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Service pressures underlying full-term stillbirths

Tuesday November 28th, 2017

Most stillbirths of infants born at term are linked to poor care – and pressure on services is responsible for much of this, according to a major report published today.

The British government responded rapidly with its own proposals to improve care, promising access to independent investigations for these families, potentially including inquests.

Researchers studying the deaths of babies who were alive at the onset of labour concluded that 80% of deaths were linked to care problems.

In more than 20% of cases the poor care was the result of “capacity” problems, linked to staffing and access to facilities, according to the latest findings of the MBRRACE-UK audit of maternity care.

The study also found that heavy workload led to delays in induction in about a third of cases.

The study also highlights issues such as the over-use of intermittent auscultation, the failure to start continuous electronic foetal monitoring and delays in escalation problems to more experienced clinicians.

The researchers analysed 78 of the 225 pregnancies in 2015 that ended in this way.

Researcher Professor Elizabeth Draper, of Leicester University, UK, said: “The premise of the enquiry was that these babies would be born alive and healthy. Findings from the panels indicated that improvements in care might have made a difference to the outcome for almost 80% of cases.

“The main issues identified were care before labour was established including induction, monitoring during labour, delay in expediting birth, heavy workload of the units, a lack of joint obstetric and neonatal input into bereavement care and a lack of rigour in the local review of the deaths.”

The Royal College of Obstetricians and Gynaecologists said the findings reflected its own concerns. Under today’s announcement, it will get support to expand its “Each Baby Counts” programme.

President Professor Lesley Regan said: “The report also highlights that the majority of these deaths were attributable to multiple factors rather than a single cause.

“It is crucial that lessons are learnt from each death and that front-line staff are given the resources they need to deliver safe care to every woman and baby.”

Today’s announcement will give new rights to families affected by stillbirth or injury during birth – with a potential impact on future litigation rates.

Health Secretary Jeremy Hunt said all affected families would be offered an investigation by the new Healthcare Safety Investigation Branch – and that he would consider allowing coroners to investigate full-term stillbirths.

There will also be a programme to train consultant physicians in maternal medicine. 12 of these posts will be created.

* A second report today estimates that 0.5% of babies born in England suffer a condition linked to brain injury.

The research was conducted by the Neonatal Data Analysis Unit at Imperial College, London, UK, and reported in the Archives of Disease in Childhood.

The most common cause in full-term babies was hypoxic ischaemic encephalopathy. In pre-term babies the most common cause was periventricular haemorrhage.

Chris Gale et al. Neonatal brain injuries in England: population based
incidence derived from routinely recorded clinical data held in the National Neonatal Research Database Archives of Disease in Childhood 28 November 2017

Tags: Childbirth and Pregnancy | NHS | Nursing & Midwifery | UK News

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