Appendix A: Adverse outcomes

Adverse outcome: in order to be able to count enough adverse events to be able to say that the results recorded are not just a result of chance, the Birthplace UK (2011) study used a composite definition of 'adverse outcome'. The definition includes the following outcomes: stillbirth during labour, death of the baby in the first week after birth, neonatal encephalopathy (disordered brain function caused by oxygen deprivation before or during birth), meconium aspiration syndrome, and physical birth injuries (brachial plexus injury and bone fractures). The term 'serious medical problems' has been used to describe this composite outcome in the guideline recommendations.

Table A1 Numbers and proportions of the individual components of the composite adverse outcomes measure recorded in the Birthplace UK (2011) study

Outcome

Actual number of babies affected out of [63,955 to 64,535]*

(number per 1000)

Percentage of all adverse outcomes measured

Stillbirth after start of care in labour

14 out of 64,535

(0.22 per 1000)

5%

Death of the baby in the first week after birth

18 out of 64,292

(0.28 per 1000)

7%

Neonatal encephalopathy (disordered brain function caused by oxygen deprivation before or during birth) (clinical diagnosis)

102 out of 63,955

(1.6 per 1000)

40%

Meconium aspiration syndrome (the baby breathes meconium into their lungs)

86 out of 63,955

(1.3 per 1000)

34%

Brachial plexus injury

24 out of 63,955

(0.38 per 1000)

9%

Bone fractures

11 out of 63,955

(0.17 per 1000)

4%

TOTAL (of all outcomes included in the 'adverse outcome' composite measure)

255 out of 63,955 to 64,535)

(approx. 4 per 1000)

99%**

Note: Each of the categories above are mutually exclusive and outcomes listed higher in the table take precedence over outcomes listed lower down. For example, if a baby with neonatal encephalopathy died within 7 days the outcome is classified as an early neonatal death.

* Denominator varies because of missing values.

** Does not equal 100% because of rounding.

  • National Institute for Health and Care Excellence (NICE)