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<pre>
 
 

Maternal and 
Perinatal Mortality 
in South Australia 

2016 

September 2018 

Pregnancy Outcome Unit, 

SA Health 
 

  

 



 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
September 2018 
 
Thirty-first Report of the Maternal and Perinatal 
Mortality Committee on maternal and perinatal deaths 
  SA Health 
 
ISSN 1032-4801 
 
Suggested citation: 
Maternal and Perinatal Mortality in South Australia 2016.  Adelaide: Pregnancy Outcome Unit, 
Prevention and Population Health Branch, SA Health, Government of South Australia, 2018. 
  

2 
 



Contents 
Committees ............................................................................................................................................. 4 
Acknowledgements ................................................................................................................................. 5 
Summary ................................................................................................................................................. 6 
Recommendations .................................................................................................................................. 6 
Introduction.............................................................................................................................................. 7 
Maternal Mortality .................................................................................................................................... 9 
Perinatal mortality ................................................................................................................................. 11 
Education Subcommittee Report .......................................................................................................... 23 
Useful links ............................................................................................................................................ 24 
Methods and terminology ...................................................................................................................... 25 
References ............................................................................................................................................ 26 
Appendix 1 ............................................................................................................................................ 27 
Appendix 2 ............................................................................................................................................ 28 
Appendix 3 ............................................................................................................................................ 33 
Appendix 4 ............................................................................................................................................ 36 
Appendix 5 ............................................................................................................................................ 37 
Appendix 6 ............................................................................................................................................ 38 
Appendix 7 ............................................................................................................................................ 42 
 

  

3 
 



Committees 
Maternal and Perinatal Mortality Committee 

Professor Jodie Dodd Obstetrician, Chair 
Dr Elinor Atkinson Obstetrician 
Dr Vineesh Bhatia Neonatal paediatrician  
Professor Gustaaf Dekker Obstetrician 
Ms Jackie Kitschke Midwife 
Professor William Hague Obstetric physician 
Professor T. Yee Khong Pathologist 
Dr Tim Porter Obstetric anaesthetist 
Dr Mojgan Vatani Obstetrician 
Dr Kenan Wanguhu General Practitioner 
Dr Wendy Scheil Public health physician, Medical Secretary 

Maternal Subcommittee 
Professor William Hague Obstetric physician, Chair 
Dr Elinor Atkinson Obstetrician 
Professor Gustaaf Dekker Obstetrician 
Professor Jodie Dodd Obstetrician  
Ms Jackie Kitschke Midwife 
Professor T. Yee Khong Pathologist 
Dr Tim Porter Obstetric anaesthetist  
Dr Kenan Wanguhu General Practitioner 
Dr Wendy Scheil Public health physician, Medical Secretary 

Perinatal Subcommittee 
Professor Gustaaf Dekker Obstetrician, Chair  
Dr Elinor Atkinson Obstetrician 
Dr Sanjay Sinhal Neonatal paediatrician 
Dr Jenni Goold General Practitioner 
Professor T Yee Khong Pathologist 
Dr Anu Kochar Neonatal paediatrician 
Dr Dee McCormack Obstetrician 
Dr Linda McKendrick Obstetrician 
Dr Vanessa Ellison Neonatal paediatrician 
Ms Jan Prider Midwife 
Dr Angela Brown Midwife 
Dr Nicholas Manton Pathologist 
Dr Tim Porter Obstetric anaesthetist 
Ms Deanna Stuart-Butler Aboriginal Health Division 
Dr Latif Mohamed Neonatal paediatrician 
Ms Gill Mibus Neonatal nurse 
Dr Wendy Scheil Public health physician, Medical Secretary 

Education Subcommittee 
Dr Mojgan Vatani Obstetrician, Chair 
Dr Vineesh Bhatia Neonatal paediatrician  
Dr Aimee Wiltshire Obstetrician 
Dr Kenan Wanguhu General Practitioner 
Dr Brian Wheatley Mentor 
Dr Wendy Scheil Public health physician, Medical Secretary 

 

  

4 
 



Acknowledgements 
The Maternal and Perinatal Mortality Committee would like to express our gratitude to Dr Wendy 
Scheil who held the position of Medical Secretary for many years and who carried out her duties with 
remarkable skill and expertise.  Our sincere thanks also go to Ms Robyn Kennare who has retired 
after many stellar years of service to the Committee and Subcommittees. Thank you also to the 
various members who invested their time on the Committee during 2017. 

The Committee would also like to thank: 

&gt; Medical practitioners who completed confidential reports on maternal and perinatal deaths and 
submitted autopsy reports 

&gt; SA Pathology and the Forensic Science Centre for providing autopsy reports 
&gt; The staff of the Births, Deaths and Marriages Registration Division 
&gt; Mr Mark Johns, State Coroner, and the staff of the Coroner's Office especially Ms Annemarie Van 

Putten 
&gt; Dr Romi Sinha, SA Health, for assistance with the preparation of tables and figures. 
 
 

  

5 
 



Summary 
 

This is the thirty-first Annual Report of the Maternal and Perinatal Mortality Committee, for deaths 
occurring in 2016. 

1. There were two maternal deaths in 2016. The maternal mortality ratio for the last six-year 
period 2011-2016 was 9.1 deaths per 100,000 women who gave birth, which is low by 
international standards, but higher than in the preceding five-year period where there were 
6.2 deaths per 100,000 women.  

2. The Committee reviewed the 175 perinatal deaths of babies born in South Australia in 2016.  
The perinatal mortality rate for all births (stillbirths of at least 400g or 20 weeks gestation and 
all live births) was 8.7 per 1,000 births. The stillbirth rate was 6.8 per 1,000 births and the 
neonatal mortality rate was 2.0 per 1,000 live births.  

3. Eighty-eight percent (88%) of the perinatal deaths occurred in preterm babies (less than 37 
weeks gestation). The leading cause of perinatal death in 2016 was congenital abnormalities, 
which accounted for 36.0% of the deaths. Other leading causes were specific perinatal 
conditions, which included conditions such as cervical incompetence, twin-twin transfusion 
and idiopathic hydrops.  

4. Fourteen (35.8%) of the 39 neonatal deaths occurred in neonates born between 20 to 23 
weeks gestation. Of the 25 deaths in neonates born at or after 24 weeks, nine (36%) were 
associated with congenital abnormalities. Four (40.0%) of the ten term infants died from 
peripartum hypoxia.  

5. Thirteen babies of Aboriginal mothers died during the perinatal period. The perinatal mortality 
rate was 17.1 per 1,000 births compared with 13.7 in 2015, and compared with 8.4 per 1,000 
births for non-Aboriginal women.  

6. The Committee s previous recommendations have been incorporated into South Australian 
policies, standards or guidelines. These recommendations are available within previous 
year s reports or from the Pregnancy Outcome Unit website.  From the review of maternal and 
perinatal deaths in 2016, the Committee has made two new recommendations.  

 

Recommendations  
1. Consultation with an obstetric provider should be sought for any woman presenting with 

hypertension and/or headache in the two weeks following birth. 

2. Pregnant women who contact the hospital with atypical abdominal pain and/or repeatedly with 
complaints of worsening abdominal pain should be assessed in person, not by telephone. 

  

6 
 



Introduction 
This is the Thirty-first Annual Report of the South Australian Maternal and Perinatal Mortality 
Committee, which was established in 1985. An earlier Committee collected maternal death data from 
1961 and perinatal death data from 1979.  The South Australian Maternal and Perinatal Mortality 
Committee is an authorised quality improvement body established under Part 7 of the South 
Australian Health Care Act 2008. Its terms of reference are as follows: 

To advise the Chief Executive of SA Health on: 

1. the pattern and causation of maternal and perinatal deaths in the state 

2. the avoidability of any factors associated with such deaths and any measures which could be 
taken to assist with the prevention of such deaths, including improvements in health services 
in the state 

3. education and training for members of the medical, midwifery and nursing professions and for 
the community generally in order to assist in the reduction of maternal and perinatal morbidity 
and mortality in the state. 

The terms of reference of the Subcommittees (Maternal, Perinatal and Education) are provided in 
Appendix 1.  Under the provisions of the Health Care Act 2008, members of the Committee and its 
Subcommittees are authorised, under strict confidentiality rules, to conduct research into the causes 
of mortality and morbidity in the state, and legal protection is given to notifiers who provide 
information. 

The Subcommittees receive notifications of deaths from the following sources: 

1. The Registrar of Births, Deaths and Marriages, from medical certificates of cause of perinatal 
death  

2. The Coroner's Office, from Coroner s findings 

3. Hospitals and medical practitioners, in cases of maternal death. 

Legislation governing the registration of births, deaths and marriages in South Australia requires that 
the medical certificate of cause of death identifies pregnancy within three months before death and 
whether the deceased was of Aboriginal or Torres Strait Islander origin. 

Further information is obtained from practitioners identified as having been in charge of clinical care 
through the completion of confidential  medical reports, and these are supplemented by autopsy 
information from the Coroner's Office and hospital pathology services.  Case summaries are prepared 
by the Committee's midwife secretary for discussion by the Subcommittees.  These do not contain 
any identifying information but the members are made aware of the type of health services available 
in each case, for example, location (metropolitan or country) and hospital category.  Where certain 
aspects of a case require clarification, a member of the Subcommittee may seek clarification from the 
practitioner concerned.  The discussions aim to identify the factors associated with the death, and to 
assign a cause or causes of death in each case.  Comments or recommendations made by the 
Subcommittees are included in the Committee Report. 

