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

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Acknowledgements CEMACH acknowledges with grateful thanks the contribution made by Dr Mary Macintosh, Medical Director of CEMACH until 30th April 2006, to the Diabetes Programme since its inception in 2001. Editor Jo Modder, Clinical Director (Obstetrics) Authors • Jo Modder, Clinical Director (Obstetrics) • Kate Fleming, Senior Data Analyst (until 8th November 2006) • Dominique Acolet, Clinical Director (Neonatology) – Chapter 12 External commentators • Kirsty Samuel, Lay Panel Assessor, Yorkshire & Humberside Region • Sue Roberts, National Clinical Director for Diabetes • Stephen Walkinshaw, Chair, CEMACH Diabetes Professional Advisory Group • John Scarpello, Deputy Medical Director, National Patient Safety Agency • Robert Fraser, Chair, NICE Diabetes in Pregnancy Guideline Development Group • Patricia Hamilton, President, Royal College of Paediatrics and Child Health Acknowledgements Thanks are due to all maternity unit co-ordinators, clinicians and staff who have contributed their time and expertise and without whom this report would not have been possible. In particular, thanks are due to: • All Panel Assessors for their extensive and detailed review of medical records during panel enquiries and the signifi cant amount of time contributed to panel meetings. • All Panel Chairs; for chairing panel enquiries in their region, supporting the CEMACH Regional Managers, and contributing to the recommendations of this report. • All CEMACH Regional Managers and Assistants for liaising with local clinicians, managing the data collection process, preparing medical records for review and organising panel enquiry meetings. • Pat Doyle, Head of Department of Epidemiology, London School of Hygiene and Tropical Medicine, for her advice on the statistical analysis of this report. • Tim Clayton, Medical Statistics Unit, London School of Hygiene and Tropical Medicine, for independent statistical review of this report. • Gillian Hawthorne, Consultant Diabetes Physician, Newcastle Diabetes Centre, for her contribution to the analysis of enquiry panels’ free text comments. • Oliver Rackham, Consulant Paediatrician, Arrowe Park Hospital, for his contribution to the analysis of cause of death of stillbirths and neonatal deaths. • Chris Wright, Consultant Paediatric Pathologist, Royal Victoria Infi rmary, for his advice regarding the data on post mortem examination. iv
• Members of the CEMACH Diabetes Professional Advisory Group (chaired by Stephen Walkinshaw) for their support during the Diabetes Programme, and in particular, their advice on the development of data tools and processes of the enquiry, the content of this report and their contribution to the recommendations contained within this report. • Members of the Neonatal Enquiry Steering Group for their contribution to the development of the Neonatal Enquiry, the content of the neonatal chapter, and their contribution to the neonatal recommendations. • Peer reviewers of the report (Appendix F). • Rosie Houston, Assistant Projects Manager, for managing the publication of this report. • Naufi l Alam, Data Analyst; Alison Miller, Programme Director and Midwifery Lead; Shona Golightly, Director of Research and Development; Richard Congdon, CEMACH Chief Executive; and all other staff at CEMACH Central Offi ce for their support and advice during the development of this report. v
Page 1 and 2: Confidential Enquiry into Maternal
Page 3: Contents Acknowledgements .........
Page 7 and 8: Erb’s palsy Injury to the nerve r
Page 9 and 10: Neonatal unit A unit which provides
Page 11 and 12: Foreword This third and fi nal repo
Page 13 and 14: 1. Introduction This is the fi nal
Page 15 and 16: 2. Key fi ndings of the CEMACH Diab
Page 17 and 18: Suboptimal fetal surveillance of ba
Page 19 and 20: 3. Summary of recommendations This
Page 21 and 22: 2. Patient pathways of care includi
Page 23 and 24: the pregnancies meeting this defi n
Page 25 and 26: in order to remove any identifi abl
Page 27 and 28: When deriving odds ratios for any p
Page 29 and 30: Associations are reported in Chapte
Page 31 and 32: Table 5.1 Characteristics of women
Page 33 and 34: Table 5.4 Characteristics of women
Page 35 and 36: was no information available to pan
Page 37 and 38: 6. Factors associated with poor pre
Page 39 and 40: Table 6.2 Association of clinical c
Page 41 and 42: Table 6.5 Association of specifi c
Page 43 and 44: Table 6.8 Association of postnatal
Page 45 and 46: folic acid before pregnancy (19% of
Page 47 and 48: Table 7.2 Panel comments on social
Page 49 and 50: 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
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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 and 102:
2.1 hours in babies remaining with
Page 103 and 104:
12.7.1 Panel comments on suboptimal
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 116 and 117:
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
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Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
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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