Thursday 19 November 2015

A new report, the MBRRACE-UK National Confidential Enquiry into antepartum term stillbirths, suggests improvements in quality of care could save hundreds of babies’ lives every year.

Researchers conducting a confidential enquiry into antepartum term stillbirths, that is, babies who die before labour but around the time they are due to be delivered, found that half of all term stillbirths were associated with major gaps in quality of care.  The enquiry consists of multi-disciplinary panels of experts examining the medical records of 85 stillbirth cases (which were representative of the more than 1000 stillbirths which occurred in 2013) and assessing their care against existing antenatal guidelines.

The enquiry has revealed vital opportunities were missed that could potentially have saved babies’ lives. These included:

•    Two out of three women with a risk factor for developing diabetes in pregnancy were not offered testing – a missed opportunity to monitor those pregnancies more closely and potentially save the baby.

•    National guidance for screening and monitoring the growth of the baby through pregnancy was not followed for two out of three stillbirths the panels 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 pregnancies, there were missed opportunities to potentially save the baby including not following up on the woman’s concerns, misinterpreting the baby’s heart trace or failing to respond appropriately to other factors.

•    From the case notes researchers investigated, it was clear that only one in four stillbirths were reviewed internally to understand whether the baby’s stillbirth might have been avoided with better care and to learn lessons for the future. Even the quality of these few reports was highly variable.

Extrapolating these findings to all births indicates that about 500 term stillbirths in the UK in 2013 (the year the report took case studies from) would have had a major issue in the care leading up to the stillbirth, where better care may have prevented the death

Judith Abela, Acting Chief Executive of Sands said:

“One in three babies who are stillborn die at term, a time when they are likely to have survived outside the womb had they been safely delivered earlier. This equates to over 1000 babies in 2013.

“It’s alarming that 15 years after a similar report, there are still critical gaps in antenatal care, suggesting we have learnt very little in the interim. This report confirms the concerns of hundreds of parents Sands supports every year: that not enough is being done to prevent babies from dying.

“Jeremy Hunt pledged last Friday to halve the stillbirth rate by 2030. But this report tells us hundreds of deaths could be avoided today simply by applying existing antenatal guidelines.  It’s particularly worrying that so many women’s concerns about changes in their baby’s movements are not being taken seriously and that a baby’s poor growth is not being spotted by simple checks.

“Tragically, the variability of hospital reviews following a stillbirth at term suggests we are not even learning when things go wrong. The Secretary of State has pledged to develop a new web-based review tool to help hospitals understand where care is failing. Sands and the Department of Health have already done the ground work for this initiative. It’s now of vital importance to get this work started.

“It is heartening to see that over half of women received good bereavement care although there are still gaps in care for many. Sands has played a significant part in developing and sharing good bereavement care. We trained over 1600 midwives in caring for bereaved families in the last financial year alone. But the ultimate goal must be to have fewer stillbirths and fewer bereaved parents to support.”

Ends

Notes to editors:

Attached is the press release issued by the University of Leicester that includes a link to the MBRRACE-UK Perinatal Confidential Enquiry: Term, singleton, normally formed, antepartum stillbirth report.

The report, commissioned by the Healthcare Quality Improvement Partnership as part of the Maternal, Newborn and Infant Clinical Outcome Review Programme, run by MBRRACE-UK, is led by a team from the University of Leicester.  It is launched on 19 November at The Royal College of Obstetricians and Gynaecologists.

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