Title: Beyond maternal death: Improving the quality of maternity care through national studies of "near-miss" maternal morbidity
Funder: Department of Health (England)

Abstract: AIMS: 1. To implement a national programme of study of near-miss maternal morbidity to complement confidential enquiries into maternal deaths. 2. To use mixed methodologies to improve the evidence base for disease prevention and treatment and to inform World Class Commissioning of maternity services. 3. To use the data to develop recommendations for practice and service provision informed by evidence. BACKGROUND A comprehensive programme of study of maternal deaths has been undertaken in the UK for more than 50 years [1]. It is now recognised that in countries such as the UK, where maternal deaths are rare, study of near-miss severe maternal morbidity (defined as a “severe life-threatening obstetric complication necessitating urgent medical intervention in order to prevent likely death of the mother” [2]) provides additional important information to aid disease prevention, treatment and service provision. The national collaboration of clinicians contributing to the UK Obstetric Surveillance System (UKOSS) provides a unique opportunity to undertake a programme of study of near-miss severe maternal morbidity. RESEARCH PLANS The component workstreams will employ observational epidemiological elements with primary data collection and secondary data analysis, literature review, economic evaluation and qualitative techniques to investigate severe maternal morbidity on a national basis. The workstreams will describe disease incidence, risk factors, management and outcomes and investigate factors associated with disease progression from severe morbidity to death. In addition, component studies will undertake economic evaluation of different treatments for severe morbidity, explore methods for improving local learning from near-miss events and investigate women’s experiences and long-term outcomes of severe maternal morbidity. RESEARCH TEAM The team is built of members from a range of organisations, has senior multidisciplinary expertise, support from professional associations and users and a track record of achievement in the field. The programme will be coordinated from the National Perinatal Epidemiology Unit (NPEU), which has a national and international reputation for conducting studies which change policy, influence practice and improve the care of women and their babies. RESEARCH ENVIRONMENT The environment in which this work will be conducted spans the NHS/Academic interface. Obstetric units throughout the UK are already engaged with this work through participation in UKOSS. Programme coordination will be led from the NPEU, University of Oxford which has a long record of conducting applied health research which has influenced health policy both nationally and locally. Other co-applicants are based at the Confidential Enquiry into Maternal and Child Health, the National Patient Safety Agency, the DIPEx Patient Experience Research Group and the Royal College of Midwives and include a lay member. ANTICIPATED OUTPUTS, OUTCOMES AND IMPACT The programme will greatly enhance the evidence base for the conditions investigated and hence improve management, outcomes and services for women with severe morbidity within the programme lifetime through recommendations for practice and information for counselling. Information to guide disease prevention will be generated as well as evidence to inform clinical practice and service provision. Local variations in incidence will be investigated. The long-term impacts of these conditions on women, their babies and families will be established in order to inform service development and also to develop patient information and medical education resources. Outputs will be disseminated through key professional and patient organisations to maximise the impact and influence change in practice. PATIENT AND PUBLIC INVOLVEMENT The programme has patient and public involvement at multiple levels: One of the co-applicants is a user representative; other user representatives have been consulted during the programme development and will form part of programme and workstream-specific advisory groups; women’s experiences explored in an interview study will be used to inform a subsequent questionnaire study. ETHICAL IMPLICATIONS The programme will be conducted with NHS Research Ethics Committee, NIGB Ethics and Confidentiality Committee and Trust R&D approval as appropriate. The majority of studies will be conducted using anonymised data only, according to established UKOSS principles, since it is not practicable to obtain consent for data collection. Informed written consent will be sought from women who are invited to participate in the interview and questionnaire studies. JUSTIFICATION OF RESOURCES REQUESTED Applicants’ salaries are related to their time commitment. In addition we are seeking to employ specific research staff and non-staff costs principally for data collection and interviewing. NHS support costs are sought for questionnaire completion.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;2.4 SURVEILLANCE AND DISTRIBUTION
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH