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The study following an investigation into 133 cases of stillbirth in the UK in 2013. In a majority of cases, it was found that national guidance was not followed by hospitals, and the investigation has identified missed opportunities which could, potentially, have saved babies' lives.
The report, commissioned by the Healthcare Quality Improvement Partnership as part of the Maternal, Newborn and Infant Clinical Outcome Review Programme, is led by a team from the University of Leicester.
For this report, the group examined stillbirths born at term who were sole births and not affected by a congenital anomaly. A random representative sample of 133 of these babies who were stillborn in 2013 was selected.
The pregnancy notes were assessed for all 133 and 85 were reviewed in detail against national care guidelines by a panel of clinicians, including midwives, obstetricians and pathologists who considered every aspect of the care.
The inquiry found that more than half of all term, singleton, normally formed, antepartum stillbirths had at least one element of care that required improvement which may have made a difference to the outcome. It was revealed that two-thirds of women with a risk factor for developing diabetes in pregnancy were not offered testing – a missed opportunity for closer monitoring. Similarly, national guidance for screening and monitoring growth of the baby was not followed for two thirds of the cases reviewed.
Meanwhile, almost half of the women had contacted their maternity units concerned that their baby's movements had slowed, changed or stopped; however in half of these cases there were missed opportunities to potentially save the baby including a lack of investigation, misinterpretation of the baby's heart trace or a failure to respond appropriately to other factors.
Only half of the stillbirths selected for confidential enquiry had a post-mortem carried out, and in a majority of cases, these were said to be of satisfactory or good quality. In addition, a good standard of bereavement care was provided for parents immediately following birth, including the offer of an opportunity to create memories of their baby.
Of the key areas for action, the team said an implementation of national guidance was needed, including the screening and identification of women who should be offered testing to detect those at risk of developing diabetes in pregnancy. Another suggestion was the management of reduced fetal movements and identification of additional risk factors, while there should be a standardised multidisciplinary review of all term stillbirths. In addition, all parents of a stillborn baby should be offered a post-mortem, and parents should also be offered a follow-up appointment with a consultant obstetrician to discuss their care, the actual or potential cause, chances of recurrence and plans for any future pregnancy.
Commenting on the report, Professor Elizabeth Draper, Professor of Perinatal and Paediatric Epidemiology at University of Leicester, said: "The panel has identified a number of areas where improvements of care are required which, if implemented, could lead to an overall reduction in this type of stillbirth, representing missed opportunities in the provision of antenatal care.
"However, not all findings were negative. We found examples of excellent bereavement care where midwives had provided long term support for families in a way that surpassed normal expectations, high quality interpreter services when these were needed as well as a high standard of post mortems."
"The findings from this enquiry are important because they provide clear pointers as to how care can be improved," added Professor Jenny Kurinczuk, Director of the National Perinatal Epidemiology Unit and National Programme Lead for MBRRACE-UK. "The guidelines are clear and individual practitioners and maternity units need to ensure that the guidelines are implemented and every opportunity is taken to prevent a stillbirth occurring."
Cathy Warwick, Chief Executive of the Royal College of Midwives (RCM), welcomed the report, commenting: "We owe it to women and their families to do everything we can to prevent avoidable antenatal stillbirths. The findings and recommendations from this report are critical in helping us to do just that. The RCM will work with others to do everything we can to ensure implementation."
Dr David Richmond, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said: "Although fewer babies in the UK are stillborn today, it's desperately disappointing that the four recommendations from this report remain exactly the same as when the last confidential enquiry took place 15 years ago.
"Today's report suggests six in 10 of these stillbirths are potentially avoidable. We can and should do better by the 1,000 families affected by stillbirths that occur before a woman goes into labour each year in the UK."
In the UK, almost one in every 200 babies is stillborn. One third of these occur when the pregnancy has reached full term.
More information on the report can be found here.