  

7 
 



Reporting of deaths to the State Coroner 

The following are some categories of death which must be reported to the State Coroner under the 
Coroner s Act 2003: 

&gt; a death by unusual, unexpected, unnatural, violent or unknown cause  
&gt; a death during, as a result of or within 24 hours of a surgical, invasive or diagnostic procedure 

including the administration of an anaesthetic for the carrying out of the procedure 
&gt; a death within 24 hours of being discharged from a hospital or having sought emergency 

treatment at a hospital 
&gt; a death in a hospital or treatment facility for the treatment for a drug addiction 
&gt; a death of a child subject to a custody or guardianship order under the Children s Protection Act 

1993 
&gt; a patient death in an approved treatment centre under the Mental Health Act 1993 
 

Definitions used by the Committee are provided in the Methods and Terminology section of this 
report.  The Committee receives notifications of maternal and perinatal deaths occurring in South 
Australia.  However, statistics presented for perinatal deaths relate only to babies born in South 
Australia.  Deaths of South Australian born babies occurring in other states are also included in the 
statistics where information is available for them.  This Thirty-first report of the Committee 
incorporates information on maternal deaths in South Australia in the year 2016 and perinatal deaths 
of babies born to mothers in South Australia in 2016.  

The term Aboriginal is used respectfully in this report as an all-encompassing term for Aboriginal or 
Torres Strait Islander people living in South Australia.  Data relating to Aboriginal mothers and babies 
have been italicised for easy identification in response to the request of the Aboriginal Health Council 
of South Australia.  The Aboriginal Health Division of SA Health has a nominee on the Committee to 
address areas of concern in relation to Aboriginal maternal and perinatal health.  

8 
 



Maternal Mortality 
Maternal mortality statistics 
The World Health Organization (WHO) defines maternal death as the death of a woman while 
pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the 
pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not 
from accidental or incidental causes.1 This definition includes both direct and indirect maternal deaths 
(see Methods and Terminology).   

The Australian Institute of Health and Welfare National Advisory Committee on Maternal Mortality 
complies with international reporting protocols2 and reports a maternal mortality ratio (see Methods 
and Terminology) which only includes pregnancy-related deaths, that is, direct and indirect maternal 
deaths, per 100,000 women who gave birth. The South Australian Maternal and Perinatal Mortality 
Committee will continue to review incidental deaths to ensure that indirect deaths are not missed. It 
will, however, report only maternal mortality ratios for pregnancy-related deaths, to be consistent with 
national and international protocols.  Pregnancy-related deaths of women occurring from 42 days to 
within a year of the end of pregnancy (late maternal deaths) are also reviewed, but these are not 
included in the South Australian statistics on maternal deaths or maternal mortality ratios. 

There were two maternal deaths in South Australia in 2016. Maternal deaths in South Australia for the 
three categories of deaths from 1986 to 2016 are presented in Table 1 by five-year periods. Maternal 
mortality ratios have been calculated for direct and indirect deaths (Table 1 and Figure 1). The 
maternal mortality ratio for the last six-year period 2011-2016 was 9.1, which was higher than the 
Australian maternal mortality ratio of 6.8 per 100,000 women for the period 2012-20142. The number 
of deaths in South Australia is small and has not changed greatly in the last three decades.  

Of a total of 53 pregnancy-related maternal deaths in the period 1986-2016, 26 were direct deaths 
and 27 were indirect deaths. Three of the 26 direct deaths and two of the 27 indirect deaths were of 
Aboriginal women. 

 

Table 1: Maternal mortality by category of death, in 5-year periods,  
South Australia, 1986   2016 

Years 

Direct 
deaths 

Indirect 
deaths 

Incidental 
deaths 

Total 
deaths 

Direct and indirect 
maternal deaths 

Number Number Number Number Number 
Maternal 
mortality 

ratio* 
1986   1990 4 8 4 16 12 12.3 
1991   1995 4 6 5 15 10 10.2 
1996 -  2000 2 4 4 10 6 6.6 
2001   2005 4 4 1 9 8 9.1 
2006   2010 5 1 2 7 6 6.2 
2011   2016** 7 4 3 14 11 9.1 

*Expressed as deaths per 100,000 women who gave birth 
** Expressed as a 6 year period. 
  

9 
 



Figure 1: Maternal Mortality Ratio, South Australia 1961-2016 

 
 

Confidential enquiries into all maternal deaths in South Australia have been conducted since 1961 
with the Minister of Health appointing a Special Medical Committee on Maternal Mortality. Reports 
published since this time show that between 1961 and 1969 there were 15 maternal deaths related to 
induced abortion.3,4  Following the 1970 legislative amendment requiring induced abortions to be 
conducted under medical supervision, there were 4 deaths due to induced abortion in the following 
decade 1970 to 1979.5,6 Over the past 36 years, since 1980, there was one maternal death in 2003 
associated with an induced abortion. 

Causes of maternal deaths 
The causes of the two maternal deaths in 2016 were as follows: 

&gt; One direct maternal death was attributed to amniotic fluid embolism occurring at the time of 
caesarean section. 

&gt; One indirect maternal death was attributed to a thalamic infarction occurring 19 days postpartum. 
 

New Maternal Subcommittee recommendations 
The Committee s previous recommendations have been incorporated into South Australian policies, 
practices, standards or guidelines. A document containing previously-made recommendations, 
together with the relevant code of practice is available from the Pregnancy Outcome Unit website. 
From the review of maternal deaths in 2016, the Committee makes the following new 
recommendation: 

1. Consultation with an obstetric provider should be sought for any woman presenting with 
hypertension and/or headache in the two weeks following birth. 

  

0

10

20

30

40

1961-65 1966-70 1971-75 1976-80 1981-85 1986-90 1991-95 1996-00 2001-05 2006-10 2011-16*

M
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10 
 



Perinatal Mortality 
Perinatal mortality statistics 
In 2016 there were 20,069 births in South Australia reported to SA Health. These included all births of 
at least 400g birthweight or 20 weeks gestation.  There were 136 stillbirths and 19,933 live births. 
Thirty-nine live born infants died within 28 days of birth (neonatal deaths).  Table 2 shows the 
numbers of stillbirths and neonatal deaths for specified birthweights or gestations. 

The perinatal mortality rate for all births in 2016 was 8.7 deaths per 1,000 births. The stillbirth rate 
was 6.8 per 1,000 births and the neonatal mortality rate 2.0 per 1,000 live births. Forty-six of the 175 
perinatal deaths (26.2%) were induced terminations of pregnancy and their exclusion would have 
resulted in a perinatal mortality rate of 6.4 deaths per 1,000 births.  

The perinatal mortality rates for other specified minimum birthweights or gestational ages (where 
birthweight was unavailable) are provided in Table 2. The WHO recommends that fetuses and infants 
weighing between 500 grams and 1,000 grams should be included in national perinatal mortality 
statistics. For international comparison, fetuses and infants weighing at least 1,000g and/or 28 weeks 
gestation is recommended. It is recommended that early neonatal deaths include neonatal deaths that 
occur during the first seven days of life (0-6 days).7  Using the WHO classification for international 
reporting, the perinatal mortality rate was 3.3 per 1,000 births in South Australia, with a stillbirth rate of 
2.4 per 1,000 births, and neonatal mortality rate of 0.9 per 1,000 live births.   

 

Table 2: Perinatal mortality, South Australia, 2016 (all births of specified 
birthweight/gestation)* 

 

Specified 
birthweight/ 
gestation 

 

 

Total 
births 

 

 

Live 
births 

Stillbirths Neonatal deaths Perinatal deaths 

Number 
Deaths 

per 1,000 
births 

Number 
Deaths 

per 1,000 
live births 

Number 
Deaths 

per 1,000 
births 

?400g/ 
20 weeks 20,061 19,925 136 6.8 39 2.0 175 8.7 

?500g/ 
22 weeks 20,009 19,918 91 4.5 32 1.6 123 6.1 

?1,000g/ 
28 weeks 19,896 19,848 48 2.4 18 0.9 66 3.3 

*Includes 8 babies who were excluded from analysis due to lack of birthweight/gestational age.  

 

 

  

11 
 



South Australian perinatal mortality rates, including stillbirth and neonatal mortality rates for all births, 
for 1986-2016 from Committee data are presented in Figure 2. The stillbirth rate for all births has not 
changed markedly over the last two decades. 

 

Figure 2: Perinatal mortality rate (births &gt;= 400g or 20 weeks gestation), South Australia 
1986-2016 

 
 

Perinatal mortality rates for births of at least 1,000g birthweight (or when birthweight was unavailable, 
28 weeks gestation) are presented in Figure 3.  Figure 3 includes only early neonatal deaths, 
occurring within the first seven days of life (WHO recommendation for international statistics). The 
early neonatal mortality rate for infants weighing at least 1000g or reached 28 weeks of gestation was 
0.6 per 1,000 live births. If only births of at least 1,000g birthweight are considered, a decrease in the 
stillbirth rate is evident from 4.2 deaths per 1,000 births in 1986 to 2.4 in 2016 (Figure 3). 

 

Figure 3: Perinatal mortality rate (births &gt;=1,000g or 28 weeks gestation &amp; early neonatal 
deaths within the first seven days of life), South Australia 1986-2016 

 

0

2

4

6

8

10

12

14

1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016

D
ea

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s 

pe
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,0
00

 b
irt

hs
 

Perinatal mortality rate Stillbirth rate Neonatal mortality rate

0

1

2

3

4

5

6

7

1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016

D
ea

th
s 

pe
r 1

,0
00

 b
irt

hs
 

Early neonatal mortality rate Stillbirth rate Perinatal mortality rate

12 
 



National comparisons of perinatal mortality rates  
Perinatal mortality rates for Australian States and Territories from the Australian Bureau of Statistics 
(ABS) are shown in Table 3. The ABS derives this information from the State and Territory Births, 
Deaths and Marriages Registry data. In South Australia, ABS records do not include stillbirths 
resulting from induced termination of pregnancy. This difference most likely accounts for the 
lower South Australian perinatal mortality rates published by the ABS.  

