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News ArticleA maternity unit criticised for the preventable stillbirth of a baby is under investigation after the unexpected death of a second baby. The newborn baby died in December last year after her birth at the standalone midwifery-led unit (MLU) at Lagan Valley Hospital in Lisburn. Despite this, the unit continued to operate as normal for another three months when the South Eastern Trust temporarily paused births at the MLU. The second tragedy came four years after Jaxon McVey was stillborn when his delivery at the unit went catastrophically wrong. A post-mortem found he died as a result of shoulder dystocia – an obstetric emergency where the head is born but the shoulder becomes trapped behind the pubic bone. Jaxon’s mum, Christine McCleery, has hit out at the South Eastern Trust and raised concerns over the measures put in place following his stillbirth on Mother’s Day 2017. “I feel like they didn’t learn from Jaxon,” she said. “I don’t know if any other babies died before Jaxon, but I know one died afterwards. Read full story (paywalled) Source: The Independent, 23 November 2022
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News Article
Pregnancy soon after miscarriage no more risky - study finds
Patient Safety Learning posted a news article in News
Contrary to current advice, getting pregnant within a few months of an abortion or a miscarriage does not appear to be extra risky for the mum and baby, say researchers who have looked at recent real-life data. The World Health Organization (WHO) recommends at least a six-month gap to give the woman time to recover. However, a study in PLoS Medicine, analysing 72,000 conceptions, suggests couples might safely try sooner for a baby. The baby loss support charity Tommy's says women who feel ready to try again immediately after a miscarriage should do so if there is no medical reason against it. The WHO says more research into pregnancy spacing is already under way and would inform any future updates to the advice. The research from Norway, spanning eight years from 2008 to 2016, found no major differences in outcomes when a new pregnancy happened sooner than a six-month delay. That is a different finding to earlier work in Latin America that - along with other studies - informed the WHO recommendations on pregnancy spacing. The authors of the latest Norwegian analysis say the advice needs reviewing so that couples can make an informed decision about when to try for a baby. Read full story Source: BBC News, 23 November 2022 -
News Article
New mothers more likely to die in UK than Scandinavia
Patient Safety Learning posted a news article in News
Women are four times as likely to die after childbirth in Britain as in Scandinavian countries, a study published in the BMJ has found. Researchers analysed data on the number of women who die because of complications during pregnancy in eight high-income European countries. They found that Britain had the second-highest death rate, with one in 10,000 mothers dying within six weeks of giving birth, only slightly less than in Slovakia, the worst performing. The study found that rates of “late” maternal death — when women die between six weeks and a year after giving birth — were nearly twice as high in Britain as in France, the only other country for which data was available. Heart problems and suicide were the main causes of death. Professor Andrew Shennan, an obstetrician at King’s College London, said: “Any death relating to pregnancy is devastating. Equally shocking are the avoidable discrepancies in worldwide maternal mortality. “Causes of [maternal] death are relatively consistent across the world, and largely avoidable. Most deaths are due to haemorrhage, sepsis and hypertensive disorders of pregnancy. “In Europe, non-obstetric causes of death have become proportionately more common than obstetric causes, including deaths from cardiovascular disease (23%) and suicide (13%); these should be prioritised.” Read full story (paywalled) Source: The Times. 17 November 2022 -
Content ArticleWomen are four times as likely to die after childbirth in Britain as in Scandinavian countries, a study published in the BMJ from Diguisto et al. has found. The authors compared maternal mortality in eight countries (France, Italy, UK, Denmark, Finland, the Netherlands, Norway, and Slovakia) with enhanced surveillance systems. They found that UK had the second-highest death rate, with one in 10,000 mothers dying within six weeks of giving birth, only slightly less than in Slovakia, the worst performing. Norway has the lowest maternal death rates in Europe, at one in 37,000. In Denmark, the second-best performing country, one in 29,000 died. In-depth analyses of differences in the quality of care and health system performance at national levels are needed to reduce maternal mortality further by learning from best practices and each other. Cardiovascular diseases and mental health in women during and after pregnancy must be prioritised in all countries.
