Saving Babies' Lives Project Impact and Results Evaluation: a Mixed Methodology Study

NCT ID: NCT03231007

Last Updated: 2018-12-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

4952 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-07-10

Study Completion Date

2018-07-05

Brief Summary

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The study is a multicentre evaluation of maternity care delivered through the Saving Babies' Lives care bundle using both quantitative and qualitative methodologies. The study will be conducted in twenty NHS Hospital Trusts from six NHS Strategic Clinical Networks totalling approximately 100,000 births. It involves participation by both service users and care providers.

To determine the impact of the care bundle on pregnancy outcomes, birth data and other clinical measures will be extracted from maternity databases and case-note audit from before and after implementation. Additionally, this study will employ questionnaires with organisational leads and review clinical guidelines to assess how resources, leadership and governance may affect implementation in diverse hospital settings. The cost of implementing the care bundle, and the cost per stillbirth avoided, will also be estimated as part of a health economic analysis. The views and experiences of service users and service providers towards maternity care in relation to the care bundle will be also be sought using questionnaires.

This study will provide practice-based evidence to advance knowledge about the processes that underpin successful implementation of the care bundle so that it can be further developed and refined. This has the potential to translate into substantial improvements in the rate of late stillbirth in the UK should the care bundle be proved effective.

Detailed Description

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Reducing stillbirth and early neonatal death is a national priority. Best practice and key evidence indicates this is potentially achievable through application of four key interventions within routine maternity care delivered as NHS England's Saving Babies' Lives care bundle. However, adoption of the care bundle by UK maternity services is still in its infancy and there is significant variation in the degree of implementation between and within units. The effectiveness of the care bundle, when implemented as a package, in reducing stillbirth and service delivery has not yet been evaluated. This study aims to evaluate the impact of implementing the care bundle on UK maternity services and perinatal outcomes.

Conditions

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Stillbirth

Study Design

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Observational Model Type

OTHER

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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Innovators

Maternity units that implemented the Care Bundle to the highest level (according to an NHS survey in 2015) are categorised as 'Innovators'.

Questionnaire

Intervention Type OTHER

A structured questionnaire will be administered to maternity service users. Another structured questionnaire will be administered to maternity healthcare professionals, and another to Organisational Leads (e.g. Clinical Directors at each site).

Early Adopters

Maternity units that implemented the Care Bundle to the second-highest level (according to an NHS survey in 2015) are categorised as 'Early Adopters'.

Questionnaire

Intervention Type OTHER

A structured questionnaire will be administered to maternity service users. Another structured questionnaire will be administered to maternity healthcare professionals, and another to Organisational Leads (e.g. Clinical Directors at each site).

Late Adopters

Maternity units that implemented the Care Bundle to the third-highest level (according to an NHS survey in 2015) are categorised as 'Late Adopters'.

Questionnaire

Intervention Type OTHER

A structured questionnaire will be administered to maternity service users. Another structured questionnaire will be administered to maternity healthcare professionals, and another to Organisational Leads (e.g. Clinical Directors at each site).

Low Adopters

Maternity units that implemented the Care Bundle to the fourth-highest level (according to an NHS survey in 2015) are categorised as 'Low Adopters'.

Questionnaire

Intervention Type OTHER

A structured questionnaire will be administered to maternity service users. Another structured questionnaire will be administered to maternity healthcare professionals, and another to Organisational Leads (e.g. Clinical Directors at each site).

Interventions

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Questionnaire

A structured questionnaire will be administered to maternity service users. Another structured questionnaire will be administered to maternity healthcare professionals, and another to Organisational Leads (e.g. Clinical Directors at each site).

