Association between reduced stillbirth rates in England and regional uptake of accreditation training in customised fetal growth assessment

Abstract

Objective: To assess the effect that accreditation training in fetal growth surveillance and evidence-based protocols had on stillbirth rates in England and Wales.

Design: Analysis of mortality data from Office of National Statistics.

Setting: England and Wales, including three National Health Service (NHS) regions (West Midlands, North East and Yorkshire and the Humber) which between 2008 and 2011 implemented training programmes in customised fetal growth assessment.

Population: Live births and stillbirths in England and Wales between 2007 and 2012.

Main outcome measure: Stillbirth.

Results: There was a significant downward trend (p=0.03) in stillbirth rates between 2007 and 2012 in England to 4.81/1000, the lowest rate recorded since adoption of the current stillbirth definition in 1992. This drop was due to downward trends in each of the three English regions with high uptake of accreditation training, and led in turn to the lowest stillbirth rates on record in each of these regions. In contrast, there was no significant change in stillbirth rates in the remaining English regions and Wales, where uptake of training had been low. The three regions responsible for the record drop in national stillbirth rates made up less than a quarter (24.7%) of all births in England. The fall in stillbirth rate was most pronounced in the West Midlands, which had the most intensive training programme, from the preceding average baseline of 5.73/1000 in 2000-2007 to 4.47/1000 in 2012, a 22% drop which is equivalent to 92 fewer deaths a year. Extrapolated to the whole of the UK, this would amount to over 1000 fewer stillbirths each year.

Conclusions: A training and accreditation programme in customised fetal growth assessment with evidence-based protocols was associated with a reduction in stillbirths in high-uptake areas and resulted in a national drop in stillbirth rates to their lowest level in 20 years.

Figure 1

Correlation between stillbirth trends 2007–2012 in English regions and Wales (table 2) and proportion (%) of pregnancies cared for in units with GROW training (table 1). Regression line: R= −0.82, p<0.01.

Figure 2

Yearly stillbirth rates in the three regions with high uptake of GROW training and protocols (‘high uptake’) vs the rest (‘low uptake’), 2008–2012 (see table 1). Analysis of trend: high uptake, p<0.01; low uptake, p=0.9.

Figure 3

Stillbirth rates in regions with high uptake of GROW training and protocols, 2007–2012 (3-year moving average).

Figure 4

Stillbirth rates in regions with low uptake of GROW training and protocols, 2007–2012 (3-year moving average).

Figure 5

Stillbirth rates in high and low uptake regions and England and Wales, 2007–2012 (3-year moving average).