Diabetes in pregnancy: are we providing the best care ... - HQIP

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Neonatal care of term babies Table 12.9 Timing of fi rst blood glucose measurement in relation to feed in babies of mothers with type 1 and type 2 diabetes Timing of first blood glucose measurement Babies remaining with mother n(%) (N=70) Babies admitted to NNU n(%) (N=42) Total (N=112) Pre-feed 43 (64) 28 (74) 71 (68) Post-feed 18 (27) 9 (24) 27 (26) Random 6 (9) 1 (3) 7 (7) Missing 3 4 7 12.6.2 Panel assessment of documentation of blood glucose management Panels assessed that documentation of blood glucose measurements was more frequently suboptimal on the postnatal ward (81%, 57/70 of babies) than on the neonatal unit (48%, 20/42 of babies, p
12.7.1 Panel comments on suboptimal care of babies on the labour ward Panels made 95 comments for the 62 babies whose care on the labour ward was suboptimal (table 12.11). The most frequently recorded issues were: a) inappropriate timing of blood glucose testing b) no close early contact between mother and baby/ missed breastfeeding opportunities c) allowing the baby to get cold and d) no plan of care. Table 12.11 Panel comments on suboptimal care on the labour ward (table contains information following categorisation of free text) Babies with suboptimal care on labour ward (N=62) No. of comments % of babies Total comments 95 Blood glucose 22 36 Done too soon 7 Delayed 5 No monitoring 2 Substandard management 7 No documentation 1 Feeding 23 37 Delayed 7 No skin-to-skin contact/breastfeeding opportunity 12 Breastfeeding impaired/overturned 2 Other management 1 No documentation 1 Temperature 29 47 Allowed to get cold 12 No monitoring 9 Not documented 8 Overall management 16 26 No clinical assessment 2 No plan of care 12 No guidelines/protocol 2 Other 5 8 12.8 Written management plans It is important to have a clear written management plan at birth for babies of women with diabetes, to help staff on the neonatal unit and midwives on the postnatal ward to direct their neonatal care appropriately. 91
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Confidential Enquiry into Maternal
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Contents Acknowledgements .........
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• Members of the CEMACH Diabetes
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Erb’s palsy Injury to the nerve r
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Neonatal unit A unit which provides
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Foreword This third and fi nal repo
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1. Introduction This is the fi nal
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2. Key fi ndings of the CEMACH Diab
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Suboptimal fetal surveillance of ba
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3. Summary of recommendations This
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2. Patient pathways of care includi
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the pregnancies meeting this defi n
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in order to remove any identifi abl
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When deriving odds ratios for any p
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Associations are reported in Chapte
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Table 5.1 Characteristics of women
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Table 5.4 Characteristics of women
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was no information available to pan
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6. Factors associated with poor pre
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Table 6.2 Association of clinical c
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Table 6.5 Association of specifi c
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Table 6.8 Association of postnatal
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folic acid before pregnancy (19% of
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Table 7.2 Panel comments on social
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7.5 Conclusions One of the key fi n
Page 51 and 52: 11.Dex S, Heather J (eds). Millenni
Page 53 and 54: 8. Clinical care issues: preconcept
Page 55 and 56: chance of induction of labour was r
Page 57 and 58: 8.6.1 Enquiry fi ndings Just over h
Page 59 and 60: Some quotes from the panel discussi
Page 61 and 62: Apart from the explanation of pregn
Page 63 and 64: was associated with poor pregnancy
Page 65 and 66: of women after the fi rst trimester
Page 67 and 68: 9.5.1 Panel comments on suboptimal
Page 69 and 70: During labour and delivery, the maj
Page 71 and 72: Just 52% of 383 women (38% of 164 c
Page 73 and 74: • ‘No serial growth scans perfo
Page 75 and 76: The panel enquiries, which are in e
Page 77 and 78: 10.3.1 Enquiry fi ndings Seventy fi
Page 79 and 80: 10.6 Communication Effective commun
Page 81 and 82: Some quotes from the panel discussi
Page 83 and 84: working between primary and seconda
Page 85 and 86: we therefore selected 7.2% of pregn
Page 87 and 88: 11.4 Preconception behaviour The CE
Page 89 and 90: enquiry related to a 12 month prior
Page 91 and 92: Table 11.10 Differences in postnata
Page 93 and 94: Type 1 and type 2 diabetes have tra
Page 95 and 96: Panels were chaired by the panel ch
Page 97 and 98: In 57% (24/42) of cases, a junior d
Page 99 and 100: Infant formula given as fi rst feed
Page 101: 2.1 hours in babies remaining with
Page 105 and 106: The concerns described here probabl
Page 107 and 108: External commentary Patricia Hamilt
Page 109 and 110: informed and motivated to manage th
Page 112 and 113: 100 Appendix A: Pre-pregnancy care
Page 114 and 115: 102 Appendix B: Diabetes enquiry pr
Page 132 and 133: Appendix C Association between demo
Page 134 and 135: Appendix C Association of preconcep
Page 136 and 137: Appendix C Association of postnatal
Page 138 and 139: Appendix D Association of social an
Page 140 and 141: Appendix D Association of diabetes
Page 142 and 143: Appendix E Association between demo
Page 144 and 145: Appendix E Association between prec
Page 146 and 147: Appendix E Association between post
Page 148 and 149: Appendix F - CEMACH advisory groups
Page 150: Appendix F - CEMACH advisory groups
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Diabetes in pregnancy: are we providing the best care ... - HQIP

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