1. Supervisors of Midwives Measuring Fetal Growth Maureen Miller & Amanda Sayers

2. Case Study - KH 4366 June 2014 19yo Prim 10+3 weeksBooking appointment with Community Midwife – Risk assessment carried out – Shared Care Pathway ▫Smoker at booking ▫Irreg cycle ▫BMI 20 ▫Referred to GP – Low mood ▫Referred to FNP/ Teenage Pregnancy Co-Ordinator 13 weeks ANC Reg USS (BPD/HC/FL = 15) dates agreed 20+3 weeks Anomaly Scan/Normal – dates agree (Growth chart was given to KH- no MHHR at apt) 25 weeks CMW DNA 28 CMW (No growth chart – no SFH documented)

3. KH 4366 June 2014 31+4 CMW ▫No growth chart – details taken to request in am ▫No SFH recorded, smoking 4-5 day ▫Appt made for USS for 34 weeks 34+1 Consultant Appt ▫“growth chart requested again!” ▫S/B Registrar – USS scan ▫EFW 2439g, liq N – advised see CMW 2/52 ▫Smoker 3 day ▫No concerns re Growth

4. KH 4366 June 2014 34+4 MAFAU – backache and reduced FM 24 hrs ▫SFH 33 - No growth chart in notes ▫+ve urinalysis; MSSU to Lab ▫CTG normal and meets Dawes Redmann Criteria ▫S/B SHO & Reg ▫Adm for Tx for UTI (WCC 16, CRP 64) ▫Cons RV am – for USS renal tracts ▫Discharged after 2 days

5. KH 4366 June 2014 36+5 weeks CMW ▫No growth chart ▫SFH 29cm ▫No Fetal Heart detected ▫Cons RV  IUD confirmed by USS  EFW 2405g, normal liquor ▫IOL commenced after 2 nd scan confirmed NO FH ▫IOL with PGE2 and ARM (+++ liquor) & synto ▫Birth weight 2035 grams

6. KH 4366 June 2014 PM report ▫Not dysmorphic ▫No congen abnormalities ▫Liver to brain ratio 5:1 (suggests IUGR)

7. Review of Care ▫Reported through Datix ▫Notified as SEA ▫Timeline of events (Statements and Reflections requested) ▫Round Table meeting with staff involved:  What went well?  What could we improve?  How can we improve it?  NOT ABOUT BLAME!!!  PATIENT SAFETY!

8. Supervisor of Midwives Involvement Met with Midwives involved Reflections Support Event recorded appropriately by SOM Learning shared with colleagues

9. Learning and Recommendations NICE guidance for Risk Assessment carried at each antenatal appointment to ensure on correct pathway Customised growth chart MUST be used and obtained if not available Careful plotting of EFW (& SFH)

10. Actions Ongoing Training In-house on Customised Growth Charts for all staff Mandatory for all Community midwives to have annual update on GROW charts Competency Tool for Fetal Growth Surveillance - Mandatory for all Community Midwives Installed the GROW icon at each Community Midwives Base to access growth charts