Safer maternity care: progress and next steps

The Department of Health has now published Safer Maternity Care: the National Maternity Safety Strategy progress and next steps.  This document reports on progress and next steps with implementation of the safer maternity care action plan and sets out measures for further and quicker improvement.  The Department has also published ‘Brain injury report’ which provides a working definition of brain injuries occurring during or soon after birth, and presents national annual brain injury rates from 2010 to 2015 for England

Families who suffer stillbirth or life-changing injuries to their babies will be offered an independent investigation to find out what went wrong and why. The government is also bringing forward from 2030 to 2025 the ambition to halve rates of stillbirths, neonatal and maternal deaths, and brain injuries occurring during or soon after birth.

Download the full report here
Read the DH press release here
Royal College of Midwives press release here

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MBRRACE-UK perinatal confidential enquiry report: term, singleton, intrapartum stillbirth and intrapartum related neonatal death

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Image Source: NPEU

This report from MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) looks at the quality of care received by babies who were either still born or who died shortly after birth. It provides a picture of current challenges faced by maternity and neonatal units and an opportunity to improve services for women and families and prevent similar deaths in the future. This type of death occurred in 225 pregnancies in 2015 in the UK. Findings from the report include:

  • The rate of term, singleton, intrapartum stillbirth and intrapartum-related neonatal death has more than halved since 1993 representing a reduction of around 220 intrapartum deaths per year.
  • Capacity issues were identified as a problem in over a quarter of the cases undergoing panel review. The majority of staffing and capacity problems were related to delivery suite.
  • The panel consensus was that in nearly 80% of deaths improvements in care were identified which may have made a difference to the outcome for the baby
  • There is an increasing proportion of births to mothers who have risk factors associated with an increased risk of perinatal death

As well as the full report available here, you can read a lay summary here
an executive report and lay summary here
an infographic here.

The Royal College of Paediatrics and Child Health (RCPCH) have responded to the report here.
A joint response from the Royal College of Obstetricians and Gynaecologists/Royal College of Midwives is also available here

Financial incentives may increase breastfeeding rates

 

baby-21167_1920Research published in the Journal of the American Medical Association has found that offering new mothers financial incentives may significantly increase low breastfeeding rates.  Effect of financial incentives on breastfeeding: a cluster randomized clinical trial reports on the study which involved more than 10,000 new mothers across South Yorkshire, Derbyshire and North Nottinghamshire being offered shopping vouchers worth up to £120 if their babies received breast milk at two days, 10 days and six weeks old. A further £80 of vouchers was available if their babies continued to receive breast milk up to six months.

Effect of Financial Incentives on Breastfeeding: A Cluster Randomized Clinical Trial
Clare Relton, PhD; Mark Strong, PhD; Kate J. Thomas, MA; et al
JAMA Pediatr. Published online December 11, 2017. doi:10.1001/jamapediatrics.2017.4523

“As the scheme was tested in areas with low breastfeeding rates (just 28 per cent of babies were receiving any breast milk at six-eight weeks), we were delighted that 46 per cent of all eligible mothers signed up to the scheme and over 40 per cent claimed at least one voucher. The trial found a significant increase in breastfeeding rates in areas where the scheme was offered”
Principal investigator Dr Clare Relton, from the University of Sheffield’s School of Health and Related Research (ScHARR)

Read the Sheffield University press release here
Read the full paper here

Congenital Cytomegalovirus Infection: Update on Treatment (Scientific Impact Paper No. 56)

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Image Source: NHS Photolibrary

Cytomegalovirus (CMV), a member of the human herpesvirus family, is the most common viral cause of congenital infection, affecting 0.2–2.2% of all live births. It is responsible for significant morbidity, especially in infants who are symptomatic in the neonatal period. It is the leading non-genetic cause of sensorineural hearing loss and a major cause of neurological disability. Around 10–15% of neonates with congenital CMV will be symptomatic at birth, with a similar percentage developing problems later in childhood.

This Scientific Impact Paper summarises the issues around screening, diagnosis and treatment of CMV in pregnancy, utilising the best available evidence and highlighting recent advances.

Read the full Scientific Impact Paper here 

Khalil AHeath PJones CSoe AVille YG on behalf of the Royal College of Obstetricians and GynaecologistsCongenital Cytomegalovirus Infection: Update on Treatment. Scientific Impact Paper No. 56BJOG 2017; DOI: 10.1111/1471-0528.14836.

Multiple birth babies requiring neonatal care

Twin pregnancy

The Twins and Multiple Births Associations (Tamba) has published Twin pregnancy and neonatal care in England: a Tamba report November 2017.  This report includes information from neonatal networks for stillbirth rates, neonatal death rates, NICE compliance and neonatal admissions for twins.  The authors suggest admissions of twins to neonatal units could be reduced by a third per year if all neonatal networks had the lowest admission rate.

 

Read the full report here

Read the RCM press release here

NIHR Signal – Aspirin reduces a woman’s chance of developing pre-eclampsia in pregnancy

Asprins Flickr
Image Source: Flickr

Giving low dose aspirin to high-risk women reduced their risk of pre-eclampsia before 37 weeks of pregnancy. Preterm pre-eclampsia developed in 1.6% of women given 150mg aspirin daily compared with 4.3% who took a placebo.

Pre-eclampsia is a condition which can harm mother and baby. In the mother, it causes high blood pressure and protein in the urine, which can show in pregnancy after 20 weeks. Women with risk factors, such as previous pre-eclampsia, diabetes or high blood pressure, are often prescribed 75mg aspirin from 12 weeks onwards. This study aimed to test double this dose (still classified as a `low dose’) after using a new risk assessment with additional clinical tests to better identify those at high risk of the condition. Aspirin did not affect other pregnancy outcomes and didn’t increase the risk of adverse effects.

This research adds to current knowledge about the range of doses that is effective and refines the definition and detection of women at high risk. The research did not compare 75mg with 150mg doses.

Read the full signal here

NHS maternity statistics, England 2016 to 2017

For the first time these statistics from NHS Digital will combine reporting from two data sources for maternity information – Hospital Episode Statistics (HES) and Maternity Services Data Set (MSDS) – to give a fuller picture of NHS maternity activity for deliveries in 2016/17. This publication was previously named Hospital Maternity Activity.

Key Facts

HES data
• There were 636,401 deliveries in NHS hospitals during 2016-17, a decrease of 1.8 per cent from 2015-16.
• The proportion of deliveries with a spontaneous onset of labour has decreased from 68.7 per cent in 2006-07 to 55.1 per cent in 2016-17.
• The proportion of deliveries where labour was induced has increased from 20.3 per cent in 2006-07 to 29.4 per cent in 2016-17.

MSDS data
• In 2016-17, 355,850 deliveries were recorded within the MSDS by 111 maternity service providers.
• 80.0 per cent of women with babies born at 37 weeks gestation or more had skin-to-skin contact within one hour of the birth.
• 11.6 per cent of women with a recorded smoking status at their booking appointment were smokers.

Download  the full statistics  here