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News Article
NHS England: Pelvic floor physiotherapy will see improved services by March 2024
Patient Safety Learning posted a news article in News
Far too many women were rushed into mesh sling surgery for stress incontinence after birth when pelvic floor physiotherapy could have fixed or eased the problem. In France, women are offered pelvic floor physiotherapy after childbirth as standard. A recent question to the Secretary of State for Health and Social Care asked what assessment the Department has made of the potential benefits of offering new mothers pelvic floor physiotherapy. This question was answered on 15 November 2022: "The National Institute for Health and Care Excellence’s guidance recognises that physiotherapy is important for the prevention and treatment of pelvic floor problems relating to pregnancy and birth. The NHS Long Term Plan committed to ensure that women have access to multidisciplinary pelvic health clinics and pathways in England. NHS England is deploying perinatal pelvic health services to improve the prevention, identification and access to physiotherapy for pelvic health issues antenatally and postnatally. Two-thirds of local maternity and neonatal systems are expected to establish these services by the end of March 2023, with full deployment in England expected by March 2024." Source: Parallel Parliament, 15 November 2022 -
News Article
Service disruption may have increased suicides among new mothers
Patient Safety Learning posted a news article in News
A new report has highlighted for the first time an apparent rise in the suicide rate for pregnant or newly postpartum women in 2020, citing disruption to NHS services due to Covid-19 as a likely cause. According to the review of maternal deaths by MBRRACE-UK, 1.5 women per 100,000 who gave birth died by suicide during pregnancy or in the six weeks following the end of pregnancy in 2020, which is three times the rate of 0.46 per 100,000 between 2017 and 2019. The number of deaths by suicide within six weeks of pregnancy in 2020 was numerically small – 10 women – but this was the same as the total recorded across 2017 to 2019. This is also despite Office for National Statistics figures showing a year-on-year fall in suicides in the population overall in 2020. In relation to the rise in suicides during pregnancy and up to a year after birth, the report states: “During the first year of the covid-19 pandemic, very rapid changes were made to health services… Mental health services were not immune from this and there was a broad spectrum of changes from teams where some staff were redeployed to other roles, through to teams that were able to operate relatively normally… “All of this occurred on a background of a recent huge expansion in specialist perinatal mental health services." Read full story (paywalled) Source: HSJ, 11 November 2022 -
Content ArticleThe MBRRACE-UK collaboration, led from Oxford Population Health's National Perinatal Epidemiology Unit (NPEU), has published the results of their latest UK Confidential Enquiry into Maternal Deaths and Morbidity. These annual rigorous reports are recognised as a gold standard in identifying key improvements needed for maternity services. The latest Saving Lives, Improving Mothers' Care analysis examines in detail the care of all women who died during, or up to one year after, pregnancy between 2018 and 2020 in the UK. This is the first report to include data that demonstrates the impact of the COVID-19 pandemic on maternal deaths.
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Content ArticleThis survey by In-FACT (Independent Fetal Anti Convulsant Trust) is intended to provide patients, no matter what anti-epileptic drug (AED) they are prescribed or what condition the AED is prescribed for, the opportunity to report problems and worries about taking their medication during pregnancy. The results will be used to inform In-FACT's ongoing work to improve medication safety and their engagement with the Medicines and Healthcare products Regulatory Agency (MHRA).
