Each baby counts

Royal College of Obstetricians and Gynaecologists | March 2020 | Each Baby Counts: 2019 progress report

The Royal College of Obstetricians and Gynaecologists has published its progress report for 2019: Each Baby Counts: 2019 progress report. 

The Each Baby Counts is a national quality improvement programme that collates the results of local investigations into stillbirths, neonatal deaths and brain injuries occurring during term labour to understand the bigger picture, share the lessons learned and prevent babies from dying or suffering brain injuries in the future.

 

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Image source: rcog.org.uk

This report presents key findings and recommendations based on the analysis of data relating to the care given to mothers and babies throughout the UK, to ensure each baby receives the safest possible care during labour.

The report can be read online chapter by chapter or downloaded in full from the Royal College of Obstetricians and Gynaecologists

 

New mothers in England to receive health check six weeks after giving birth

The Guardian| February 2020 | New mothers in England to receive health check six weeks after giving birth

From April 2020 new mums in England who have babies in England will undergo an assessment of their health and wellbeing with either a GP or practice nurse at the surgery. 

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The appointments will be dedicated to exploring the mother’s health and be separate to the six-week check that all babies already receive. However, many of them will occur immediately before or after the infant’s check, to make the best use of mothers’ and NHS staff’s time.

As reported in The Guardian 

NHS England: Implementing routine outcome monitoring in specialist perinatal mental health services

NHS England | December  2019 | Implementing routine outcome monitoring in specialist perinatal mental health services

NHS England has released a new publication, which focuses on good practice examples, tools, tips and information to help perinatal mental health (PMH) services embed appropriate perinatal mental health outcomes measures at a local level, using outcome measures that are already part of the Mental Health Services Dataset (Source: NHS England).

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Image source: england.nhs.uk

 

Implementing routine outcome monitoring in specialist perinatal mental health services

Saving Lives, Improving Mothers’ Care 2019

Maternal, Newborn and Infant Programme: Saving Lives, Improving Mothers’ Care 2019 | 13 Dec 2019 |  Healthcare Quality Improvement Partnership

This report, the sixth MBRRACE-UK annual report of the Confidential Enquiry into Maternal Deaths and Morbidity, includes surveillance data on 549 women who died during or up to one year after pregnancy between 2015 and 2017 in the UK.

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Image source: https://www.hqip.org.uk/

In addition, it includes Confidential Enquiries into the care of women who died between 2015 and 2017 in the UK and the Republic of Ireland from cardiovascular causes, hypertensive disorders, early pregnancy conditions and accidents.

The report also includes a Morbidity Confidential Enquiry into the care of women with newly diagnosed breast cancer.

This report can be read as a single document; each chapter is also designed to be read as a standalone report: the topics covered are:

  1. Surveillance of maternal deaths
  2. Cardiovascular diseases
  3. Morbidity from breast cancer
  4. Hypertensive disorders
  5. Early pregnancy disorders
  6. Accidents
  7. Critical maternal care.

You can download the report from the Healthcare Quality Improvement Partnership

See also: Key messages Infographic 

Planned delivery reduces impact of potentially fatal pregnancy complication, trial finds

NIHR | September 2019| Planned delivery reduces impact of potentially fatal pregnancy complication, trial finds

The Lancet has now published the findings of a trial that aimed to determine whether planned earlier initiation of delivery reduces maternal adverse outcomes without substantial worsening of neonatal or infant outcomes, compared with expectant management (usual care) in women with late preterm pre-eclampsia.

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Researchers from King’s College London carried out the PHOENIX trial comparing the current and new methods in women suffering from pre-eclampsia at 34-37 weeks of pregnancy, to see if they could reduce adverse outcomes for the mother such as hypertension, and without impacting substantially on the baby.

In women with late preterm pre-eclampsia, the optimal time to initiate delivery is unclear because limitation of maternal disease progression needs to be balanced against infant complications.

Lead author Professor Lucy Chappell from King’s Department of Women & Children’s Health said: “Our trial supports offering initiation of delivery in women with late preterm pre-eclampsia. Doctors and women will need to consider the trade-off between lower maternal complications and severe hypertension against more neonatal unit admissions, but the trial results tell us that these babies were not sicker from being born earlier. We suggest that these results should be discussed with women with late preterm pre-eclampsia to allow shared decision making on timing of delivery.” (Source: NIHR)

NIHR press release Planned delivery reduces impact of potentially fatal pregnancy complication, trial finds

Full reference: Chappell, L.C., et al | 2019| Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial finds | The Lancet | DOI:https://doi.org/10.1016/S0140-6736(19)31963-4

Summary
Background

In women with late preterm pre-eclampsia, the optimal time to initiate delivery is unclear because limitation of maternal disease progression needs to be balanced against infant complications. The aim of this trial was to determine whether planned earlier initiation of delivery reduces maternal adverse outcomes without substantial worsening of neonatal or infant outcomes, compared with expectant management (usual care) in women with late preterm pre-eclampsia.

Methods

In this parallel-group, non-masked, multicentre, randomised controlled trial done in 46 maternity units across England and Wales, we compared planned delivery versus expectant management (usual care) with individual randomisation in women with late preterm pre-eclampsia from 34 to less than 37 weeks’ gestation and a singleton or dichorionic diamniotic twin pregnancy. The co-primary maternal outcome was a composite of maternal morbidity or recorded systolic blood pressure of at least 160 mm Hg with a superiority hypothesis. The co-primary perinatal outcome was a composite of perinatal deaths or neonatal unit admission up to infant hospital discharge with a noninferiority hypothesis (non-inferiority margin of 10% difference in incidence). Analyses were by intention to treat, together with a per-protocol analysis for the perinatal outcome.

The trial is closed to recruitment but follow-up is ongoing.

Findings

Between Sept 29, 2014, and Dec 10, 2018, 901 women were recruited. 450 women (448 women and 471 infants  analysed) were allocated to planned delivery and 451 women (451 women and 475 infants analysed) to expectant management. The incidence of the co-primary maternal outcome was significantly lower in the planned delivery

group (289 [65%] women) compared with the expectant management group. The incidence of the co-primary perinatal outcome by intention to treat was significantly higher in the planned delivery group (196 [42%] infants) compared with the expectant management group. The results from the per-protocol analysis were similar. There
were nine serious adverse events in the planned delivery group and 12 in the expectant management group.
Interpretation There is strong evidence to suggest that planned delivery reduces maternal morbidity and severe hypertension compared with expectant management, with more neonatal unit admissions related to prematurity but no indicators of greater neonatal morbidity. This trade-off should be discussed with women with late preterm
pre-eclampsia to allow shared decision making on timing of delivery

The full article is available from The Lancet

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[NICE Guideline update] Preterm labour and birth

NICE| August 2019| Preterm labour and birth NICE guideline [NG25]

NICE has updated Preterm labour and birth guideline 

This guideline covers the care of women at increased risk of, or with symptoms and signs of, preterm labour (before 37 weeks), and women having a planned preterm birth. It aims to reduce the risks of preterm birth for the baby and describes treatments to prevent or delay early labour and birth.

In August 2019, NICE made new recommendations on prophylactic vaginal progesterone and prophylactic cervical cerclage for preterm labour and birth. For further details see update information (Source: NICE).

See NICE for full details