MSDS Recording birthweight centiles and birthweight

NHS England has developed The Saving Babies’ Lives Care Bundle (SBLCB), which provides evidence-based best practice, for providers and commissioners of maternity care across England to reduce perinatal mortality. This is in line with the national maternity safety ambition, to halve rates of perinatal mortality from 2010 to 2025 (DHSC 2017).

Building on the success of previous iterations, version 3 of the care bundle has been co-developed with clinical experts and service users and includes a refresh of all existing elements, It draws on national guidance from the National Institute for Health and Care Excellence (NICE), the Royal College of Obstetricians and Gynaecologists (RCOG) green top guidelines, and frontline learning to reduce unwarranted variation. It also includes a new, additional element on the management of pre-existing diabetes in pregnancy based upon data from The National Pregnancy in Diabetes (NPID) audit.

There are 6 elements of care within the bundle:

• Element 1: Reducing smoking in pregnancy
• Element 2: Fetal growth
• Element 3: Raising awareness of reduced fetal movement
• Element 4: Effective fetal monitoring
• Element 5: Reducing preterm birth
• Element 6: Management of pre-existing diabetes

Within each element there are process and outcome indicators which enable trusts to measure improvements in care. In support of this, the Maternity Services Dataset is capable of capturing a proportion of these metrics (see technical glossary) through trusts’ monthly data submissions. These data outputs are available to view via NHS England published monthly statistics.

Birthweight centiles are used in the Saving Babies Lives Element 2 Outcome Indicator 1 metric (Percentage of babies who are below the third centile of weight, born after 37+6 weeks gestation). There are two ways a birthweight centile can be obtained from MSDS:

1. The birthweight centile can be directly recorded by a trust in their MSDS submission.
2. The birthweight centile can be estimated based on data recorded by a trust. The additional data required for this estimation are birthweight, gestational age, and sex. Estimated fetal weight tables* taken from the World Health Organisation are then used to determine babies who are below the expected weight for babies in the third centile.

It is important to note, option 1 is the preferred choice for the Saving Babies Lives metric. Providers are encouraged to submit birthweight centile information wherever this is available. Where a recorded birthweight centile has been provided (option 1), this is preferenced over calculating an estimated birthweight centile (option 2).

*Estimated fetal weight tables are taken from The World Health Organisation Fetal Growth Charts: Table 11, using estimated weights of babies in the third centile.

However, birthweight should also still be recorded for every baby, as it is an important piece of data for multiple measures and breakdowns in the maternity services monthly statistics publication.

The tables below list all MSDS fields needed by NHS England to compile the information needed to obtain the birthweight centile. More information can be found in the Technical Output Specification. Information on the role of these fields in the construction of the Saving Babies Lives Element 2 Outcome Indicator 1 measure can be found in the MSDS metadata.

SNOMED codes are used to establish where a birthweight centile, birthweight or weight has been recorded. This information is obtained from the MSD405 Care Activity (Baby) table.

Please note – some birthweight codes not mentioned in this guidance document may be included in measure constructions to ensure the measures are capturing as much data as possible. These are set out in the MSDS metadata. We would encourage providers to use the SNOMED codes included in this guidance document where possible.

MSDS data items required where birthweight centiles are recorded

The birthweight centile information can be recorded in the MSD405 Care Activity (Baby) table.

MSDS data items required where birthweight centiles are not recorded

If a birthweight centile has not been recorded, the following are MSDS data items needed to estimate the birthweight centile. The birthweight information can be recorded in the MSD405 Care Activity (Baby) table.

Standard MSDS data items required:

Any data submission to MSDS must include valid records from the following tables: MSD000 MSDS Header; MSD001 Mother's Demographics; MSD002 GP Practice Registration; and MSD101 Pregnancy and Booking Details for the submission to be accepted.