, 7.78) in South East Wales (Table A9(2)).

The funnel plot shows the perinatal mortality rates over a five-year period for Health Boards for Welsh resident mothers (Figure 5). None of the Health Boards had a perinatal mortality rate beyond the 95% confidence limits.

Figure 5: Perinatal mortality rate (excluding late terminations) by Health Board to mother’s resident in Wales: 2011-2015

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Source: NCCHD and AWPS/MBRRACE-UK

Perinatal mortality by deprivation quintile

Within Wales, perinatal mortality rates are persistently higher in the most deprived quintile of social deprivation measured using the Welsh Index of Multiple Deprivation (WIMD), although there is a narrowing of the difference between quintiles over recent years (Figure 6). Cases were allocated to the appropriate quintile of deprivation based on mother’s residence and Lower Super Output Areas (LSOA).

Figure 6: Perinatal mortality rate by deprivation quintile: five year rolling rates (1994-1998 to 2011-2015)

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Source: NCCHD and AWPS/MBRRACE-UK

Cause of perinatal deaths in Wales

We present data on cause of perinatal death using the Cause of Death and Associated Conditions (CODAC) classification (Figures 7a-7e). CODAC classification is explained further in Appendix E. Between 2013 and 2015, among all perinatal deaths, the cause of death was unknown in 39% and was missing in 8% of cases (Figure 7a).

Where a cause was associated with death, intrapartum (8%), neonatal (14%), placenta (9%), and congenital anomalies (10%) were leading causes of perinatal deaths.

Figure 7a: Single main cause of perinatal death using CODAC classification: 2015

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Among all perinatal deaths in 2015, the cause of death was unknown in 44% and was missing in 6% of cases.

Figure 7b: Single main cause of perinatal death using CODAC classification: 2015

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When the placenta category was broken down further, abruption or retro-placental hematoma were leading recorded causes of death, although the number of deaths in this category was small (n=19).

Figure 7c: Placenta category broken down to level 2 of CODAC classifications: 2015

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When the neonatal category was broken down further, extreme prematurity was the leading cause of death, although the number of deaths in this category was also small (n=37).

Figure 7d: Neonatal category broken down to level 2 of CODAC classifications: 2015

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The results for the congenital anomaly category are shown on Figure 7e. The number of deaths in this category was small (n=18).

Figure 7e: Congenital anomaly category broken down to level 2 of CODAC classifications: 2015

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Source: MBRRACE-UK/AWPS

Key findings from the ONS 2012 report for England and Wales1 were that the perinatal mortality rates were higher for mothers in the ‘under 20’s’ and ‘40 and over’ age group at 9.1 deaths per 1,000 livebirths in both age categories. Very low birthweight (VLBW) (<1500g) infants had the highest infant and perinatal mortality rates.

References

1. Office for National Statistics ONS. ‘Available at:’ http://www.ons.gov.uk/ons/dcp171778_397789.pdf Accessed July 2016.