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Event
Priorities for improving care and support for pregnant women
Sam posted an event in Community Calendar
This Westminster Health Policy forum conference will discuss the next steps for improving care and support for pregnant women. Delegates will assess priorities for the safety and quality of maternity services moving forward following the release of the Final Ockenden review: Independent Review of Maternity Services, and for the Maternity and Newborn Safety Investigation Special Health Authority (MNSI) division of the Healthcare Safety Investigation Branch being established for April 2023. It will be an opportunity to assess priorities for the Secretary of State, and to examine the future outlook for supporting pregnant women following the publication of the Women’s Health Strategy for England, which highlighted a need for pregnant women to be listened to - and included the ambition for 4m people to receive personalised care by March 2024. Areas for discussion include: personalised care: assessment of individual needs - improving the access to mental health services - promoting healthy lifestyle choices during pre-conception, pregnancy, and early years workforce support: encouraging professional development, including funding and education - maternal workforce recruitment and retention - improving senior leadership improving patient safety ensuring strong communication in maternity teams providing appropriate pregnancy risk assessment recommendations and guidance for clinical decision making encouraging and delivering continuity of care progress and next steps for the Maternity Transformation Programme following the Better Births report investigation: priorities for the MNSI and ensuring safety concerns are investigated and addressed - learning from mistakes - listening to families quality of care: developing best practice guidelines - delivering high quality services - improving pregnancy outcomes - improving communication with pregnant women inequalities: addressing variation in service provision - tackling disparities in pregnancy outcomes, particularly for ethnic minorities. Register -
News Article
Government ambassador warns abortion is ‘fundamental’ part of healthcare
Patient Safety Learning posted a news article in News
Abortion access is a “fundamental” part of women’s healthcare the government’s women’s health ambassador has warned. Dame Lesley Regan, who was appointed as Women’s Health Ambassador by the Government in July, has said in answer to questions from The Independent about the voting records of ministers: “I think it’s really important that we never ever get complacent about freedom of choice. “Now what my view is about whether abortion is good or bad is really irrelevant. My job is to tell the Prime Minister if he’ll listen and the Secretary of State that it [abortion] is an absolutely fundamental part of women’s healthcare." “Because I’ve done so much work overseas during my career, what I know is that if you make it difficult to access, or you make it illegal, the problem doesn’t go away but women die as a result.” Her comments come after it was revealed this week that the prime minister and senior members of his government have voted against boosting access to abortions or have opted out of key votes. More than a third of the government’s current cabinet voted against early medical abortion at-home measures rolled out in the wake of the pandemic being made permanent. The Department for Health and Social Care’s minister for women, Maria Caufield, who has been granted responsibility for abortion care, has previously voted to curtail access rights. Earlier this year The Independent revealed women seeking abortions in the UK are having to travel hundreds of miles to access care as “untenable” waiting times put unsustainable pressure on services. Read full story Source: The Independent, 8 November 2022 -
News Article
Pill to prevent pre-eclampsia gets UK fast track for development
Patient Safety Learning posted a news article in News
A new pill that could prevent pre-eclampsia has become the first pregnancy drug to be fast-tracked for development by the UK’s drug regulator. Scientists at MirZyme Therapeutics, a biopharmaceutical company, believe they have developed a drug that when given to women from 20 weeks of pregnancy could stop them developing the condition. Pre-eclampsia endangers the lives of thousands of expectant mothers and their babies in the UK each year, and has no therapeutic options. Globally, it affects between 2% and 8% of pregnancies and kills up to half a million babies and 100,000 women a year. MirZyme Therapeutics has been awarded an innovative licensing and access pathway (ILAP), or so-called innovation passport, by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA). The passport was established in January 2021 to expedite access to essential new drugs at the height of the Covid pandemic. It is granted to medicines that address the needs of patients with life-threatening and unmet medical needs, with a view to getting the drug to the market as quickly as possible. Read full story Source: The Guardian, 8 November 2022 -
Content ArticleMaternal Mortality Review Committees (MMRCs) in the US are multidisciplinary committees that convene at the state or local level to comprehensively review deaths during or within a year of pregnancy. MMRCs have access to clinical and non-clinical information to more fully understand the circumstances surrounding each death, determine whether the death was pregnancy-related, and develop recommendations for action to prevent similar deaths in the future. This article summarises the data from MMRCs in 36 US states between 2017 and 2019, demonstrating variations in prevalence and cause of death according to race, ethnicity and geographical area. The data suggests that over 80% of pregnancy-related deaths examined were determined to be preventable.
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Content ArticleThis is the transcript of a Westminster Hall debate in the House of Commons on Black Maternal Health Awareness Week 2022, dedicated to raising awareness about disparities in maternal outcomes.
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Content ArticleInflammatory rheumatic disease (IRD), such as rheumatoid arthritis, can cause poor outcomes in pregnancy, and the health of the mother and developing foetus must be balanced when making decisions about medication. This updated guideline from the British Society for Rheumatology contains evidence and best practice for prescribing rheumatology medications during pregnancy and breastfeeding. It includes a table that summarises information about drug compatibility in pregnancy and breastfeeding.
