Remote consultations blamed for stillbirths

A LACK of face-to-face appointments during the pandemic may have contributed to stillbirths in the first wave, investigators have found.

The study by the Healthcare Safety Investigation Branch (HSIB) into 37 cases found that remote consultations may have driven down the ability to carry out key checks, with some doctors unable to access medical records.

The review was prompted by an increase in stillbirths after the onset of labour referred to the HSIB between April and June 2020 – 45 compared with 24 in the same period in 2019.

The report found the pressures and changes as a result of the pandemic may have affected the care they received.

It comes after a senior coroner recently warned that a lack of face-toface appointments was linked to five deaths. Sajid Javid, the Health Secretary, told the Commons yesterday “GPS should be offering face-to-face access”.

The HSIB report found remote consultations resulted in fewer opportunities for physical examinations for pregnant women, meaning trends in how the baby was growing could be missed. Some face-to-face appointments were postponed until later in the pregnancy, while in some consultations clinicians did not have access to clinical notes or ultrasound scan reports.

In one case, a mother had to read the results of her ultrasound scan over the phone to the obstetrician.

Some women opted not to attend appointments for fear of catching Covid. Investigating the timing of the babies’ deaths in relation to when the mothers had contact with healthcare services, the report found 19 showed no signs of life at the first visit to the hospital when they were in early labour.

Of those, 11 (58 per cent) had sought healthcare advice over the phone and were advised to remain at home.

The HSIB said many of the safety risks identified in the review were already known to maternity services and exacerbated by the pandemic.

Kathryn Whitehill, principal national investigator at the HSIB, said: “Our review did highlight the extreme pressure maternity services were under. They had to balance the risks associated with uncertainty and emerging evidence on Covid-19 transmission with the clinical assessments that are needed to monitor the safety of patients.”

Following the report, the HSIB recommends NHS England and NHS Improvement should lead work to “collate and act on” evidence regarding the risks and benefits associated with having remote consultations while pregnant. Jane Brewin, the chief executive of Tommy’s, the largest UK charity researching pregnancy complications and baby loss, said the report acknowledges the efforts made to keep maternity services running during the pandemic.

But she added: “It also shows the impact of some mothers not getting the right care in the right place at the right time, and lessons must be learned from the lives tragically lost. It’s not always possible to know why a stillbirth happened, but sometimes there are warning signs and these babies’ lives could be saved.”