Learnings to be made from report into stillbirth and neonatal deaths

A Perinatal Confidential Enquiry report released by MBRRACE-UK, the collaboration appointed by the Healthcare Quality Improvement Partnership, has highlighted how certain stillbirth and neonatal deaths may have had different outcomes had different care have been provided.

The report highlights that there has been a reduction in the number of stillbirths and neonatal deaths within the UK, from 0.62 to 0.28 per 1000 total births since 1993. This is thought to represent a decrease of 220 intrapartum (term) deaths per year.

Whilst it is promising to see a reduction in the mortality rate the report does highlight certain areas for concern and suggests that the mortality rate may further be reduced should important actions be implemented. In instances where the quality of care has negatively impacted the outcome for mother and baby, the hospitals in question may be subject to a medical negligence claim in order to seek compensation.

The MBRRACE- UK report specifically studied stillbirth and neonatal deaths, born at term who were alive at the start of labour and were known to not have a major congenital abnormality. During 2015 this accounted for 5% of perinatal deaths with a total of 225 babies dying under such circumstances.

The report chose a representative sample of 78 deaths of babies in 2015. They then reviewed in extensive detail the care that the baby and mother received during this time period and compared this against national guidelines and standards with a panel of clinicians – including midwives, bereavement midwives, obstetricians, neonatal nurses and pathologists. The clinical team looked at each element of the care received in each individual circumstances and determined that in 80% of these cases, different care may have resulted in a different outcome for the baby.

In particular the report highlighted that in at least 25% of the cases reviewed there were problems with inadequate staffing and resources which could have impeded safe care. In instances where the quality of care was directly impacted by a lack of available staff the hospitals in question may be subject to a hospital negligence claim as part of a birth injury claim.

Additional findings of the report included:

  • Guidelines were not always followed when monitoring the baby’s heart rate which led to delays when babies needed to be delivered urgently,
  • Heavy workload contributed to delays in induction in one third of women being induced,
  • Those who had previously had a caesarean section did not always have a clear discussion regarding their birthing plan,
  • There were issues recognising when a woman had moved to established labour and appropriate monitoring was not always initiated,
  • One in three neonatal deaths did not have a post-mortem examination or placental histology conducted,
  • 95% of intrapartum related deaths were reviewed, however nine out of ten reviews were of poor quality and did not follow guidance for serious incident reviews.

It is hoped that the findings of this report will be sufficient for learnings to be made to avoid similar instances occurring and to help further reduce the number of those affected by stillbirths or neonatal deaths.

 

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