Medical negligence solicitor Despina Kavadas wonders if the proposed Saving Babies’ Lives care bundle will help prevent stillbirths.
A research paper in 2013 concluded that the single largest risk factor for stillbirths is unrecognised fetal growth restriction, and that preventative strategies needed to focus on improving antenatal detection.
Stillbirth rates in the UK are among the highest of the high income countries. Reducing stillbirth rates was identified as both a key national and local priority for the NHS and strategic clinical networks and was also supported by the Department of Health National Outcomes Framework of 2013/2014. The evidence showed that fetal growth restriction was by far the single strongest risk factor for stillbirth after 34 weeks’ gestation and accounted for approximately 50% of all stillbirths before 34 weeks’ gestation.
In January 2015 NHS England prepared a draft care bundle for reducing stillbirths and early neonatal deaths. The Saving Babies’ Lives care bundle is a package of measures which includes a recommendation to improve the detection of growth restricted babies. The package of measures includes the use of a growth chart to plot the fundal height, which is the distance from the maternal pelvis to the top of the growing womb, and estimated fetal rate. Both of these measures are used to estimate a baby’s growth.
The care bundle is due to be published as a guidance document later this year and will be followed by an implementation toolkit. In the meantime, it is being voluntarily implemented by maternity care providers.
One such provider is Gateshead Maternity Service which has seen an improvement in their perinatal mortality rates since full implementation of the care bundle in March 2015. Their aim was to reduce the perinatal mortality rate by 50% and, as at August 2015, they say that they had reduced the rate by over 80%.
The Health and Social Care Information Centre suggests that the full formal rollout of the care bundle will be in 2017/2018.
We act for mothers who have suffered a stillbirth as a result of clinical negligence. I welcome the care bundle proposed by the NHS and hope that, as in the case of Gateshead Maternity Service, this has a positive impact on detecting fetal growth restriction and ultimately preventing avoidable stillbirths.
Given that fetal growth restriction or intrauterine growth restriction can occur when the placenta starts to fail, particularly after 40 weeks’ gestation, I consider that increased scanning during the course of the pregnancy, and particularly in the third trimester, is warranted and should be considered in all cases whether a mother is classified as low risk or high risk in her pregnancy.