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Content ArticleExtreme preterm birth, defined as birth before 28 weeks’ gestational age affects about two to five in every 1000 pregnancies, and varies slightly by country and by definitions used. Severe maternal morbidity, including sepsis and peripartum haemorrhage, affects around a quarter of mothers delivering at these gestations. For the babies, survival and morbidity rates vary, particularly by gestational age at delivery but also according to other risk factors (birth weight and sex, for example) and by country. In this BMJ clinical update, Morgan et al. focuses on high income countries and provide a broad overview of extreme preterm birth epidemiology, recent changes, and best practices in obstetric and neonatal management, including new treatments such as antenatal magnesium sulphate or changes in delivery management such as delayed cord clamping and placental transfusion. The authors cover short and long term medical, psychological, and experiential consequences for individuals born extremely preterm, their mothers and families, as well as preventive measures that may reduce the incidence of extreme preterm birth.
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News Article
Blackpool death: Abortion sepsis risk training inadequate
Patient Safety Learning posted a news article in News
Doctors are receiving "inadequate" training about the risk of sepsis after a mother-of-five died following an abortion, a coroner has warned. Sarah Dunn, 31, died of "natural causes contributed to by neglect" in hospital on 11 April 2020, an inquest found. Assistant coroner for Blackpool and Fylde, Louise Rae, said Ms Dunn had been treated as a Covid patient even though the "signs of sepsis were apparent". Her cause of death was recorded as "streptococcus sepsis following medical termination of pregnancy". In her record of inquest, the coroner noted Ms Dunn was admitted to Blackpool Victoria Hospital in Lancashire on 10 April 2020. She was suffering from a streptococcus infection caused by an early medical abortion on 23 March, which had produced sepsis and toxic shock by the time she was admitted to hospital. The coroner said "signs of sepsis were apparent" before and at the time of Ms Dunn's hospital admission but she was instead treated as a Covid-19 patient. "Sepsis was not recognised or treated by the GP surgery, emergency department or acute medical unit and upon Sarah's arrival at hospital, the sepsis pathway was not followed," she added. Read full story Source: BBC News, 19 May 2022 -
Content ArticleSarah Louise Dunn was admitted to the Blackpool Victoria Hospital on 10 April 2020. She was suffering from a Group A Streptococus infection following an early medical abortion on 23 March 2020 which by the time of her admission at hospital had produced sepsis and had progressed to toxic shock. Signs of sepsis were apparent before and on her admission given Sarah’s history and symptoms but Sarah was treated upon admission to hospital as a Covid-19 patient. Prior to admission, Sarah had not been seen by a doctor on either 9 or 10 April despite contacting both her GP surgery and the Out of Hours Service. The surgery pharmacist had not read Sarah’s notes properly and was not aware on 9 April that she had recently had undergone an early medical abortion. Her GP on 1 April had not recorded his face to face consultation with her nor noted the possibility of infection. Sepsis was not recognised or treated by the GP surgery, emergency department or Acute Medical Unit and upon Sarah’s arrival at hospital, the sepsis pathway was not followed. Antibiotics were not given to Sarah until 7.5 hours after her arrival at hospital. Sarah suffered a seizure at 6.30pm on the Acute Medical Unit and was transferred to the Intensive Care Unit. These matters in aggregate impacted on her care and Sarah would not have died had she been admitted to hospital sooner. Sarah died on 11 April 2020 on the Intensive Care Unit at Blackpool Victoria Hospital at 2.15am.
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Content ArticleThe Queen’s Speech was debated on Tuesday 17 May 2022. Copied below is Baroness Julia Cumberlege's excerpts on fulfilling the recommendations of the Cumberlege Report for a redress scheme.
