van der Scheer, J.W. orcid.org/0000-0002-4368-0355, Blott, M., Dixon-Woods, M. et al. (13 more authors) (2025) Detecting and responding to deterioration of a baby during labour: surveys of maternity professionals to inform co-design and implementation of a new standardised approach. BMJ Open, 15 (3). e084578. ISSN 2044-6055
Abstract
Objectives
Detecting and responding to deterioration of a baby during labour is likely to benefit from a standardised approach supported by principles of track-and-trigger systems. To inform co-design of a standardised approach and associated implementation strategies, we sought the views of UK-based maternity professionals.
Design
Two successive cross-sectional surveys were hosted on an online collaboration platform (Thiscovery) between July 2021 and April 2022.
Setting
UK.
Participants
Across both surveys, 765 UK-based maternity professionals.
Primary and secondary outcome measures
Count and percentage of participants selecting closed-ended response options, and categorisation and counting of free-text responses.
Results
More than 90% of participants supported the principle of a standardised approach that systematically considers a range of intrapartum risk factors alongside fetal heart rate features. Over 80% of participants agreed on the importance of a proposed set of evidence-based risk factors underpinning such an approach, but many (over 75%) also indicated a need to clarify the clinical definitions of the proposed risk factors. A need for clarity was also suggested by participants’ widely varying views on thresholds for actions of the proposed risk factors, particularly for meconium-stained liquor, rise in baseline fetal heart rate and changes in fetal heart rate variability. Most participants (>75%) considered a range of resources to support good practice as very useful when implementing the approach, such as when and how to escalate in different situations (82%), how to create a supportive culture (79%) and effective communication and decision-making with those in labour and their partners (75%).
Conclusions
We found strong professional support for the principle of a standardised approach to detection and response to intrapartum fetal deterioration and high agreement on the clinical importance of a set of evidence-based risk factors. Further work is needed to address: (1) clarity of clinical definitions of some risk factors, (2) building evidence and agreement on thresholds for action and (3) deimplementation strategies for existing local practices.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. |
Keywords: | Capacity Building; Health & safety; NEONATOLOGY; OBSTETRICS; Quality Improvement; Surveys and Questionnaires; Humans; Female; Pregnancy; Cross-Sectional Studies; United Kingdom; Surveys and Questionnaires; Infant, Newborn; Risk Factors; Obstetric Labor Complications; Labor, Obstetric; Adult; Attitude of Health Personnel; Heart Rate, Fetal |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > Health Sciences School (Sheffield) |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 07 Apr 2025 15:15 |
Last Modified: | 07 Apr 2025 15:15 |
Status: | Published |
Publisher: | BMJ |
Refereed: | Yes |
Identification Number: | 10.1136/bmjopen-2024-084578 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:225264 |