 

Table 3: Perinatal mortality rate* by State or Territory of usual residence of mother, 
Australian states, 2007   2016 

Year NSW VIC Qld SA WA Tas NT ACT AUSTRALIA 

2007 8.1 8.6 10.6 6.7 6.9 9.2 12.7 9.4 8.6 

2008 7.8 7.9 9.9 6.5 8.1 9.1 7.8 6.4 8.2 

2009 7.9 8.9 10.4 6.2 8.8 10.6 14.8 7.0 8.8 

2010 7.6 8.0 10.5 6.1 8.0 10.9 12.5 16.7 8.6 

2011 8.0 8.1 9.1 6.0 9.7 10.1 12.8 7.2 8.4 

2012 7.5 7.7 10.0 5.9 8.4 10.1 9.4 10.0 8.2 

2013 8.1 8.2 9.1 6.1 7.5 9.5 14.4 7.0 8.2 

2014 7.0 7.4 9.8 5.9 8.1 15.5 11.3 9.7 8.0 

2015 7.8 6.4 9.5 6.5 8.4 9.6 14.1 7.5 7.9 

2016 6.8 7.4 9.5 5.5 8.2 11.5 11.4 6.6 7.7 

*Rates are expressed as stillbirths and neonatal deaths within the first 28 days of life per 1,000 births for births of 
at least 400g birthweight (or if birthweight is unavailable, 20 weeks gestation), based on registered births 
according to the usual residence of the mother. 
** Perinatal mortality rate in South Australia inclusive of GTOPs is 8.7 per 1000. 
 
Source: Australian Bureau of Statistics. Catalogue No 3303.0   Causes of Death, Australia, 2015, 28th 
September 2016 

There are other minor differences between the perinatal deaths that the ABS include, compared with 
the Committee:  

&gt; The ABS rates report State and Territory perinatal deaths according to the usual residence of the 
mother, whereas the Committee rates include all perinatal deaths occurring in South Australia, 
irrespective of the mother s usual State or Territory of residence.  

&gt; The ABS rates are based on deaths registered in Australia in the year in which they are 
registered, whereas the Committee rates include all perinatal deaths which occurred in South 
Australia in the year in which the birth occurred.  

&gt; The South Australian ABS data includes all live births of any gestation and since 2006 has only 
included fetal deaths of at least 400 grams birthweight or at least 20 weeks gestation.  Prior to 
2011, the Committee s perinatal mortality rate also included all live births which resulted in a 
neonatal death, irrespective of birthweight or gestation. From 2012 and onwards, only live births 
of at least 400 grams birthweight or 20 weeks gestational age which resulted in neonatal death 
have been included in the perinatal mortality data. 

 

 

 

13 
 



The Australian Bureau of Statistics (ABS) rates for South Australia and Australia for 1999-2016 are 
presented in Figure 4, together with the perinatal mortality rate in South Australia based on 
notifications to the South Australian Maternal and Perinatal Mortality Committee (SAMPMC). 

 

Figure 4: Perinatal Mortality Rates South Australia, Australia and SAMPMC 1999-2016 
Deaths per 1,000 births  

 

Source: Australian Bureau of Statistics. Catalogue No 3303.0   Causes of Death, Australia, 2015, 28th 
September 2016 

  

0

2

4

6

8

10

12

1999 2001 2003 2005 2007 2009 2011 2013 2015

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Australia (ABS) South Australia (ABS) South Australia (SAMPMC)

14 
 



Birthweight-specific perinatal mortality 
The birthweight-specific rates of stillbirths, neonatal deaths and perinatal deaths for 2016 are provided 
in Table 4.  Of the 175 perinatal deaths, 152 (86.9%) were of low birthweight (&lt;2,500g) and 30 
(76.9%) of the 39 neonatal deaths were low birthweight babies. Fifty-one of the perinatal deaths 
(29.1%) were less than 400g birthweight. 

 

Table 4: Perinatal mortality by birthweight, all births, South Australia, 2016 
 
 
 
Birthweight 
(grams) 

 
 
 

Total 
births 

 
 
 

Live 
births 

Stillbirths Neonatal deaths Perinatal deaths 

 
 

Number 

Deaths 
per 1,000 

births 

 
 

Number 

Deaths 
per 1,000 
live births 

 
 

Number 

Deaths per 
1,000 
births 

&lt;400 52 7 45 865.4 6 857.1 51 980.8 

400-499 31 7 24 774.2 4 571.4 28 903.2 

500-749 69 48 21 304.3 9 187.5 30 434.8 

750-999 38 32 6 157.9 2 62.5 8 210.5 

1,000-1,499 131 121 10 76.3 2 16.5 12 91.6 

1,500-1,999 291 282 9 30.9 4 14.2 13 44.7 

2,000-2,499 925 918 7 7.6 3 3.3 10 10.8 

2,500-2,999 3226 3223 3 0.9 2 0.6 5 1.5 

3,000-3,499 7410 7402 8 1.1 3 0.4 11 1.5 

3,500-3,999 5996 5994 2 0.3 3 0.5 5 0.8 

4,000-4,499 1654 1653 1 0.6 1 0.6 2 1.2 

&gt;4,500 235 235 0 0.0 0 0.0 0 0.0 

Unknown 11 11 0 0.0 0 0.0 0 0.0 

Total 20,069 19,933 136 6.8 39 2.0 175 8.7 

 

There were 136 stillbirths, accounting for 77.7% of the perinatal deaths in 2016. Of the 55 intrapartum 
deaths, 50 were under 750g birthweight (Table 5).  

  

15 
 



Table 5: Time of perinatal death by birthweight, South Australia, 2016 (=&gt;400g 
birthweight or 20 weeks gestation) 

Birthweight 
(grams) 

Stillbirths 
Neonatal 
deaths Total Antepartum Intrapartum 

Uncertain if 
antepartum or 

intrapartum 

&lt;500 21 41 7 10 79 

500-749 10 9 2 9 30 

750-999 4 1 1 2 8 

1,000-1,499 10 0 0 2 12 

1,500-1,999 9 0 0 4 13 

2,000-2,499 6 1 0 3 10 

2,500-2,999 3 0 0 2 5 

3,000-3,499 7 1 0 3 11 

3,500-3,999 2 0 0 3 5 

4,000-4,499 0 1 0 1 2 

Total 72 54 10 39 175 

 

Gestation-specific perinatal mortality 
The distribution of perinatal deaths by gestational age is provided in Table 6. There were 154 preterm 
births (&lt;37 weeks gestation) that resulted in a perinatal death, accounting for 88% of all perinatal 
deaths. 

 

Table 6: Perinatal mortality by gestational age at birth, South Australia, 2016 (=&gt; 400g or 
20 weeks gestation) 

Gestational 
age at birth 
(weeks) Total 

births 
Live 
births 

Stillbirths Neonatal deaths Perinatal deaths 

Number 

Deaths 
per 
1,000 
births 

Number 

Deaths 
per 1,000 
live 
births 

Number 
Deaths 
per 1,000 
births 

&lt;24 108 27 81 750.0 14 518.5 95 879.6 

24-27 72 62 10 138.9 8 129.0 18 250.0 

28-31 177 163 14 79.1 2 12.3 16 90.4 

32-36 1557 1537 20 12.8 5 3.3 25 16.1 

37-41 18106 18095 11 0.6 10 0.6 21 1.2 

42+ 38 38 0 0.0 0 0.0 0 0.0 

Unknown 11 11 0 0.0 0 0.0 0 0.0 

TOTAL 20,069 19,933 136 6.8 39 2.0 175 8.7 

16 
 



Classification of perinatal deaths 
The Perinatal Subcommittee classified each of the 175 perinatal deaths, which occurred in 2016, 
according to the Perinatal Society of Australia and New Zealand   Perinatal Death Classification 
(PSANZ-PDC). This hierarchical classification, together with the Australian birthweight/gestation 
percentile charts (for singletons and twins), is available on the Perinatal Society of Australia and New 
Zealand (PSANZ) website. The Committee has used this classification system for deaths from 1999 
onward. The South Australian Protocol for investigation of stillbirths is also available at Appendix 6. 
The classification of perinatal deaths in 2016 according to PSANZ-PDC is as follows (Table 7): 

Table 7: Classification of perinatal deaths, PSANZ-PDC, South Australia, 2016 

 PSANZ-PDC  Number Percent Deaths per 1,000 
births 

1. Congenital abnormality 63 36.0 3.2 

2. Perinatal infection 15 8.6 0.8 

3. Hypertension 6 3.4 0.3 

4. Antepartum haemorrhage (APH) 14 8.0 0.7 

5. Maternal conditions 4 2.3 0.2 

6. Specific perinatal conditions 21 12.0 1.1 

7. Hypoxic peripartum death 4 2.3 0.2 

8. Fetal growth restriction 7 4.0 0.4 

9. Spontaneous preterm 19 10.9 1.0 

10. Unexplained antepartum death 20 11.4 1.0 

11. No obstetric antecedent 2 1.1 0.1 

 Total 175 100.0 9.0 

 

The PSANZ-PDC for perinatal deaths in 2016 is shown in Figure 5 and its breakdown by subgroups 
and birthweight groups is provided in Appendix 2 and Appendix 3. PSANZ perinatal cause of death by 
birthweight is located in Appendix 4.  