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Content ArticlePregnant women seeking asylum in the UK face many challenges in accessing healthcare and support during pregnancy and after birth. In this blog, Ros Bragg, director of Maternity Action, highlights evidence the organisation recently gave to the Women and Equalities Select Committee as part of their inquiry into equality and the UK asylum system. She highlights the inadequate level of financial support given to pregnant women seeking asylum, which means they are not able to eat healthily or buy necessary equipment during the perinatal period. She also draws attention to the fact that recent updates to the Home Office policy on dispersal for pregnant women - that state that they should not be moved more than once during pregnancy, and should be moved to suitable accommodation - are not being followed in practice. This prevents women seeking asylum from accessing consistent healthcare and building trust and relationships with midwives and other healthcare professionals.
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News ArticleWomen and babies in the UK are “dying needlessly” because of a lack of suitable medicines to use in pregnancy, according to a report that calls for a radical overhaul of maternal health. A “profound” shortage of research and the widespread exclusion of pregnant and breastfeeding women from clinical trials means hardly any new drugs are approved for common medical problems in pregnancy or soon after childbirth, the report finds. Meanwhile, scarce or contradictory information about the safety of existing medicines women may be taking for continuing conditions can make it impossible to reach a confident decision on whether or not to continue them in pregnancy, the experts add. “While pregnancy in the UK is generally considered safe, women and babies are still dying needlessly as a direct result of preventable pregnancy complications,” the authors say. Each year, 5,000 babies in the UK are either stillborn or die shortly after birth, while about 70 women die of complications in pregnancy. The Healthy Mum, Healthy Baby, Healthy Future report draws on evidence from patient groups, clinicians, researchers, lawyers, insurance specialists and the pharmaceutical industry, it proposes “urgent” changes to transform women’s access to modern medicine. The report highlights the “profound lack of research activity” and up-to-date information that leaves pregnant women and their physicians in the dark about whether to continue with certain medicines in pregnancy. Some epilepsy drugs, for example, can increase the risk of birth defects, but coming off them can put the woman at risk of severe seizures, which can also harm the baby. Lady Manningham-Buller said the situation “urgently needs to change”, with the report setting out eight recommendations to prevent needless deaths. Read full story Source: The Guardian, 12 May 2022
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News Article
Senegal midwives convicted over mother's death
Patient Safety Learning posted a news article in News
Three Senegalese midwives involved in the death of a woman in labour have been found guilty of not assisting someone in danger. They received six-month suspended sentences, after Astou Sokhna died while reportedly begging for a Caesarean. Her unborn child also died. Three other midwives who were also on trial were not found guilty The case caused a national outcry with President Macky Sall ordering an investigation. Mrs Sokhna was in her 30s when she passed away at a hospital in the northern town of Louga. During her reported 20-hour labour ordeal, her pleas to doctors to carry out a Caesarean were ignored because it had not been planned in advance, local media reported. The hospital even threatened to send her away if she kept insisting on the procedure, according to the press reports. Her husband, Modou Mboup, who was in court, told the AFP news agency that bringing the case to light was necessary. "We highlighted something that all Senegalese deplore about their hospitals," "If we stand idly by, there could be other Astou Sokhnas. We have to stand up so that something like this doesn't happen again." Read full story Source: BBC News, 11 May 2022 -
Content ArticleIn a UK-first report launched in the House of Commons, leading figures from charity, healthcare, industry, law and academia have outlined a collaborative vision for UK leadership to improve maternal health. The Healthy Mum, Healthy Baby, Healthy Future: The Case for UK Leadership in the Development of Safe, Effective and Accessible Medicines for Use in Pregnancy report proposes a clear roadmap to improve the lives of millions of people, not just for women while they are pregnant, but for future generations. Over the past year, a Birmingham Health Partners led Policy Commission – co-chaired by Baroness Manningham-Buller, Co-president of Chatham House and Professor Peter Brocklehurst, University of Birmingham – has heard from key stakeholders on how best to develop safe, effective and accessible medicines for use in pregnancy. Compelling evidence gathered throughout the process has informed eight critical recommendations which, if implemented by government, will successfully prevent needless deaths and find new therapeutics to treat life-threatening conditions affecting mothers and their babies.
