Sands Awareness Month: explaining the link between small babies and stillbirth

Posted: 05/06/2018

June is Sands Awareness Month which highlights the facts surrounding stillbirth and neonatal deaths and the impact on those families that are affected.

A small baby is at a much higher risk of being stillborn and, accordingly, measures have been put in place to try to identify these babies during pregnancy. However, it seems that, despite this, some babies are still falling through the net. In 2016, a confidential enquiry found that screening for small babies was one of the most frequent areas of suboptimal care associated with stillbirth before labour and from the experience of the clinical negligence team at Penningtons Manches, this pattern appears to be continuing.

A baby who is small for its gestation is referred to as small for gestational age (SGA), whereas babies who are experiencing growth restriction are termed fetal growth restricted (FGR). These two terms are often used interchangeably, although medically they do mean different things. Both SGA and FGR babies are at an increased risk of stillbirth; the risk is greatest in those who fall in the FGR group, but this amounts to only 30-50% of all SGA babies.

Once a baby is found to be presenting as SGA, vigilant monitoring is needed and this will include the use of repeated ultrasound scans, checking the level of fluid around the baby and the blood flow between mother and baby.

In FGR babies, this monitoring will highlight a gradual deterioration. The decision made as a result of these findings will vary depending on the gestation of the baby, but it will usually result in the baby being delivered early to ensure that it is born safely.

Although a small or growth restricted baby who is delivered early may need some extra care on arrival, ultimately it will usually be healthy, as the monitoring in place is there to ascertain the optimum time for safe delivery. This is why it is so important that midwives and doctors correctly follow the measures put in place to identify these babies – they have a very good chance of survival when the correct care is delivered.

Unfortunately, errors in the provision of care do arise, and most frequently these involve:

• failing to identify a woman as being at high risk of FGR (for example, not noting a previous SGA baby which puts a mother at a significantly greater risk of a subsequent baby experiencing the same problems);
• failing to act on a blood test result at 12 weeks indicating the mother is at risk of developing problems with the placenta (this test is taken as part of the screening for Down’s Syndrome);
• delays between identifying potential growth restriction and referring for or undertaking a growth scan to check the baby’s size;
• failing to act on ultrasound scans which show that a baby’s weight is below the 10th centile;
• incorrect plotting of the baby’s weight on the growth chart, leading to false reassurance of the baby’s growth.

Helen Hammond, senior associate in Penningtons Manches’ clinical negligence team in Basingstoke, who specialises in stillbirth cases, comments: “In the past, the majority of stillbirths were termed ‘unexplained’. However, medical research in recent years has shown that most stillborn babies did not have anything structurally wrong with them but were small for their gestational age. If there is a suggestion that a baby who was stillborn was small, the care given to the mother during pregnancy should be reviewed. Ideally, this will be considered by the hospital in its internal investigation following the birth, but that may not always be the case.

“If you have concerns that growth problems may have been a factor relating to the stillbirth of your baby, our specialists can look into this. Our initial consultation is offered free of charge and without obligation.”

Return to news headlines