Congenital abnormalities were the leading cause of perinatal death in 2016, accounting for 36% of all 
deaths. The next leading cause was specific perinatal conditions (12.0%) and unexplained 
antepartum deaths (11.4%); the predominant conditions were cervical incompetence, twin-twin 
transfusion and idiopathic hydrops. This was followed by spontaneous preterm birth (10.9%) and 
perinatal infection (8.6%), including six deaths attributed to Group B Streptococcus. Antepartum 
haemorrhage was the next most common (8.0%, Table 7). 

The rate of unexplained antepartum deaths (1.0 per 1,000 births) compares with 0.7 per 1,000 births 
in 2015.  

The proportion of perinatal deaths from spontaneous preterm birth has increased this year from 6.4% 
in 2014 to 10.3% in 2015.  In 2016 this proportion increased again to 10.9%. The proportion of 
perinatal deaths from fetal growth restriction was 4.0%, decreasing from 9.6% in 2015 (noting that this 
figure can vary dependent upon being recorded as a primary or secondary cause of death). 

  

17 
 



A brief description of each of the 11 PSANZ categories follows. 

Congenital abnormality   sixty-three deaths 
This group of 63 deaths included 46 terminations of pregnancy, at 20 weeks gestation or more, of 
fetuses with congenital abnormalities. The types of abnormalities were as follows: 

Central nervous system   seventeen deaths 

&gt; Four had abnormalities of the corpus callosum 
&gt; Five had neural tube defects 
&gt; Four had abnormalities of the cerebellum 
&gt; Four others had various other CNS anomalies 

 
Cardiovascular   eight deaths 

&gt; Three had hypoplastic left heart syndrome 
&gt; Five had other cardiovascular complications including premature closure of the ductus arteriosus, 

transposition of the great vessels and dilated cardiomyopathy 
 

Urinary System   four deaths 

&gt; Two had bilateral renal agenesis 
&gt; Two had multicystic dysplastic kidneys 

 
Gastrointestinal system   two deaths 

&gt; Both had complications related to oomphalocele 
 

Chromosomal   fourteen deaths 

&gt; Three had Trisomy 18 
&gt; Three had Trisomy 13 
&gt; Three had Trisomy 21 
&gt; Five others had various chromosomal abnormalities 

 
Metabolic   one death 

&gt; Metabolic dysfunction was found to have a genetic cause in postnatal investigations. 
 

Multiple   thirteen deaths 

&gt; Thirteen had multiple congenital anomalies 
 

Other   four deaths 

&gt; These deaths were attributed to osteogenesis imperfecta, hydrops and  lymphangiomatosis 
 

Perinatal infection   fifteen deaths 
Bacterial   twelve deaths 

&gt; These deaths were attributed to various bacteria including Group B Streptococcal infection, and 
Escherichia coli amongst others 

  

18 
 



Viral   two deaths 

&gt; These deaths were attributed to Cytomegalovirus 
 

Other unspecified organisms   one death 

Hypertension   six deaths 

&gt; These six deaths were all attributed to complications of pre-eclampsia or eclampsia, including 
superimposed chronic hypertension 

Antepartum haemorrhage   fourteen deaths 

&gt; Eleven deaths were due to placental abruption 
&gt; Three were associated with other placental conditions 
Maternal Conditions   four deaths 

&gt; Two deaths were due to maternal diabetes 
&gt; The others were caused by other maternal complications 
Specific perinatal conditions   twenty-one deaths 

&gt; Eight deaths were associated with cervical incompetence 
&gt; Six deaths were due to twin to twin transfusion syndrome 
&gt; The other deaths were due to various conditions such as idiopathic hydrops and cord 

complications 
Hypoxic peripartum death   four deaths 

&gt; These four deaths were attributed to events such as cord prolapse and uterine rupture 
Fetal growth restriction   seven deaths 

&gt; All seven of these deaths were associated with placental pathology including chronic villitis, fetal 
thrombotic vasculopathy 

Spontaneous preterm (&lt;37 weeks gestation)   nineteen deaths 

&gt; Seven of these deaths were associated with chorioamnionitis 
&gt; The other deaths include babies whose membranes were ruptured for longer than 24 hours and 

babies who had unknown duration of membrane rupture 
Unexplained antepartum deaths   twenty deaths 

&gt; Sixteen of these deaths were associated with placental pathologies including, long umbilical 
cords, circumvallate placenta, marginal haemorrhage, irregular cord coiling, chronic villitis and 
fetal thrombotic vasculopathy 

&gt; Four of the deaths had no placental pathology 
No obstetric antecedent   two deaths 

&gt; These two deaths were unrelated to any obstetric related complication 
  

19 
 



Classification of neonatal deaths 
The classification of the 39 neonatal deaths according to the Perinatal Society of Australia and New 
Zealand   Neonatal Death Classification (PSANZ-NDC) is provided in Appendix 3. This classification 
is also available, together with PSANZ-PDC, on the PSANZ website. 

A brief description of these neonatal deaths by gestational age grouping follows:  

20-23 weeks gestation   fourteen neonatal deaths 

&gt; Eight neonates had no resuscitation, or resuscitation was ultimately unsuccessful 
&gt; The others died from complications such as intraventricular haemorrhage and necrotising 

enterocolitis. 
 

24-31 weeks gestation   ten neonatal deaths 

&gt; Five deaths were attributed to intraventricular haemorrhage 
&gt; The other deaths were attributed to cardiovascular complications, urinary system abnormalities, 

necrotising enterocolitis and growth restriction 
 

32-36 weeks gestation   five neonatal deaths 

&gt; These neonates were affected by conditions such as multiple congenital anomalies and 
intraventricular haemorrhage 
 

37 weeks and greater gestation   ten neonatal deaths 

&gt; Four of these deaths were attributed to congenital anomalies 
&gt; Four deaths were due to hypoxic-ischaemic encephalopathy 
&gt; One of these deaths was unable to be classified 
 

Aboriginal perinatal deaths 
There were thirteen perinatal deaths (13 stillbirths and no neonatal death) among the births to 759 
Aboriginal women.  

In 2016 the perinatal mortality rate for births to Aboriginal women was 17.1 per 1,000 births, 
compared to 8.4 per 1,000 births for births to non-Aboriginal women. The perinatal death rate has 
increased for Aboriginal women in 2016. Although the perinatal mortality rate for Aboriginal births 
fluctuates widely due to the small number of deaths, recent years show an overall downward trend 
(Figure 6). 

Eight of the thirteen infants were born in public metropolitan hospitals and five infants were born in a 
country hospital. Twelve of the infants were preterm births, with seven born at or before 23 weeks 
gestation.  Eight of the thirteen mothers were country residents and one mother resided in another 
state.  

The causes of the thirteen deaths were attributed to such causes as congenital abnormalities, 
perinatal infection, spontaneous preterm birth and unexplained antepartum deaths. 

  

20 
 



Figure 5: Perinatal mortality by maternal Aboriginal status, South Australia, 2002 - 2016 

 

 

Autopsies in perinatal deaths 
Pathological examinations were undertaken at the State Perinatal Autopsy Service, provided by SA 
Pathology at the Women s and Children s Hospital. The different types of pathological examinations 
were categorised as follows: 
&gt; full autopsy   examination of all cavities and dissection of all organs 
&gt; limited autopsy   examination of one or more cavities (such as chest and/or abdomen) and 

dissection of one or more organs, but not the whole body  
&gt; other examination   external examination of the body and growth parameters in conjunction with 

any other relevant investigations such as radiological survey, genetic testing, placental histology, 
virology and microbiology 

Autopsies were performed for 95 of the 175 perinatal deaths (54.3%), including two  limited  
autopsies. This proportion has decreased slightly from 2015 (55.3%).  
Additionally,  Other examinations  were performed for 17 (9.7%) of perinatal deaths. Placental 
histological examinations were undertaken for 166 perinatal deaths (94.9%). Please see Appendix 7 
for placental histology guidelines. 
The distribution of autopsies by place of death is presented in Table 8. Both Women s and Children s 
and Flinders Medical Centre hospitals have Level 6 neonatal services, and Lyell McEwin has a Level 
5 neonatal service. Service delineations in South Australia are set out in the Standards for Maternal 
and Neonatal Services in South Australia document, available from the SA Health website here. 
  

0

5

10

15

20

25

30

2002 2004 2006 2008 2010 2012 2014 2016

D
ea

th
s 

pe
r 1

,0
00

 b
irt

hs
 

Non-Aboriginal mothers Aboriginal mothers

21 
 




Table 8: Autopsy status of perinatal deaths by place of death, South Australia, 2016 

Place of death 
Deaths Autopsies performed 

Number Number Percent of deaths 

Women s &amp; Children s Hospital 101 56 55.4 

Lyell McEwin Hospital 18 8 44.4 

Flinders Medical Centre 29 16 55.2 

Other metropolitan public hospitals 1 1 100.0 

Metropolitan private hospitals  8 6 75.0 

Country hospitals  16 6 37.5 

Home 2 2 100 

Total 175 95 54.3 
* Includes 2 autopsies with limited dissection 

 

The low proportion of autopsies conducted in perinatal deaths (54.3%) remains a concern. A good 
quality autopsy is invaluable in confirming antenatal diagnoses, eliciting other findings of clinical 
significance, particularly significant negative findings, and determining the time course of events 
leading to death.8,9  It may thus be invaluable in alleviating parental guilt, helping with the grieving 
process and parental counselling, and gaining understanding of the patterns and evaluation of fetal 
and neonatal disease.  Parental permission for autopsy should therefore be sought as often as 
possible by senior staff. There have been several cases in which an autopsy has identified a 
previously unsuspected cause of death. This is most valuable in the management of future 
pregnancies and counselling of parents, including grief counselling.   

