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News Article
Third scan could greatly reduce UK breech birth numbers, study suggests
Patient Safety Learning posted a news article in News
Giving women a third scan at the end of their pregnancy could dramatically reduce the number of unexpected breech births and the risk of babies being born with severe health problems, research suggests. Pregnant women in the UK have routine scans at 12 and 20 weeks only, with no further scan offered in the third trimester unless they are considered at risk of a complicated pregnancy. The researchers hope their findings could lead to a change in guidance for clinicians that will improve maternity care. Prof Asma Khalil, who led the study at St George’s, University of London, said: “For the first time we’ve shown that just one extra scan could save mothers-to-be from trauma, an emergency C-section, and their babies from having severe health complications which could otherwise have been prevented.” She said the two routine scans were “far too early” to establish how the baby would be positioned during labour. “That’s why a third scan at 36-37 weeks could be a gamechanger to pregnancy and birth care.” Read full story Source: The Guardian, 7 April 2023 -
News ArticleExhausted after three sleepless days in labour, Jane O’Hara, then 34, screamed and burst into tears when the midwives and doctors at Harrogate District Hospital told her the natural birth she wanted was not going to happen. She ended up needing life-saving surgery and 11 pints of blood after a severe haemorrhage. Mercifully, Ivy was fine and is now a healthy 12-year-old. In recent weeks, the NHS has been rocked by the conclusions of an inquiry into the worst maternity disaster in its history: 201 babies and nine mothers died and another 94 babies suffered brain damage as a result of avoidable poor care at Shrewsbury and Telford Hospital NHS Trust. This has been linked to a culture of promoting natural — that is, vaginal — birth and avoiding caesarean sections. Blame thus far has been aimed largely at the NHS — but parents have started speaking out online about what they believe has been the role of the National Childbirth Trust (NCT), a leading provider of antenatal classes in Britain, in promoting vaginal births. “I can absolutely point to key decisions that I made that were influenced by the NCT’s mantra. I was led into a position where I believed I had more control over my birth than I actually did,” says O’Hara, who is now a professor of healthcare quality and safety at the University of Leeds. She believes she was a victim of a “normal birth” ideology that was heavily promoted at the NCT classes she attended. Read full story (paywalled) Source: The Times, 10 April 2022
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News ArticleMothers and babies are being put at risk because maternity services are still providing unsafe care, despite a series of scandals that have cost lives, the NHS ombudsman has warned. More tragedies will occur unless the health service takes decisive action to put an end to repeated and deeply ingrained problems which lead to “the same mistakes over and over again”, he said. Rob Behrens, the NHS ombudsman for England, voiced his concerns when he launched a report on Tuesday which details the failings several women experienced while giving birth. It also sets out the lessons the NHS needs to learn, but Behrens claimed that too many trusts were not doing so. Behrens voiced alarm that, although efforts have been made to improve the care mothers and their children receive, progress is too slow – and that means patients remain in danger. His report says that: “We recognise that people working in maternity services want to provide high-quality care. Culture, systems and processes can get in the way of achieving that goal. “But improvements are not happening quickly enough, and we have not seen sustainable change. We must do more to make services safer for everyone.” Read full story Source: The Guardian, 28 March 2023 Further reading on the hub: Patient Safety Learning - Mind the implementation gap: The persistence of avoidable harm in the NHS
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News Article
Birmingham hospital apologises after delays leave baby disabled
Patient Safety Learning posted a news article in News
Dilshad Sultana was 36 weeks pregnant with her second child in 2019 when she experienced stomach pain and noticed her baby was moving less. Mrs Sultana, from Sutton Coldfield, said she had been due to have a Caesarean section on 8 July but on 20 June she started to feel pain in her abdomen and lower back. She said she was confused but that it did not feel like a contraction and called hospital staff at about 17:00 to say it felt like her baby was moving less. After following advice to rest and take pain relief, she attended hospital at about 22:30 and staff started monitoring Shanto's heart rate. It was not until almost three hours later that Shanto was delivered by emergency C-Section. Shanto suffered severe brain damage and would spent the next 22 days in intensive care, suffering seizures and multiple brain haemorrhages. Shanto now requires around-the-clock care and Mrs Sultana enlisted lawyers to pursue a care of medical negligence against the trust. Birmingham Women's and Children's NHS Foundation Trust has admitted liability and made a voluntary interim payment allowing the family to move to a new home specifically adapted to meet Shanto's extensive care, therapy and equipment needs. Fiona Reynolds, the chief medical officer, said: "We'd like to offer our heartfelt apologies again to the family. "It's clear the standard of care we offered to them fell below those required and expected. For this, we are truly sorry." Now, Mrs Sultana is campaigning for change - she wants to see mothers listened to in maternity care and more attention paid to monitoring babies' heart rates. Read full story Source: BBC News, 27 March 2023 -
News Article
Why US mothers are more likely to die in childbirth
Patient Safety Learning posted a news article in News
The United States remains one of the most dangerous wealthy nations for a woman to give birth. Maternal mortality rose by 40% at the height of the pandemic, according to new data released by the US Centers for Disease Control and Prevention. In 2021, 33 women died out of every 100,000 live births in the US, up from 23.8 in 2020. That rate was more than double for black women, who were nearly three times more likely to die than white women, according to the CDC. Compared to other countries, the maternal mortality rate was twice as high in the US than in the UK, Germany and France; and three times higher than in Spain, Italy, Japan and several other countries, according to the most recent global comparison data kept by the World Bank. "Clearly the US is an outlier," said Joan Costa-i-Font, a professor of health economics at the London School of Economics. "Covid has made [maternal mortality] worse, but it was already a major issue in the US." Read full story Source: BBC News, 18 March 2023 -
News Article
Missed contraceptive coil left woman unable to have children
