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3eca9132e4a2f58b | #### **5. Reducing preterm birth**
This is an additional element to the care bundle developed in response to The Department of Health's ['Safer Maternity Care'](https://www.gov.uk/government/publications/safer-maternity-care-progress-and-next-steps) report which extended the 'Maternity
Safety Ambition' to include red... |
22a1f91065d0f3df | #### **5. Reducing preterm birth**
The second version of the care bundle includes a greater emphasis on continuous improvement with a reduced number of process and outcome measures. The implementation of each element will require a commitment to quality improvement with a focus on how processes and pathways can be dev... |
8072013aff2a3023 | #### **5. Reducing preterm birth**
SBLCBv2 includes sections which reference the importance of other interventions outside of the remit of the care bundle, such as continuity of carer models, following NICE guidance, delivering 'healthy pregnancy messages' before and during pregnancy and offering choice and personalis... |
a0e81daada485738 | ### Introduction
The 2017 Office for National Statistics (ONS) report shows a fall in stillbirth rates in England to 4.1 per thousand. This is testament to the continued efforts of maternity services across England to deliver system-wide improvements in maternity care. The fall should be seen within the context of the... |
ec7f6418e07287c1 | ### Introduction
The fall in the stillbirth rate represents an 18% reduction in the stillbirth rate since 2010, resulting in 827 fewer stillbirths in 2017 compared to 2010. While this reduction shows that the NHS is on target to meet the interim ambition of a 20% reduction in stillbirths by 2020 there are still too ma... |
846e008cd26fa227 | ### Introduction
SBLCBv2 should not be implemented in isolation but as one of a series of important interventions to help reduce perinatal mortality and preterm birth. It is important that providers implement best practice care whenever possible, including by following NICE guidance and continuity of carer models whic... |
bf8b42b6e1bd5915 | ### Introduction
The [NHS Long Term Plan](https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/) (LTP) reiterates the NHS's commitment to a 50% reduction in stillbirth, maternal mortality, neonatal mortality and serious brain injury and a reduction in preterm birth rate, from 8% to 6%, by 2025. An additional... |
c555b29c5137cd0e | ### Introduction
The SBLCBv2 will be included in the [planning guidance](https://www.england.nhs.uk/publication/preparing-for-2019-20-operational-planning-and-contracting/) and incorporated into the [standard](https://www.england.nhs.uk/nhs-standard-contract/19-20/) [contract](https://www.england.nhs.uk/nhs-standard-c... |
e863a06a0a260bdf | ## Summary of the Saving Babies' Lives Care Bundle Evaluation Report
In May 2016 NHS England commissioned the Tommy's Stillbirth Research Centre at the University of Manchester to evaluate the SBLCB. The report, ['Evaluating the](https://www.manchester.ac.uk/discover/news/action-plan-can-prevent-over-600-stillbirths-a... |
da0b18862b6c3b50 | ## Summary of the Saving Babies' Lives Care Bundle Evaluation Report
luation which involved nineteen NHS Trusts in England implementing the care bundle from April 2015. The purpose of the evaluation was to "assess the effectiveness of the care bundle at reducing stillbirth rates and the associated costs". It also asse... |
c959ea742d41ce73 | ## Summary of the Saving Babies' Lives Care Bundle Evaluation Report
- Stillbirth rates declined by 20% in the participating Trusts during the period in which the care bundle was implemented. This fall cannot be explicitly attributed to implementation of the care bundle due to other improvement activities happening ac... |
9f33470f0a7e96e6 | ## Rationale for changes in version two of the Saving Babies' Lives Care Bundle
The independent evaluation of SBLCB shows that it appears to help reduce stillbirth rates but the evaluation suggests there is room for improvement. The introduction of any new pathway carries a risk of 'intervention creep' and the increas... |
af304feb43b23cf7 | ## Rationale for changes in version two of the Saving Babies' Lives Care Bundle
Prior to 39 weeks gestation, induction of labour or operative delivery is associated with small increases in perinatal morbidity. However, at 39 weeks gestation and beyond, induction of labour is not associated with an increase in caesarea... |
a1d2b70f233e3c6e | ## Rationale for changes in version two of the Saving Babies' Lives Care Bundle
The aim of these outcome measures is to facilitate a better understanding of maternity services and identify where there are opportunities for quality improvement. To this end each element now contains a continuous learning section which h... |
2fe073c45eb7950f | ## Important principles to be applied when implementing version two of the Saving Babies' Lives Care Bundle
The following principles should be considered when implementing the care bundle. |
99ac3d8a3033ee60 | #### **Promote the availability of continuity of carer to women**
The SBLCBv2 should not be implemented in isolation but as one of a series of important interventions to help reduce perinatal mortality and preterm birth. It is acknowledged how important it is for women to know and form a relationship with the professi... |
a4e5d0449e877d7d | #### **During pregnancy:**
- Pregnant women should have 10µg of vitamin D a day.
