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Experts identify gaps in care affecting stillbirth

Six in 10 stillbirths are potentially avoidable, says report

Adrian O'Dowd

Thursday, 19 November 2015

Experts have identified several ways of potentially reducing the rates of stillbirths in the UK by improving antenatal care, according to a report published today.

An investigation by a team of experts into 133 cases of stillbirth in 2013 found that national guidance was not followed by hospitals in the majority of cases and identified missed opportunities which could have potentially saved babies lives.

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

A team of academics, clinicians and charity representatives, called MBRRACE-UK, looked at how care for these mothers and term babies could be improved.

The report, commissioned by the Healthcare Quality Improvement Partnership as part of the maternal, newborn and infant clinical outcome review programme, was led by a team from the University of Leicester.

In the report, the group examined stillbirths born at term who were singletons (sole births) and not affected by a congenital anomaly.

They studied a random representative sample of 133 of these babies who were stillborn in 2013. The pregnancy notes were assessed for all 133 and 85 were reviewed in detail against national care guidelines.

The investigation 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.

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, but in half of these cases there were missed opportunities to potentially save the baby including a lack of investigation.

Only half of the stillbirths selected for confidential enquiry had a post mortem carried out, but in the majority of cases, post mortems were of satisfactory or good quality.

The experts recommended full implementation of national guidance such as that which governs screening and identification of women who should be offered testing to detect those at risk of developing diabetes in pregnancy.

There should be better management of reduced fetal movements and identification of additional risk factors and standardised multidisciplinary review of all term stillbirths.

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.”

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.

“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.”

Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists, 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.”

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