Induce older mums early to cut stillbirth risk:
Pregnant women aged over 40 should be given the option of being induced early to reduce the risks of losing their baby, says a Royal College of Obstetricians and Gynaecologists paper.
POAC welcomes this step forward to reduce STILLBIRTHS:
“long overdue”, mums who wish induction should also “insist” their baby’s heart rate be constantly monitored (CTG) by fully qualified/competent staff.
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NHS Scotland revealed:
£213m bill to NHS in negligence claims
While the majority of cases filed (16%) related to botched surgery, this was closely followed by serious errors in obstetrics and gynaecology – pointing to medical blunders during pregnancy or childbirth. These accounted for 15% of cases nationally, but were notably higher in NHS Lanarkshire where almost one in four claims (23%) related to maternity care.
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WHY Antenatal Screening Must Improve. Headline Summary.
• The rate of major obstetric haemorrhage (MOH) is increasing and now affects 1 in 170 women giving birth in Scotland. Other causes of severe morbidity in pregnancy are declining.
• There are deficiencies in the prevention and the management of MOH.
• Episodes of MOH continue to be under investigated locally via adverse event reporting with 42% of episodes being reviewed by maternity units’ risk management teams.
• Although one in five women experiencing MOH are not attended directly by a consultant obstetrician (one in three overnight), data suggests that these cases are less severe and that all severe episodes were attended by a consultant obstetrician.
• Rates of peripartum hysterectomy related to MOH rose in 2011.
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BBC Born Asleep
More than half of stillbirths in the UK could be prevented if the NHS implemented additional scans, a leading obstetrician has told Panorama. Each year, more than 3,000 babies are stillborn in the UK, one of the worst rates in the developed world. Prof Kypros Nicolaides says offering all women Doppler scans, which measure blood flow between the placenta and foetus, could save 1,500 babies a year. The Department of Health said it has asked him to submit his research. POAC, says DOH should consider immediate action as 3 scans are offered in many countries, the more they delay prevention, more lives and families will be destroyed. The 32wk scan is critical, safety and prevention will reduce the number of stillbirths, weekly NST (monitoring) provides doctors valuable information of the baby’s wellbeing before a big task as Labour is for Mum and Baby, NST is performed in many countries the last 4 to 6wks of pregnancy, and last but detrimental to the baby’s good health; “strep B testing”. We POAC want all boxes ticked on the most important list, our babies firs right; to be born healthy ! Why not in UK. Three-quarters of a million babies are born in the UK each year. One in 200 dies before birth, mostly to mothers with no known risk factors.
Stillbirth rate 'poor' says Scotland's leading maternity doctor.
Reduced Fetal Movement(RFM); Giving advise and information to future Mothers is the responsibility of the Scottish Health Minister, Doctors & Midwife's "NOT SANDS"
It is critical to know how and why to monitor their babies movements in the 3rd trimester, and there should be a fetal presentation and well-being scan performed by an obstetrician around 34/36 wks of gestation.
POAC's vision is to give every pregnant Mum access to “Free Fetal CTG” monitoring in the last 4wks of pregnancy, in order to filter out babies who may need observation and possible extra obstetric care. Fetal monitoring is a none invasive and perfectly safe test, applied in many other countries, and a "global" proven method in reducing stillbirth and birth trauma. “Why not in the UK” ?
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Britain's stillbirths among the worst in developed world
What has changed Since 14 April 2011 - Britain's record of stillbirths was condemned as a "national scandal" today after it was shown to be one of the worst in the developed world. April 2013 Our research indicates an increase in UK stillbirths.
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Fetal heart rate monitoring was introduced in the 1970's.
At Monica our aims and values are closely aligned to POAC and through the advancement of technology and education of the clinicians and carers involved we aim to reduce stillbirths, unnecessary interventions and improve outcomes for mothers, children and families as a whole. We wish POAC every success in their endeavours.
Fetal heart rate monitoring was introduced in the 1970's and was seen as a solution for the assessment fetal well being in the second trimester and during L&D. The objective was to reduce the incidence of cerebral palsy and stillbirths. It was universally embraced by the obstetric community without question. In the 1970s a number of monitoring modalities were available from phonocardiography (using a microphone to pick up the fetal heart beat) to Doppler Ultrasound based techniques (using high frequency ultrasound to insonate the fetal heart, any reflected sound from the fetal heart was shifted in frequency/pitch due to the movement of the heart/blood) and fetal ECG.