- Don't drink alcohol.
- Don't smoke and avoid second hand smoke.
- Don't use illegal street drugs or other substances.
- Have the seasonal flu vaccination.
- Have the pertussis (whooping cough) vaccination.
- Avoid contact with people wh... |
575ef0c0330350b1 | #### **Implement NICE guidance**
Providers and commissioners are strongly encouraged to implement NICE guidance relating to antenatal, intrapartum and postnatal care. Implementation of the NICE guidance on the [management of diabetes in pregnancy,](https://www.nice.org.uk/guidance/ng3) [hypertension in pregnancy](http... |
225293a6d31e5661 | #### **Implement best practice care in the event of a stillbirth**
Despite the reduction in stillbirth rates sadly thousands of parents each year will experience the devastation of their baby dying before, during or shortly after birth. The Greater Manchester and Eastern Cheshire Maternity Clinical Network have publis... |
0af3ab50299e181a | #### **Inform women of the long-term outcomes of early term birth**
to delivery prior to reaching maturity, for example, the baby's brain continues to develop at term. Delivery results in huge changes to the baby's physiology, for example, the arterial partial pressure of oxygen increases by a factor of three to four ... |
5ffb697ec6fe991b | #### **Consider how the risks of induction of labour change with gestational age**
For uncomplicated pregnancies NICE guidance on induction of labour should be followed20. In all cases of induction, it is important women receive a clear explanation about why they are being offered induction and that the risks, benefit... |
e6c030850df4ae52 | #### **Reduce the risks of human error through the use of antepartum computerised CTG**
When the available evidence is inconclusive SBLCBv2 aims to implement pragmatic best practice care, based upon clinical experience and a recognition of the important human factors. Human error in antepartum CTG interpretation has b... |
183fcfdfbd185b5a | ## Continuous improvement and the Maternal and Neonatal Health Safety Collaborative
As part of the SBLCBv2, we are including a greater emphasis on continuous improvement. Within each element the focus is on a small number of outcomes with fewer process measures. The implementation of the elements will require a more c... |
78c65828cf8f778a | ## Continuous improvement and the Maternal and Neonatal Health Safety Collaborative
e rate and consequence of preterm delivery is also reflected in the ambitions of the collaborative. Our focus on optimisation of the preterm baby aims to improve care in the antenatal, peripartum and postpartum period. These interventi... |
66818cb285201ef0 | #### **Element description**
**Reducing smoking in pregnancy by assessing exposure to carbon monoxide (CO) as appropriate to assist in identifying smokers (or those exposed to CO through other sources) and refer them for support from a trained stop smoking advisor.** |
8e5386bc6cc7187e | #### **Interventions**
- 1.1 CO testing should be offered to all pregnant women at the antenatal booking appointment, with the outcome recorded.
- 1.2 Additional CO testing should be offered to pregnant women as appropriate throughout pregnancy, with the outcome recorded.
- 1.3 CO testing should be offered to all preg... |
da46f4dd96a0e294 | #### **Continuous learning**
- 1.6 Maternity care providers must examine their outcomes in relation to the interventions and trends and themes within their own incidents where smoking in pregnancy is felt to have been a contributory factor.
