Page last updated: 26-JAN-2010

SPIMMR

Statistical Publication Notice

26 January 2010

Scottish Perinatal and Infant Mortality and Morbidity Report 2008.

INTRODUCTION

The Scottish Stillbirth and Infant Death Survey (SSBIDS) is administered by the Reproductive Health Programme of NHS Quality Improvement Scotland (NHS QIS), working in partnership with Information Services Division of NHS National Services Scotland (ISD).   The process is overseen by the Scottish Perinatal Mortality and Morbidity Review Advisory Group (SPMMRAG) and results in this annual Scottish Perinatal and Infant Mortality and Morbidity Report (SPIMMR). 
 
Annual reports on perinatal mortality in Scotland have been published since 1977.   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).
 
The report also includes information on the incidence of selected congenital anomalies.

KEY POINTS

  • Births in Scotland continue to rise, as they have every year since 2002.
  • The rate of twin births (16 per 1000 births) is the highest ever recorded.
  • The perinatal mortality rate (7.4 per 1000 births) is the lowest ever recorded.
  • The rate of stillbirths has remained constant at between 5 and 6 per 1000 births for the last two decades.
  • The need to revise the system for classifying stillbirths and neonatal deaths is recognized.

INTERPRETATION

Much of the information in this report is based on small numbers, especially at the level of individual health boards. Variations from year to year are, therefore, generally not of significance and a longer time span is necessary to identify genuine trends.

DETAILED FINDINGS

Total births and deaths in 2008:

  • Total births: 60,366 (increase of 2,258 from 2007).
  • 685 deaths notified to survey - 107 late fetal deaths; 325 stillbirths; 168 neonatal deaths and 85 post-neonatal deaths.

Stillbirths:

  • Stillbirth rate 5.4/1000 total births.
  • FIGO 'preventable' stillbirth rate 3.6/1000.

Neonatal deaths:

  • Total neonatal death rate 2.8/1000 live births, the lowest ever recorded.
  • Early neonatal mortality rate 2.0/1000 live births.
  • Perinatal mortality rate 7.4/1000 total births, the lowest ever recorded.
  • FIGO ‘preventable' neonatal mortality rate 0.9/1000 live births.

Other mortality rates:

  • Post-neonatal mortality rate 1.4/1000 live births.
  • Infant mortality rate 4.2/1000 live births, the lowest ever recorded.

Singleton births:

  • Stillbirth rate 5.1/1000 total singleton births: 
    • 67% 'unexplained' obstetric cause
    • 13% antepartum haemorrhage
    • 11% congenital anomaly
  • Neonatal death rate 2.4/1000 singleton live births:
    • 52% 'unexplained' obstetric cause
    • 30% congenital anomaly

Multiple births:

  • Twinning rate 16.0/1000 births, the highest rate since records began in 1855.
  • Stillbirth rate 13.9/1000 total multiple births.
  • Neonatal death rate 16.2/1000 multiple live births.

Classification:

  • The limitations of the current classification system are described.
  • A pilot assessment of histological placental dysfunction and of intrauterine growth restriction showed rates of 47% and 27% respectively among stillbirths assigned to the 'unexplained' category.

Low birthweight and preterm birth:

  • Account for just under 6% of all births but for over 60% of perinatal deaths.
  • The fall in neonatal mortality in 2008 occurred among all gestations and birthweights.

Postmortem examinations:

  • Postmortem rate for all deaths 54%
  • Rates for individual hospitals from 24% to 68%

Post-neonatal mortality:

  • 79% of deaths occurred before six months of age.
  • Rate for sudden unexpected death in infancy 0.2/1000 live births, the lowest ever recorded.

Congenital anomalies:

  • Most anomalies are of the heart and circulatory system.
  • Antenatal screening and detection and pregnancy termination reduces the rate at birth of neural tube defects by 53% and of Down syndrome by 39%.

CONCLUSIONS

While the annual collection, interpretation and publication of data concerning stillbirths and neonatal deaths is important, fluctuations from year to year are rarely significant and longer time trends are necessary to identify genuine changes. Nonetheless, there are encouraging features of this 2008 report; in particular, Scotland’s lowest ever perinatal mortality rate, mainly because of a slight but steady decline in neonatal mortality. The stillbirth rate remains resistant to improvement.  Current work to revise the system for classifying the causes of stillbirth in order to better reflect modern knowledge and practice may provide hepful information.

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MAIN CONTACTS:

Etta Shanks
Maternity and Neonatal Team Leader
0131 275 6761
etta.shanks@nhs.net

Dr Jim Chalmers (Consultant in Public Health Medicine)
Head of Programme
Women & Children’s Health Information Programme
0131 275 6136
jim.chalmers@nhs.net

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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.

Post-neonatal: 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.

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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
Scottish Perinatal Mortality and Morbidity Review Advisory Group
 
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: 25/11/2008
Next Due: Annual
Data Available Since: 

 


Main contact: Email Etta Shanks