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News Article
Fertility treatment triggers suicidal thoughts in nearly half of patients
Patient Safety Learning posted a news article in News
One in 10 patients undergoing fertility treatment experience suicidal thoughts “all the time”, a survey suggests. Fertility Network UK, which carried out the poll, said the findings reveal the “far-reaching trauma” of experiencing infertility and undergoing IVF in the UK. Four in 10 respondents - 98% of whom were women - said they had experienced suicidal feelings. Gwenda Burns, chief executive of Fertility Network UK, said: “Fertility patients encounter a perfect storm: not being able to have the child you long for is emotionally devastating. "But then many fertility patients face a series of other hurdles, including potentially paying financially crippling amounts of money for their necessary medical treatment, having their career damaged, not getting information from their GP, experiencing their relationships deteriorate, and being unable to access the mental support they need." “This is unacceptable. Infertility is a disease and is as deserving of medical help and support as any other clinical condition.” Three in four patients said their GP did not provide sufficient information about fertility problems and treatment. Read full story (paywalled) Source: The Telegraph, 31 October 2022 -
Content Article
Considering Valproate video (February 2022)
Patient-Safety-Learning posted an article in Medication
Sodium valproate is a medication used to treat epilepsy, bipolar disorder and migraines, but it can cause birth defects, learning disabilities and developmental problems in babies if taken during pregmamcy. This video by Central and North West London NHS Foundation Trust discusses the various effects of using valproate, including the potential harmful effects the medication can have on unborn foetuses. It features a conversation between a pharmacist and patient discussing the need for a valproate pregnancy prevention programme if the patient is to be prescribed valproate. -
News Article
Care substandard at 39% of maternity units in England, NHS watchdog finds
Patient Safety Learning posted a news article in News
Two out of five maternity units in England are providing substandard care to mothers and babies, the NHS watchdog has warned. “The quality of maternity care is not good enough,” the Care Quality Commission (CQC) said in its annual assessment of how health and social care services are performing. It published new figures showing it rated 39% of maternity units it inspected in the year to 31 July to “require improvement” or be “inadequate” – the highest proportion on record. Ian Trenholm, the CQC’s chief executive, said maternity services were deteriorating, substandard care was unacceptably common and failings were “systemic” across the NHS. Its latest state of care report said: “Our ratings as of 31 July 2022 show that the quality of maternity services is getting worse, with 6% of NHS services (nine out of 139) now rated as inadequate and 32% (45 services) rated as require improvement. “This means that the care in almost two out of every five maternity units is not good enough.” The report said: “The findings of recent reviews and reports … show the same concerns emerging again and again. The quality of staff training, poor working relationships between obstetric and midwifery teams and a lack of robust risk assessment all continue to affect the safety of maternity services. These issues pose a barrier to good care.” Staff not listening to women during pregnancy and childbirth is a recurring problem, Trenholm said. Their concerns “are not being heard” by midwives and obstetricians “in the way that they should”. Read full story Source: The Guardian, 21 October 2022 -
News Article
Expert advisers urge FDA to pull pregnancy drug from market
Patient-Safety-Learning posted a news article in News
An expert panel convened by the US Food and Drug Administration voted 14-1 on Wednesday to recommend withdrawing a preterm pregnancy treatment from the market, saying it does not work. During the sometimes contentious three days of hearings, the drugmaker Covis Pharma, backed by some clinicians and patient groups, had argued there is evidence to suggest the drug, called Makena, might work in a narrower population that includes Black women at high risk of giving birth too soon. But FDA experts and others said the data does not support such a view. In closing arguments, Peter Stein, director of the Office of New Drugs at the FDA’s Center for Drug Evaluation and Research, agreed on the urgent need for a drug to reduce the incidence of preterm birth — a leading cause of infant mortality in the United States. But he said the data indicates that Makena is not that drug. Stein said, “Hope is a reason to keep looking for options that are effective,” he said. “Hope is not a reason to take a drug that is not shown to be effective, or keep it on the market.” Read full story Source: The Washington Post, 19 October 2022 -
News Article
'Speaking about the 22 babies I lost is seen as taboo'
Patient Safety Learning posted a news article in News