- 1.7 Individual Trusts must examine their outcomes in relation to similar Tru... |
baf122039271865b | #### **Continuous learning**
| Process indicators | | Outcome indicators | |
|--------------------|--------------------------------------------------------------------------------------------------------------------------------|--------------------|----------------------------------------------------------------------... |
374a267cebf3518d | #### **Continuous learning**
| Process indicators | | Outcome indicators | |
|--------------------|--------------------------------------------------------------------------------------------------------------------------------|--------------------|----------------------------------------------------------------------... |
741dfd61502fc9e6 | #### **Continuous learning**
| Process indicators | | Outcome indicators | |
|--------------------|--------------------------------------------------------------------------------------------------------------------------------|--------------------|----------------------------------------------------------------------... |
78fac522d09e62db | #### **Continuous learning**
| Process indicators | | Outcome indicators | |
|--------------------|--------------------------------------------------------------------------------------------------------------------------------|--------------------|----------------------------------------------------------------------... |
e2981ef3c26a4147 | #### **Continuous learning**
| Process indicators | | Outcome indicators | |
|--------------------|--------------------------------------------------------------------------------------------------------------------------------|--------------------|----------------------------------------------------------------------... |
215965a769e681ad | ### Rationale
There is strong evidence that reducing smoking in pregnancy reduces the likelihood of stillbirth25. It also impacts positively on many other smoking-related pregnancy complications, such as preterm birth, miscarriage, low birthweight and Sudden Infant Death Syndrome (SIDS)26. Whether or not a woman smoke... |
6a71f57526e3010b | ### Rationale
This element is strongly evidence based and provides a practical approach to reducing smoking in pregnancy by following NICE guidance28. It requires electronic testing of all pregnant women for CO exposure and referring those with a positive reading to a trained stop smoking advisor. We know adherence to... |
fe7359918645313e | ### Implementation
Healthcare professionals must have the time and the tools to carry out the activities required by this element. Midwives need adequate time at the first booking appointment to carry out the CO test and deliver key messages.
Key factors for effective implementation include:
**CO testing**: All staf... |
328b33375e795931 | ### Implementation
**Pathways**: Effective pathways are in place from maternity services into specialist stop smoking support with access to nicotine replacement (for example, immediate referral for specialist support, specialist appointments within 24 hours, co-location of antenatal and stop smoking clinics and in ho... |
12e697f121283aa2 | ### Implementation
**CO testing at the 36 week appointment**: CO testing should be offered, and the result recorded, if the woman attends this appointment in her 35th or 36th week of pregnancy. If at any subsequent appointment it is apparent that CO testing at the 36 week appointment has been missed the practitioner s... |
019cf0ae58d88763 | ### Implementation
**Considerations for frequency of additional testing**: Additional testing of all women at the 16 or 25 week appointment to identify smokers who have not engaged with specialist support or those who may have relapsed. Additional monitoring should also be considered at each antenatal appointment for ... |
cd307f785b42860f | ### Implementation
**Increasing reach**: A multidisciplinary approach should be utilised to share the workload (for example, conducting CO monitoring and the provision of VBA by Maternity Support Worker (MSW) or other healthcare professionals (HCPs)), and engage and support partners and/or other family members to achi... |
52b866db9f79004e | ### Implementation
ion about local authority stop smoking provision and signpost to current resources and information. Those with an interest can also join the Smokefree Pregnancy Information Network administered by Action on Smoking and Health, which will provide up to date information throughout the year. For more i... |
0aff18929acf79bc | #### **Element description**
**Risk assessment and management of babies at risk of fetal growth restriction (FGR).** |
6713f9dc7b557c41 | #### **Prevention**
- 2.1 Assessing women at booking to determine if a prescription of aspirin is appropriate using the algorithm given in Appendix C or an alternative which has been agreed with local commissioners (CCGs) following advice from the provider's Clinical Network.
