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The first perinatal report from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) was launched on 10 June 2015 at the Royal College of Obstetricians and Gynaecologists and presented the data for 2013.1 This followed the report in December 2014 of the latest triennial confidential enquiry review of maternal deaths, and the report on congenital diaphragmatic hernia, so it is timely to reflect on the whole enterprise of perinatal surveillance in the UK and how analysis of the outcomes of maternity services might develop in the future.
The need for perinatal surveillance remains as pressing as ever. It is important that the UK continues to contribute to EURO-PERISTAT (see http://www.europeristat.com) so that we can benchmark ourselves against the rest of Europe: comparisons of our perinatal outcomes with other countries are not flattering because although we do not have the worst rates in Europe, we are a long way from being even close to the best. Where exactly we should aspire to be in the ranking of nations, given our population mix and other structural factors, was a matter for considerable debate at the conference.
The new approaches that MBRRACE-UK has taken are largely to be welcomed. First, rather than report traditional perinatal mortality (stillbirths plus deaths in the first week), the focus is on ‘extended’ perinatal mortality: stillbirths plus deaths up to 28 days postnatally. For some time this has been recognised as a better measure of the outcome of maternity services than traditional perinatal mortality, though arguably it is even more useful to count stillbirths plus all deaths up to the end of the first postnatal year. At present, MBRRACE-UK's case ascertainment methodology makes this aspirational rather than realistic. At the lower end of the scale, all live births from 20 weeks, and all …
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