Persistently high rate of stillbirths mystifies doctors

Ten babies are stillborn every day in England, Wales and Northern Ireland causing lasting distress to the bereaved parents and mystifying doctors, a report released yesterday said.

The rate of stillbirths has remained stubbornly high for 15 years, despite improvement in every other area of infant health, but the causes are little understood.

The report is the latest from the Confidential Enquiry into Maternal and Child Health (CEMACH) examining perinatal mortality in 2005 - deaths of all babies from 28 weeks of gestation to four weeks of age.

It found wide variations among NHS trusts in the number of babies dying in the womb or in the first weeks of life, which it described as an "area of concern". Of the unidentified trusts surveyed, 15 had death rates significantly above the average.

Levels of deprivation and ethnic mix are known to play a role in the death rates along with quality of care. Mothers in deprived areas, and those who are black or Asian, were twice as likely to have a baby who died.

Overall there were 3,600 stillbirths in the year, one in 200 pregnancies. There has been no improvement in the stillbirth rate since the early 1990s, in sharp contrast to the survival rate for premature babies. In the past decade the proportion of premature babies born at 25-weeks' gestation who lived for more than four weeks has risen from below 60 per cent to 77 per cent.

Richard Congdon, chief executive of CEMACH, said: "The rapid improvement in recent years in the survival prospects of babies who have been born very prematurely is highly welcome, but unfortunately there seem to be deep-seated reasons why we are not seeing the same improvement in the number of stillbirths. We believe this needs attention."

Women over 40 have the highest stillbirth rate at 7.2 per 1000 live births, a third higher than the average. As the age of motherhood is rising with more women giving birth in their forties, the report warns that the rate of stillbirths and perinatal mortality could rise.

Half of stillbirths are recorded as "unexplained" making it difficult for doctors and managers to change the care provided.

The report pointed out that there had been a "long period of steady progress" since the 1950s in reducing the stillbirth rate, which ended in the early 1990s. Since 1992, the stillbirth rate has remained largely unchanged while the perinatal mortality rate - deaths in the first four weeks of life - had fallen "significantly".

Jim Dorman, vice-president of the Royal College of Obstetricians and Gynaecologists, said: "These results show that the occurrence of stillbirth is still a major and tragic problem in this country. Advances in technology mean that neonatal mortality [deaths in the first week] through to premature births have fallen but stillbirths present us with a challenge."