- 2.2 Assessment of smoking status (see El... |
2b53d22167f59eea | #### **Risk assessment and surveillance of women at increased risk of FGR**
2.3 Use a risk assessment pathway (for example, Appendix D) which triages women at increased risk of FGR into an appropriate clinical pathway to provide surveillance for FGR. The pathway must be agreed with local commissioners (CCGs) following... |
479942ced9de4864 | #### **Risk assessment and management of growth disorders in multiple pregnancy**
2.4 Risk assessment and management of growth disorders in multiple pregnancy should comply with NICE guidance or a variant that has been agreed with local commissioners (CCGs) following advice from the provider's Clinical Network. |
4f7814027233147d | #### **Surveillance of low risk population**
2.5 In women not undergoing serial ultrasound scan surveillance of fetal growth, assessment is performed using antenatal symphysis fundal height (SFH) charts by clinicians trained in their use. All staff performing these measurements are to be competent in measuring, plotti... |
60a76642a36f89d3 | #### **Management of the SGA and growth restricted fetus**
- 2.6 Staff managing fetal growth problems should appreciate that small for gestational age (SGA) (estimated fetal weight (EFW) <10th centile) and FGR (where a fetus fails to reach its growth potential) are distinct entities. Although SGA babies are at increas... |
5d33b3ed65cde9ec | #### **Management of the SGA and growth restricted fetus**
- 2.8 Maternity care providers caring for women with FGR identified prior to 34+0 weeks must have an agreed pathway for management which includes network fetal medicine input (for example, through referral or case discussion by phone).
- 2.9 Accepting the prov... |
ffdc29bea032fa29 | #### **Management of the SGA and growth restricted fetus**
- 2.10 Fetuses between 3rd 10th centile will often be constitutionally small and therefore not at increased risk of stillbirth. Care of such fetuses should be individualised and the risk assessment should include Doppler investigations, the presence of any oth... |
d30659b4acde9e04 | #### **Learning from excellence and error, or incidents**
- 2.11 Maternity care providers must determine and act upon all themes related to FGR (risk assessment, detection or management) that are identified from investigation of incidents, perinatal reviews and examples of excellence. This should include demonstration... |
31d3c6d9f236fa86 | #### **Learning from excellence and error, or incidents**
- c. Monitoring of babies born >39+6 and <10th centile to provide an indication of detection rates and management of SGA babies.
- 2.13 Use the PMRT to calculate the percentage of perinatal mortality cases annually where the identification and management of FGR... |
4a3f0891e8edc61a | #### **Learning from excellence and error, or incidents**
| | Process indicators | Outcome indicators |
|------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------... |
f422473257e9f342 | #### **Learning from excellence and error, or incidents**
| | Process indicators | Outcome indicators |
|------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------... |
5c05dce2ac263627 | ### Rationale
There is strong evidence to suggest that FGR is the biggest risk factor for stillbirth . Therefore, antenatal detection of growth restricted babies is vital and has been shown to reduce stillbirth risk significantly because it gives the option to consider timely delivery of the baby at risk.
The previou... |
8bd90e7313e7fc88 | #### **The risks and benefits of early term delivery**
It is well recognised that preterm birth is associated with both short and long-term sequelae for the infant. The distinction between preterm and term birth is based on the 37+0 week threshold. However, like any threshold on a continuous scale, the separation into... |
080a32e47243274b | #### **The risks and benefits of early term delivery**
rm morbidity can be captured by analysing the risk of admission of the infant to the neonatal unit. One of the best UK analyses was published by Stock et al where they compared the risk of neonatal unit admission associated with induction of labour at the given we... |
f02a7e9bc93721a4 | #### **The risks and benefits of early term delivery**
| Week of gestational age | Neonatal admission per 1,000 | | Adjusted odds ratio (95% CI) |
|----------------------------|---------------------------------|-----------------|---------------------------------|
| 40 | 80 | 73 | 1.14 (1.09-1.20) |
| 41 | 66 | 84 | 0.... |
b7236451d54a919b | #### **The risks and benefits of early term delivery**
However, delivery of the baby early prevents the subsequent risk of antepartum stillbirth. As antepartum stillbirth is the major single cause of perinatal death at term, earlier delivery will prevent perinatal death. The same paper also reported data on the risk o... |
9c84e308367b0032 | #### **The risks and benefits of early term delivery**
The dilemma is that early term delivery reduces the risk of a very rare but serious adverse event (stillbirth or neonatal death) while increasing the risk of much more common but less severe adverse events. Decision-making balances the risks of causing mild harm t... |
4863655a0a0ac051 | ### Implementation
This element recognises that there is a range of expert opinions on some interventions and allows some flexibility in the choice of pathways. The pathway in Appendix D is a suggestion but not mandated. A pathway should, however, be agreed with local
commissioners (CCGs) following advice from the pr... |
a9c41d47016121c2 | ### Implementation
- ensure that all pregnant women are assessed for their risk of placental dysfunction with the associated potential for FGR in early pregnancy.
