Notes on the perinatal mortality survey

Notes on the Perinatal Mortality Survey A perinatal mortality survey, whose director is Dr. Neville Butler, is taking place during March, April and May, and a precis of the procedure follows : Definition. For purposes of this survey the word perinatal has been taken as stillbirths and neonatal deaths (up to 28 days), though analysis will also be carried out on the group of stillbirths and deaths in the first week. Questionnaire survey on perinatal mortality, due to take place 1st March to 31st May, 1958, on every stillbirth and neonatal death (expected number approximately 6,000), and on every baby born between 3rd and 9th March, 1958 (expected number approximately 13,500). Of the stillbirths and neonatal deaths, only those occurring in March will receive post mortems (expected number approximately 2,000). The object of the survey is to obtain important information on the distribution of all births and perinatal deaths throughout England, Scotland and Wales, which is lacking from the Registrar General and other official sources, and to correlate social details and clinical factors of pregnancy and labour with individual causes of death as discovered by post-mortern examination. The questionnaires have been piloted in Nottingham (100 births) in May, 1957, and in South-West Region (200 births and 70 deaths) in October, 1957. The questionnaire has been designed by a committee of obstetricians, social medicine experts, statisticians, paediatricians and representatives of the midwife and nursing professions. Representatives from all the main bodies connected with the maternity services, and observers from the Ministry of Health, Welsh Board Of Health, Department of Health in Scotland, and Central Midwives Board have attended steering committee meetings. Help has been given on certain aspects of the questionnaire by the M.R.C.Obstet. Medicine Research Unit at Aberdeen.

The Pathology Part of the Enquiry. The vast majority of pathologists interested in the field of perinatal pathology all over England, Scotland and Wales have kindly offered their co-operation in the post-mortem investigation. Bodies of stillbirths and neonatal deaths will be moved from the place of death, in hospital or at home, throughout March, 1958, to Regional Centres for specialist autopsy. A pilot survey carried out in the South Western Region in October, 1957, showed that 80 % of 94 perinatal deaths were moved successfully to a Regional Centre at Southmead Hospital, Bristol, some as far as 60 miles. The object of the pathology enquiry is to provide an exact cause of death, without which the clinical data would lose much of its value : it will also provide a large number of special groups For examination, such as approximately 300 congenital abnormalities, and will provide material for special research (virology, serology, neurohistology, etc.) on a regional basis. THE ROLE OF VARIOUS AUTHORITIESIN THE MAIN SURVEY (1) The Society of Medical Officers of Health has considered and approved the project. County and county borough medical officers of health will be distributing and arranging for the completion of questionnaires on all non-institutional deliveries. including nursing-home deliveries. They will receive questionnaires from all sources for checking and return them to the headquarters of the Perinatal Mortality Survey. One hundred and eighty-seven out of 197 county and county borough local health authorities have already signified their willingness to co-operate and there has been no complete refusal. 464

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(2) The midwives will be completing the actual questionnaires with clinical help from obstetricians and paediatricians. The Royal College of Midwives is supporting the project and is arranging meetings throughout the country for briefing. (3) Regional Hospital Boards and Boards of Governors of teaching hospitals will be responsible for the co-ordination of the hospital side of the survey. Group secretaries of hospital management committees will distribute questionnaires to matrons of N.H.S. maternity units, and will arrange, as far as possible, for the transport of bodies from N.H.S. maternity units to the Regional Pathology Centre, and, in some cases, help transfer bodies from the home. (4) The Ministry of Health fully supports the aims of the survey and has arranged to finance coding and tabulation of the results by the Social Survey Department, Central Office of Information. PRECIS OF THE CONTENTS t)F THE QUESTIONNAIRE

A. Social Background. Age, marital status, school-leaving age and number of brothers and sisters, and occupation of mother's father. Date of marriage, age and occupation of husband. Paid work in pregnancy (home responsibilities at beginning of pregnancy). Smoking in pregnancy. Normal weight. Height. Number of rooms in household and those living in them. B. Past Obstetric History. C. Pregnancy. Booking for this pregnancy, and reasons ira domiciliary booking. Place(s) and amount of antenatal care. Number and height of blood-pressure readings. Presence or absence of oedema or albuminuria. Hospital admissions (including toxaemia). Blood group (ABO and Rh). Hbg. reading. X-rays in pregnancy. Abnormalities of present pregnancy. D. Labour. Length of labour. Interval onset of labour to hospital admission. Availability of notes at labour. Interval rupt. membranes to delivery. Induction (method, indication and I.D.A.). Presenting part at delivery. Method of delivery. Reason, if not spontaneous. Episiotomy. Analgesia. Anaesthesia. Those present at delivery. E. Infant. Live birth or stillbirth. Sex. Weight. Resuscitation. Drugs and antibiotics given to baby. Pathology investigations on baby. Congenital abnormalities. Other illnesses. F. lfPerinatal Death. Time of foetal death. Maceration or not. Registered cause (Scotland) of stillbirth. Clinical summary of pregnancy. Clinical summary of labour. If NND, clinical summary of progress of infant, age at death and registered cause of death.