In the early 1980's HP introduced digital signal processing and pulsed Doppler ultrasound and this swept away all other methods for monitoring fetal heart rate. This type of fetal heart monitor is still used today for L&D and antenatal care has not changed either in performance or clinical utility since the early 1980's. Despite being the standard of care used in 80% of deliveries and for assessing fetal well being during the antenatal period, evidence to support its continued use is weak and many obstetricians see fetal monitoring as being the cause of the increase in caesarean section rate, with no change to still births or cerebral palsy. Despite fetal monitoring not living up to its initial expectations it has become the standard of care and is used to support increased intervention including inductions, epidurals and caesarean sections.
Monica Healthcare has gone back to one of the initial monitoring modalities dating back to the 1970s – Fetal ECG - that will allow the assessment of many physiological parameters that are known in adult heart monitoring to impact on health. These physiological parameters include true beat to beat heart rate variability that can only be detected with precise fetal ECG measurement and fetal ECG morphology – the shape of the ECG waveform. In addition by taking advantage of modern signal processing devices which are wearable and can be used over extended periods weoffer new opportunities and windows for assessing and monitoring fetal well being.
Today evidence is now required to support a change in practise and Monica with its research partners is working to show obstetricians how these new parameters and ways of monitoring can be used to reduce still births and caesarean sections and improve the experience of women during labour.
For more information on Monica and our products please visit our website www.monicahealthcare.com
Choosing Cesarean, a Natural Birth Plan.
Pauline Hull, founder of electivecesarean and co-author of Choosing Cesarean, a Natural Birth Plan, contacted the charity to offer her full support. She says POAC deserves recognition for its commitment to exploring new research and helping prevent the loss of precious lives. Technology is often seen as a last resort in pregnancy and childbirth, and the tendency is to approach intervention as a last resort only. In fact, using technology during pregnancy could help many women to make a more informed choice about their birth plan, in consultation with a medical professional.For more information visit http://www.electivecesarean.com
Ultrasound on women in labour can reduce birth complications
How can a developing country be so far in front of the UK with a clear vision for the future? Are UK colleges doing enough to prevent unnecessary deaths? The rise in NHS-Litigation points out clearly that the UK has serious front line issues relating to Education/Training/Knowledge and a lack of skilled obstetricians.
An ultrasound scan can be a solution to accurate diagnosis during or before labour and can help the obstetricians to act accordingly..... common sense, if you don't look you won't find.
The Facts on baby deaths in the UK
What are the facts today?
· 17 babies die every day in the UK, 11 are stillborn and another 6 die shortly after birth – this equates to 6,500 babies dying every year
· Stillbirth is not a rare event; 1 in 200 babies are stillborn (die in the womb after 24 weeks gestation) and a third of these deaths happen at full term, (after 37 weeks gestation), at an age when a baby is preparing to start life outside the womb. If these babies can be identified, then early delivery could save many of these babies’ lives
· Babies who die within the first four weeks of life (neonatal deaths) are also not rare, 1 in 300 babies die before they are a month old
· UK rates of stillbirth are the same today as in the late 1990s, in the same period infant mortality rates have fallen to their lowest ever rate
· While there is proper focus and concern about preventing child deaths caused by, for example: meningitis (around 50 deaths per year); road deaths (81 in 2009); or cot deaths (400 per year), the 4,000 stillbirths each year are more or less ignored
· The Lancet medical journal’s 2011 Stillbirth Series, showed the UK to be among the poorest performing countries when it comes to tackling stillbirth, placing us 33rd out of 35 similar high income countries.
Contributing to baby deaths in the UK and the action we believe is needed to prevent deaths in the future:
1. Lack of research to understand the causes of stillbirth:
· Over 90% of babies who are stillborn have no congenital abnormality; around a third of stillbirths are unexplained (in other words perfectly formed, normal-sized babies); and a further third are also perfectly formed but small. The most prevalent underlying cause in all these groups relate to problems with the placenta.
What needs to be done?
· Problems with the placenta are poorly understood and require urgent research – until there is a way to test whether a placenta is functioning well, all women and their babies are potentially at risk. Government research funding bodies must direct funds expressly into the causes and prevention of unexplained stillbirth.
“For an otherwise healthy baby to die undelivered near term is, with hindsight, an easily avoidable event. Research to make it avoidable in practice is a priority”. Professor Jim Thornton, Professor of Obstetrics and Gynaecology, University of Nottingham.
