Investigation following perinatal death
Autopsy
The National Perinatal Mortality Data Collection collects data on whether or not an autopsy was performed and, where applicable, the type of autopsy performed (a full autopsy, limited autopsy or external examination).
For the purposes of this report, deaths where any of these autopsy types have been performed will collectively be treated as deaths where an ‘autopsy’ has been performed.
The purpose of an autopsy is to accurately identify the cause(s) of death. Autopsy results contribute to clinical audit and assist with identification of factors contributing to the death. Perinatal autopsy examinations require written consent from parent(s) following informed discussion.
In 2015 and 2016, there were 5,702 perinatal deaths, 5,462 of which (4,081 stillbirths and 1,381neonatal deaths) had a stated autopsy status. Of deaths where autopsy status was stated, there were:
- 2,246 (41.1%) perinatal deaths that had an autopsy performed
- 1,830 (44.8%) stillbirths and 416 (30.1%) neonatal deaths that had an autopsy performed.
Placental examination
Data on placental histology examinations are not available for Queensland, Western Australia or South Australia. Data are reported with these states excluded from the analysis (refer to Data quality and availability of national perinatal mortality data for more information).
The placenta is integral to a baby’s growth and survival prior to birth. Histological examination of the placenta is of particular importance when the baby’s weight is not consistent with its gestation at birth, when birth is significantly preterm or the baby is ill at birth, or a stillbirth has occurred. Consent is not required for placental examination.
Of the 5,702 perinatal deaths in 2015 and 2016, there were 3,366 from New South Wales, Victoria, Tasmania, Australian Capital Territory and Northern Territory where placental histology status was stated. Of deaths where placental histology status was stated:
- 2,724 (80.9%) of perinatal deaths had a placental histological examination performed.
Contributing factors
State and territory perinatal mortality committees examine circumstances associated with perinatal deaths to identify possible contributing factors, so that systemic factors affecting the perinatal mortality rate may be identified. Review of a perinatal death may identify more than one contributing factor.
Contributing factors are grouped into three main categories:
- Professional practice (such as failure to recognise clinical deterioration and inadequate clinical monitoring in at-risk situations).
- Lack of, or delay in, access to appropriate care (including access to appropriate expertise, services and treatment).
- Family and social situation (such as substance abuse, family violence and language barriers).
In 2015 and 2016, Victoria, Tasmania and Northern Territory supplied the findings of 339 perinatal deaths (232 stillbirths and 107 neonatal deaths) reviewed for contributing factors to the NPMDC. Contributing factors were identified in relation to 176 of these perinatal deaths, with factors found to have significantly contributed to the outcome in 82 (24.2%) of the 339 perinatal deaths that were reviewed. No contributing factors were identified for 163 (48.1%) of the cases reviewed.
Of the 214 contributory factors identified, most frequent were those relating to the mother, her family and the social situation (56.1%), and related to professional practice (32.2%). On average, more than 1 contributory factor for each case reviewed were identified. For neonatal deaths, a greater proportion of factors were identified related to professional practice (50.0%).
Refer to Data quality and availability of national perinatal mortality data for more information on the collection of contributory factors in the NPMDC.