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News Article
Covid vaccines are ‘safe for pregnant women and cut stillbirth risk’, study says
Patient Safety Learning posted a news article in News
Covid-19 vaccines are safe for pregnant women to take and can even reduce the risk of stillbirths, according to a new study. Researchers at St George’s University of London and the Royal College of Obstetricians and Gynaecologists collated data from studies and trials involving over 115,000 vaccinated pregnant women. They found that pregnant women – who are more likely to become serious ill if they catch Covid-19 – are 15% less at risk of stillbirth if vaccinated. “We wanted to see if vaccination was safe or not for pregnant women,” said Asma Khalil, professor of obstetrics and maternal fetal medicine at London’s St George’s Hospital in London to The Guardian. “It is safe, but what’s surprising, and it’s a positive finding, is that there was a reduction in stillbirths.” “So far, most of the data on vaccines in pregnancy have been about protecting the pregnant woman herself from Covid. Now we have evidence that the vaccines protect the baby too,” she added. Read full story Source: The Independent, 10 May 2022 -
News Article
Baby death mother 'was not seen by obstetrician'
Patient Safety Learning posted a news article in News
A woman whose baby died after sustaining severe brain damage during labour was not seen by an obstetrician during her pregnancy, an inquest heard. It meant his mother Eileen McCarthy was unable to discuss her birthing options. Walter German was starved of oxygen during a long labour at the Royal Sussex County Hospital in Brighton. Lawyers at Fieldfisher are pursuing a civil negligence case, claiming a C-section should have been offered due to a previous third-degree tear. Walter was born in December 2020. His life-support was turned off after nine days, as his injuries were unrecoverable. Recording a narrative verdict, coroner Sarah Clarke said Walter died as a result of his brain being starved of oxygen, likely due in part to an umbilical cord obstruction. She said: "Walter's mother was not seen by an obstetrician during her pregnancy and this led to her being unable to discuss birth options regarding delivery given her previous third degree tear. "Walter's mother was in the advanced stages of labour for a prolonged period of time with an indication for an earlier obstetric review being apparent." Read full story Source: BBC News, 4 May 2022 -
News Article
US Supreme Court may overturn abortion law, leak suggests
Patient Safety Learning posted a news article in News
The US Supreme Court could be about to overturn the nationwide legal right to abortion, according to an unprecedented leaked draft of a court document. In a 98-page draft opinion, Justice Samuel Alito writes that the 1973 Roe v Wade decision legalising abortion across the US is "egregiously wrong". If the top US court strikes down the ruling, "trigger laws" could instantly make abortion illegal in 22 US states. The justices are not expected to issue a ruling until early July. It sparked immediate outcry from Democrats, and protests - by both pro and anti-abortion supporters - outside the Supreme Court on Monday night. Speaker of the House of Representatives Nancy Pelosi and Senate Majority Leader Chuck Schumer - both Democrats - issued a joint statement saying that if the report was accurate, the "Supreme Court is poised to inflict the greatest restriction of rights in the past 50 years". News outlet Politico published the leaked document in full, quoting Justice Alito as saying: "Roe was egregiously wrong from the start. Its reasoning was exceptionally weak, and the decision has had damaging consequences. "And far from bringing about a national settlement of the abortion issue, Roe and Casey have enflamed debate and deepened division." Read full story Source: BBC News, 3 May 2022 -
Content Article
Maternity Action - Dignity in pregnancy
Patient-Safety-Learning posted an article in Maternity
This video by the organisation Maternity Action looks at the impact of UK Border Agency policies on pregnant women seeking asylum. The video highlights the unique challenges faced by women in this situation, including the risk of sudden deportation, lack of rights and mental health issues associated with trauma and lack of perinatal support. Two women share their stories of being pregnant and having young babies while in the asylum system. -
Content ArticleThis report represents the views of organisations and experts who responded to the Department of Health & Social Care's call for evidence on its Women's Health Strategy. The call for evidence was released in March 2021. This report focuses on submissions received from 436 organisations and individuals with expertise in women’s health, including the charity sector (34%), academia (22%), industry (10%), clinicians (7%), professional bodies (7%), pressure groups (7%), NHS organisations (3%), parliamentary groups (2%), royal colleges (1%), local government (1%), think tanks (1%) and others (6%).
