5 years of cerebral palsy claims

In this lecture Dr Michael Margo reviews cerebral palsy claims from the UK over a 5 year period.  He identifies problems with how serious incident investigations are conducted and considers key learnings. Recommendations are provided on how to conduct better investigations including:

• Active involvement of women and families in investigation
• Training for those conducting investigations
• Emotional support for staff throughout investigation

Further clinical recommendations are also made including:

• Staff must undergo annual, locally led multi-professional training
• CTG interpretation should occur in isolation
• Effectiveness of training should be monitored by linking it to clinical outcomes

The full lecture is available here.

Study – Increase in trauma to mums and babies from forceps deliveries

A study conducted in Canada of 2 million deliveries from 2004 – 2015 found an increase in injuries to women. The biggest increase in trauma involved forceps deliveries with a rate of 19.4 per cent in first-time mothers in 2004 that increased to 26.5 per cent in 2014. Not only that but rates of trauma to babies also increased among first-time mothers, from 4.5 to 6.8 per 1,0000 deliveries. This article suggests that skills and training in forceps use is declining resulting in the increased trauma. ​

I attended the first British Intrapartum Care Society meeting yesterday. It was a great success and congratulations to all the organisers.
 
Full dilation CS (FDCS) is a subject very close to my heart. The talk on this left us with more questions than answers and I feel that these need to be addressed.
 
One of the hardest tasks performed by an obstetrician is to have to tell parents that there was nothing wrong with their baby, but they just couldn’t get the baby out safely even at a CS after a long labour.
 
The idea of Fetal Pillow was conceived after such an incident many years back. Fetal Pillow has now gained mainstream status in UK and Australia (more than 40%) of all hospitals using it and the numbers are growing. It was cleared by FDA last year after all the available clinical data was presented to them along with stringent mechanical safety testing.
 
Q. Should we be reducing the second stage CS and not doing “any”?
 
A. A laudable aim and no doubt should be attempted and already being tried by many others. Using rotational forceps might help but we will always have full dilation CS.
 
Q. Use of forceps is much higher north of Birmingham. Does that mean there are no FDCS in that area?
 
A. In fact there are more users of FP north of Birmingham than south of it despite significantly higher use of rotational forceps in some of the hospitals.
 
Q. Can we push from below with the palm rather than fingers and also rotate the head at the same time?
 
A. No. For those of us who have had to do this will know that it is impossible to push using palm due to lack of space and awkward direction of push that is required. To be able to rotate the fetal head along with this is an impossible task.
 
Q. Can we teach rotational forceps in a 3 hr session every six months as suggested by the speaker?
 
A. No. Firstly there are not enough teachers to go around and the risks involved are high so this is unlikely to ever happen.
 
Q. Can Fetal Pillow elevate a 3.5kg baby along with IU pressures of second stage labour?
 
A. Yes. This is a question that used to be asked 7yrs back so it is a bit of a surprise that after almost 15,000 FP uses and lots and lots of clinical data that this should even come up again. To elaborate on this, intra uterine pressures in second stage of labour along with maternal effort are around 140mmHg. For the FDA we carried out mechanical test on FP and subjected it to pressures of 3000mmHg (more than 20 times the IUPs) and could inflate the device easily and elevate a dummy fetal head successfully using a 60cc syringe.
 
Q. Is reverse breech a better way to deliver a deeply impacted head?
 
A. No. The best way to manage this problem is to PREVENT the difficulty arising from a deeply impacted head by using FP. Reverse breech is an extremely difficult procedure to perform and the rarity of this condition makes it difficult if not impossible to teach to the trainees and in any case most senior haven’t done it either.

Author
Dr R Varma 
FRCOG
Consultant Obstetrician & Gynaecologist
r.varma@safeob.com
 
About the author
 
Dr Varma is a consultant Obstetrician & Gynaecologist with 35 years’ experience in the field of O&G.  He is the inventor of fetal pillow and a part time Medical Director of Safe Obstetric Systems. He is still in active clinical practice in the field of Urogynaecology.

Reduced mortality rates in UK for 2013 – 2016 - 4th MBRRACE-UK Perinatal Mortality Surveillance Report
The 4th MBRRACE-UK Perinatal Mortality Surveillance report for births in 2016 has been released. The report highlights a reduction in mortality rates from 2013 to 2016 with 300 fewer baby deaths, 200 fewer still births and 100 fewer neonatal deaths. improvements in survival rates for twins was particularly significant. The report did highlight wide regional variation in neonatal mortality rates in England. Full report is available here.

Use of ‘Count the Kicks’ app helping to reduce still births

A mother from the US has said the app Count the Kicks combined with a little vigilance saved her daughters life.

