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Preventing stillbirths : should more be done?

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    Rosie Blacker writes about a recent national enquiry into stillbirths in the UK, the issues raised and considers the future in light of this enquiry and whether changes could and should be implemented to reduce the number of stillbirths.

    By Rosie Hodgetts

I was shocked and saddened to read this week in the latest MBRRACE-UK National Confidential Enquiry into antepartum term stillbirths, that hundred of babies’ lives could be saved each year if improvements were made to the quality of care offered to pregnant women. This, coupled with Jeremy Hunt’s pledge to reduce the number of stillbirths, neonatal and maternal deaths in England by 2030 raises questions about whether more could and should be done in the UK?

What are stillbirths and how often do they occur?

Antepartum term stillbirths were the subject of this latest enquiry and refer to instances where a baby dies before labour has started but around the time they are due to be delivered.

It is believed that in 2013, there were more than 1,000 instances of antepartum term stillbirths and 85 of these were studied in the latest enquiry.

There are of course also cases where a baby may sadly pass away during or shortly after birth and, it is estimated that in 2013, this accounted for a further 4712 deaths (Sands response to Health Secretary announcement of drive to cut stillbirths and neonatal deaths by half by 2030)

What has the MBRRACE-UK National Confidential Enquiry Found?

In the latest confidential enquiry, the care offered to pregnant mothers was assessed against existing antenatal guidelines.

Of concern to me, the enquiry found that vital opportunities were missed which may have ultimately saved babies’ lives, most significantly, it was revealed that:

1. 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.

2. Only 1 in 4 stillbirths were reviewed internally to understand whether the baby’s stillbirth could have been avoided.

3. Almost half of the women  had previously contacted their maternity units with concerns about changes in their baby’s movements. A further half of these showed missed opportunities by medical staff such as misinterpreting the baby’s heart trace or failing to appropriately respond to other factors.

4. 2 out of 3 women with a risk factor for developing diabetes in pregnancy were not offered testing which meant that opportunities to monitor the pregnancy more closely and potentially save the baby were missed.

5. National guidelines for screening and monitoring the growth of the baby during the pregnancy were not followed in 2 out of 3 still births.

What can be done?

It seems that hundreds of stillbirths could have been prevented if existing antenatal guidelines were followed and if pregnant mother’s concerns about changes in the movement of their baby’s were listened to more closely and acted on accordingly – these are factors which can be controlled and therefore more could and should be done to ensure changes for the care of future pregnant women.

The Secretary of State, Jeremy Hunt has pledged to reduce the numbers of stillbirths, neonatal and maternal deaths and has suggested a new web based review tool be developed to help hospitals understand where the care they are providing may be failing and has pledged £500,000 toward this.

As clinical negligence Solicitors, I and my colleagues welcome improvements to the care offered to pregnant women but recognise that, as well as advances in technology, additional training for medical staff may be required in order to see a reduction in the number of tragic, avoidable deaths.

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