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Women who received their antenatal care, delivered and were discharged from the same maternity unit
* Women who have given birth after 28 weeks of gestation


* Midwives working before and after implementation of the care bundle (including antenatal ward, antenatal clinic, community-based staff, antenatal assessment unit and labour ward)
* Community midwives working before and after implementation of the care bundle
* Sonographers working before and after implementation of the care bundle
* Junior doctors working before and after implementation of the care bundle
* Consultant obstetricians working before and after implementation of the care bundle
* Clinical Directors and Heads of Midwifery working before and after implementation of the care bundle

Exclusion Criteria

* Maternal age ≤ 16 years
* Individuals who cannot understand/not fluent in English (to enable consent without interpreter)
* Multiple pregnancy
* Fetuses known to have any congenital or severe structural abnormalities
* Home births


\- Staff who were employed after the care bundle was implemented
Minimum Eligible Age

16 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Somerset NHS Foundation Trust

OTHER

Sponsor Role collaborator

Royal Devon and Exeter NHS Foundation Trust

OTHER

Sponsor Role collaborator

University Hospital Plymouth NHS Trust

OTHER

Sponsor Role collaborator

Royal United Hospital Bath NHS Trust

OTHER

Sponsor Role collaborator

North Bristol NHS Trust

OTHER

Sponsor Role collaborator

Liverpool Women's NHS Foundation Trust

OTHER

Sponsor Role collaborator

St Helens & Knowsley Teaching Hospitals NHS Trust

OTHER

Sponsor Role collaborator

Countess of Chester NHS Foundation Trust

OTHER

Sponsor Role collaborator

University Hospitals of Morecambe Bay NHS Trust

OTHER

Sponsor Role collaborator

Barnsley Hospital NHS Foundation Trust

OTHER

Sponsor Role collaborator

Doncaster And Bassetlaw Hospitals NHS Foundation Trust

OTHER

Sponsor Role collaborator

York Teaching Hospitals NHS Foundation Trust

OTHER

Sponsor Role collaborator

Hull University Teaching Hospitals NHS Trust

OTHER_GOV

Sponsor Role collaborator

Mid Yorkshire Teaching NHS Trust

OTHER

Sponsor Role collaborator

Oxford University Hospitals NHS Trust

OTHER

Sponsor Role collaborator

Gateshead Health NHS Foundation Trust

OTHER

Sponsor Role collaborator

North Cumbria University Hospitals NHS Trust

OTHER

Sponsor Role collaborator

Sherwood Forest Hospitals NHS Foundation Trust

OTHER

Sponsor Role collaborator

Manchester University NHS Foundation Trust

OTHER_GOV

Sponsor Role collaborator

Birmingham Women's NHS Foundation Trust

OTHER_GOV

Sponsor Role collaborator

University of Manchester

OTHER

Sponsor Role lead

Responsible Party

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Dr Alexander Heazell

Professor of Obstetrics

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Barnsley Hospital NHS Foundation Trust

Barnsley, , United Kingdom

Site Status

Royal United Hospitals Bath NHS Foundation Trust

Bath, , United Kingdom

Site Status

Birmingham Women's and Children's NHS Foundation Trust

Birmingham, , United Kingdom

Site Status

North Bristol NHS Trust

Bristol, , United Kingdom

Site Status

North Cumbria University Hospitals NHS Trust

Carlisle, , United Kingdom

Site Status

Countess of Chester Hospital NHS Foundation Trust

Chester, , United Kingdom

Site Status

Doncaster and Bassetlaw Hospitals NHS Foundation Trust

Doncaster, , United Kingdom

Site Status

Royal Devon & Exeter NHS Foundation Trust

Exeter, , United Kingdom

Site Status

Gateshead Health NHS Foundation Trust

Gateshead, , United Kingdom

Site Status

Oxford University Hospitals NHS Trust

Headington, , United Kingdom

Site Status

Hull and East Yorkshire Hospital NHS Trust

Hull, , United Kingdom

Site Status

University Hospitals of Morecambe Bay NHS Foundation Trust

Kendal, , United Kingdom

Site Status

Liverpool Women's NHS Foundation Trust

Liverpool, , United Kingdom

Site Status

Central Manchester University Hospitals NHS Foundation Trust

Manchester, , United Kingdom

Site Status

Plymouth Hospital NHS Trust

Plymouth, , United Kingdom

Site Status

St Helens and Knowsley Teaching Hospitals NHS Trust

Prescot, , United Kingdom

Site Status

Sherwood Forest Hospitals NHS Foundation Trust

Sutton in Ashfield, , United Kingdom

Site Status

Taunton and Somerset NHS Foundation Trust

Taunton, , United Kingdom

Site Status

The Mid Yorkshire Hospitals NHS Trust

Wakefield, , United Kingdom

Site Status

York Teaching Hospital NHS Foundation Trust

York, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Office of National Statistics. Characteristics of birth 1, England and Wales, 2013. London: ONS, 2014.