She had been using the app to monitor her baby’s movements so when they were reduced she realised something was wrong. Upon arrival at hospital doctors discovered the umbilical cord was wrapped around the baby 3 times limiting her movement. The baby was safely delivered via an emergency caesarean section.

Since beginning a campaign in the US the founder of Count the Kicks says there has been a 26% decrease in still births.  Read the full story here

PROMPT Vaginal Breech Training
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PROMPT Maternity have released this video on how to manage a vaginal breech birth. The short video guides you through the manoeuvres that can be used to assist in the birth. It includes advice for when the head is both descended and when it isn’t descended enough. 

Randomised study suggests increased resident/junior supervision does not significantly reduce the rate of medical errors

A randomised trial conducted in the US has investigated the impact that 2 different levels of supervision has on a resident/junior doctor. Individuals received either direct supervision with joined rounds for previously admitted patients or standard supervision with support available but not attending the round.

Findings show increased supervision did not significantly reduce the rate of medical errors but did result in interns speaking less and residents reporting a decreased level of autonomy.

Full study available here:
Effect of Increased Inpatient Attending Physician Supervision on Medical Errors, Patient Safety, and Resident Education. A Randomized Clinical Trial

Crazy Socks for Docs day
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Today (1st June) is crazy socks for docs day. This campaign is aimed at raising awareness of mental health issues experienced by doctors. Statistics from Australia suggest:

• 1 in 5 doctors have depression
• 1 in 4 doctors have thought about suicide
• 1 in 50 had tried

People are encouraged to wear crazy socks, post a picture on social media using #CrazySocks4Docs and start a conversation with your colleagues about mental health.

Finding the words – Talking about baby loss

Everyday in the UK 15 babies die before, during or shortly after birth. Sands has launched a campaign to break the silence around stillbirth and neonatal death by encouraging conversations with someone who has lost a baby. The website provides advice about how to start the conversation. 

Incidence of Postpartum Haemorrhage increasing – Study from Australia

​A population‐based study using Victorian Perinatal Data Collection data for 764 244 births found that the incidence of primary postpartum haemorrhage, severe primary postpartum haemorrhage and associated maternal morbidities have increased significantly over time. The highest incidence of PPH was experienced in women who had an unplanned caesarean birth. Study available here

IJGO Special edition - Thinking beyond maternal mortality: Re-conceptualizing and
measuring maternal morbidity
 
The International Journal of Gynaecology and Obstetrics has published a special supplement presenting a series of papers which shares aspects of the maternal morbidity working groups work over the past 5 years. It includes new insights into the assessment of maternal morbidity and tools to do so. Read it in full here.

World Preeclampsia Day
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Tuesday was world preeclampsia day. It can have severe consequences for mothers and babies and it is estimated 20% of the worlds maternal deaths are from preeclampsia.

How I saved my daughter from a medical error
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This article written by a physician highlights an incident involving his 4 day old daughter. He provides advice to parents when visiting hospital including being prepared providing an accurate medical history, ask questions and be heard. 

Each baby costs UK hospitals £1000 injury insurance

NHS maternity hospitals are paying out insurance premiums of almost £1000 for each baby they deliver to protect themselves and staff against the cost of medical negligence this Times article reports. Jeremy Hunt last month told a medical conference that 25 babies were injured during birth each week in NHS hospitals with 4-5 of those suffering lifelong brain damage.

Every year more than 50,000 women nearly die in childbirth in the US

50,000 women nearly die each year in the US during childbirth. Of those women that do die over half of the deaths could be prevented. In this video 3 mothers tell the stories of what happened to them. 

UK Maternal Mental Health Matters Awareness Week

This week is the UK Maternal Mental Health Matters Awareness Week. Up to 1 in 5 women will develop a mental illness during pregnancy or in the first year after birth. An RCOG survey of women’s experiences of mental health problems during or after pregnancy found:

• Women reported experiencing low rates of referral, long waits, regional variation of care, a lack of continuity of care, misunderstanding and stigma
• The mental health of women’s partners is also often neglected by healthcare professionals and services

The Perinatal Mental Health Partnership Facebook & Twitter has some great information covering what is perinatal mental health,  removing barriers to services, paternal mental health and recovery. 

When childbirth results in physical and emotional trauma – Podcast
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Up to 40% of women don’t have a ‘normal’ birth. This podcast with the founders of the of the Australasia birth trauma association discusses when childbirth results in physical and emotional trauma and how experiences can be improved.

American Congress of Obstetrician & Gynaecologists annual meeting 2018
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Last weekend the ACOG Annual Clinical Meeting took place in Texas. ACOG TV captured some of the key takeaways from the meeting including this video which talks about the ‘Second Victim’ Phenomenon and the measures in place to support clinicians.  A second victim is a health care provider who has been involved in an unanticipated adverse patient event, medical error or patient related injury and is traumatised by the event.