NHS Tayside had the second highest stillbirth rate in the UK during the first year of the pandemic, according to a report which found growing variations in performance between similar maternity units.
The annual MBRRACE (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries) surveillance report on perinatal mortality - neonatal deaths and stillbirths combined - is the most comprehensive evaluation of trends in birth outcomes across the UK.
The latest report is the first to cover the Covid period, although it stresses that it is “extremely difficult” to assess the direct and indirect impact of the pandemic.
Scotland recorded the highest stillbirth rate in the UK during 2020, but the lowest neonatal mortality rate - deaths which occur in the first 28 days after birth.
However, the findings pre-date the highly unusual spikes in neonatal mortality detected in Scotland during September 2021 and March 2022, which are now the subject of a national review by Healthcare Improvement Scotland.
NHS Tayside - praised by Unicef for its maternity and neonatal care - was found to have had the second highest stillbirth rate in the UK during 2020, jointly exceeded only by Swansea Bay health board in Wales and Bradford NHS Foundation Trust in England.
Tayside recorded 19 stillbirths, which translated into a "stabilised and adjusted" rate of 4.1 per 1000 births, compared to 4.15 per 1000 in both Swansea and Bradford.
It is the highest stillbirth rate recorded by NHS Tayside in any of the four years evaluated, from 2017 onwards.
NHS Tayside is the only health board in Scotland to be awarded the Unicef Baby Friendly Initiative's Gold Award for both its hospital and community-based maternity care.
Stillbirths can be caused by a range of factors, including infections during pregnancy and labour complications, but in around a third of cases no cause is found.
MBRRACE adjusts for risk factors such as maternal age, deprivation, and smaller numbers of births to ensure fair comparison between areas.
Different health boards and trusts are also compared against authorities providing a similar service - for example, neonatal intensive care - in order to assess whether their outcomes are above or below the national average.
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Four Scottish health boards - Tayside, Fife, Lanarkshire, and Greater Glasgow and Clyde - were ranked 'red' for stillbirths, meaning that their rates were more than five per cent higher than the UK average for comparable units.
NHS GGC is a Level 3 NICU with neonatal surgery, meaning it cares for the sickest and most complex newborns; Tayside, Fife and Lanarkshire are Level 3 NICUs.
This is the highest number of Scottish health boards be rated 'red' for stillbirth rates over the four-year period.
In 2017, only one - NHS GGC - was red-flagged, with none in 2018 or 2019.
The MBRRACE report found that there was much wider area-by-area variation in stillbirth rates in 2020 compared to previous years.
It suggested that this “may reflect differences in organisational measures established to address the pandemic at Trust and Health Board level as well as problems with staffing levels due to sickness and retention”.
The report also found similarly wide variation in neonatal mortality rates across the UK, adding: “Investigations into the reasons for this wide variation for both stillbirth and neonatal mortality rates should continue to be carried out at local, organisation and population levels to determine whether this is a lack of appropriate resourcing to address local population characteristics, which may include deprivation and ethnicity, organisational issues during the pandemic period, or quality of care provision.”
Three Scottish health boards - Fife, Lanarkshire and Forth Valley - were rated ‘red’ for neonatal mortality rates in 2020.
Only one - NHS Lothian - was rated green, meaning its rate was 15% lower than the UK average when compared to other Level 3 NICUs with neonatal surgery.
The report stresses that, based on a UK-wide evaluation, the first nine months of the Covid-19 pandemic appear to have had “little effect on stillbirth and neonatal mortality rates”.
However, it stresses that this is “extremely difficult to assess” given that care provision during this period was "subject to constant, sometimes weekly change”.
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It adds: “The degree of local, regional and national variation means that it is extremely challenging to identify a clear and reliable message about the pandemic’s impact over the initial nine month period covered by this report.”
Overall, the report found much higher rates of stillbirths and neonatal deaths in babies born to mothers from deprived or Black and minority ethnic communities.
Sara Ledger, of the charity Baby Lifeline, described the discrepancy as "truly shocking", adding: "This current situation – in which Black and Brown babies and those born to mothers with co-morbidities and/or higher levels of social deprivation, are more likely to die – is simply unacceptable."
In a joint statement, charities Tommy's and Sands, which campaign to reduce levels of stillbirth and neonatal death, said the "variation in the number of deaths between different maternity units across the country remains too high, even when data is adjusted to take into account local levels of deprivation and babies' ethnicity".
A spokeswoman for NHS Tayside said: “Stillbirth can be caused by a number of factors and our teams work hard to support families affected by stillbirth.
“NHS Tayside closely monitors and reports on rates of stillbirth, neonatal and infant mortality.
"Every stillbirth and neonatal death is reviewed and investigated by a multidisciplinary team as part of the NHS Tayside clinical governance process and the findings are shared with families and staff.”
A Scottish Government spokeswoman said: “Every case of stillbirth or neonatal death is a tragedy for all concerned and it’s vital that we learn lessons from each one.
“Scotland’s stillbirth rate has continued to decline over the last 10 years reducing from 5.1 per 1000 live births in 2011 to 3.8 in 2021.
“We are aware rates rose slightly in 2020 and we will continue to work to understand, raise awareness and address stillbirth to drive improvement.”
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