Medical practitioners are advised that the State Perinatal Autopsy Service is available at no cost to 
the parents and this includes transportation and return of the body from the place of death, including 
country regions.  This Service may be contacted by telephone on (08) 81616315.   

All hospitals with maternity services receive information on the State Perinatal Autopsy Service. The 
Department of Health has produced an Autopsy Request and Authority form for use for all non-
coronial autopsy examinations together with a booklet entitled  The Hospital Autopsy Process. When 
a person dies - information for family and friends.  These forms must be used and are available from 
the State Perinatal Autopsy Service. 

 

Perinatal Subcommittee recommendations 
The Committee s previous recommendations have been incorporated into South Australian policies, 
practices, standards or guidelines (Appendix 5).  From the review of perinatal deaths in 2016, the 
Committee makes the following new recommendation: 

New recommendation  

1. Pregnant women who contact the hospital with atypical abdominal pain and/or repeatedly with 
complaints of worsening abdominal pain should be assessed in person, not by telephone. 

  

22 
 



Education Subcommittee Report 
The twenty-first annual educational meeting -  The Annual Dr Brian Pridmore Perinatal Forum  - was 
held on the evening of 9th August 2017. The forum is organized by the Education Subcommittee of 
the Maternal and Perinatal Mortality Committee.  

The forum was titled  Pills, Potions and Pregnancy  and included an interactive forum about the 
pharmacology of common over-the-counter and prescribed medications used in pregnancy and during 
breastfeeding.  

The 2017 forum was held in Room 102 in the Napier Building at the University of Adelaide, attracting 
approximately 100 people. 

Dr Aimee Wiltshire introduced the topic, followed by a short presentation by each of the panel 
members. The evening concluded with a question and answer session. Major topics were as follows: 

&gt; Ms Cath Leggett   Medicines Information Manager, WCH. Who uses the service? Why do people 
call? 

&gt; Dr Claire Whitehead   Maternal Fetal Medicine. Medication use and birth defects. 
&gt; Ms Donna Mansell   Eligible Midwife in private practice. A breastfeeding case study.  
The forum was well received by the audience both at the time and from formal feedback, although 
most agreed the presentations could be shortened. The audience included midwives from the private 
and public sector, obstetricians, university staff and trainee medical officers. The feedback is used by 
the Subcommittee to guide future topic choices and improve the event. 

New recommendations made by the Maternal and Perinatal Mortality Committee, following review of 
the deaths in 2015, were presented to the audience. These recommendations were published in the 
30th annual report in September 2017. 

This forum was filmed. An edited version with transcripts can be viewed on the SA Health online 
website by visiting www.sahealth.sa.gov.au/perinatal 

The Subcommittee wishes to thank the panel and participants for their continued support and will 
endeavour to ensure that the event continues to be an important part of perinatal services within 
South Australia. 

 

 

  

23 
 




Useful links 
 

&gt; The SA Health Pregnancy Information website: www.health.sa.gov.au/pregnancy 
&gt; The South Australian Perinatal Practice Guidelines website:  

http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resou
rces/clinical+topics/perinatal  

&gt; The Child Death and Serious Injury Review Committee reports: 
www.cdsirc.sa.gov.au 

&gt; The Sudden Infant Death Syndrome website: https://rednose.com.au/ 
&gt; The South Australian Parenting and Child Health website: 

 www.cyh.com.au  
&gt; The South Australian Safe Infant Sleeping Standards 

http://www.sahealth.sa.gov.au/wps/south+australian+safe+infant+sleeping+standards 
&gt; The Courts Administration Authority of South Australia, Coroners Findings: 

www.courts.sa.gov.au/CoronersFindings/Pages/default.aspx 
&gt; Gestation Network customised birthweight centile calculator:  www.gestation.net/cc/about.htm  
&gt; Perinatal Society of Australia and New Zealand (PSANZ) website (www.psanz.org.au)   

24 
 













Methods and terminology 
Live birth: the complete expulsion or extraction from its mother of a product of conception, 
irrespective of the duration of pregnancy, which after such separation breathes or shows any other 
evidence of life, such as beating of the heart, pulsation of the umbilical cord or definite movement of 
voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. 

This report does not include live births less than 20 weeks gestation and less than 400g birthweight. 

Maternal death: the death of a woman while pregnant or within 42 days of termination of pregnancy, 
irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by 
the pregnancy or its management, but not from accidental or incidental causes.10 

Maternal deaths are classified as follows: 

1. Direct obstetric deaths: resulting from obstetric complications of the pregnant state 
(pregnancy, labour and puerperium), from interventions, omissions, incorrect treatment, or 
from a chain of events resulting from any of the above. 

2. Indirect obstetric deaths: resulting from previous existing disease or disease that developed 
during pregnancy and which was not due to direct obstetric causes, but which was 
aggravated by physiologic effects of pregnancy. 

3. Incidental deaths in pregnancy: the pregnancy is unlikely to have contributed significantly to 
the death, although it may be possible to postulate a remote association. Examples of 
incidental deaths are drowning and road accidents. 

In order to avoid missing indirect deaths which may be difficult to distinguish from incidental deaths 
occurring in pregnant women, the Maternal and Perinatal Mortality Committee reviews all deaths in 
pregnancy and within 42 days of the end of pregnancy. However, only direct and indirect deaths 
(pregnancy-related deaths) are included in the calculation of the maternal mortality ratio. 

Maternal mortality ratio: the number of direct and indirect maternal deaths in a defined time period, 
divided by the total number of women who gave birth in the same time period, multiplied by 100,000 

Neonatal death: death of a live born infant within 28 days of birth 

Neonatal death rate: the number of neonatal deaths in a defined time period, divided by the total 
number of live births in the same time period, multiplied by 1,000 

Perinatal death: stillbirths and neonatal deaths combined 

Perinatal mortality rate: the number of stillbirths and neonatal deaths in a defined time period, 
divided by the total number of still births and live births in the same time period, multiplied by 1,000 

Stillbirth: birth of a fetus at or after 20 weeks gestation or with a birthweight of 400g or more, with no 
signs of life at birth. 

Stillbirth rate: the number of stillbirths in a defined time period, divided by the total number of live 
births and stillbirths in the same time period, multiplied by 1,000 

Sudden Infant Death Syndrome (SIDS): the sudden unexpected death of an infant less than one 
year of age, with onset of the fatal episode apparently occurring during sleep, that remains 
unexplained after a thorough investigation, including performance of a complete autopsy and review 
of the circumstances of death and the clinical history.11 

Women who gave birth: women who gave birth after a pregnancy ending with the birth of one or 
more live births and/or stillbirths. 

  

25 
 



References 
 

1. World Health Organization. International Statistical Classification of Diseases and Related Health 
Problems. Tenth Revision. Volume 2. Geneva: WHO, 1993. 

2. Australian Institute of Health and Welfare 2017. Maternal deaths in Australia 2012-2014, Cat. no. 
PER 92. Canberra: AIHW. 

3. South Australian Special Medical Committee. First report on Maternal Mortality covering the period 
June 1961 to December 1963. Med J Aus 1964; 2:254-257. 

4. Miller JM. Second report of South Australian Special Medical Committee on Maternal Mortality for 
the period January 1964 to December 1969. Med J Aus 1973; 1: 121-125. 

5. Martin MR. Maternal deaths in South Australia 1970 to 1975, South Australian Health Commission. 
Medical Journal of Australia 1979; 1: 310-313. 

6. South Australian Health Commission. Maternal Mortality Committee 1983 Report, incorporating 
Report on Maternal Deaths 1976-1980 and Synopsis of Second Annual Report on Perinatal Deaths, 
August 1983. 

7. World Health Organisation, Neonatal and perinatal mortality: country, regional and global 
estimates. Geneva:WHO, 2006. 

8. Gordijn SJ, Erwich JJ, Khong TY. Value of the perinatal autopsy: critique. Pediatr Dev Pathol 
2002;5:480-488. 

9. Becher JC, Laing IA, Keeling JW, McIntosh N. Restoring high neonatal autopsy rates. Lancet  
2004;364:2019-2020. 

10. World Health Organization. International Statistical Classification of Diseases and Related Health 
Problems. Tenth Revision. Volume 2. Geneva: WHO, 1993.    

11. Krous HF, Beckwith JB, Byard RW, Rognum TO, Bajanowski T, Corey T et al.  Sudden infant 
death syndrome and unclassified sudden infant deaths: a definitional and diagnostic approach. 
Paediatrics 2004;114:234-8. 

  

26 
 



 
Appendix 1 
Terms of reference, Subcommittees of the Maternal and Perinatal Mortality Committee 

Maternal Subcommittee 

1. To review the causes of death associated with pregnancy and childbirth; to determine 
whether these may have been preventable, and to establish what were the avoidable factors, 
if any, presented in the case history. 

2. To report to the Maternal and Perinatal Mortality Committee. 

3. To undertake review, educational and advisory roles as appropriate from time to time, by 
initiation or by invitation. 

Perinatal Subcommittee 

1. To review each perinatal death from an obstetric, paediatric and pathological perspective and 
to collate this information. 

2. To determine and monitor the epidemiology of perinatal deaths in South Australia. 

3. To identify avoidable factors and confidentially provide feedback information to clinicians. 

4. To identify areas which need special study and/or action. 

5. To liaise with other national and international perinatal mortality study groups. 

6. To report to the Maternal and Perinatal Mortality Committee. 

Education Subcommittee 

1. To provide an annual interactive forum for the continuing education of midwives and medical 
practitioners involved in the provision of perinatal services within the metropolitan and 
regional South Australia. 

2. To act as an additional means of communication to the above providers, other health 
professionals and the community generally from the other subcommittees of the Maternal and 
Perinatal Mortality Committee. 