- ensure that a robust training programme and competency assessment is included in any processes designed to detect a SGA fetus, for example measurement of ... |
69857e6650f814a9 | ### Implementation
This updated element recognises that uterine artery Doppler measurement in high risk pregnancies can improve efficiency by targeting scan resources (Appendix D). The use of uterine artery Doppler measurement in women whose pregnancies are at high risk for placental dysfunction will require training ... |
c7355e101c3d0029 | ### Implementation
The RCOG SGA guideline advises that fetal biometry surveillance scans need not be performed more frequently than every three weeks unless potential abnormalities in fetal growth are identified, in which case scans may need to be performed more frequently (see intervention 2.7). Ultrasound surveillan... |
16722e529ece475d | ### Implementation
Trusts submitting data to the MSDS will be able to view the percentage of <10th centile and <3rd centile births in each gestational week of the third trimester in their unit annually. These data will allow Trusts to compare outcomes with similar units and to monitor the performance of their SGA and ... |
c30c27a8c20099ab | #### **Element description**
**Raising awareness amongst pregnant women of the importance of reporting reduced fetal movements (RFM), and ensuring providers have protocols in place, based on best available evidence, to manage care for women who report RFM.** |
7a63b6433fc6f461 | #### **Continuous learning**
| Process indicators | Outcome indicators |
|-------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------... |
cad9230389647796 | ### Rationale
Enquiries into stillbirth have consistently described a relationship between episodes of RFM and stillbirth, ranging from the 8th CESDI report published in 2001 to the MBRRACE-UK reports into antepartum and intrapartum stillbirths respectively . In all of these case reviews unrecognised or poorly managed... |
ec2601104f3b251a | ### Implementation
It is possible that this element will cause an increase in ultrasound scans and obstetric interventions, such as induction of labour and caesarean section45. The AFFIRM study found that a care package which recommended all women have an ultrasound assessment of fetal biometry, liquor volume and umbi... |
2b2d04e8ba682b22 | ### Implementation
In order to reduce the number of scans required to implement this element providers are encouraged to offer computerised CTGs. If a computerised CTG has been performed and is normal and there are no other indications for an ultrasound scan then a scan is not required for a first presentation of RFM ... |
db28f08c7ca3478a | ### Implementation
Prior to 39 weeks gestation, induction of labour or operative delivery is associated with small increases in perinatal morbidity and neurodevelopmental delay. Thus, a recommendation for delivery needs to be individualised and based upon evidence of fetal compromise (for example, abnormal CTG, EFW <1... |
06888376bb5c4283 | ### Implementation
At 39 weeks gestation and beyond, induction of labour is not associated with an increase in caesarean section, instrumental vaginal delivery, fetal morbidity or admission to the neonatal intensive care unit. Induction of labour therefore, could be discussed (risks, benefits and mother's wishes) with... |
144e5e3b05eb2117 | #### **Interventions**
- 4.1 All staff who care for women in labour are required to undertake annual training and competency assessment on cardiotocograph (CTG) interpretation and use of auscultation. Training should be multidisciplinary and include training in situational awareness and human factors. The training and... |
c844170dd033f1cd | #### **Continuous learning**
- 4.5 Maternity care providers must examine their outcomes in relation to the interventions, trends and themes within their own incidents where fetal monitoring was likely to have been a contributory factor.