(JP)
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Improved Care Needed To Prevent Stillbirths
A new report has identified a number of key steps for hospitals to take in order to improve care for expectant women and babies.The study following an investigation into 133 cases of stillbirth in the UK in 2013. In a majority of cases, it was found that national guidance was not followed by hospitals, and the investigation has identified missed opportunities which could, potentially, have saved babies' lives.
The report, commissioned by the Healthcare Quality Improvement Partnership as part of the Maternal, Newborn and Infant Clinical Outcome Review Programme, is led by a team from the University of Leicester.
For this report, the group examined stillbirths born at term who were sole births and not affected by a congenital anomaly. A random representative sample of 133 of these babies who were stillborn in 2013 was selected.
The pregnancy notes were assessed for all 133 and 85 were reviewed in detail against national care guidelines by a panel of clinicians, including midwives, obstetricians and pathologists who considered every aspect of the care.
The inquiry found that more than half of all term, singleton, normally formed, antepartum stillbirths had at least one element of care that required improvement which may have made a difference to the outcome. It was revealed that two-thirds of women with a risk factor for developing diabetes in pregnancy were not offered testing – a missed opportunity for closer monitoring. Similarly, national guidance for screening and monitoring growth of the baby was not followed for two thirds of the cases reviewed.
Meanwhile, almost half of the women had contacted their maternity units concerned that their baby's movements had slowed, changed or stopped; however in half of these cases there were missed opportunities to potentially save the baby including a lack of investigation, misinterpretation of the baby's heart trace or a failure to respond appropriately to other factors.
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Only half of the stillbirths selected for confidential enquiry had a post-mortem carried out, and in a majority of cases, these were said to be of satisfactory or good quality. In addition, a good standard of bereavement care was provided for parents immediately following birth, including the offer of an opportunity to create memories of their baby.
Of the key areas for action, the team said an implementation of national guidance was needed, including the screening and identification of women who should be offered testing to detect those at risk of developing diabetes in pregnancy. Another suggestion was the management of reduced fetal movements and identification of additional risk factors, while there should be a standardised multidisciplinary review of all term stillbirths. In addition, all parents of a stillborn baby should be offered a post-mortem, and parents should also be offered a follow-up appointment with a consultant obstetrician to discuss their care, the actual or potential cause, chances of recurrence and plans for any future pregnancy.
Commenting on the report, Professor Elizabeth Draper, Professor of Perinatal and Paediatric Epidemiology at University of Leicester, said: "The panel has identified a number of areas where improvements of care are required which, if implemented, could lead to an overall reduction in this type of stillbirth, representing missed opportunities in the provision of antenatal care.
"However, not all findings were negative. We found examples of excellent bereavement care where midwives had provided long term support for families in a way that surpassed normal expectations, high quality interpreter services when these were needed as well as a high standard of post mortems."
"The findings from this enquiry are important because they provide clear pointers as to how care can be improved," added Professor Jenny Kurinczuk, Director of the National Perinatal Epidemiology Unit and National Programme Lead for MBRRACE-UK. "The guidelines are clear and individual practitioners and maternity units need to ensure that the guidelines are implemented and every opportunity is taken to prevent a stillbirth occurring."
Cathy Warwick, Chief Executive of the Royal College of Midwives (RCM), welcomed the report, commenting: "We owe it to women and their families to do everything we can to prevent avoidable antenatal stillbirths. The findings and recommendations from this report are critical in helping us to do just that. The RCM will work with others to do everything we can to ensure implementation."
Dr David Richmond, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said: "Although fewer babies in the UK are stillborn today, it's desperately disappointing that the four recommendations from this report remain exactly the same as when the last confidential enquiry took place 15 years ago.
"Today's report suggests six in 10 of these stillbirths are potentially avoidable. We can and should do better by the 1,000 families affected by stillbirths that occur before a woman goes into labour each year in the UK."
In the UK, almost one in every 200 babies is stillborn. One third of these occur when the pregnancy has reached full term.
More information on the report can be found here.
(JP)
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