In May 2018 we published the NICEimpact report on maternity. This considered how NICE’s evidence-based guidance might contribute to improvements in the safety and personalisation of maternity care.

Since the last impact report new data and quality improvement initiatives have reported on the uptake of NICE recommendations. In addition the NHS Long Term Plan was published which included a renewed commitment to maternity services. This sets out that the NHS will accelerate action to achieve 50% reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025.

Safety – multiple pregnancy

Increasing adherence to NICE guidance for multiple pregnancy helps to contribute to reductions in neonatal admissions and emergency caesarean rates.

Since the last impact report on maternity the Twins and Multiple Births Association (TAMBA) concluded a 3 year maternity engagement project to improve outcomes for multiple pregnancy families by promoting the use of NICE guidance.

As part of this they worked with 30 maternity units across England and published a report on the outcomes, NICE works. There were 40 positive findings, including a reduction in neonatal admissions rates and emergency caesarean section rates for multiple pregnancy.

As part of the project, an antenatal care pathway improvement tool developed by TAMBA was endorsed by NICE in May 2018. This provides healthcare professionals with a tool to ensure they meet NICE guidance, therefore ensuring families receive the specialist care they need.

An update for the NICE guidance on twin and triplet pregnancy was published in September 2019.

Findings from units in the TAMBA maternity engagement project

From maternity units that made improvements:

  • 65% of units reduced neonatal admissions
  • 60% of units reduced the emergency caesarean section rate.

If all maternity units in England increased adherence to NICE guidance, it could lead to:

  • 1,308 fewer neonatal admissions per year
  • 634 fewer emergency caesarean sections per year.

Shared learning example

Implementation of NICE guidance significantly improves outcomes in multiple pregnancy

East and North Hertfordshire NHS Trust has recently implemented a continuity of carer pathway for women with multiple pregnancies to meet the NICE guideline. Following an audit of their service by the Twins and Multiple Births Association (TAMBA) in 2017 they received recommendations to enhance their service and implement a continuity of carer pathway. A later audit in 2018 identified the service as outstanding for multiple pregnancy. Further focus on other areas to improve experience of care have been beneficial. There has been a marked improvement on appointment attendance, enhanced collaborative team working, an enriched education programme for antenatal care and a better communication package.

Safety – fetal rhesus-D genotype test

High-throughput non‑invasive prenatal testing (NIPT) for fetal RHD genotype, as recommended by NICE in November 2016, was the first reliable way of testing the D status of a baby before it is born. If the baby’s D status is different to that of the mother, it can cause serious complications. The test helps to decide whether anti-D immunoglobulin prophylaxis is required to prevent severe fetal anaemia, fetal heart failure, fluid retention and swelling, and intrauterine death.

Since the last impact report on maternity the number of trusts providing NIPT for fetal RHD genotype have increased from 40 to 54 and the number of tests being carried out has continued to increase, as shown in data from NHS Blood and Transplant. This is expected to increase further by 2021/22 when the test is fully rolled out nationally.

NIPT tests per month have continued to increase since the NICE guidance was published in 2016, shown in data from NHS Blood and Transplant

NIPT tests per month

NICE adoption support resource

Practical information and advice to support the adoption of high-throughput non-invasive prenatal testing (NIPT) for fetal RHD genotype.

Safety – smoking in pregnancy

Evidence shows that stopping smoking in pregnancy reduces the likelihood of stillbirth. It also reduces the chances of babies being born prematurely, with a low birth weight or suffering from sudden infant death syndrome. Smoking in pregnancy also affects babies later in life who are more likely to suffer from asthma and other serious illnesses. The NICE guideline on stopping smoking in pregnancy and after childbirth contains recommendations on identifying women who need help to quit, referring them to stop smoking services and providing support to help them stop.

Since the last impact report on maternity the proportion of mothers who smoke at the time of delivery has remained similar as shown in the latest NHS Digital statistics on Women’s Smoking Status at Time of Delivery in England.

Over the last 3 years, the proportion of mothers who smoke at time of delivery has remained similar.

Mothers who smoke at time of delivery