3. The membership and chairperson will be nominated by the chairperson of the Maternal and 
Perinatal Mortality Committee. 

4. The Subcommittee may co-opt members as required. 

  

27 
 



Appendix 2 
Perinatal Society of Australia and New Zealand-Perinatal Death Classification (PSANZ-PDC), 
South Australian perinatal deaths, 2016 

  
Category Subcategory Category 

No No % 

1 CONGENITAL ABNORMALITY (including terminations for congenital abnormalities) 63   36.0 

 1.1 Central nervous system 17  9.7 

 1.2 Cardiovascular system 8  4.6 

 1.3 Urinary system 4  2.3 

 1.4 Gastrointestinal system 2  1.1 

 1.5 Chromosomal 14  8.0 

 1.6 Metabolic 1  0.6 

 1.7 Multiple/non chromosomal syndromes 13  7.4 

 1.8 Other congenital abnormality     

           1.81 Musculoskeletal  1 0.6 

           1.82 Respiratory  1 0.6 

           1.83 Diaphragmatic hernia     

           1.84 Haematological     

           1.85 Tumours  1 0.6 

           1.88 Other specified congenital abnormality  1 0.6 

           1.9 Unspecified congenital abnormality     
2 PERINATAL INFECTION 15   8.6 

 
2.1 Bacterial     

 
          2.11 Group B Streptococcus  6 3.4 

 
          2.12 E coli  1 0.6 

 
          2.13 Listeria monocytogenes     

 
          2.14 Spirochaetal e.g. Syphilis     

 
          2.18 Other bacterial  4 2.3 

 
          2.19 Unspecified bacterial  1 0.6 

 
2.2 Viral  

 
  

 
          2.21 Cytomegalovirus  2 1.1 

 
          2.22 Parvovirus  

 
  

 
          2.23 Herpes simplex virus  

 
  

 
          2.24 Rubella virus  

 
  

 
          2.28 Other viral  

 
  

 
          2.29 Unspecified viral  

 
  

 
2.3 Protozoal e.g. Toxoplasma 

 
   

 
2.5 Fungal 

 
   

 
2.8 Other specified organism 

 
   

 
2.9 Other unspecified organism 1  0.6 

  
 
 

 
 

 
 

28 
 



Category Subcategory Category 

No No % 

3 HYPERTENSION 6   3.4 

 
3.1 Chronic hypertension: essential 

 
   

 
3.2 Chronic hypertension: secondary, e.g. renal disease 

 
   

 
3.3 Chronic hypertension: unspecified 

  
  

 
3.4 Gestational hypertension 

 
   

 
3.5 Pre-eclampsia 3  1.7 

 
          3.51 With laboratory evidence of thrombophilia 

 
1 0.6 

 
3.6 Pre-eclampsia superimposed on chronic hypertension 2  1.1 

 
          3.61 With laboratory evidence of thrombophilia 

 
   

 
3.9 Unspecified hypertension 

 
   

4 ANTEPARTUM HAEMORRHAGE (APH) 14   8.0 

 
4.1 Placental abruption 9 

 
5.1 

 
          4.11 With laboratory evidence of thrombophilia 

 
2 1.1 

 
4.2 Placenta praevia 2  1.1 

 
4.3 Vasa praevia 

 
   

 
4.8 Other APH 1  0.6 

 
4.9 APH of undetermined origin 

 
   

5 MATERNAL CONDITIONS 4   2.3 

 
5.1 Termination of pregnancy (other than for congenital fetal abnormality) 

 
   

 
5.2 Diabetes / Gestational diabetes 2  1.1 

 
5.3 Maternal injury 

 
   

 
          5.31 Accidental 

 
   

 
          5.32 Non-accidental 

 
   

 
5.4 Maternal sepsis 

 
   

 
5.5 Antiphospholipid syndrome 1 

 
0.6 

 
5.6 Obstetric cholestasis 

  
  

 
5.8 Other specified maternal conditions 1 

 
0.6 

  

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

29 
 



Category Subcategory Category 

No No % 

6 SPECIFIC PERINATAL CONDITIONS 21   12.0 

 
6.1 Twin-twin transfusion 6 

 
3.4 

 
6.2 Fetomaternal haemorrhage 2 

 
1.1 

 
6.3 Antepartum cord complications  

 
  

 
          6.31 Cord haemorrhage 

 
   

 
          6.32 True knot with evidence of occlusion 

 
1 0.6 

 
          6.38 Other 

 
   

 
          6.39 Unspecified 

 
   

 
6.4 Uterine abnormalities, eg bicornuate uterus, cervical incompetence 8 

 
4.6 

 

6.5 Birth trauma (typically infants of &gt;24 weeks gestation or &gt;600g 
      birthweight) 

  

  

 
6.6 Alloimmune disease  

 
  

 
          6.61 Rhesus  

 
  

 
          6.62 ABO  

 
  

 
          6.63 Kell  

 
  

 
          6.64 Alloimmune thrombocytopenia  1 0.6 

 
          6.68 Other 

  
  

 
          6.69 Unspecified 

  
  

 
6.7 Idiopathic hydrops 2  1.1 

 
6.8 Other specific perinatal conditions 

  
  

 
          6.81 Rupture of membranes after amniocentesis 

 
   

 

          6.82 Termination of pregnancy for suspected but unconfirmed 
                   congenital abnormality 

 

1 0.6 

 
          6.83 Fetal subdural haematoma 

 
   

 
          6.88 Other     

 
          6.89 Unspecified 

 
   

7 HYPOXIC PERIPARTUM DEATH (typically infancts of &gt;24 weeks gestation or &gt;600g birthweight 4   2.3 

 
7.1 With intrapartum complications 

 
   

 
          7.11 Uterine rupture  1 0.6 

 
          7.12 Cord prolapse 

 
1 0.6 

 
          7.13 Shoulder dystocia 

  
  

 
          7.18 Other  

 
  

 

7.2 Evidence of non-reassuring fetal status in a normally grown infant (e.g 
      abnormal fetal heart rate, fetal scalp pH/lactate, fetal pulse oximetry 
      without intrapartum complications)  

 

  

 

7.3 No intrapartum complications and no evidence of non-reassuring fetal 
      status     

 
7.9 Unspecified hypoxic peripartum death 2  1.1 

  

 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 

30 
 



 
Category 

 
Subcategory 

 
Category 

No No % 

8 FETAL GROWTH RESTRICTION (FGR) 7   4.0 

 

8.1 With evidence of reduced vascular perfusion on Doppler studies and /or 
      placental histopathology (e.g. significant infarction, acute atherosis, 
      maternal and or fetal vascular thrombosis or maternal floor infarction) 5 

 

2.9 

 
          8.11 With placental or laboratory evidence of thrombophilia 

  
  

 
          8.12 With smoking 

  
  

 
          8.13 With substance abuse 

  
  

 
          8.14With alcohol abuse 

  
  

 
          8.15 With diabetes/gestational diabetes 

  
  

 
8.2 With chronic villitis 1 

 
0.6 

 
8.3 No placental pathology 

  
  

 
8.4 No examination of placenta 

  
  

 
8.8 Other specified placental pathology 1 

 
0.6 

 
8.9 Unspecified or not known whether placenta examined 

  
  

9 SPONTANEOUS PRETERM (&lt;37 weeks gestation) 19   10.9 

 

9.1 Spontaneous preterm with intact membranes, or membrane rupture &lt;24 
hours before delivery 

  

  

 
          9.11 With chorioamnionitis on placental histopathology 

 
7 4.0 

 
          9.12 Without chorioamnionitis on placental histopathology 

 
2 1.1 

 

          9.13 With clinical evidence of chorioamnionitis, no examination of 
                  placenta 

  

  

 
          9.17 No clinical signs of chorioamnionitis, no examination of placenta 

 
1 0.6 

 
          9.19 Unspecified or not known whether placenta examined 

  
  

 

9.2 Spontaneous preterm with membrane rupture &gt;=24 hours before 
       delivery 

  

  

 
          9.21 With chorioamnionitis on placental histopathology 

 
6 3.4 

 
          9.22 Without chorioamnionitis on placental histopathology 

 
1 0.6 

 

          9.23 With clinical evidence of chorioamnionitis, no examination of 
                   placenta 

  

  

 
          9.27 No clinical signs of chorioamnionitis, no examination of placenta 

  
  

 
          9.29 Unspecified or not known whether placenta examined 

  
  

 

9.3 Spontaneous preterm with membrane rupture of unknown duration 
       before delivery 

  

  

 
          9.31 With chorioamnionitis on placental histopathology 

 
1 0.6 

 
          9.32 Without chorioamnionitis on placental histopathology 

 
1 0.6 

 

          9.33 With clinical evidence of chorioamnionitis, no examination of 
                   placenta 

  

  

 
          9.37 No clinical signs of chorioamnionitis, no examination of placenta 

  
  

 
          9.39 Unspecified or not known whether placenta examined 

  
  

  

 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 

31 
 



 
Category 

 
Subcategory 

 
Category 

No No % 

10 UNEXPLAINED ANTEPARTUM DEATH 20   11.4 

 

10.1 With evidence of reduced vascular perfusion on Doppler studies and 
        or placental histopathology (e.g. significant infarction , acute atherosis, 
        maternal and or fetal vascular thrombosis or maternal floor infarction) 4 

 

2.3 

 
          10.11 And thrombophilia 

  
  

 
          10.12 And smoking 

  
  

 
          10.13 And substance abuse 

  
  

 
          10.14 And alcohol abuse 

  
  

 
          10.15 And diabetes/gestational diabetes 

  
  

