Making pregnancy safer: can we do better?

A PMMRC workshop on improving outcomesfor New Zealand mothers and babies

Purpose of the PMMRC

• To review and report to the Health Quality and Safety Commission on perinatal and maternal deaths with a view to reducing the numbers

• To support quality improvement through local

lperinatal and maternal mortality review meetings

• To develop strategic plans and methodologies to reduce morbidity and mortality

PMMRC annual reporting

• Annual reports– November 2009

• Reported on perinatal and maternal data for 2007

– October 2010• Reported on perinatal and maternal data for 2008

– July 2011• Reported on perinatal and maternal data for 2009

The 2009 report

What’s new in this report?

• Contributory factors and potentially avoidable deaths

• Focus on teenage mothers

Contributory factors and potentially avoidability

– 721 perinatal deaths for 2009 pp60• 23.5% had contributory factors

– Barriers to accessing and engaging in care – Personnel factors– Organisation and management factors

• 13.6% were classified as potentially avoidable – 98 perinatal deaths

– 49 maternal deaths from 2006-2009 p72• 14 in 2009

– 4 were from H1N1

• In 2009 5 had contributory factors and 3 were potentially avoidable

Recommendations• Key stakeholders should work together to identify existing

research on • reasons for barriers to accessing maternity care

• interventions to address barriers to engagement with maternity care

• Clinical services and clinicians have a responsibility to ensure the following:

• CME – focus on personnel and best practice• Policies /guidelines -up to date, implemented and audited • A culture of teamwork• A culture of practice reflection on patient outcomes with a link to

quality improvement • Staffing arrangements that ensure timely access to specialists

Young mothers2007-2009 p35

Recommendations• All LMCs should be aware that teenage mothers are at

increased risk – preterm birth, fetal growth restriction and perinatal infection

• Maternity services for teenager mothers need to address this increased risk – provision of services that specifically meet their needs

• Research on the best model of care for teenage pregnant mothers – view to reducing perinatal deaths

• Engagement with MoE – appropriate education and maternity care in the school setting

Other work of the PMMRC

Neonatal Encephalopathy Working Group p78• Investigating morbidity in newborn

Australasian Maternity Outcomes Surveillance System p79 (AMOSS)

• Investigating morbidity in mothers

Neonatal Encephalopathy Working Group p79

• The PMMRC asked to identify ways to reduce morbidity as well as mortality

• The outcome for affected infants may include mortality and long-term neurodevelopmental morbidity

• Aim to investigate the size of the problem in New Zealand and to explore ways of

improving outcomes • Collection of data began 1st January 2010 with

notification of cases through the PSU

Australasian Maternity Outcomes Surveillance System p79

• Maximise the safety & quality of maternity care and outcomes in Australasia

• Described severe morbidity and mortality from these conditions

• Quantify the burden on the healthcare sector

• Address the lack of robust evidence for clinical practice

• Data collection commenced 1st January 2010

AMOSS – conditions

Current conditions • Antenatal pulmonary embolism• Amniotic fluid embolism• Eclampsia• Placenta accreta• Peripartum hysterectomy

Completed surveys• ICU admission with Influenza• Morbid obesity (BMI>50) * numbers only/no

data

Current structure of PMMRC

Finally

• Thank you to all midwives, nurses, doctors, analysts, epidemiologists and managers who have worked to collect this data and produce this report

PMMRC

www.pmmrc.health.govt.nz