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News Article
Pregnant women 'afterthought' in Covid jab rollout
Patient Safety Learning posted a news article in News
Pregnant women have been an "afterthought" during the coronavirus pandemic and some of their deaths were "preventable", a leading scientist has told Newsnight. Data shows there have been at least 40 maternal deaths from Covid in the UK. Almost all were unvaccinated and more than half happened after pregnant women were advised to take-up the vaccine. The regulator says vaccines during pregnancy are "safe". Professor Marian Knight, who investigates every maternal death in the UK, said lifesaving messaging is still "struggling" to reach pregnant women, a year on since all of them were advised to get vaccinated. Professor Knight said: "This has perhaps been the first year where my job has made me cry because that was a preventable situation." During the first months of the vaccine rollout, only pregnant health or care workers or those in at-risk groups were advised by the Joint Committee on Vaccination and Immunisation to "consider" the jab due to a "lack of evidence". In April 2021, the advice was updated to cover all pregnant women after real-world data raised no safety concerns. By December 2021, a year after the rollout began, pregnant women were deemed to be more at risk of falling seriously ill from Covid and were put on the priority list for jabs. Professor Knight, the maternal lead for pregnancy monitoring group MBRRACE-UK, said changing initial advice wasn't helpful, but stresses the JCVI had little choice because pregnant women were not included in Covid vaccine trials. "It's a complicated message," she said. "The message 'don't get vaccinated because we haven't got any information' is very subtly different from 'don't get vaccinated because it's not safe'. You may think, 'I can't get vaccinated because I'm pregnant, it must not be safe'. Whereas actually we don't yet have enough information." Read full story Source: BBC News, 20 April 2022 -
Content ArticleChildren born to women who take valproate during pregnancy are at significant risk of birth defects and persistent developmental disorders. As such, it is vital that women and girls are dispensed valproate safely. The General Pharmaceutical Council is reminding all pharmacy professionals of what they must do to ensure women and girls receive the right information about valproate and the risk of birth defects. The update includes
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Community Post
'Drug scandal that damaged 20,000 babies'
Patient Safety Learning posted a topic in Adverse interactions
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An investigation by The Sunday Times has found that the drug sodium valproate is still being handed out to women in plain packets with the information leaflets missing, or with stickers over the warnings. Sodium valproate, has been given to women with epilepsy for decades without proper warnings, and has caused autism, learning difficulties and physical deformities in up to 20,000 babies in Britain. The government is refusing to offer any compensation to those affected by sodium valproate, despite an independent review by Baroness Cumberlege concluding in 2020 that families should be given financial redress. Read the Twitter thread from Rebecca Bromley who has been working with families who have suffered:- Posted
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News Article
Mums-to-be still being given unsafe epilepsy drug
Patient Safety Learning posted a news article in News
The moment her newborn son Sebastian was handed to her, Catherine McNamara knew something was terribly wrong. His tiny hands were deformed, unnaturally twisted and facing in the wrong direction. One was missing a thumb. A few days later, the couple were devastated as doctors told them Sebastian’s deformities were permanent — and had been caused by the drug McNamara had been taking to control her epilepsy. Like thousands of women, McNamara had been told her epilepsy medicine, sodium valproate, was safe to take during pregnancy. “They told me everything would be fine,” she said. Sodium valproate, which was given to women with epilepsy for decades without proper warnings, has caused autism, learning difficulties and physical deformities in up to 20,000 babies in Britain. Yet despite a 2020 report that criticised the failure over four decades to inform women about the dangers, doctors are still not properly warning women of the risks. According to the latest data, published in March, sodium valproate was prescribed to 247 pregnant women between