29 Jun MBRRACE-UK’s 2018 Report – We need to do more for babies and families
Expert-led training to predict and prevent preterm births and stillbirths could be key.
The latest MBRRACE-UK report was published this month, and things are generally moving in the right direction; however, more work needs to be done to reach government targets to halve stillbirths and neonatal deaths by 2025. In a similar vein to the MBRRACE Report foreword itself, it is important to note that each baby’s death belongs to a bereaved family and this should be respected and recognised throughout. The intention behind both the report and our work is to reduce this catalogue of misery.
Of over 780,000 births in the UK in 2016, a reported 4402 babies were stillborn or died in the neonatal period. Overall, there was a reduction in mortality rates between 2013 – 2016:
- Extended perinatal deaths have reduced from 6.04 to 5.64 per 1000 births
- Stillbirths have reduced from 4.20 to 3.93 per 1000 births
- Neonatal deaths have reduced from 1.84 to 1.72 per 1000 births
There was also an improved survival rate for twins; with stillbirths almost halving since 2014, and neonatal deaths in twins reducing by almost a third.
Moving in the Right Direction, but Need to Get There Faster
Though there has been an overall reduction in stillbirths and neonatal deaths, the rate of reduction for stillbirths has been 2.4% in the period between 2010 – 2016. In order to meet the Secretary of State for Health and Social Care’s target of halving stillbirths by 2025, there needs to be a reduction of 4% per year. More needs to be done.
Improvements are Possible
Around 1 in 3 stillbirths and neonatal deaths occur at term. The recent report by MBRRACE-UK in November 2017 reported that nearly 80% of those intrapartum term deaths investigated may have been preventable with different care. Similarly, a report into term antepartum stillbirths found that 60% of deaths may have been preventable.
In addition, there needs to be more effort to improve care pathways for babies at risk of being born too soon, or too small. Around 40% of stillbirths occur before 32 weeks gestational age, and similarly over half of neonatal deaths occur before 32 weeks gestational age. Around 70% of all extended perinatal deaths occur before term, and nearly 40% are extremely preterm at before 28 weeks. As the report suggests, in order to meet national aspirations there needs to be a focus on strategies to predict and prevent circumstances leading to preterm deaths, as the majority are likely to be different than for those babies who die at term.
As well as noted avoidable deaths with improvements to care, there is still evidence of regional variation in mortality, although less than previously. Some regions have lower mortality rates which are not accounted for by key factors which are known to increase the risk of perinatal mortality (e.g. mother’s age and socioeconomic deprivation).
What Can We Do?
As well as improvements to reporting, which MBRRACE recommend will be alleviated with the timely use of the Perinatal Mortality Review Tool, we believe that training teams in implementing appropriate and evidence-based care pathways in order to prevent stillbirths and babies being born too early or small, is key.
We work with an expert team to look at the prediction and prevention of stillbirth, preterm birth, and babies that are small for their gestational age. The study day we provide is ‘Implementing Saving Babies’ Lives: prevention of preterm births, growth restriction, and stillbirth’. The Course Directors and speakers are experts in researching and also practicing in this area. This exciting one-day course will be of interest to all clinical staff with an interest in the prediction and prevention of preterm labour together with the management of small babies using the best evidence (where available) in order to guide clinicians in relation to diagnosis, investigation and management.
The team behind the training:
Professor Alex Heazell – Stillbirth Expert
Professor in Obstetrics & Honorary Consultant
Obstetrician, University of Manchester
Dr Ed Johnstone – SGA Expert
Consultant Obstetrician; Senior Lecturer in Obstetrics & Fetal Medicine, University of Manchester
Mr Nigel Simpson – Preterm Birth Expert
Senior Lecturer in Obstetrics & Gynaecology, University of Leeds
Ms Suzanne Thomas – SGA Specialist Midwife
SGA Specialist Midwife (Placenta Clinic & Rainbow Clinic); Research Midwife Coordinator, St Mary’s Hospital, Manchester
It is clear that improvements can be made with more knowledge and better care, and our experts are motivated to make this change happen.
The feedback for the course has been exceptional:
100% of delegates rated ‘Good’, ‘Very Good’ or ‘Excellent’ for overall quality of education
100% reported that following the course they would consider or intended to modify practice after seeking more information
“This is one of the most useful, informative and enjoyable study days I have attended in 25 years of midwifery.”
“I have never enjoyed a study day or got as much out of one as I have done today. It has been a delight to listen to such passionate caring professionals.”
In conclusion, although there have been advances in reducing mortality rates, there is room for improvement when it comes to preventing stillbirths and neonatal deaths; as shown by the work done in improving twin survival rates and perinatal mortality in general, and the number of investigated deaths that are reported as preventable with better care. The focus for future work needs to be on strategies to predict and prevent preterm births and babies that are small for their gestational age, and standardising this throughout the UK.
We believe the key is sharing expert-led knowledge and research on the most effective care pathways, as well as the recommendations made by MBRRACE centred around reporting. We need to learn to report better and filter down expertise and learning to frontline staff.