2. Routine antenatal care is failing to detect babies at risk of stillbirth:
· Routine antenatal care is clearly failing to spot too many babies who need help. 4,000 babies are stillborn every year in the UK, 1,200 of these babies after 37 weeks gestation when the baby is full-term.
· Screening methods used today in antenatal care are not dissimilar to those in use 40 years ago. Lack of research into the causes of stillbirth has hampered the development of effective tools for assessing how healthy the baby is in the womb in the third trimester; babies continue to slip through the net and die.
What needs to be done?
· New reliable screening tests to prevent stillbirths are urgently needed. It is time there was an effective screening programme for stillbirth which is fit for 21st century healthcare.
3. Poor awareness of the risks of stillbirth
· Many mothers are unaware of the risk of stillbirth or that 1 in 200 babies are stillborn, as public health messages, focusing on health in pregnancy, are not linked to the possibility of a baby dying. If pregnant women are unaware of the risk factors for stillbirth and potential warning signs that their baby is not thriving, how can they contribute to the management of their care or alert health care staff that something may be wrong?
· Doctors and midwives are also often unaware of both how common stillbirths are and how profound the impact of a baby’s death is. Stillbirths barely feature in undergraduate or on-the-job training for doctors and midwives.
What needs to be done?
· The establishment of a national forum to share understanding of the public health aspects of perinatal death and develop public health and education messages.
· There must be medical training for doctors and midwives to include a module on the risks and impact of perinatal deaths to improve awareness and understanding.
4. No national data collected on baby deaths to improve care and save lives in the future:
· Good data and audit are essential to advance understanding of why babies die and to improve care in the future. But the UK’s national audit programme (The Clinical Outcome Review Programme for Maternal and Newborn Health) for collecting perinatal mortality data in the UK is currently suspended – babies who die today will not go into any kind of national audit to help us understand why babies die and how to improve care. This is unacceptable.
What needs to be done?
· The Clinical Outcome Review Programme for Maternal and Newborn Health must be resumed by April 2012 at the latest so that data on the number of babies dying every year is not irrevocably lost.
· This work must be properly funded so that full and thorough analysis can be carried out on all factors leading to a death, including quality of care. The remit of the audit programme must also ensure that it can make recommendations to improve care and reduce rates of baby death.
5. Need for rigorous review of every death:
· Sometimes babies die because of failures of care. A national confidential enquiry into stillbirth in 2000 found that sub-optimal care contributed to the death of a baby in three quarters of cases. Yet lessons about what went wrong are often overlooked and opportunities to improve care are missed. There is currently no standardised process of review when a baby dies in the UK. The quality and rigour of the process of review varies widely between hospital trusts and is not independently scrutinised.
What needs to be done?
· Standardised review of all baby deaths must be developed and followed in all hospital trusts. This needs to include the parents’ perspective on their care.
6. Under-resourced maternity, neonatal and pathology services:
· Safety and quality are currently threatened by under-staffing in every area of perinatal care and service delivery, from midwives to specialist pathologists.
o The Royal College of Midwives is petitioning the government for 5,000 more midwives and warns that shortages are affecting both quality and safety.
o The Royal College of Obstetricians and Gynaecologists continues to be concerned by the lack of 24-hour obstetric cover on maternity wards.
o The Royal College of Pathologists estimate that a 20% increase in the numbers of perinatal pathologists is needed to deal with even the current low rates of post mortem take up.
What needs to be done?
· Urgent action is needed to ensure minimum levels of staffing and the right skills mix in all areas of maternity care and perinatal pathology service delivery.
RCOG release: Reduced fetal movements – New Green-top Guideline
New advice for clinicians on the management of women with reduced fetal movements (RFM) during pregnancy has been published by the Royal College of Obstetricians and Gynaecologists (RCOG) today.
This is the first edition of this guideline and looks at how women should be aware of their baby’s movement patterns in the womb. It also gives advice to clinicians and reviews the risk factors and factors influencing maternal perception.
Fetal movements can be anything from a kick, flutter, swish or roll and movements are typically first felt by the mother between 18-20 weeks of gestation and rapidly acquire a regular pattern. Fetal activity provides an indication of the integrity of the central nervous system and musculoskeletal systems.
