Increase in Intrapartum Stillbirths During First Wave of COVID-19

Priscilla Lynch 

September 16, 2021

There was a significant increase in intrapartum stillbirths during the initial stages of the COVID-19 pandemic, with the virus creating specific safety risks in maternity services, a Healthcare Safety Investigation Branch (HSIB) review report has found.

This review was prompted by an increase in referrals of intrapartum stillbirths to HSIB that fitted its specific criteria between April and June 2020 (45 compared with 24 in the same period in 2019).

HSIB thematically analysed 37 maternity investigation reports focused on intrapartum stillbirths from April to June 2020 to determine what learning could be drawn from these cases.

The report suggests that many safety risks identified in the review were already known to maternity services but were further exacerbated by the pandemic, for example, the sustainability of staffing levels in maternity units.

It also highlights that COVID-19 created specific safety risks, including the impact of limiting face-to-face interactions and increasing remote consultations.

The report concludes with eight safety recommendations and three safety observations aimed at reducing variation and improving safety regarding the development of maternity guidance, remote consultation, communication, monitoring of foetal well-being, telephone triage and availability of interpretation services.

Further safety recommendations relate to taking a proactive approach to the assessment of patient safety risks and the use of an overall safety management system in maternity care, as used in other safety-critical industries.

Kathryn Whitehill, Principal National Investigator at HSIB, said: “As the NHS continues to tackle COVID-19 and deal with the impact on services, it is important that learning is shared across the system. Our review provides an independent examination of the factors that influenced care during the first wave. Our recommendations are aimed at identifying where there might be gaps in safety management and supporting the system to take a proactive approach in ensuring the wellbeing and effective care of women and pregnant people and their babies across the country.” 

RCOG Response

In a statement, Dr Edward Morris, president of the Royal College of Obstetricians and Gynaecologists, said: "The pandemic has put huge pressure on all healthcare services but despite this maternity staff have maintained a high standard of care to pregnant women and their babies.

"We are aware that during the first peak of the pandemic, some pregnant women had difficulty accessing maternity services or presented late with reduced foetal movements – which can be a sign their baby is unwell, and of women missing antenatal appointments.

"This may have been due to confusion around whether these appointments were essential, fear of attending a hospital or not wanting to burden the NHS.

"Ahead of the second wave, we issued clear advice to NHS services to ensure women were encouraged to attend day assessment and triage services if they had concerns about their wellbeing or that of their babies.

"We also recommended a full schedule of antenatal care be offered wherever possible, with appointments offered in-person especially for those from black, Asian or minority ethnic communities and women living with medical, social or psychological issues.

"Antenatal care is essential and face-to-face appointments are necessary to support a healthy pregnancy.

"We understand during the pandemic more remote appointments have been taking place and would welcome further investigation to see the impact of remote consultations during pregnancy."

This article was adapted from Univadis, part of the Medscape Professional Network.

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