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Watford Observer


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Stillbirth review

6:51am Sunday 22nd November 2015 content supplied by Netmums

The report, led by a group of academics and clinicians called MBRRACE-UK, looked at 85 stillbirths in detail and found care could have been better in two-thirds of cases.

A particular area of concern is that national guidelines for screening and monitoring the growth of two-thirds of the babies who died were not followed. Many women with a higher risk of stillbirth, such as those at risk of diabetes, had not been properly monitored, the researchers found. 

Dr David Richmond, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said it was "desperately disappointing" that the recommendations within the report were the same as those in a similar report of 15 years ago. Refusing to accept these stillbirths as "unavoidable tragedies", he said:

We can and should do better by the 1,000 families affected each year in the UK.

Professor Elizabeth Draper, Professor of Perinatal and Paediatric Epidemiology at University of Leicester, pointed out the "missed opportunities" in the provision of antenatal care, but praised midwives for the quality of their bereavement care:

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.

In the UK today, almost one in every 200 babies is stillborn and one third of these occur when the pregnancy has reached full term.

How was the study carried out?

  • The study was carried out on singletons (sole births) 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.

What did the enquiry find?

  • More than half of all the selected stillbirths had at least one element of care that required improvement which may have made a difference to the outcome. (These were normally-formed, singleton pregnancies that had gone to full term, but died "antepartum" - prior to birth).
  • Two thirds of women with a risk factor for developing diabetes in pregnancy were not offered testing – a missed opportunity for closer monitoring.
  • National guidance for screening and monitoring growth of the baby was not followed for two thirds of the cases reviewed.
  • Almost half of the women had contacted their maternity units concerned that their baby’s movements had slowed, changed or stopped. 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.
  • 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.

Cathy Warwick, Chief Executive of The Royal College of Midwives (RCM), said:

The RCM welcomes this important report. It is imperative that it does not sit on the shelf but instead is translated into practice and service change. We owe it to women and their families to do everything we can to prevent avoidable antenatal stillbirths.

Health Minister, Ben Gummer, said:

“This is further evidence of the urgent need for change - we need to do everything we can to reduce the number of families going through the heartache of stillbirth and ensure the NHS is one of the very best and safest places to have a baby across the world. 

“Last week we launched our ambition to halve stillbirths, neonatal deaths, maternal deaths and neonatal brain injuries, through cutting-edge technology and multi-disciplinary training. The MBRRACE-UK recommendations will help the NHS to further improve and shape future, safer care."

Some key areas for action identified in the report:

  • Routine measurement of the baby’s growth and detailed plotting of the growth at each antenatal appointment from 24 weeks of pregnancy.
  • Management of reduced fetal movements and identification of additional risk factors.
  • All parents of a stillborn baby should be offered a post-mortem. This offer should be clearly documented in the mother’s notes.
  • All parents should 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.
  • A summary of the follow-up appointment should be written in plain English and sent to the parents and their GP.

The study was carried out by a team of academics, clinicians and charity representatives, called MBRRACE-UK.

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