News and Updates
Statistical Publication Notice
(30/October/2007)
Scottish Perinatal and Infant Mortality and Morbidity Report 2006
INTRODUCTION/CONTEXT
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.
Annual reports on perinatal mortality in Scotland have been published since 1977 (and by ISD since 1985). Over time, the report has been expanded to include late fetal deaths (from 20 weeks gestation) and infant deaths (all deaths in the first year of life).
In recent years the report has focused on morbidity as well as mortality and now includes chapters on selected congenital anomalies as well as a clinically focused chapter. This year’s clinical chapter examines trends in the incidence of ectopic pregnancy.
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KEY POINTS (3 - 5)
- Total births in Scotland have risen steadily over the past 5 years: from 51,548 in 2002 to 55,986 in 2006.
- Rates of death in infancy continue to fall slowly, with the 2006 combined rate of stillbirth and infant death being the lowest ever recorded. Nevertheless, it is a cause for concern that the stillbirth rate has remained static over the past decade and detailed study is warranted.
- Prematurity continues to have a major impact on mortality rates: the smallest babies have a risk of neonatal death of 300 times that of a term baby. Immaturity has a particular impact on mortality among twins and higher order multiple births: twins have a perinatal mortality rate six times higher than singleton babies.
- Only 47% of stillbirths and neonatal deaths underwent autopsy examination. Clinicians are encouraged to counsel bereaved parents about the beneficial knowledge which may be gained from autopsy.
- The Scottish rate of ectopic pregnancy has reached a plateau. Robust national data systems, extended to capture outpatient interventions, are essential for future monitoring of trends.
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DETAILED FINDINGS / COMMENTARY
Total births and deaths: there were 55,986 births (live and stillborn) in Scotland in 2006; a rise of 1,308 over 2005. In total, 690 deaths were notified to the SSBID Survey; comprising 146 late fetal deaths; 296 stillbirths; 172 neonatal deaths and 76 postneonatal deaths.
Stillbirth: the 2006 stillbirth rate was 5.3/1000 total births.
Neonatal deaths: the 2006 neonatal death rate was 3.1/1000 live births.
Postneonatal deaths: the 2006 rate was 1.4/1000 live births.
Singleton births:
Stillbirth rate among singleton births: 5.0/1000 singleton total births.
Neonatal death rate, 2.6/1000 singleton live births.
Causes of death were broadly similar to previous years. Among singleton stillbirths, 67% were 'unexplained' with congenital anomaly (11%) and antepartum haemorrhage (11%) being the commonest identifiable causes. Among singleton neonatal deaths, the 'unexplained' categories (51%) and congenital anomalies (31%) were the main contributors.
Multiple births: twinning rate, 15.6/1000 maternities.
Stillbirth rate: 14.9/1000 multiple total births
Neonatal death rate: 19.8/1000 multiple live births
These rates are similar to those in previous recent years.
Gender: 2006 stillbirth rates, 5.0/1000 and 4.9/1000; neonatal death rates, 2.7/1000 and 2.2/1000 for males and females respectively. These 2006 rates follow the general trend that males have higher mortality rates than females.
Low birthweight and preterm births: account for around 6% of all births, but for over 60% of perinatal deaths. The smallest babies (
Postmortem examinations: among the deaths covered by the SSBID Survey (late fetal death, stillbirth and neonatal death), the autopsy rate was 47%. Rates for individual hospitals ranged from 37% to 61%.
Postneonatal mortality: Most deaths (73%) occurred before six months of age. The rate attributed to Sudden Infant Death Syndrome (SIDS) was similar to 2005 (0.4/1000).
Congenital anomalies: for the five-year period 2001-2005, rates per 1,000 births of selected anomalies detected at birth or during infancy among singleton babies were:
Heart and circulatory system: 9.71
Down syndrome (trisomy 21): 1.71
Cleft lip or palate: 1.62
Neural tube defects: 0.98
Edwards syndrome (trisomy 18): 0.48
Patau syndrome (trisomy 13): 0.17
Data collected through SMR01 and SMR02 were used to describe trends in the incidence of ectopic pregnancy between 1980 and 2005. The rate increased from 6.3 to 14.4 per 1000 births between 1980 and 1994, but has plateaued thereafter. Mean gestation at diagnosis fell from 7.8 to 6.3 weeks and woman’s age at presentation increased from 28.3 to 30.6 years over the period of study.
-----------------------------------------------------------------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.
- SIDS: Sudden Infant Death Syndrome
Abbreviations used in Chapter 11, ‘Recent trends in the incidence of ectopic pregnancy’
- EPAU: early pregnancy assessment unit
- HCG: human chorionic gonadotrophin
- PID: pelvic inflammatory disease
- PUL: pregnancy of unknown location
- SMR: (01/02) Scottish Morbidity Record (forms 01 and 02)
- SPCERH: Scottish Programme for Clinical Effectiveness in Reproductive Health
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MAIN CONTACTS:
Etta Shanks
Maternity and Neonatal Team Leader
Tel: 0131 275 6761
Etta.Shanks@isd.csa.scot.nhs.uk
Dr Jim Chalmers (Consultant in Public Health Medicine)
Head of Programme
Women & Children's Health Information Programme
Tel: 0131 275 6136
Jim.Chalmers@isd.csa.scot.nhs.uk
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PRE-RELEASE ACCESS TO THIS PUBLICATION WAS GIVEN TO:
Scottish Government Health Department, NHS Quality Improvement Scotland, Scottish Perinatal Mortality & Morbidity Review Advisory Group, NHS Board Chief Executives and Directors of Public Health
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HISTORY OF THIS PUBLICATION:
Last Published: 28th November 2006
Next Due: 25th November 2008
Date available since: 1985
Etta Shanks
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