Making pregnancy safer: can we do better?

1. Making pregnancy safer: can we do better? A PMMRC workshop on improving outcomesfor New Zealand mothers and babies

2. 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

3. 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

4. The 2009 report

5. What’s new in this report? • Contributory factors and potentially avoidable deaths • Focus on teenage mothers

6. 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

7. 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

8. Young mothers2007-2009 p35

9. 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

10. 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

11. Neonatal EncephalopathyWorking 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

12. Australasian MaternityOutcomesSurveillance 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

13. 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

14. Current structure of PMMRC

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

16. PMMRC www.pmmrc.health.govt.nz