Scottish Perinatal and Infant Mortality and Morbidity Report (SPIMMR)

This report presents the findings from the 2005 Scottish Stillbirth and Infant Death Survey and also includes a report of work to develop new centile reference charts for birthweights in Scotland.

The Scottish Stillbirth and Infant Death Survey  (SSBIDS) is jointly administered by the Scottish Programme for Clinical Effectiveness in Reproductive Health and the Information Services Division on behalf of NHS Quality Improvement Scotland.  An annual perinatal mortality report has been published since 1977 and more recently has also included the birth prevalence of selected congenital anomalies.

Total births and deaths:
There were 54,678 live and stillbirths in Scotland in 2005; a rise of 404 births since 2004. 699 deaths were notified to the SSBID Survey, comprising 123 late fetal deaths, 292 stillbirths, 190 neonatal deaths and 94 postneonatal deaths (please refer to the glossary for definitions of these categories).

Stillbirths
The 2005 stillbirth rate was 5.3 stillbirths per 1000 total births. For comparison, the average stillbirth death rate from 1995 to1999 was 5.9 per 1000 and from 2000 to 2004 was 5.6 per 1000. 

Neonatal deaths
The 2005 neonatal death rate was 3.5 per 1000 live births. For comparison the average rate for 1995 to 1999 was 3.6 per 1000 and for 2000 to 2004 was 3.5per 1000. 

Infant deaths
The 2005 infant death rate was 5.2 per 1000 live births.  For comparison the average for 1995 to 1999 was 5.2 per 1000 and for 2000 to 2004 was 5.3 per 1000.

Trends in mortality
The rates of stillbirth, neonatal and infant death for 2005 show no discernible change compared to previous years and the fluctuations in the rates over time are likely to be heavily influenced by random fluctuations consequent on the small numbers of events each year.

The FIGO classification
In order to make meaningful comparisons of perinatal mortality it is important to distinguish deaths due to a major congenital anomaly from those from other causes.  The FIGO classification is the international standard used to achieve this and additionally only includes infants weighing more than 1000 grams (this is roughly equivalent to 28 weeks gestation).

FIGO classified stillbirths and neonatal deaths
Under the FIGO classification system the stillbirth rate (among normally formed infants weighing 1000 grams or over) was 3.2 per 1000. For comparison the average from 1995 to1999 was 3.6 per 1000 and from 2000 to 2004 was 3.5 per 1000.

Under the FIGO system the neonatal mortality rate (among normally formed infants weighing 1000 grams or over) was 1.0 per 1000.  For comparison the average from 1995 to1999 was 1.0 per 1000 and from 2000 to 2004 was 1.0 per 1000.

Trends in FIGO classified mortality:
The FIGO rates of stillbirth and neonatal death for 2005 show no discernible trend compared to previous years and the fluctuations in the rates over the time period are likely to be heavily influenced by random fluctuations consequent on the small numbers of events each year.

Singleton births:
The stillbirth rate among singleton births for 2005 was 5.2 per 1000 singleton total births. The average for 1995 to1999 was 5.5 per1000 and for 2000 to 2004 was 5.3 per 1000.  There is no discernible trend. The causes of stillbirth among singletons were broadly similar to previous years: 66% were 'unexplained'; 14% were due to a congenital anomaly and 10% were due to antepartum haemorrhage.

The neonatal death rate among singleton births for 2005 was 3.0 per 1000 singleton live births. The average between 1995 and 1999 was 3.0 per 1000 and from 2000 to 2004 was 2.9 per 1000.  Again there is no discernible trend.  Among singleton neonatal deaths, 47% were in the 'unexplained' category and 33% were due to congenital anomalies.

Multiple births:
The twinning rate for 2005 was 15.7 per 1000 maternities and was the highest since records began in 1855.  Between 1995 and 1999 the average rate was 13.7 per 1000 maternities and between 2000 and 2004 was 14.7 per 1000 maternities. 

The stillbirth rate for multiple births in 2005 was 11.1 per 1000 multiple total births and the neonatal death rate was 18.3 per 1000 multiple live births. These rates, which are higher than the rates seen in singleton births, are similar to those in previous recent years. 

Eight sets of triplets were registered during 2005 but there were no stillbirths or infant deaths.

Gender: 
The 2005 stillbirth rates for boys was 4.8 per 1000 and for girls 5.5 per 1000. The neonatal death rates were 3.3 for boys and 1000 and 2.7 per 1000 for girls. The 2005 stillbirth rates differ from the general observation that males generally have higher mortality rates than females. 

Postmortem examination
During 2005 the postmortem rate examination for deaths covered by the SSBID surevy was 47%. Rates for individual hospitals ranged from 28% to 61%. 

Postneonatal mortality
Postneonatal mortality occurs within the first year of life but excludes deaths with in the first four weeks of life. Most deaths (81%) occurred before six months of age. The rate attributed to Sudden Infant Death Syndrome (SIDS) was 0.4 per 1000 and is similar to the rates for 2004.  The rate of postneonatal mortality attributable to SIDS has fallen in recent years.

New birthweight centiles:
Collaboration between ISD and a research team based at Napier University has permitted development of new birthweight centile reference charts based on recent Scottish population data. These new charts will improve surveillance of growth-restricted fetuses in future.

 

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Main Contacts:

Etta Shanks
Maternity & Neonatal Team Leader
Tel: 0131 275 6761
Email: etta.shanks@isd.csa.scot.nhs.uk

Jim Chalmers
Consultant in Public Health Medicine
Tel: 0131 275 6136
Email: jim.Chalmers@isd.csa.sccot.nhs.uk

Anne Leigh-Brown
Programme Principal, Women and Children?s Health Information Programme
Tel: 0131 275 6481
Email: anne.leigh-brown@isd.csa.scot.nhs.uk

(Dr Gillian Penney, Programme Co-ordinator for the Scottish Programme for Clinical Effectiveness in Reproductive Health)

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Preview access to this release was given to:
SEHD, NHS Quality Improvement Scotland, Scottish Perinatal Mortality & Morbidity Review Advisory Group, NHS Chief Executives and Directors of Public Health

Glossary:
Stillbirth: infants born with no sign of life after 24th week of pregnancy,
Perinatal death: stillbirths and deaths in the first week of life.
Neonatal death: deaths in the first four weeks of life.
Early neonatal death: deaths in the first week of life.
Late neonatal death: deaths in weeks two to four of life.
Postneonatal: deaths after the first four weeks but before the end of the first year of life.
Infant deaths: deaths in the first year of life.
Late fetal deaths: infants born dead at 20-23 weeks of pregnancy or earlier in pregnancy if the birthweight is 500g or more.
FIGO: International Federation of Gynaecology and Obstetrics classification system for perinatal mortality.  The classification excludes major congenital anomalies and infants weighing less than 1000grams.

In the context of SPIMMR, a congenital anomaly is defined as any genetic or structural defect arising at conception or during emrbyogenesis incompatible with life or potentially treatable but causing death.

Publication History:
Last published:  10th Nov 2005
First Published 1977
Next due: 29th Nov 2007