Reducing baby deaths and injuries

Teamwork in maternity units key to reducing baby deaths and brain injuries during childbirth. Adherence to best practice on fetal monitoring and neonatal care also identified as crucial to improving outcomes

The Royal College of Obstetricians and Gynaecologists has published Each Baby Counts: 2015 Summary Report. The report provides a detailed analysis of all stillbirths, neonatal deaths and brain injuries that occurred during childbirth in 2015 and identifies the key clinical actions needed to improve the quality of care and prevent future cases. These clinical actions include: improving fetal monitoring; enhancing neonatal care; and reducing human factors by understanding ‘situational awareness’ to ensure the safe management of complex clinical decisions.

The full report can be downloaded here

Additional links: Each Baby Counts project | Royal College of Midwives news | BBC News report

Inducing labour in older women having their first baby does not increase the chance of caesarean delivery

Planning to artificially start labour for older women, pregnant with their first child, in the 39th week of pregnancy does not affect the chance of having a caesarean delivery | NIHR Signal

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Image source: NIHR

Older women having a first baby have a higher risk of stillbirth and other complications than younger mothers and inducing labour at or before the due date is thought to reduce this risk. However, there have been fears that inducing labour may raise the risk of a caesarean delivery.

This study found that women aged 35 or over having their first child and who were induced at 39 weeks had no higher risk of a caesarean (32%) than women who had standard wait-and-see care (33%) with intervention if necessary.

It’s important to note that this study did not investigate whether women whose labour was induced had a lower risk of stillbirth. A large trial is in progress to investigate this issue. In the meantime, the findings may reassure some women aged over 35 that labour induction may carry no more risk of having a caesarean than spontaneous labour.

Read the full overview here

Labor or Cesarean for Superobese Women?

Rates of severe maternal and neonatal morbidity were similar among superobese women undergoing primary cesarean delivery versus a trial of labor, most often ending in vaginal delivery | Clinical Anesthesiology

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Researchers say a prospective clinical trial is needed to determine whether one method of birth is superior to the other in mothers who are superobese.

According to Alexander Butwick, MBBS, FRCA, MS, among women who are superobese, rates of cesarean delivery are particularly high (≥50%), but little has been known about how delivery mode affects perinatal and neonatal outcomes. Dr. Butwick, who presented the findings at the 2016 annual meeting of the Society for Obstetric Anesthesia and Perinatology (abstract 01-02), is associate professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine, in California.

Over the years, clinicians have observed that obesity is associated with an increased risk for obstetric, perinatal and anesthetic morbidities. Obese pregnant women are at an increased risk for gestational diabetes, preeclampsia, operative delivery, postpartum infection and venous thromboembolism.

Read the full article here

Saving Babies Lives

NHS England’s National Clinical Director for the Maternity Review and Women’s Health evaluates the Saving Babies’ Lives Care Bundle for reducing stillbirths | NHS England

It has never been safer to give birth in this country, but there is more that we can do and reducing stillbirth continues to be a priority for the NHS.

There are currently around 665,000 babies born in England each year. But there are over 3,000 stillbirths. While the majority of women receive high quality care, there is around a 25 per cent variation in the stillbirth rates across England. This presents us with an opportunity to make improvements.

In March last year a new set of guidance called the Saving Babies’ Lives Care Bundle was launched by the NHS England Maternity Transformation Programme, as part of a drive to halve the rate of stillbirths from 4.7 per thousand to 2.3 per thousand by 2030 – potentially avoiding the tragedy of stillbirth for more than 1,500 families every year.

The package was developed by groups brought together by NHS England, including midwives, obstetricians and representatives from stillbirth charities.

It brings together four elements of care identified by best available evidence and good practice to help reduce stillbirth rates. These include:

  1. Reducing smoking in pregnancy
  2. Risk assessment and surveillance for fetal growth restriction
  3. Raising awareness of reduced fetal movement, and
  4. Effective fetal monitoring during labour.

Read more via NHS England

UK maternity care

MBRRACE-UK has published Saving Lives, Improving Mothers’ Care: Surveillance of maternal deaths in the UK 2012–14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–14.

The report presents the findings of maternal mortality surveillance 2012 to 2014 in the UK and the lessons learned from the confidential enquiries into maternal deaths from cardiovascular causes, blood pressure disorders of pregnancy, early pregnancy causes together with messages for critical care.

MBRRACE-UK Maternal Report 2016 – Full Report

MBRRACE-UK Maternal Report 2016 – Lay Summary

Additional link: RCOG press release

Intrapartum care for healthy women and babies

NICE has updated its clinical guideline Intrapartum care for healthy women and babies (CG190). This guideline covers the care of healthy women and their babies during labour and immediately after the birth.  NICE has reviewed the evidence on the effectiveness of midwife-led continuity models and other models of care and deleted a recommendation about team midwifery.

This guideline includes recommendations on:nice-logo

  • choosing place of birth
  • the latent first stage of labour
  • initial and ongoing assessment
  • transfer of care
  • pain relief and monitoring during labour
  • care in the first, second and third stages of labour
  • care of the baby and woman after the birth

NICE calls for increased use of magnesium sulfate in preterm labour

NICE | Published online: 19 October 2016

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Image source: NICE

The new quality standard highlights the key areas where preterm labour and birth services need to improve.

Studies show the risk of cerebral palsy in babies is significantly lower when women who may give birth early are treated with magnesium sulfate, which can protect developing babies’ brains.

The standard also calls for women who have previously lost a baby mid-trimester or had a previous preterm birth to be offered treatment to prevent the cervix opening early to delay labour and birth.

Professor Gillian Leng, deputy chief executive of NICE, said:

“We know the risks of long-term developmental problems are greater the earlier a baby is born. This quality standard highlights key issues, originally raised in the NICE guideline on Preterm labour and birth, where care needs to improve. For instance the quality standard calls for greater use of magnesium sulfate in women at risk of a preterm birth, which we know has significant potential to reduce disability among babies born preterm.”

The guidance also recommends certain pregnant women are offered maternal corticosteroids, which help with babies’ lung development.

Read the overview here

Read the full guidance here