 
10.2 With chronic villitis 1 

 
0.6 

 
10.3 No placental pathology 4 

 
2.3 

 
10.4 No examination of placenta 

  
  

 
10.8 Other specified placental pathology 11 

 
6.3 

 
10.9 Unspecified or not known whether placenta examined 

  
  

11 NO OBSTETRIC ANTECEDENT 2   1.1 

 
11.1 Sudden Infant Death Syndrome (SIDS) 

  
  

 

          11.11 SIDS Category IA: Classic features of SIDS present and 
                    completely documented 

  

  

 

          11.12 SIDS Category IB: Classic features of SIDS present but 
                    incompletely documented 

  

  

 

          11.13 SIDS Category II: Infant deaths that meet Category I except for 
                    one or more features 

  

  

 
11.2 Postnatally acquired infection 1 

 
0.6 

 
11.3 Accidental asphyxiation 

  
  

 
11.4 Other accident, poisoning or violence (postnatal) 

  
  

 
11.8 Other specified 

  
  

 
11.9 Unknown/Undetermined 

  
  

 
          11.91 Unclassified Sudden Infant Death 

 
1 0.6 

 
          11.92 Other Unknown/Undetermined 

  
  

  TOTAL 175   100.0 
 

  

32 
 



Appendix 3 
Perinatal Society of Australia and New Zealand-Neonatal Death Classification (PSANZ-NDC), 
South Australian neonatal deaths, 2016 

  

Category Subcategory Category 

No No % 

1 CONGENITAL ABNORMALITY 11   28.2 

 1.1 Central nervous system     

 1.2 Cardiovascular system 3  7.7 

 1.3 Urinary system 2  5.1 

 1.4 Gastrointestinal system     

 1.5 Chromosomal 3  7.7 

 1.6 Metabolic     

 1.7 Multiple/non chromosomal syndromes 3  7.7 

 1.8 Other congenital abnormality     

           1.81 Musculoskeletal     

           1.82 Respiratory     

           1.83 Diaphragmatic hernia     

           1.84 Haematological     

           1.85 Tumours     

           1.88 Other specified congenital abnormality     

           1.9 Unspecified congenital abnormality     

2 EXTREME PREMATURITY 8   20.5 

 
2.1 Not resuscitated 7  17.9 

 
2.2 Unsuccessful resuscitation 1  2.6 

 
2.9 Unspecified or unknown whether resuscitation attempted     

3 CARDIO-RESPIRATORY DISORDERS       

 
3.1 Hyaline membrane disease / Respiratory Distress Syndrome (RDS)  

 
  

 
3.2 Meconium aspiration syndrome  

 
  

 
3.3 Primary persistent pulmonary hypertension  

 
  

 
3.4 Pulmonary hypoplasia  

 
  

 

3.5 Chronic neonatal lung disease (typically bronchopulmonary 
dysplasia)  

 

  

 
3.6 Pulmonary haemorrhage  

 
  

 
3.7 Pneumothorax  

 
  

 
3.8 Other  

 
  

  

 
 
 
 
 
 

 
 
 
 
 
 

 
 
 
 
 
 

33 
 



Category Subcategory Category 

No No % 

4 INFECTION 2   5.1 

 
4.1 Bacterial  

 
  

 
          4.11 Congenital bacterial 

 
   

 
                    4.111 Group B Streptococcus 

 
   

 
                    4.112 E coli 

 
   

 
                    4.113 Listeria monocytogenes 

 
   

 
                    4.114 Spirochaetal, eg syphilis 

 
   

 
                    4.118 Other bacterial 

 
   

 
                    4.119 Unspecified bacterial 

 
   

 
          4.12 Acquired bacterial  

 
  

 
                    4.121 Group B Streptococcus 

 
   

 
                    4.122 E coli 

 
   

 
                    4.125 Other Gram negative bacilli (other than E coli) 

 
   

 
                    4.126 Staphylococcus aureus 

 
   

 
                    4.127 Coagulase negative Staphylococcus 

 
   

 
                    4.128 Other specified bacterial 

 
1 2.6 

 
                    4.129 Unspecified bacterial 

 
   

 
4.2 Viral  

 
  

 
          4.21 Congenital viral 

 
   

 
                    4.211 Cytomegalovirus 

 
   

 
                    4.213 Herpes simplex virus 

 
   

 
                    4.214 Rubella virus 

 
   

 
                    4.218 Other specified viral 

 
   

 
                    4.219 Unspecified viral 

 
   

 
          4.22 Acquired viral 

 
   

 
                    4.221 Cytomegalovirus 

 
   

 
                    4.223 Herpes simplex virus 

 
   

 
                    4.224 Rubella virus 

 
   

 
                    4.228 Other specified viral 

 
1 2.6 

 

                    4.229 Unspecified viral 

 
   

 
4.3 Protozoal e.g. Toxoplasma  

 
  

 
4.5 Fungal  

 
  

 
4.8 Other specified organism  

 
  

 
4.9 Unspecified organism  

 
  

34 
 



  

Category Subcategory Category 

No No % 

5 NEUROLOGICAL 13   33.3 

 

5.1 Hypoxic ischaemic encephalopathy / Perinatal asphyxia (typically 
infants of &gt;24 weeks gestation or &gt;600g birthweight) 5 

 

12.8 

 
5.2 Intracranial haemorrhage  

 
  

 
          5.21 Intraventricular haemorrhage 

 
7 17.9 

 
          5.22 Subgaleal haemorrhage 

 
   

 
          5.23 Subarachnoid haemorrhage 

 
   

 
          5.24 Subdural haemorrhage 

 
   

 
          5.28 Other Intracranial haemorrhage 

 
1 2.6 

 

5.8 Other 

 
   

6 GASTROINTESTINAL 4   10.3 

 
6.1 Necrotising enterocolitis 2 

 
5.1 

 
6.8 Other 2 

 
5.1 

7 OTHER 1   2.6 

 
7.1 Sudden Infant Death Syndrome (SIDS)  

 
  

 

          7.11 SIDS Category IA: Classic features of SIDS present and 
                  completely documented 

 
   

 

          7.12 SIDS Category IB: Classic features of SIDS present but  
                  incompletely documented 

 
   

 

          7.13 SIDS Category II : Infant deaths that meet category I except  
                  for one or more features 

 
   

 
7.2 Multisystem failure  

 
  

 
          7.21 Secondary to intrauterine growth restriction 

 
   

 
          7.28 Other specified 

 
   

 
          7.29 Unspecified/undetermined primary cause or trigger event 

 
   

 
7.3 Trauma  

 
  

 
          7.31 Accidental 

 
   

 
          7.32 Non-accidental 

 
   

 
          7.39 Unspecified 

 
   

 
7.4 Treatment complications  

 
  

 
          7.41 Surgical 

 
   

 
          7.42 Medical 

 
   

 
7.8 Other specified  

 
  

 
7.9 Undetermined/Unknown  

 
  

 
          7.91 Unclassified Sudden Infant Death 

 
   

 
          7.92 Other Unknown/Undetermined 

 
1 2.6 

  TOTAL 39   100.0 

35 
 



Appendix 4 
Perinatal Society of Australia and New Zealand Perinatal Death Classification (PSANZ-PDC), 
South Australian perinatal deaths by birthweight, 2016 

    Birthweight (g) Total 

  PSANZ-PDC &lt;500 500-749 
750-
999 

1000-
1,499 

1500-
1,999 

2,000-
2,499 2,500+ No % 

1 Congenital abnormality 38 8 0 4 3 6 4 63 36 

2 Perinatal infection 4 2 1 3 1 2 2 15 8.6 

3 Hypertension 2 0 1 2 1 0 0 6 3.4 

4 Antepartum haemorrhage 6 4 1 0 1 0 2 14 8 

5 Maternal conditions 3 0 0 0 0 0 1 4 2.3 

6 Specific perinatal conditions 10 4 2 0 1 1 3 21 12 

7 Hypoxic peripartum death 0 0 0 0 1 0 3 4 2.3 

8 Fetal growth restriction 3 1 0 1 2 0 0 7 4 

9 Spontaneous preterm 11 7 0 1 0 0 0 19 10.9 

10 Unexplained antepartum death 2 4 3 1 3 1 6 20 11.4 

11 No obstetric antecedent 0 0 0 0 0 0 2 2 1.1 

  Total 79 30 8 12 13 10 23 175 100.0 

  Percent 45.1 17.1 4.6 6.9 7.4 5.7 13.1 100.0 % 

 

  

36 
 



Appendix 5 
Archived recommendations 

Many Committee recommendations have been incorporated into South Australian policies, standards 
or guidelines. For a complete list of recommendations made by the Committee in previous years, 
please see the Archived Recommendations document on the Pregnancy Outcome Unit web page. 

 

  

37 
 




 
Appendix 6 
South Australian Protocol for investigation of stillbirths 

Working party members (August 2012): 

Professor G Dekker (Chair) 

Professor TY Khong 

Professor W Hague 

Dr Linda McKendrick 

Introduction 

About 75% of the overall perinatal mortality in South Australia is related to stillbirths.  Over the past 
several years approximately 11% of stillbirths had no cause identified, possibly, in part due to the lack 
of a systematic and up-to-date approach to the investigation of stillbirths for which there is no 
immediate obvious cause. Currently protocols for investigating such cases vary markedly between 
hospitals and generally have not kept pace with advances in obstetric knowledge, particularly in the 
area of vasculopathy.  

The  Stillbirth investigations algorithm  of the Perinatal Society of Australia and New Zealand (PSANZ) 
on the following page summarises the recommended core investigations for all stillbirths, and further 
investigations to be undertaken based on specific conditions.  