April 2018 and September 2021. An investigation by The Sunday Times has found that the drug is still being handed out to women in plain packets with the information leaflets missing, or with stickers over the warnings. The government is refusing to offer any compensation to those affected by sodium valproate, despite an independent review by Baroness Cumberlege concluding in 2020 that families should be given financial redress. The former health secretary Jeremy Hunt says doctors should now be banned from prescribing the drug to pregnant women — and that the families affected by it must be properly compensated. He has compared the case to the scandal of the anti-morning-sickness drug thalidomide, which caused deformities in thousands of babies after it was licensed in the UK in the 1950s. Read full story (paywalled) Source: The Sunday Times, 16 April 2022 -
Content ArticleThis report by the charity Maternity Action looked at the lived experience of pregnant women seeking asylum in the UK. It highlights that pregnant women face barriers in accessing appropriate housing and nutrition during pregnancy, and that midwives and voluntary sector organisations play an important role in supporting pregnant women seeking asylum.
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Content ArticleThis article examines the lasting impact of the tragic case of Daksha Emson, a 34-year old psychiatrist who took her own life and that of her baby daughter in an episode of postpartum psychosis. Daksha had a history of bipolar disorder and had attempted suicide before, and the inquiry into her death found that she received “significantly poorer standard of care than that which her own patients might have expected.” The authors highlight the impact of her story on the development in the UK of both specialist perinatal mental health services and specialised confidential services for health professionals, which remove some of the stigma attached to help-seeking.
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News Article
End ‘natural birth’ bias in midwife job ads, hospitals told
Patient Safety Learning posted a news article in News
NHS bosses have written to hospitals telling them to stop using language that implies a bias against caesarean sections when advertising jobs in maternity services. A recent report into an NHS maternity scandal found that a focus on “normal birth” had played a key role in babies dying or being born disabled. Women at the Shrewsbury and Telford trust were forced to undergo traumatic natural births when they should have been offered surgical intervention. However, even since its publication, trusts have published job adverts looking for a member of staff “to help us promote normality” or saying that they are “proud of our commitment to normal birth”. In a letter sent, Dr Matthew Jolly, NHS clinical director for maternity, and Professor Jacqueline Dunkley-Bent, chief midwifery officer, ask maternity services “to review the language that they are using about their services, in job adverts, and any other information designed to support decision-making on pregnancy and birth choices”. The letter continues: “There have been a number of concerns raised about the language used in some NHS trust maternity service job adverts and materials — phrases that suggest bias toward one mode of birth. “The NHS has a duty to provide safe and personalised care to women and families according to best practice guidance informed by evidence and the changes that are taking place in society, midwifery, maternity, and neonatal care services. “It is a fundamental requirement of a maternity multidisciplinary team to inform and listen to every woman, respect their views and help them to try and achieve the type of birth they aspire to.” Read full story (paywalled) Source: The Times, 15 April 2022 -
Content ArticleIn this blog for Refinery 29, journalist L'Oréal Blackett discusses the additional risk and associated worries faced by black pregnant women in the UK. With black women four times more likely to die in childbirth than white women, and 40% more likely to suffer a miscarriage, she examines what action the government is taking to improve outcomes for black women and their babies. She speaks to a number of campaigners who highlight the importance of including black women at every stage of research and policy to tackle race-based health inequalities, and who question whether this is being done by the UK government's new Maternity Disparities Taskforce. She also argues that empowering women to make informed, evidence-based decisions is the most effective way to improve maternal safety for black women.