- 4.6 Individual Trusts must examine their outcomes in relation to similar Trusts ... |
dc7d1f159b0d72ac | ### Rationale
CTG monitoring is a well-established method of confirming fetal wellbeing and identification ofpotential fetal hypoxia. In the case of a high risk labour where continuous monitoring is needed, CTG is the best clinical tool available to carry this out.
However, CTG interpretation is a high-level skill an... |
9ea22e489b2477c9 | ### Rationale
The importance of good fetal monitoring during labour, in achieving delivery of a healthy baby, is underlined by data from the RCOG's Each Baby Counts report51, showing that fetal monitoring was identified in 74% of babies as a critical contributory factor where improvement in care may have prevented the... |
c642f00e075bc3fb | ### Rationale
- a regular/rolling programme of training in the use of electronic fetal monitoring
- simple guidelines on the interpretation of electronic fetal monitoring
- clear lines of communication when an abnormal CTG is suspected
- guidelines on appropriate management in situations where the CTG is abnormal
Imp... |
ae1274fc55a06874 | ### Rationale
Many of the findings and recommendations from the Each Baby Counts report are echoed in the 2017 MBRRACE-UK Perinatal Confidential Enquiry that focussed on term, singleton, intrapartum stillbirth and intrapartum-related neonatal death. Recommendations that have now been incorporated into this element of ... |
1dfc804b073cc43d | ### Rationale
training and competency assessment. In addition, both reports identify the fact that CTG or IA monitoring cannot be used in isolation and are only part of a complex assessment of fetal wellbeing – "Failure to recognise an evolving problem, or the transition from normal to abnormal, was a common theme. It... |
54d08aa6a02750c4 | ### Implementation
- Include multidisciplinary and scenario-based training this should involve all medical and midwifery staff who care for women in birth settings.
- Teaching about fetal physiological responses to hypoxaemia, the pathophysiology of fetal brain injury, and the physiology underlying changes in fetal he... |
d14f0622926988a2 | ### Implementation
- o interpretation in specific clinical circumstances (such as previous caesarean sections, breech and multiple pregnancy).
- Interventions that can affect the FHR (such as medication) and those that are intended to improve the FHR (such as oxygen).
- Additional tests of fetal wellbeing that help cl... |
416822c25565b3b3 | ### Implementation
- Training in situational awareness and human factors to enable staff to respond appropriately to evolving, complex situations.
- Provision of adequate training is a Trust priority as a minimum all staff should receive a full day of multidisciplinary training (following the principles outlined above... |
cc88e3890d2dd4f4 | ### Implementation
Competency assessment: all staff will have to pass a formal annual competency assessment that has been agreed by the local commissioner (CCG) based on the advice of the Clinical Network. The assessment should include demonstrating a clear understanding of the areas covered in training (see principle... |
ebd433172af8a273 | ### Implementation
**Intervention 2**: The MBRRACE-UK Perinatal Confidential Enquiry report recommended the national development of a standardised risk assessment tool. As this has not yet been developed the procedure should comply with NICE guidance53. A case example based upon NICE guidance has been provided in Appe... |
ced9fa1ab46e1bfd | ### Implementation
The discussion should include evaluation of the FHR (CTG or IA), review of risk factors such as persistently reduced fetal movements before labour, fetal growth restriction, previous caesarean section, thick meconium, suspected infection, vaginal bleeding or prolonged labour and should lead to escal... |
4e64de3ca6917a31 | ### Implementation
**Intervention 4**: Some Trusts may choose to extend the remit of the Practice Development Midwife to fulfil the role of Fetal Monitoring Lead, whereas others may wish to appoint a separate clinician. The critical principle is that the Fetal Monitoring Lead has dedicated time when their remit is to ... |
3a9b84a6ddf48d31 | #### **Prediction**
5.1 Assess all women at booking for the risk of preterm birth and stratify to low, intermediate and high risk pathways using the criteria in Appendix F or an alternative which has been agreed with local commissioners (CCGs) following advice from the provider's Clinical Network. |
7f2ceff61c3877a0 | #### **Prevention**
- 5.2 Assess all women at booking to determine if a prescription of aspirin is appropriate using the algorithm given in Appendix C or an alternative which has been agreed with local commissioners (CCGs) following advice from the provider's Clinical Network.
