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Improving intrapartum care: can we use routinely available data to monitor the effects of our actions?
  1. Marian Knight
  1. Correspondence to Professor Marian Knight, National Perinatal Epidemiology Unit, University of Oxford, Oxford, OX3 7LF, UK; marian.knight{at}npeu.ox.ac.uk

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Over the past century in the UK, there has been a dramatic decrease in maternal mortality, attributed to improvements in obstetric care as well as social and living conditions. This has not been matched by an equivalent decline in stillbirths and neonatal mortality as comparative death rates show (figure 1). Intrapartum stillbirths and early neonatal deaths occurring as a consequence of events during labour are thought to be largely preventable with high-quality labour care in high-resource settings.1 2 However, the majority of stillborn babies die in the antepartum period, when prevention through better obstetric care is more challenging. Concerns have been expressed that current actions to prevent intrapartum stillbirths and neonatal deaths are simply ‘shifting the problem’, that is, babies who previously would have died either during labour or shortly after birth are those who are now born and survive with brain injuries and their subsequent long-term consequences. In England, this led the government to introduce, alongside a national ambition to halve the number of stillbirths and neonatal deaths, an ambition to halve the number of brain injuries occurring during or soon after birth by 2030.

Figure 1

Stillbirth, neonatal death and maternal death rates, UK 2003/2004–2014/2015*. *Figures for maternal deaths are rolling 3-year average rates reported for the midyear of each 3-year period. **Stillbirth rates reported per 10 000 total births, neonatal death rates reported per 10 000 live births and maternal death rates reported per 10 000 maternities. Source: Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across  the UK.

Although there are some variations in the gestational and birth weight limitations used, defining and counting …

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