Page last updated: 26-MAY-2009

Perinatal Mortality

ONS kitemarkStatistical Publication Notice

26 May 2009

Trends in Perinatal Mortality in Scotland - A review over 30 years

INTRODUCTION

Annual reports on perinatal mortality in Scotland, including a classification according to obstetric event leading to death, have been produced since 1977. Since 1987, a paediatric classification which summarises the clinico-pathological events in the fetus or baby, has been included to complement the obstetric classification.
 
This report reviews the data over a variety of time periods (from 33 years to 15 years), depending on the available dataset and describes some of the changes since data collection started. The data is collected across Scotland and therefore represents changes in the whole population.
 
The aim of the report, which is jointly produced by ISD and NHS Quality Improvement Scotland, is to explore whether routinely collected data can be used to highlight any areas of concern and to suggest areas for further monitoring, analysis and reporting. It does not attempt to engage in detailed statistical analysis.

KEY POINTS

  • Stillbirth rates have changed little over the past two decades, having declined markedly in the previous decade.
  • Women aged between 25-34 years have the lowest stillbirth rate.
  • There is a steady rise in the number of women over the age of 35 having their first child.
  • There is a suggestion that term stillbirths and intrapartum stillbirths (fetal deaths during labour) have risen slightly in the past decade.
  • The rate of twins has almost doubled in the past thirty years. There has also been an increase in the rate of preterm deliveries and caesarean section for these births.

INTERPRETATION

The data sources used in the report are – European Perinatal Health Report; GROS (General Register Office for Scotland); SSBID (Scottish Stillbirth and Infant Death Survey) and SMR02 (Scottish Morbidity Record 2, the Maternity Hospital Discharge Summary).
 
In the section on European comparison the reader should note that perinatal mortality data differ among European countries. There are many reasons for these variations including differences in data collection and definitions.
 
There was a change to the definition of a stillbirth on 1st October 1992, from a death before 28 to before 24 completed weeks of gestation.
 
The age standardisation has been calculated using the distribution of mother's age at baseline year i.e. 1985.

DETAILED FINDINGS

  • Stillbirth rates have changed little over the past two decades, having declined markedly in the previous decade. Although the current rate is significantly lower than in 1974, stillbirth rates have fluctuated between 5 and 6 per 1000 total births since 1981.
  • Women aged between 25-34 years have the lowest stillbirth rate. In the three year period 2005/07 the stillbirth rate of 9.4 per 1000 total births for women aged over 40 years was more than double that found in women aged 25-34 years (4.5 per 1000 total births for women aged 25-29 and 4.4 for 30-34 years).
  • There is evidence of a direct relationship between deprivation and stillbirth rate. The stillbirth rate for women from areas of high deprivation was 7.22 per 1000 total births for the three year period 2005/07 and 4.67 per 1000 total births for those from the least deprived areas.
  • There is a steady rise in the number of women over the age of 35 having their first child.
  • There is a suggestion that term stillbirths and intrapartum stillbirths have risen slightly in the past decade.
  • The rate of twins has almost doubled in the past thirty years (from 9.2 in 1975 to 15.2 in 2007). There has also been an increase in the rate of preterm deliveries and caesarean section for twin births. The percentage of preterm twins (under 37 weeks gestation) has increased from 32.8% in 1975 to 52.6% in 2007. Most multiple pregnancies are now delivered by caesarean section. In 1975, 5.3% of twins were delivered by elective caesarean section and 4.4 by emergnecy caesarean section. By 2005 these figures had increased markedly to 27.2% and 30.9% respectively.


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MAIN CONTACTS:

Dr Jim Chalmers (CPHM)
Head of Programme
Women & Children’s Health Information Programme
0131 275 6136
Jim.Chalmers@nhs.net

Leslie Marr
Reproductive Health Programme Co-ordinator
NHS Quality Improvement Scotland
0131 623 4710
Leslie.Marr@nhs.net

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GLOSSARY:

  • Stillbirth: infants born with no sign of life after 24th week of pregnancy (was 28 weeks until 1st Oct 1002)
  • 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. 
  • Post-neonatal: deaths after the first four weeks but before the end of the first year of life. 
  • Fetal mortality: In the section on European comparison the fetal mortality rate is defined as the number of fetal losses at or after 22 completed weeks of gestation. 
  • Antepartum - before delivery. 
  • Intrapartum - during labour/delivery. 
  • 'Optimum women' - for the purpose of this report 'optimum women' refer to women aged between 20 and 34 and are from the two least deprived quintiles. 
  • IUGR - Intrauterine growth restriction
  • SGA - small for gestational age
 
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PRE-RELEASE ACCESS

Under terms of the ‘Pre-Release Access to Official Statistics (Scotland) Order 2008’, ISD are obliged to publish information on those receiving Pre-Release Access (‘Pre-Release Access’ refers to statistics in their final form prior to publication). The standard maximum Pre-Release Access is five working days. Shown below are details of those receiving standard Pre-Release Access and, separately, those receiving extended Pre-Release Access.
 
Standard (five day) Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
NHS Board Chief Executives
NHS Board Communication leads
Chair of the Scottish Perinatal Mortality and Morbidity Review Advisory Group (SPMMRAG)
Clinical Advisor, Reproductive Health Programme, NHS QIS and Reproductive Health Programme Coordinator, NHS QIS (both members of SPMMRAG)
 
Extended Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
This extended Pre-Release Access is given to a small number of named individuals in the Scottish Government Health Department (Analytical Services Division). This Pre-Release Access is for the sole purpose of enabling that department to gain an understanding of the statistics prior to briefing others in Scottish Government (during the period of standard Pre-Release Access).
 
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HISTORY OF THIS PUBLICATION:

Last Published: This report has not been published before.
Next Due: No further editions planned.
Data Available Since: May 2009.

 


Main contact: Email Etta Shanks