Issue 2 / 25 January 2016

NATIONAL data sharing and collection in the field of stillbirths and other aspects of perinatal mortality are on the brink of a big improvement in Australia, says a leading obstetrician and policymaker.

In the wake of unflattering statistics released by The Lancet in their Ending preventable stillbirths series, Professor Jeremy Oats, chair of Victoria’s Consultative Council on Obstetric and Paediatric Mortality and Morbidity, told MJA InSight that he was optimistic that Australia’s fractured data collection process will be revamped.

The Lancet reported that between 200 000 and 1.3 million stillbirths worldwide could have been prevented in 2015, and that although Australia ranks 15th lowest in the world, it has a stillborn rate of 2.7/1000 total births, double that of Iceland, which comes in at the lowest rate of 1.3/1000. Ukraine has the highest rate of stillbirths in the world, at 8.8/1000. Autopsies occurred in just 30% of Australian stillbirths.

Related: MJA – Ethnicity and the risk of late-pregnancy stillbirth

Associate Professor Vicki Flenady from the University of Queensland, a coauthor on the fourth instalment of The Lancet series – Stillbirths: recall to action in high-income countries – told The Guardian that stillbirths could occur in healthy women, often in the last days of their pregnancy, but because Australia does not have national reporting system and database of stillbirths, it was difficult to investigate why.

“What we could be doing better is investigating every case of stillbirth more thoroughly than we are now to identify factors that may have gone wrong,” she told The Guardian. “That’s where we fall down in Australia, we need to implement a national program where every case is investigated and an autopsy carried out. Countries like the Netherlands and New Zealand have such a national audit program and have seen significant reductions in stillbirth rates.”

Professor Oats said plans were underway to implement just such a program.

“There has been a quantum change in attitude,” he told MJA InSight.

Related: MJA – Bringing stillbirth out of the shadows for all women having a baby in Australia

The Australian Institute of Health and Welfare’s National Maternity Data Development Project has completed stage one, and the second stage is about to release its report, according to Professor Oats.

“I am much more optimistic [that a national data collection system can be established] because the whole atmosphere has changed around this subject,” he said.

“The big problem has been the sharing of data, because some jurisdictions have legal barriers, particularly to sharing identifiable information, but we are making progress.

“There’s no question that for the credibility of our data, and for effectively changing outcomes, we need a national system of perinatal morbidity data collection and sharing.”

Related: MJA InSight – Stillbirth causes still a mystery

Professor Michael Permezel, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, told MJA InSight that most states “put a lot of resources” into looking into perinatal mortality and morbidity, but that data was “not collated well nationally”.

As for The Lancet data, Professor Permezel said:

“It’s hard to compare countries because different definitions are used. I believe Australia performs reasonably well.

“A national database should be a priority and it’s good to know that some progress is being made.”

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