Analysis of Irish inquiry reports relating to pregnancy loss services (2005 – 2018)

Analysis of Irish inquiry reports relating to pregnancy loss services (2005 – 2018)

Änne Helps (1,2,3), Sara Leitao (2), Laura O’Byrne (1), Richard Greene (2), Keelin O’Donoghue (1,3)

(1) Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Ireland; (2) National Perinatal Epidemiology Centre (NPEC), University College Cork, Ireland; (3) The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland

Background
External inquiries are carried out following specific adverse maternal events and aim to identify issues in the maternity care provided to pregnant women and make recommendations to improve standards of care. Published literature comparing external reports and assessing their impact on maternity services is limited.

Methods
From the national inquiries into the maternity services in Ireland, 10 publically-available health-service-commissioned inquiry reports published between 2005-2018 relating to pregnancy loss services, were analysed. Two clinicians reviewed these, separately, to examine the content and recommendations made in each report. Quantitative and qualitative data was collected using a specifically designed review tool. The findings and recommendations from each report were studied by descriptive thematic analysis outlining emerging themes and issues.

Results
The reports focused on maternity services in relation to pregnancy loss and/or clinical care provided around the time of the loss. The inquiry team was multi-disciplinary (MDT) and named in 5 reports (4-14 people). It was clearly stated that affected families and relevant clinical staff were involved in four inquiries, only one of these described supports to families during the inquiry process. Only 4 reports commented on good aspects of care provided; reports focusing mostly on unfavourable issues.

Conclusions
This was the first structured review of pregnancy-loss national inquiry reports in Ireland, outlining some of the main issues arising from them. Clinical staff and families should always be involved and supported during the inquiry process. Inquiries are important to highlight issues of concern; by standardising the process relevant implementable recommendation are more likely to be generated. Recommendations made in inquiry reports, can have a profound impact on maternity services if/when implemented adequately.

Ethics statement
No ethical approval was sought or necessary for the completion of this literature review.

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