Reference Type BACKGROUND

Flenady V, Wojcieszek AM, Middleton P, Ellwood D, Erwich JJ, Coory M, Khong TY, Silver RM, Smith GCS, Boyle FM, Lawn JE, Blencowe H, Leisher SH, Gross MM, Horey D, Farrales L, Bloomfield F, McCowan L, Brown SJ, Joseph KS, Zeitlin J, Reinebrant HE, Cacciatore J, Ravaldi C, Vannacci A, Cassidy J, Cassidy P, Farquhar C, Wallace E, Siassakos D, Heazell AEP, Storey C, Sadler L, Petersen S, Froen JF, Goldenberg RL; Lancet Ending Preventable Stillbirths study group; Lancet Stillbirths In High-Income Countries Investigator Group. Stillbirths: recall to action in high-income countries. Lancet. 2016 Feb 13;387(10019):691-702. doi: 10.1016/S0140-6736(15)01020-X. Epub 2016 Jan 19.

Reference Type BACKGROUND
PMID: 26794070 (View on PubMed)

Manktelow BN, S.L., Seaton SE, Hyman-Taylor P, Kurinczuk JJ, Field DJ. MBRRACE-UK Perinatal Mortality Surveillance Report, UK Perinatal Deaths for Births from Janurary to December 2014. Leicester: The Infant Mortality and Morbidity Studies, Department of Health Sciences, University of Leicester, 2016.

Reference Type BACKGROUND

Draper ES, K.J., Kenyon S (Eds) on behalf of MBRRACE-UK, MBRRACE-UK Perinatal Confidential Enquiry. Term, singleton, normally formed, antepartum stillbirth. Leicester: The Infant Mortality and Morbidity Studies, Department of Health Sciences, Univesity of Leicester. 2015.

Reference Type BACKGROUND

Widdows K, Roberts SA, Camacho EM, Heazell AEP. Stillbirth rates, service outcomes and costs of implementing NHS England's Saving Babies' Lives care bundle in maternity units in England: A cohort study. PLoS One. 2021 Apr 19;16(4):e0250150. doi: 10.1371/journal.pone.0250150. eCollection 2021.

Reference Type BACKGROUND
PMID: 33872334 (View on PubMed)

Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. BMJ. 2013 Jan 24;346:f108. doi: 10.1136/bmj.f108.

Reference Type BACKGROUND
PMID: 23349424 (View on PubMed)

Marufu TC, Ahankari A, Coleman T, Lewis S. Maternal smoking and the risk of still birth: systematic review and meta-analysis. BMC Public Health. 2015 Mar 13;15:239. doi: 10.1186/s12889-015-1552-5.

Reference Type BACKGROUND
PMID: 25885887 (View on PubMed)

RCOG Green-Top Guideline 31: The Investigation and Management of the Small-for-Gestational Ages Fetus. Royal College of Obstetricians and Gynaecologists, 2013.

Reference Type BACKGROUND

Alfirevic Z, Devane D, Gyte GM. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev. 2006 Jul 19;(3):CD006066. doi: 10.1002/14651858.CD006066.

Reference Type BACKGROUND
PMID: 16856111 (View on PubMed)

Widdows K, Reid HE, Roberts SA, Camacho EM, Heazell AEP. Saving babies' lives project impact and results evaluation (SPiRE): a mixed methodology study. BMC Pregnancy Childbirth. 2018 Jan 30;18(1):43. doi: 10.1186/s12884-018-1672-x.

Reference Type DERIVED
PMID: 29378526 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Other Identifiers

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R04666

Identifier Type: -

Identifier Source: org_study_id

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