Retrospective cohort study of all deaths among infants born between 22 and 27 completed weeks of gestation

The aim of this research is to assess causes and circumstances of deaths in extremely low gestational age neonates (ELGANs) born in Switzerland over a 3-year period | BMJ Open

Design: Population-based, retrospective cohort study.

Setting: All nine level III perinatal centres (neonatal intensive care units (NICUs) and affiliated obstetrical services) in Switzerland.

Patients: ELGANs with a gestational age (GA) <28 weeks who died between 1 July 2012 and 30 June 2015.

Results: A total of 594 deaths were recorded with 280 (47%) stillbirths and 314 (53%) deaths after live birth. Of the latter, 185 (59%) occurred in the delivery room and 129 (41%) following admission to an NICU. Most liveborn infants dying in the delivery room had a GA ≤24 weeks and died following primary non-intervention. In contrast, NICU deaths occurred following unrestricted life support regardless of GA. End-of-life decision-making and redirection of care were based on medical futility and anticipated poor quality of life in 69% and 28% of patients, respectively. Most infants were extubated before death (87%).

Conclusions: In Switzerland, most deaths among infants born at less than 24 weeks of gestation occurred in the delivery room. In contrast, most deaths of ELGANs with a GA ≥24 weeks were observed following unrestricted provisional intensive care, end-of-life decision-making and redirection of care in the NICU regardless of the degree of immaturity.

Full reference: Berger, T.M. et al. (2017) Retrospective cohort study of all deaths among infants born between 22 and 27 completed weeks of gestation in Switzerland over a 3-year period. BMJ Open. 7:e015179

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

New leaflet and poster on reduced fetal movement

This leaflet and poster on reduced fetal movement was developed by Tommy’s and NHS England with support from Kicks Count and other charities.

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Image source: tommys.org

The ‘Feeling your baby move is a sign that they are well’ leaflet was developed by Tommy’s and NHS England with support from other charities.

The leaflet contains clear messaging on reduced fetal movements consistent with national guidelines.

It aims to tackle the myths and untrue messaging that women are likely to experience in pregnancy around this topic, such as:

  • the baby’s movements slow down in the the third trimester because it runs out of room
  • if the baby’s has ten movements in a day it is fine
  • women can’t be checked at the weekend.

This leaflet was developed in partnership with NHS England as part of the Stillbirth Care Bundle. The aim of the leaflet is to raise awareness of the importance of monitoring fetal movements and reporting reduced movements.

Read the full overview here

View the leaflet here

View the A3 poster here

Updated Sands guidance launched

Dabrowski, R. Royal College of Midwives. Published online: 16 September 2016

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Image source: Sands

The new edition of Sands’ Pregnancy loss and the death of a baby: guidelines for professionals is now available. The fourth edition, in which there are four new chapters, was officially launched this week. The new chapters are ‘Termination of pregnancy for fetal anomaly or maternal medical conditions’; ‘Labour and birth when a baby has died’; ‘Mental health’; and ‘Receiving and responding to feedback: parent experiences’. The first two are an expansion of a single chapter in the previous edition, the latter two are entirely new.

It is a comprehensive update of the previous 2007 edition and contains vital information for professionals regarding losses at any stage during pregnancy.

Sands resources for professionals are available here

Each Baby Counts

The Royal College of Obstetricians & Gynaecologists has published the first annual report from the Each Baby Counts initiative.

The report identifies that the quality of local investigations into cases of stillbirth, early neonatal death and severe brain injury occurring as a result of incidents during term labour must improve.  27% of the 921 reports examined so far were classed as poor quality.  This is an early brief report which has been released as there are clear messages for improvement identifiable from the interim data.

Additional link: RCOG press release