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News ArticleExhausted after three sleepless days in labour, Jane O’Hara, then 34, screamed and burst into tears when the midwives and doctors at Harrogate District Hospital told her the natural birth she wanted was not going to happen. She ended up needing life-saving surgery and 11 pints of blood after a severe haemorrhage. Mercifully, Ivy was fine and is now a healthy 12-year-old. In recent weeks, the NHS has been rocked by the conclusions of an inquiry into the worst maternity disaster in its history: 201 babies and nine mothers died and another 94 babies suffered brain damage as a result of avoidable poor care at Shrewsbury and Telford Hospital NHS Trust. This has been linked to a culture of promoting natural — that is, vaginal — birth and avoiding caesarean sections. Blame thus far has been aimed largely at the NHS — but parents have started speaking out online about what they believe has been the role of the National Childbirth Trust (NCT), a leading provider of antenatal classes in Britain, in promoting vaginal births. “I can absolutely point to key decisions that I made that were influenced by the NCT’s mantra. I was led into a position where I believed I had more control over my birth than I actually did,” says O’Hara, who is now a professor of healthcare quality and safety at the University of Leeds. She believes she was a victim of a “normal birth” ideology that was heavily promoted at the NCT classes she attended. Read full story (paywalled) Source: The Times, 10 April 2022
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News Article
Thousands have PTSD symptoms after miscarriage
Patient Safety Learning posted a news article in News
Tens of thousands of women in the UK may be experiencing symptoms of post-traumatic stress disorder (PTSD) after miscarriages each year, a leading researcher warns. Prof Tom Bourne estimates the number affected could run to 45,000 annually. But he says most are not given prompt psychological support that could help prevent PTSD developing. The Miscarriage Association says there is an urgent need for better access to talking and other psychological therapies for those affected. At present, most women have to ask for help themselves rather than support being in place. Prof Bourne believes there needs to be more research into other ways of helping people experiencing loss. His team is trying out a variety of new approaches - including virtual reality - to help address the issue. One idea his team is experimenting with is offering women virtual reality headsets during miscarriage procedures. It builds on previous work that shows VR headsets can help reduce pain during some medical procedures. Researcher Dr Nina Parker says the aim is "to transport them to sort of a more calm, virtual reality world for distraction from the pain and anxiety during the procedure". She adds: "There is nothing that we are ever going to be able to do that takes away from the loss and the trauma of losing pregnancy and having a miscarriage. "But if we can do everything that we can to minimise any additional trauma we might be adding to in the interactions that are had within the hospital, then we are obligated to do that." Read full story Source: BBC News, 8 April 2022 -
Content ArticleIn the 1790s, François Marie Prevost, a young French surgeon fresh from his medical training in Paris moved to Port-de-Paix, Haiti. “Of course at that time Haiti was France's most economically valuable colony”, says historian Deirdre Cooper Owens. “So there he began some experimental work on enslaved Haitian women, trying to perfect the caesarean section.” Prevost's sojourn coincided with the leadership of Toussaint Louverture, who had been born a slave, the fight for Haitian independence, and the abolition of slavery. And so Prevost left Haiti for Louisiana. “He moved to a little town outside of Baton Rouge, and began experimental surgery on enslaved women there, perfecting the caesarean section, and he did this in the 1830s, the era before the civil war that ends slavery.” It was also an era in which Louisiana surgeons were reluctant to attempt the experimental surgery on white women. Of the 15 caesarean sections done by Prevost and others in Louisiana between 1820 and 1861, all were performed on enslaved women. “At the time, in the 19th century, during the time of slavery, they couldn’t consent”, she explains. “But this is the really interesting thing: from the 1830s all the way to the 21st century, Louisiana has been in the top three states with the most caesarean sections on Black women patients…So what's going on, did all of these women need to have caesarean sections?”
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Content ArticleJail can never be a safe place to be pregnant but the flouting of rules makes things worse. No woman should suffer as I did, writes Anna Harley in this Guardian article.