It is important that clinicians initiate a comprehensive approach to all cases of stillbirth; however, as in 
all aspects of clinical medicine common sense should prevail. In order to adequately assess causative 
and contributing factors in cases of stillbirth, certain core investigations will be required in all cases as 
outlined in the  Core Investigations of All Stillbirths  section in the  Stillbirth investigations algorithm  on 
the following page. South Australian specific considerations are summarised in the pages following 
the  Stillbirth investigations algorithm . Some investigations are best suited to those cases in which no 
cause of death is apparent.  

38 
 



  

Perinatal Society of Australia and New Zealand Perinatal Mortality Audit Guideline; Second Edition, Version 2.2, 
April 2009.  Section 5: Investigation of Stillbirths; Appendix 1 
http://www.psanz.com.au/special-interest/perinatal-mortality-group/psanzcpg 

  

39 
 




South Australian Core investigations (to be performed in all cases of stillbirth): 

The following outlines the current South Australian recommended core investigations into stillbirth. 

&gt; A detailed history and examination of the mother and careful review of the antenatal record 
  This can often provide clues to intercurrent infection, previously undiagnosed pre-eclampsia, 
drug use, obstetric cholestasis or missed intrauterine growth restriction. 

&gt; Maternal blood - In addition to the blood tests listed in the core investigations section of the 
 Stillbirth investigation algorithm , a blood glucose test should be done. Testing for fetomaternal 
haemorrhage involves a Kleihauer test at SA Pathology and, if positive, Fluorescence-Activated 
Cell Sorting (FACS, a type of flow cytometry) to quantify the fetomaternal haemorrhage. 

&gt; Autopsy of the stillbirth - With parental consent, an autopsy should be conducted by the State 
Perinatal Autopsy Service. In those cases where parents give full consent with regard to autopsy, 
the perinatal pathologists will take appropriate samples for genetic testing, and there is no need 
for the obstetrician to take separate fetal samples. 

&gt; External examination of the baby - In cases where parental consent for autopsy cannot be 
obtained, where possible, external examination of the baby by a pathologist experienced in this 
area should be sought. If this is not possible an X-ray of the baby and/or a clinical photograph 
should be taken and sent to a major centre for review. 

&gt; Histopathology of placenta - Whether or not an autopsy is performed the placenta should be 
placed in a dry sterile container (no formalin or saline), the container surrounded in ice and 
forwarded to the State Perinatal Autopsy Service. Histopathological examination combined with 
other investigations may provide a diagnosis and information that can be helpful in planning 
another pregnancy.  

&gt; Guthrie card - Where permission for an autopsy has been declined, parents should be asked if 
blood can be taken for the Newborn Screening Guthrie Card that is requested for all babies in 
Australia. This blood can be drawn from a heel prick or from the cut end of the umbilical cord of 
the placenta in the case of a fresh stillbirth (&lt;7 days between intrauterine death and birth). 

Termination of pregnancy for fetal abnormalities 

In cases where a termination of pregnancy has been carried out for fetal malformation, an autopsy 
may still be desirable to confirm the diagnosis or discover unexpected associated malformations. 

Congenital abnormality 

Investigations to be performed when an intrauterine fetal death occurs in conjunction with a known 
fetal abnormality: 

&gt; Genetic testing - preferably on amniotic fluid obtained by amniocentesis since this provides the 
least contaminated sample, but if maternal consent for this cannot be obtained then on cord blood 
(if obtainable) or fetal skin.  

&gt; Maternal serology - for syphilis, cytomegalovirus, toxoplasma, herpes and parvovirus.  Serum 
should be taken and forwarded with the baby. Investigation for congenital infection should be 
pursued if abnormalities indicative of infection are found (for example, hydrocephalus, 
hepatomegaly, cataracts, fetal hydrops, calcification of brain or placenta). 

&gt; Maternal screen for blood group antibodies   forward serum with baby for later investigation if 
hydrops is evident at autopsy. 

Vasculopathies  

Pre-eclampsia, placental abruption and intrauterine growth restriction. 

All should have a thrombophilia screen comprising   

At time of delivery: 

&gt; Anti-cardiolipin antibody    
&gt; Lupus anticoagulant (Diagnosis of antiphospholipid antibody syndrome requires a least two 

positive tests of moderate to high titre)  

40 
 



&gt; Factor V Leiden gene mutation, prothrombin gene mutation. 
At three months post-partum: 
&gt; Homocysteine - may be done earlier if follow-up uncertain 
&gt; Protein S (a formal diagnosis of protein S deficiency requires 2 abnormal results at least six 

weeks apart outside of pregnancy).  
(Note: MTHFR testing, as listed in the  Thrombophilia studies 8-12 weeks postpartum  section of the 
 Stillbirth investigations algorithm , is no longer routinely performed in South Australia) 

Pre-eclampsia  

 Those with early onset pre-eclampsia (&lt;28 weeks) should also have: 

&gt; Anti-nuclear antibody 
&gt; Fetal genetic testing (see "Congenital abnormality") 
Placental abruption 

In cases of placental abruption: 

&gt; A history of trauma, including domestic or other violence, should be sought. 
&gt; Testing for fetomaternal haemorrhage and D-dimers is indicated if the diagnosis is in doubt. 
Intrauterine growth restriction (IUGR) 

Where intrauterine growth restriction is evident, without further evidence of a vasculopathy, the 
following should be performed in addition to the thrombophilia screen: 

&gt; maternal serology for cytomegalovirus, toxoplasma and rubella (if not immune) on held maternal 
serum  

&gt; fetal genetic testing (see "Congenital abnormality ) 
&gt; maternal urinary drug screen as well as a drug-related history. 
Intrapartum stillbirths 

&gt; If associated with pre-eclampsia, intrauterine growth restriction and/or abruption follow the 
placental vasculopathy protocol. 

&gt; In the absence of obvious causes, test for fetomaternal haemorrhage and cord (or heart) blood for 
haemoglobin, platelets and nucleated red blood cells. 

Unexplained stillbirths 

In the absence of discernible factors pertaining to fetal demise, or any obvious congenital abnormality, 
in addition to the  Core investigations  the following should be conducted:  

&gt; cord blood bile acids if possible 
&gt; maternal thyroid stimulating hormone 
&gt; maternal serology for syphilis, cytomegalovirus, toxoplasma herpes, parvovirus and rubella (if not 

immune) on held maternal serum  
&gt; microbiology - fetal throat swab, placental intermembranous swab 
&gt; drug history and urine drug screen 
&gt; Cord or heart blood - haemoglobin, platelets, nucleated red blood cells, blood group (for anti-D if 

mother is Rhesus negative) 
&gt; maternal antibody screen 
&gt; fetomaternal haemorrhage testing 

&gt; check the mother s history for the possibility of tropical infectious disorders. Where there is a history of a 
recent visit to a tropical area, contact an infectious disease specialist with regard to required investigations.  

41 
 



Appendix 7 
Placental histology guidelines 

Histological examination of the placenta provides additional information about perinatal deaths and 
placentas should be sent for examination where possible. 

As a guide, placentas and all relevant clinical information should be sent to Pathology from all: 

&gt; stillborn infants, early neonatal deaths and mid-trimester miscarriages 
&gt; multiple pregnancies with same sex infants 
&gt; triplet and higher order multiple pregnancies 
&gt; cases of discordant twin growth with greater than 20% weight difference 
&gt; cases of prolonged rupture of membranes or suspected chorioamnionitis or maternal fever (any 

cause) 
&gt; preterm births 
&gt; cases where birthweight is less than the 10th percentile or greater than the 95th percentile for 

gestational age 
&gt; cases of fetal malformation 
&gt; cases of pregnancy complicated by oligohydramnios, polyhydramnios or placental abnormalities 

detected prenatally (vascular channels, chorioangioma, etc) 
&gt; cases with a physical abnormality in the placenta (eg. a mass, abnormal colour, malodour) 
&gt; cases subjected to chorion villus sampling or amniocentesis, if complications occur 
&gt; cases of pre-existing diabetes, pre-eclampsia, systemic lupus erythematosus and documented 

thrombophilias known to be associated with fetal hazard 
&gt; cases of placental abruption 
&gt; cases where the infant is transferred to a Level 6 nursery or the infant is severely depressed at 

birth (Apgar score &lt;5 at five minutes) 
&gt; instances where either mother or baby is retrieved shortly after birth 
&gt; cases of maternal death. 
  

42 
 



 
 

 

For more information 

Maternal and Perinatal Mortality Committee 
Pregnancy Outcome Unit 
SA Health, Government of South Australia 
PO Box 6, Rundle Mall, Adelaide 
South Australia, 5000, Australia 
Telephone: (08) 8226 6371 
www.sahealth.sa.gov.au 

      

  Department for Health and Wellbeing, Government of South Australia. All rights reserved 

43 
 



	Committees
	Maternal and Perinatal Mortality Committee
	Maternal Subcommittee
	Perinatal Subcommittee
	Education Subcommittee

	Acknowledgements
	Summary
	Recommendations
	Introduction
	Maternal Mortality
	Maternal mortality statistics
	Causes of maternal deaths
	New Maternal Subcommittee recommendations

	Perinatal Mortality
	Perinatal mortality statistics
	National comparisons of perinatal mortality rates
	Birthweight-specific perinatal mortality
	Gestation-specific perinatal mortality
	Classification of perinatal deaths
	Classification of neonatal deaths
	Aboriginal perinatal deaths
	Autopsies in perinatal deaths
	Perinatal Subcommittee recommendations

	Education Subcommittee Report
	Useful links
	Methods and terminology
	References
	Appendix 1
	Appendix 2
	Appendix 3
	Appendix 4
	Appendix 5
	Appendix 6
	Appendix 7

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