Figure 1 Total deliveries 2005-2008 Figure 2 6-monthly PNMR <1000g Continued progress 2009-2012 Despite these successes, however, the hospital team was well aware that the real challenge lay in sustaining them over time. The foundation for success had been laid by paying attention to staffing and commitment, training and audit, basic rules for safe practice, improving paperwork and protocols and by improving the working environment. By building on this foundation we were able to achieve continued improvements in the following areas. Continued improvement in service utilisation The total number of deliveries increased again by 68.5% in the second four year period, for a total increase of 158% since 2005. (See Figure 3) Figure 3 Total deliveries 2005-2012 Continued reduction in corrected perinatal mortality rate We recognised that the PNMR is likely to vary slightly over time. We therefore started to focus on the annual PNMR and in 2012 set ourselves the ambitious target of reducing it to under 20 per 1000. Figure 4 6-monthly PNMR >1000g Figure 5 Annual PNMR >1000g Changing the profile of causes of perinatal death In addition to the reduction in mortality, another success was in reducing intra-partum asphyxia in particular. This is the leading cause of perinatal death countrywide, but is often avoidable. Figure 6 shows the steady reduction in the proportion of cases in which intrapartum asphyxia was the primary cause of death for infants over 1000g. In 2012, for the first time, intrapartum asphyxia was displaced as the leading cause of death (by unexplained MSB).
Figure 1 Total deliveries 2005-2008 Figure 2 6-monthly PNMR <1000g Continued progress 2009-2012 Despite these successes, however, the hospital team was well aware that the real challenge lay in sustaining them over time. The foundation for success had been laid by paying attention to staffing and commitment, training and audit, basic rules for safe practice, improving paperwork and protocols and by improving the working environment. By building on this foundation we were able to achieve continued improvements in the following areas. Continued improvement in service utilisation The total number of deliveries increased again by 68.5% in the second four year period, for a total increase of 158% since 2005. (See Figure 3) Figure 3 Total deliveries 2005-2012 Continued reduction in corrected perinatal mortality rate We recognised that the PNMR is likely to vary slightly over time. We therefore started to focus on the annual PNMR and in 2012 set ourselves the ambitious target of reducing it to under 20 per 1000. Figure 4 6-monthly PNMR >1000g Figure 5 Annual PNMR >1000g Changing the profile of causes of perinatal death In addition to the reduction in mortality, another success was in reducing intra-partum asphyxia in particular. This is the leading cause of perinatal death countrywide, but is often avoidable. Figure 6 shows the steady reduction in the proportion of cases in which intrapartum asphyxia was the primary cause of death for infants over 1000g. In 2012, for the first time, intrapartum asphyxia was displaced as the leading cause of death (by unexplained MSB).
Proceedings-2013.docx