Abstract
(BJOG. 2020;127:1665–1675) The UK has higher rates of stillbirth and neonatal mortality than similar countries. A 2015 UK-wide confidential inquiry, Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK), identified key issues contributing to perinatal death, including inadequate maternal monitoring, errors in fetal monitoring, and failure to recognize the transition from the latent phase of labor to the active phase. The majority of deaths included in MBRRACE-UK occurred in hospital obstetric units (OUs), but the proportion of births occurring in midwifery-led settings in England is increasing. While there is no evidence that midwifery-led settings experience higher rates of intrapartum-related perinatal deaths compared with OU, contributing factors to perinatal deaths in midwifery settings may differ. Enhancing the safety of Midwifery-led births Enquiry (ESMiE) reviewed the quality of care in pregnancy, labor, birth, and postpartum in births resulting in intrapartum-related deaths in midwifery-led settings and compared the findings with those of MBRRACE-UK.
Highlights
Stillbirth and neonatal mortality rates in the United Kingdom remain high compared with other similar countries.[1,2] National policy aims to halve the rates of stillbirth, neonatal death and perinatal brain injury by 2025;3 intrapartumrelated perinatal deaths have been identified as a group where improvements in perinatal care have the potential to improve outcomes.[4,5,6]Confidential enquiries are an established method for assessing quality of care against national standards and guidance, usually when adverse events such as death or a 2020 The Authors
Intrapartum-related perinatal deaths in births planned in midwifery-led settings in Great Britain: findings and recommendations from the ESMiE confidential enquiry
BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of
Summary
Stillbirth and neonatal mortality rates in the United Kingdom remain high compared with other similar countries.[1,2] National policy aims to halve the rates of stillbirth, neonatal death and perinatal brain injury by 2025;3 intrapartumrelated perinatal deaths have been identified as a group where improvements in perinatal care have the potential to improve outcomes.[4,5,6]Confidential enquiries are an established method for assessing quality of care against national standards and guidance, usually when adverse events such as death or a 2020 The Authors. A UK-wide confidential enquiry of 78 term intrapartum stillbirths and intrapartum-related neonatal deaths, carried out in 2015 by the MBRRACE-UK collaboration as part of the national Maternal, Newborn and Infant Clinical Outcome Review Programme (MNICORP), identified overall improvements in care that may have made a difference to the outcome for the baby in 80% of the deaths.[6] Key issues included: failure to recognise the transition from the latent to the active phase of labour and institute appropriate monitoring; incomplete or inadequate maternal monitoring; errors in the method, interpretation, escalation and response to fetal monitoring; variable quality of bereavement care and poor-quality local reviews
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