- 5.3 Assessment of smoking status (see E... |
1b141de97b932417 | #### **Prevention**
- 5.5 Assess women with a history of preterm birth to determine whether this was associated with placental disease and discuss prescribing aspirin with the woman based upon her personalised risk assessment.
- 5.6 All women to be offered testing for asymptomatic bacteriuria by sending off a midstrea... |
86322dd18b126ef6 | #### **Prevention**
- 5.8 Every provider should have referral pathways to tertiary prevention clinics for the management of women with complex obstetric and medical histories. This should include access to clinicians who have the expertise to provide high vaginal (Shirodkar) and transabdominal cerclage. These procedur... |
f58cf6fa3d8ad079 | #### **Prevention**
**Preparation**: optimising care of women and babies at high risk of imminent preterm birth. 5.9 Optimise place of birth – women at imminent risk of preterm birth should be offered transfer to a unit with appropriate and available neonatal cot facilities when safe to do so and as agreed by the rele... |
e6801598bcdfc9dc | #### **Prevention**
- 5.10 Antenatal corticosteroids to be offered to women between 24+0 and 33+6 weeks, optimally at 48 hours before a planned birth. A steroid-to-birth interval of greater than seven days should be avoided if possible.
- 5.11 Magnesium sulphate to be offered to women between 24+0 and 29+6 weeks of pr... |
d2151114cbbc5be4 | #### **Prevention**
- 5.13 For women between 23 and 24 weeks of gestation, a multidisciplinary discussion should be held before birth between the neonatologist, obstetrician and the parents about the decision to resuscitate the baby. If resuscitation is agreed to be attempted, women should be offered magnesium sulphat... |
3aaaea729c092cc8 | #### **Continuous learning**
- 5.14 Maternity care providers must determine and act upon all themes related to preterm birth (prediction, prevention, preparation) that are identified from investigation of incidents, perinatal reviews and examples of excellence. This should include demonstration of improvement by reass... |
5847648249525db4 | #### **Continuous learning**
- 5.16 Use the PMRT to calculate the percentage of perinatal mortality cases annually where the prevention or prediction of or preparation for preterm birth was a relevant issue.
- 5.17 Individual Trusts must examine their outcomes in relation to similar Trusts to understand variation and ... |
cc40dc414d82e8e2 | #### **Continuous learning**
- c. Optimisation of women with suspected preterm labour, including effective use of antenatal corticosteroids and magnesium sulphate.
- d. Appropriate place of birth for women at risk of preterm birth.
- 5.19 Maternity providers will share evidence of these improvements with their Trust ... |
86652eea098c0677 | #### **Continuous learning**
| | Process indicators | Outcome indicators |
|------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------... |
a339dcf0c581944c | #### **Continuous learning**
| | Process indicators | Outcome indicators |
|------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------... |
8da2d4ee0678465a | #### **Continuous learning**
| | Process indicators | Outcome indicators |
|------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------... |
49459269244e92db | #### **Continuous learning**
| | Process indicators | Outcome indicators |
|------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------... |
41c6f9683ce310e6 | ### Rationale
Preterm birth (PTB), defined as delivery at less than 37+0 week's gestation, is a common complication of pregnancy, comprising around 8% of births in England and Wales56. It is the most important single determinant of adverse infant outcome with regards to survival and quality of life57. Babies born pret... |
47cd13d9b1961a03 | ### Rationale
- reduce deaths in babies and young children
- improve the safety of maternity services (admission of full-term babies to neonatal care) |
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