Supervisors of Midwives

Measuring Fetal Growth

Maureen Miller & Amanda Sayers

Case Study - KH 4366 June 2014• 19yo Prim10+3 weeks Booking appointment with Community Midwife – Risk assessment carried out – Shared Care Pathway

▫ Smoker at booking ▫ Irreg cycle▫ BMI 20▫ Referred to GP – Low mood▫ Referred to FNP/ Teenage Pregnancy Co-Ordinator

• 13 weeks ANC RegUSS (BPD/HC/FL = 15) dates agreed

• 20+3 weeks Anomaly Scan/Normal – dates agree (Growth chart was given to KH- no MHHR at apt)

• 25 weeks CMW DNA • 28 CMW (No growth chart – no SFH documented)

KH 4366 June 2014

•31+4 CMW▫No growth chart – details taken to request

in am▫No SFH recorded, smoking 4-5 day▫Appt made for USS for 34 weeks

•34+1 Consultant Appt▫“growth chart requested again!”▫S/B Registrar – USS scan ▫EFW 2439g, liq N – advised see CMW 2/52▫Smoker 3 day▫No concerns re Growth

KH 4366 June 2014

•34+4 MAFAU – backache and reduced FM 24 hrs▫SFH 33 - No growth chart in notes▫+ve urinalysis; MSSU to Lab▫CTG normal and meets Dawes Redmann

Criteria▫S/B SHO & Reg▫Adm for Tx for UTI (WCC 16, CRP 64)▫Cons RV am – for USS renal tracts▫Discharged after 2 days

KH 4366 June 2014

•36+5 weeks CMW▫No growth chart▫SFH 29cm▫No Fetal Heart detected ▫Cons RV

IUD confirmed by USS EFW 2405g, normal liquor

▫IOL commenced after 2nd scan confirmed NO FH

▫IOL with PGE2 and ARM (+++ liquor) & synto

▫Birth weight 2035 grams

KH 4366 June 2014

• PM report ▫Not dysmorphic▫No congen abnormalities▫Liver to brain ratio 5:1 (suggests IUGR)

Review of Care

▫Reported through Datix ▫Notified as SEA▫Timeline of events (Statements and

Reflections requested)▫Round Table meeting with staff involved:

What went well? What could we improve? How can we improve it?

NOT ABOUT BLAME!!! PATIENT SAFETY!

Supervisor of Midwives Involvement

•Met with Midwives involved •Reflections •Support •Event recorded appropriately by SOM•Learning shared with colleagues

Learning and Recommendations•NICE guidance for Risk Assessment

carried at each antenatal appointment to ensure on correct pathway

•Customised growth chart MUST be used and obtained if not available

•Careful plotting of EFW (& SFH)

Actions

•Ongoing Training In-house on Customised Growth Charts for all staff

•Mandatory for all Community midwives to have annual update on GROW charts

•Competency Tool for Fetal Growth Surveillance - Mandatory for all Community Midwives

•Installed the GROW icon at each Community Midwives Base to access growth charts