Published on March 19, 2014
Introduction to the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) Diana Stubbs Liaison Midwife Gemma Wills Research Midwife Clinical Councils Department of Health Melbourne Victoria Australia Perinatal Review Process
Introduction to CCOPMM • The Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) was established in 1962 to improve outcomes relating to paediatric and maternal morbidity and mortality in Victoria. CCOPMM is legislated to: • Conduct study, research and analysis into obstetric and paediatric mortality • Conduct a perinatal data collection unit • Provide information to health service providers • Consider, investigate and report on any other matters in respect of obstetric and paediatric mortality and morbidity • Publish an annual report on the research and activities of CCOPMM
Legislated Activities of Council CCOPMM uses legislated, prescribed functions to provide: • strategic direction • advice to reduce adverse events • and improve system focused outcomes across Victoria.
Legislated Activities of Council The major activities of CCOPMM may be summarised as: - Collection of data; - Analysis and monitoring of data; - Investigation of matters referred to Council; - Provision of information or strategies; - Facilitation of research by external bodies; - Liaising with other bodies or agencies; - Reporting of changes to the Minister/Secretary of the department; and - Management of internal systems and processes to support Council operations.
Introduction of Mandated reporting on perinatal deaths 2008: Health Act changes • Section 39 of the Act authorizes the Chairperson of CCOPMM to request health service providers to provide such information as necessary to enable CCOPMM to perform its functions. • CCOPMM is obliged under Section 42 of the Act to protect the confidentiality of this information, which involves not publishing identifying information, and not releasing information to any other party except in the limited circumstances prescribed in the Act.
Perinatal mortality review: Improving the robustness of investigation and auditing Sub committees comprising: • Stillbirth • Neonatal • Infant, child and adolescent • Maternal http://www.health.vic.gov.au/ccopmm/
Cause of death Stillbirths Neonatal death Total PSANZ PDC 2009 % Rate 2009 % Rate n % Rate 1. Congenital Abnormality 180 23.5 2.5 86 38.1 1.2 266 26.8 3.6 2. Infection 15 2.0 0.2 5 2.2 0.1 20 2.0 0.3 3. Hypertension 21 2.7 0.3 3 1.3 0.0 24 2.4 0.3 4. Antepartum haemorrhage 46 6.0 0.6 17 7.5 0.2 63 6.3 0.9 5. Maternal conditions 229 29.9 3.1 3 1.3 0.0 232 23.4 3.2 6. Specific perinatal conditions 52 6.8 0.7 14 6.2 0.2 66 6.6 0.9 7. Hypoxic peripartum death 7 0.9 0.1 13 5.8 0.2 20 2.0 0.3 8. Fetal growth restriction 56 7.3 0.8 3 1.3 0.0 59 5.9 0.8 9. Spontaneous preterm 46 6.0 0.6 77 34.1 1.1 123 12.4 1.7 10. Unexplained antepartum death 115 15.0 1.6 0 - - 115 11.6 1.6 11. No obstetric antecendent 0 - - 5 2.2 0.1 5 0.5 0.1 Total 767 100 10.5 226 100 3.1 993 100 13.6
a Congenital abnormality includes terminations ≥ 20 weeks (154 stillbirths and 42 neonatal deaths). b Maternal conditions includes terminations ≥ 20 weeks for psychosocial indications (214 stillbirths). c Stillbirth and perinatal death rates were calculated using total births (live births and stillbirths) as the denominator. Neonatal death rates were calculated using live births as the denominator. The previous table shows the major causes of perinatal death by PSANZ PDC as congenital abnormality (26.8%), followed by maternal conditions (23.4%) and spontaneous preterm (12.4%). Figure 18a also indicates the proportion of perinatal deaths due to congenital abnormality and maternal psychosocial indications that resulted in late termination of pregnancy (TOP). Perinatal mortality review:
Identifying trends contributing to poor Outcomes: including using the PSANZ guidelines • clinical • systems • management issues • making recommendations
Autopsies • All autopsies performed in Victoria are paid for by CCOPMM • Funeral car transport of baby to nearest pathology service is also covered • PSANZ Guidelines encourage autopsies with discussion on options available to parents if they are not overly enthused about a full autopsy • Placenta should always be sent with the baby particularly those babies being transferred by NETS
Future direction for Perinatal Audit and CCOPMM • Greater emphasis given to triennial strategic planning • establishing criteria for ongoing evaluation and monitoring of activities • development of a communication strategy for external bodies and stakeholders.
Future direction for Perinatal Audit and CCOPMM • Data management framework- addresses the stringent legislative requirements regarding the release of data • Electronic transfer of data- a national perinatal and maternal database are being piloted nationally in 2013
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