Patient Safety Learning posted a news article in News
A woman was denied the chance to have children with her husband after a contraceptive coil was accidentally left in place for 29 years. Jayne Huddleston, from Crewe, had eight rounds of fertility treatment she did not need because the correct checks were not carried out by her doctor. She said the mistake happened in 1990. "The GP said it couldn't be seen, so I was sent for a scan and the scan didn't pick anything up, the GP recommended another coil was fitted," she told the BBC. She was told the coil she had fitted around a year earlier had probably fallen out. When she and her husband, David, then decided they wanted to have a child, the second coil was removed, but the first coil, which had gone undetected, remained inside her. They tried for years to have a baby, with no success, including IVF treatment which cost them thousands of pounds. The mistake was only discovered when she went for an X-ray in 2019 after complaining of back pain and the original coil was revealed. Mr and Mrs Huddleston were awarded a six-figure out of court settlement after taking their case to Irwin Mitchell solicitors. Read full story Source: BBC News, 16 March 2023 -
News ArticleSome hospitals are suspending supplies of gas and air, after it was found to pose health risks to midwives. What can be done to ensure pregnant women still get the help they need? When Leigh Milner was expecting her first baby, she knew exactly how she wanted her labour to go. Her birth plan included an epidural for the pain and she was hoping, she says ruefully, for “all the drugs”. But that is not how things worked out. Milner, 33, a BBC presenter, ended up giving birth to Theo at Princess Alexandra hospital in Harlow last month with nothing but paracetamol for pain relief, in what she calls a positively “Victorian” experience. “I kept begging over and over again – ‘I need something for pain relief’ – and the only thing they could give me was paracetamol because they didn’t have gas and air. I was quite frightened, I didn’t know what else to do,” says Milner. "Birth is painful, but it shouldn’t be traumatic.” Read full story Source: The Guardian, 16 March 2023
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Content ArticleThis Quality Standard from the National Institute for Health and Care Excellence (NICE) has been updated to instruct healthcare professionals to diagnose women under the age of 65 with a urinary tract infection (UTI) if they have two or more key symptoms.
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Content Article
A bitter pill: Primodos (Sky News, 3 January 2023)
Patient-Safety-Learning posted an article in Medication
This Sky News investigation looks at one of the pharmaceutical industry's biggest scandals—the hormone pregnancy test Primodos which was prescribed to pregnant mothers in the UK between 1958 and 1978. Primodos was found to lead to birth defects, miscarriages and stillbirth, and regulatory failings led to avoidable harm to thousands of babies. -
Content ArticleThe Health and Social Care Select Committee have published a new report reviewing the progress that the UK Government has made in implementing the recommendations of the Independent Medicines and Medical Devices Safety Review, sometimes referred to as the Cumberlege Review. This blog sets out Patient Safety Learning’s reflections on this report.
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Content ArticleThis Health and Social Care Select Committee report reviews the progress that the UK Government has made in implementing the recommendations of the Independent Medicines and Medical Devices Safety Review, sometimes referred to as the Cumberlege Review. You can read Patient Safety Learning’s reflections on this report here.
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Content Article
CQC: Maternity survey 2022
Patient Safety Learning posted an article in Maternity
This survey from the Care Quality Commission (CQC) looked at the experiences of women and other pregnant people who had a live birth in early 2022. -
Content ArticleRecording of the Health and Social Care Committee meeting held on Tuesday 13 December 2022. Meeting started at 10.03am, ended 11.45am.
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Content ArticleThis policy paper, published by the Department of Health and Social Care, provides an update on the UK Government’s progress in implementing the recommendations of the Independent Medicines and Medical Devices Safety (IMMDS) Review, sometimes referred to as the Cumberlege Review.
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Content ArticleThis investigation by the Healthcare Safety Investigation Branch (HSIB) explores the issues associated with the assessment of risk factors for venous thrombosis in pregnancy and the first six weeks after birth. Venous thrombosis occurs when a blood clot forms and causes a blockage in a person’s vein. This can lead to venous thromboembolism (VTE), when part of the clot breaks off and travels through the bloodstream, blocking a blood vessel elsewhere in the body. Pregnant women and pregnant people are at greater risk of developing a venous thrombosis than those who are of the same age and not pregnant. Because of the increased risk, healthcare staff assess a pregnant woman’s risk factors for VTE at key stages before and after the birth, so that they can be given preventative treatment if necessary. While rare, in the UK venous thrombosis and VTE is the leading direct cause of death of pregnant women during pregnancy or up to six weeks after the end of pregnancy. Reference event The reference event for this investigation was the case of Alice, who was 26 years old and was pregnant with her second child. A VTE risk assessment was completed for Alice at her first antenatal appointment, when she was admitted to hospital for the birth of her child, and 24 hours after admission. Her score was zero each time, meaning no risk factors were identified for VTE. During her pregnancy Alice reported experiencing some pain in her calf; she was examined by a doctor who referred her for a scan. This ruled out a deep vein thrombosis (DVT). After giving birth by caesarean section, Alice's risk assessment was repeated, and as it indicated that medication was required, a preventative dose of low-molecular-weight heparin was prescribed and Alice was discharged. Eleven days after the birth of her baby, Alice was taken by ambulance to the emergency department with chest pain, shortness of breath and leg cramps. She was diagnosed with a pulmonary embolism (PE) and was started on a treatment dose of blood-thinning injections. Following investigation, it was found that Alice may not have received an appropriate preventative dose of low-molecular-weight heparin to help prevent the VTE.
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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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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 -
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 -
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