A significant reduction or sudden change in movement is an important clinical sign. Reduced fetal movements usually does not indicate a problem with the pregnancy but can sometimes be an important warning sign that the fetus is not receiving enough oxygen from the mother, via the placenta.
Fetal activity is influenced by a wide variety of factors and movements are most commonly assessed by maternal perception. There is some evidence that women perceive most movement when lying down, fewer when sitting and least while standing. Busy pregnant women for example who are not concentrating on fetal activity often report a misperception of a reduction of fetal movement.
The guideline states that if a woman is worried about her unborn baby’s movements she should contact her maternity unit. However, clinicians should be aware that instructing women to monitor fetal movements is potentially associated with increased maternal anxiety.
After 28 weeks of gestation if a woman is unsure whether movements are reduced she is advised to lie on her left side and focus on fetal movement for 2 hours. If she does not feel 10 or more discrete movements then she should contact her midwife or maternity unit immediately.
If a clinician is presented with a woman reporting RFM, a relevant history should be taken to assess the woman’s risk factors for stillbirth and fetal growth restriction (FGR).
In most cases a handheld Doppler device can be used to confirm the presence of the fetal heart beat. If the presence of a fetal beat is not confirmed then immediate referral for an ultrasound scan is needed to assess fetal cardiac activity.
Cardiotocographic (CTG) monitoring of the fetal heart rate should be used if the pregnancy is over 28 weeks of gestation and there is still a decrease in fetal movements after fetal viability has been confirmed. CTG monitoring for at least 20 minutes can provide an easily accessible means of detecting any problems.
Ultrasound scanning can also be used as part of the preliminary investigations of a woman reporting RFM if the perception of RFM persists despite a normal CTG.
However, the guideline states that women should be reassured that 70% of pregnancies with a single episode of RFM are uncomplicated. Women who report RFM on two or more occasions are at an increased risk of a poorer perinatal outcome including an increased risk of stillbirth, fetal growth restriction and/or preterm birth.
Dr Melissa Whitworth, Consultant Obstetrician, St Mary’s Hospital, Manchester and lead author of the guideline said:
“Being aware of babies’ movements is something that Mums can do to monitor the health of their unborn child. A reduction in movements can mean that the baby is not well in the womb and a very small proportion of these babies need to be delivered urgently. This guideline will hopefully help clinicians to provide high quality care for women with reduced fetal movements.”
The President of the RCOG, Dr Tony Falconer said:
“Maternal perception of fetal movement is one of the first signs of fetal life and is an exciting time for the mother. Understandably, mothers may feel anxious if there is a decrease in fetal movement however there are often plausible reasons for this.
“The fetus may be in a state of sleep or the mother may be too busy to focus on fetal activity. It is important to remember however that each case is different and this new guideline is an extremely useful resource for clinicians treating women who may encounter reduced fetal movements.”
For more information please contact Naomi Weston on 020 7772 6357 or firstname.lastname@example.org
3 million stillbirths are completely preventable
According to The Lancet's series, STILLBIRTHS, at least 50% of our world’s almost 3 million stillbirths are completely preventable. The statistics used in The Lancet consider a stillborn baby, "the death of a baby at 28 weeks’ gestation or more." What does that mean to us? It means simple interventions may save the life of a precious baby ~ if you are told what to do and what to look out for by empowering and educating parents. Dr. Ruth Fretts, OB-GYN and assistant professor at Harvard Medical School in Boston, believes the risk of stillbirth increases late in pregnancy and many could be prevented. "We don't do a very good service to women by not informing them of the risks and giving them options to be evaluating the baby's well being . The Royal College of Obstetricians and Gynecologist in the United Kingdom, whose stillbirth rates are one of the most dire for a country which is not considered to be one of the 98% low or middle income countries with abysmally high stillbirth rates, just issued a statement on reduced feta movement, "Clinicians should be aware (and should advise women) that although fetal movements tend to plateau at 32 weeks of gestation, there is no reduction in the frequency of fetal movements in the late third trimester."
The American College of Obstetricians and Gynecologists support kick counting ~ it is rarely mentioned or explained to pregnant women in the office or during prenatal classes. Don’t take it for granted everyone caring for you and delivering your baby is aware of kick counting and the important role it can play in assuring a happy, healthy and hearty delivery day. Make it your passion to educate all young men and women, moms and dads to be, their doctors, midwives and health care team to the importance of baby's movements from 20 weeks onwards and the importance of daily kick counting from 28 weeks onwards.
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