The incidence of fatal fetal anomalies associated with perinatal mortality in Ireland

The incidence of fatal fetal anomalies associated with perinatal mortality in Ireland

Ms Stacey Power (1), Dr Sarah Meaney (1,2), Dr Keelin O’Donoghue (1)

(1) Pregnancy Loss Research Group, The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland (2) National Perinatal Epidemiology Centre, University College Cork, Ireland

Background
Major congenital anomalies were responsible for 146 of the 374 perinatal deaths in Ireland. Little is known about what conditions are most responsible for perinatal mortality. While there is no universally-agreed definition in Ireland, the term fatal fetal anomaly (FFA) is used in Law to describe a condition likely to lead to death of the fetus in utero or within 28 days of birth. The aim of this study was to identify what congenital anomalies are responsible for perinatal death and whether they are classified as a FFA.

Method
Anonymised data pertaining to all perinatal deaths that occurred between January 2011 and December 2016, from all 19 maternity units in Ireland, were obtained from the National Perinatal Epidemiology Centre. Secondary data analysis was conducted using SPSS Version 23.

Results
Between 2011 and 2016 there were 3,048 perinatal deaths in Ireland; of which 59.3% (n=1807) were stillbirths and 40.7% (n=1241) were neonatal deaths. Congenital anomalies were present in one third of all perinatal deaths (34.4%; n=1049) and were more likely to be present for infants who died following birth than those who died in utero (46.2% v 26.6%; p<0.001). Of these 1,049 perinatal deaths, 28.5% (n=299) could be definitively classified as FFA with an additional 40.2% (n=422) lacking sufficient information to be classified. Stillbirths were more likely to have a congenital anomaly classified in line with commonly accepted definitions of FFA than neonatal deaths (33.5% v 24.3%; p<0.001).

Conclusion
Irish legislation now allows for termination of pregnancy for FFA. There is no agreed definition or classification of FFA, however this descriptive analysis from a national registry of perinatal deaths illustrates that 10% of deaths over a 6 year period can be attributed to FFA using the criteria set out in the Irish legislation. This knowledge is required to inform clinical practice and counselling of parents who receive a diagnosis of a fetal congenital anomaly.

Ethics statement
This study is secondary data analysis of anonymous data. Ethical approval was sought by the National Perinatal Epidemiological Centre, from the Clinical Research Ethics Committee of the Cork Teaching Hospitals, prior to collecting same.

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