How will the new Confidential Enquiries into Maternal and Infant Death in the UK operate? The work of MBRRACE-UK


  • Marian Knight MA DPhil FFPH

    1. NIHR Research Professor/Honorary Consultant in Public Health, MBRRACE-UK Maternal Programme Lead, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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The UK Confidential Enquiries into Maternal Deaths as well as surveillance of maternal and perinatal deaths, formerly undertaken under the auspices of the Centre for Maternal and Child Enquiries (CMACE), are now being run by a new group, MBRRACE-UK. MBRRACE-UK is a collaboration led from the National Perinatal Epidemiology Unit, University of Oxford, including collaborators from The Infant Mortality and Morbidity Studies group at the University of Leicester, the Universities of Liverpool and Birmingham, and Imperial College, London, General Practice, and SANDS, the stillbirth and neonatal death charity. In addition to the work previously undertaken by CMACE, the new group will also be undertaking surveillance of infant deaths up to age 1 year and topic-based confidential enquiries on specific maternal and perinatal or infant morbidities. Reports from both maternal and infant programmes will be issued on an annual basis from 2014.

The Confidential Enquiries into Maternal Death have been operating in the UK for more than 60 years, and safeguarding the continuity of the enquiry is an important priority for MBRRACE-UK. Information about all maternal deaths occurring since the beginning of 2009, including late deaths up to 1 year after the end of pregnancy, is actively being sought to enable confidential review of these cases to take place during 2013. This will ensure that there has been no break in the enquiry since its inception in 1952. Any maternal deaths not already reported should be notified either through the MBRRACE-UK web reporting system or directly to the MBRRACE-UK office by telephone. The MBRRACE-UK team will then request further information including anonymised case notes, details of postmortem examinations and local reviews, as well as summaries of the case and lessons learned from local supervising obstetricians, midwives, anaesthetists and other relevant specialists. A team of expert obstetric case assessors has been recruited through the Royal College of Obstetricians and Gynaecologists, and they, along with other specialty assessors, will be responsible for reviewing the anonymised information about all women who have died.

The maternal enquiry report planned for publication in 2014 will thus include surveillance information on all deaths occurring between 2009 and 2012, as well as accounts of the confidential reviews of the cases of women who died from specific causes. The change to an annual report programme has been made to enable the information to be available more quickly and hence the lessons learned can be translated more rapidly into changes in clinical practice. The annual frequency of reports, however, means a move to a topic-based format, such that while surveillance information will be provided for all deaths each year, each annual report will only contain a selection of reports of the confidential enquiries into specific mortality topics. Each mortality topic will be included once every three years. A further element of this annual report will be the results of a maternal morbidity confidential enquiry. For the next report, the topic chosen is sepsis; an expert group is currently being recruited to undertake confidential case reviews into women who survived an episode of septic shock during or following pregnancy. These women have been identified from the UK Obstetric Surveillance System study of severe maternal sepsis. The aim of this expansion of confidential enquiries is to identify more generalisable lessons learned which can be taken forward to help prevent and manage severe morbidity as well as mortality.

Information on stillborn babies, those who die during the neonatal period and those who die during infancy will be collected through the new web-based data collection system. The MBRRACE-UK perinatal team, led from the University of Leicester, have considerable experience of case-mix adjustment and assessment of outlier status through their work with the Paediatric Intensive Care Audit Network. Additional data are therefore being collected on all perinatal and infant deaths to enable appropriate adjustment of rates to account for case-mix, and thus to ensure that in the future any assessment of variation in reported mortality rates takes this into account. Part of this adjustment will include accounting for terminations, stillbirths, miscarriages or early neonatal deaths arising from deliveries at 22 and 23 completed weeks of gestation, and units are therefore asked to report all deliveries occurring at these gestations as well as those at 24 weeks and above. In addition to this surveillance, a new perinatal/infant topic based confidential enquiry will take place each year. The first topic identified is congenital diaphragmatic hernia; recruitment of an expert assessment group for this enquiry has just commenced.

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