Imtiaz Fazil has been pregnant 24 times, but she only has two living children. She first fell pregnant in 1999 and, over the subsequent 23 years, has had 17 miscarriages and five babies die before their first birthdays due to a rare genetic condition. The 49-year-old, from Levenshulme in Manchester, told BBC North West Tonight her losses were not easy to talk about, but she was determined to do so, in part because such things remained a taboo subject among South Asian groups. She said she wanted to change that and break down the stigma surrounding baby loss. She said her own family "don't talk to me very much about the things" as they think "I might get hurt [by] bringing up memories". "It's too much sadness; that's why nobody approaches these sort of things," she said. Sarina Kaur Dosanjh and her husband Vik also have the hope of breaking the silence surrounding baby loss. The 29-year-olds, from Walsall in the West Midlands, have set up the Himmat Collective, a charity which offers a virtual space for South Asian women and men to share their experiences. The couple, who have had two miscarriages in the past two years, said the heartache was still not something that people easily speak about. "I think it's hidden," Sarina said. "It's really brushed under the carpet." Read full story Source: BBC News, 13 October 2022 -
Content ArticleMBRRACE-UK is commissioned by the Healthcare Quality Improvement Partnership (HQIP) to undertake the Maternal, Newborn and Infant Clinical Outcome Review Programme (MNI-CORP). The aims of the MNI-CORP are to collect, analyse and report national surveillance data and conduct national confidential enquiries in order to stimulate and evaluate improvements in health care for mothers and babies. This report focuses on the surveillance of perinatal deaths from 22+0 weeks’ gestational age (including late fetal losses, stillbirths, and neonatal deaths) of babies born between 1 January and 31 December 2020.
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News Article
University of Leicester team finds more stillbirths in deprived areas
Patient Safety Learning posted a news article in News
Research suggests there are higher rates of stillbirth and neonatal death for those living in deprived areas and minority ethnic groups. A report from a team at the University of Leicester shows that while overall stillbirth and neonatal mortality rates have reduced, inequalities persist. MBRRACE-UK, the team that carried out the research, said it had looked at outcomes for specific ethnic groups. The report showed the stillbirth rate in the UK had reduced by 21% over the period 2013 to 2020 to 3.33 per 1,000 total births. Over the same period the neonatal mortality rate has reduced by 17% to 1.53 per 1,000 births. However despite these improvements, the authors found inequalities persisted, with those living in the most deprived areas, minority ethnic groups and twin pregnancies all experiencing higher rates of stillbirth. Elizabeth Draper, professor of perinatal and paediatric epidemiology at the university, said: "In this report we have carried out a deeper dive into the impact of deprivation and ethnicity on stillbirth and neonatal death rates. "For the first time, we report on outcomes for babies of Indian, Pakistani, Bangladeshi, Black Caribbean and Black African, rather than reporting on broader Asian and black ethnic groups, who have diverse backgrounds, culture and experiences. "This additional information will help in the targeting of intervention and support programmes to try to reduce stillbirth and neonatal death." Read full story Source: BBC News, 14 October 2022 -
News Article
Buffer zone to be set up outside Bournemouth abortion clinic
Patient Safety Learning posted a news article in News
An extensive buffer zone is being put in place around a clinic in Dorset in order to prevent anti-abortion campaigners harassing service users and staff. The zone will cover six streets around the British Pregnancy Advice Service clinic in Bournemouth and will be in force for 12 hours a day, five days a week for the next three years. Anyone caught protesting, harassing, intimidating or photographing visitors or staff could incur a fixed penalty notice of £100 or be liable for conviction at a magistrates court. Women have complained of being followed into the clinic or accosted when they leave. They have reported being told “the baby loves them” or asked whether they know they “murder babies” inside the building. One worker told the Guardian she has witnessed “many distressed clients”, including one who injured herself trying to climb a wall to avoid walking past the protesters. In another serious incident, an individual dressed in a monk’s cassock followed a staff member along the street in the dark while recording her. One service user said: “It was really intimidating. You’re in a really vulnerable situation and you have all these people shouting at you and saying you’re going to hell.” Read full story Source: The Guardian, 11 October 2022 -
