• National Perinatal Epidemiology Centre: severe maternal morbidity report 2011.

      National Perinatal Epidemiology Centre; UCC (2013-03)
      This is the first national audit of severe maternal morbidity in Ireland. Between 1st January 2011 and the 31st December 2011, anonymised data on severe maternal morbidity were collected from 19 of the 20 maternity units in Ireland (this includes one private and 18 public maternity units). In total, 67,806 maternities were reported from the 19 participating maternity units, representing 93% of maternities in Ireland for the calendar year 2011. Severe maternal morbidity was classified as the presence of one or more of 15 categories of maternal morbidity including: major obstetric haemorrhage (MOH), eclampsia, renal/liver dysfunction, cardiac arrest, pulmonary oedema, acute respiratory dysfunction, coma, cerebrovascular accident, status epilepticus, septicaemic shock, anaesthetic complications, pulmonary embolism, peripartum hysterectomy, admission to intensive care and interventional radiology. Major obstetric haemorrhage was defined as an estimated blood loss of ≥ 2,500ml, and or a transfusion of ≥ 5 units of blood and or documented treatment for coagulopathy. The methodology for case ascertainment and morbidity inclusion criteria, adapted by the National Perinatal epidemiology Centre (NPEC), was based on the Scottish Confidential Audit of Severe Maternal Morbidity (SCASMM) and are described in Appendix B. As such, use of this validated data collection tool with the kind permission of the Reproductive Health Programme of the National Health Service (NHS) Quality Improvement Scotland, facilitated international comparison with a relatively similar health care provision service and pregnant population. Although severe maternal morbidity may reflect the complexity of the pregnant population, evaluation of such cases has been acknowledged as a surrogate measure of quality care in the maternity services.
    • Perinatal mortality in Ireland annual report 2012

      Manning, E; Greene, RA; Meaney, S; Corcoran, P; UCC (National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, UCC, 5th Floor, Cork University Maternity Hospital, Wilton, Cork, Ireland, 2014)
      This is the second national clinical audit on perinatal mortality in Ireland using the NPEC data collection tool and classification system. Anonymised data were reported by the 20 Irish maternity units on a total of 485 perinatal deaths occurring in 2012 and arising from 71,755 births of at least 24 weeks gestation or at least 500g birthweight. Stillbirths, early neonatal and late neonatal deaths accounted for 304 (62.7%), 141 (29.1%) and 40 (8.2%) of the 485 deaths, respectively. The perinatal mortality rate was 6.2 per 1,000 births in 2012; corrected for congenital malformation, the rate was 4.1 per 1,000 births; the stillbirth rate was 4.2 per 1,000 births; and, the early neonatal death rate was 2.0 per 1,000 live births. International comparisons are hampered by variation in definitions, availability of screening programmes for congenital anomalies and national legislation on abortion. Nevertheless, the Irish perinatal mortality rates compare favourably with those of countries in the UK and Europe. The year 2012 is the fifth year the NPEC has reported national perinatal mortality rates and while this period is too short to establish trends, it is promising that the observed rates have decreased by approximately 10%.
    • Severe maternal morbidity in Ireland annual report 2012 and 2013.

      Corcoran, P; Greene, RA; Meaney, S; Manning, E; UCC (2015)
      This is the second report from the national audit of severe maternal morbidity (SMM) in Ireland. It reports on 615 cases of SMM that occurred in maternity units in 2012 and 2013. There were 292 cases in 2012 notified by nineteen of the country’s 20 maternity units and 323 cases notified for 2013 when all 20 units participated. Over the three years of this audit, the reported incidence of SMM in Irish maternity units increased from 3.83 per 1,000 maternities in 2011 to 4.44 per 1,000 in 2012 and 4.75 per 1,000 in 2013, suggesting an upward trend in SMM. Despite this, the incidence of SMM in Ireland compares favourably with the rate reported from the methodologically comparable national audit in Scottish maternity units (SCASMM) over similar years. The most recently reported Scottish SMM rate is 7.3 per 1,000 maternities for 2012. The majority of the women (70%) who experienced SMM in 2012 and 2013 were diagnosed with one SMM, one in four (24%) were diagnosed with two severe morbidities, 6% with three and 1% of the women were diagnosed with four morbidities. Similar to findings in the Scottish audit, major obstetric haemorrhage (MOH) was the most frequently reported SMM (55%). The next most common reportable SMM events were admission to intensive care unit or coronary care unit (ICU/CCU; 42%), renal or liver dysfunction (7%), peripartum hysterectomy (7%) and pulmonary embolism (6%). The 341 reported MOH cases gave an incidence rate of 2.55 per 1,000 maternities in 2012/2013, less than half the equivalent rate in Scotland for the same years. Uterine atony was the most common underlying cause (38%) of MOH followed by retained placenta/ membranes (17%). This mirrors findings from successive SCASMM reports. The vast majority of MOH cases (84%) occurred during or after birth, 18% occurred in the intrapartum period and two thirds in the postpartum period. Almost all women who experienced MOH (93%) received a blood transfusion. Admission into an ICU/CCU has been used as a marker for SMM internationally and is a reportable event in this audit. MOH was associated with 41% of the 261 ICU/CCU admissions reported for 2012/2013. However, an increasing proportion of reported ICU/CCU cases had no other associated SMM as defined in this audit (25% in 2011, 35% in 2012 and 41% in 2013). Our discussions with the units suggests such ICU/CCU admissions reflect resource issues in maternity units when women need a higher level of monitoring. This finding is one of the motivations for the new NPEC Audit of Critical Care in Obstetrics in Ireland which is currently being implemented in maternity units across the country.