News ArticleEven mild cases of Covid-19 during pregnancy “exhaust” the placenta and damage its immune response, new research suggests. The findings, which come as coronavirus cases are again on the rise in the UK, lend weight to multiple studies over the course of the pandemic linking the virus to a rise in dangerous pregnancy complications such as pre-eclampsia. But the results of the study – the largest yet involving the placentas of infected women – may represent the “the tip of the iceberg” of how Covid-19 affects foetal or placental development, warned Dr Kristina Adams Waldorf, the senior author on the study, which was published last month in the American Journal of Obstetrics & Gynecology. Early in the pandemic, it was widely assumed that the coronavirus did not harm the developing foetus because so few babies were born with the infection, said Dr Adams Waldorf, a professor of obstetrics and gynaecology at the University of Washington School of Medicine. “But what we’re seeing now is that the placenta is vulnerable to Covid-19, and the infection changes the way the placenta works, and that in turn is likely to impact the development of the foetus,” explained the professor. Read full story Source: The Independent, 9 October 2022
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News Article
More than 400 pregnant women prescribed topiramate in the past year
Patient Safety Learning posted a news article in News
Between April 2021 and March 2022, more than 400 pregnant women were prescribed the anti-epileptic medicine topiramate, which has been found to cause congenital malformations, figures published by NHS Digital have revealed. The data, published on 29 September 2022, covers prescribing of anti-epileptic drugs in females aged 0–54 years in England from 1 April 2018 through to 31 March 2022. Overall, it shows a reduction in the number of females prescribed sodium valproate; from 27,441 in April 2018 to 19,766 in March 2022. However, the numbers also show that sodium valproate, which can cause birth defects, is still being prescribed during pregnancy, with 42 women being prescribed the drug at some point during their pregnancy between April 2021 and March 2022, compared with 43 in the previous year. In addition, the data show that, during that same time period, 430 females were prescribed topiramate, which is used for treatment of migraines as well as epilepsy, during their pregnancy. In 2021, a safety review, carried out by the Medicines and Healthcare products Regulatory Agency (MHRA) found that carbamazepine, phenobarbital, phenytoin and topiramate were associated with an increased risk of major congenital malformations. In July 2022, the MHRA launched a further review looking specifically at the safety of topiramate, after study results showed an increased risk of autism, developmental disorders and learning difficulties among babies exposed to the medicine during their mother’s pregnancy. Daniel Jennings, senior policy and campaigns officer at Epilepsy Action, said it was “concerning” to see that prescribing figures for valproate had not decreased, compared with the previous year, and that despite the MHRA identifying other epilepsy medicines that could pose a risk if taken in pregnancy, there had been “little or no communication” about these risks. “There is also still a large group of epilepsy medicines where we don’t have an adequate bank of evidence about their safe use during pregnancy,” he added. “The MHRA and NHS England need to work together to communicate the risks and carry out research to protect women with epilepsy.” Read full story Source: The Pharmaceutical Journal. 7 October 2022 -
News Article
Mother given substantial damages over baby's care
Patient Safety Learning posted a news article in News
A mother from County Down will receive "substantial" undisclosed damages over alleged hospital treatment failures and care given to her daughter. Christina Campbell from Ballygowan brought medical negligence lawsuits over treatment she received at the Ulster Hospital in Dundonald after her daughter, Jessica, died in 2017 with a rare genetic disorder. The claim said that failure to test Ms Campbell during her pregnancy meant the condition went undetected. Damages were also sought for an alleged "ineffective" end of life care plan for the four month old. Jessica was diagnosed with trisomy 13 shortly after her birth in December 2016. She experienced feeding and respiratory difficulties, as well as a congenital heart defect and a bilateral cleft lip and palate. She was discharged from hospital with a home-based end-of-life care plan, including community and respite referral to the hospice, but a few months later. The claims said a failure to provide Ms Campbell with a amniocentesis test, which checks for genetic or chromosomal conditions, meant Jessica's condition was not discovered sooner. The lawsuit also highlighted concerns about Jessica's hospice treatment. It includes alleged uncertainty about the provision of humidified oxygen, a defective feeding pump and delays in a specific feeding plan and saline nebuliser being provided for the family. The family's solicitor said the awarding of damages "signifies the importance of lessons learned" as a result of Ms Campbell's campaign. "It is hoped that lessons can now be learned to ensure no other family has to go through a similar experience," he said. Read full story Source: BBC News, 29 September 2022
