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Background: Severe maternal morbidity (SMM) occurs in 1–2% of pregnancies. Despite the knowledge that a SMM event can contribute to poor fetal/neonatal outcomes, little is known about the preventability of these adverse outcomes. Aims: To examine adverse fetal/neonatal outcomes associated with SMM to determine if these outcomes were potentially preventable. Materials and Methods: A New Zealand national retrospective cohort study examining cases of SMM with an adverse fetal/neonatal outcome. Maternity and initial neonatal care were explored by multidisciplinary panels utilising a preventability tool to assess whether the fetal/neonatal harm was potentially preventable. Adverse fetal/neonatal outcomes were defined as fetal or early neonatal death, Apgar score <7 at five minutes, admission to neonatal intensive care unit or special care baby unit and neonatal encephalopathy. Results: Of 85 cases reviewed, adverse fetal/neonatal outcome was deemed potentially preventable in 55.3% of cases (n = 47/85). Preventability was related to maternal antenatal/peripartum care (in utero) in 39% (n = 33/85), to initial neonatal care (ex utero) in 36% (n = 29/80), and to both maternal and neonatal care in 20% (16/80) of cases. Main contributors to potential preventability were factors related to healthcare providers, particularly lack of recognition of high risk, delayed or failure to diagnose, and delayed or inappropriate treatment. Conclusions: Multidisciplinary panels found that over half of adverse fetal/neonatal harm associated with SMM was potentially preventable. The novel approach of examining both maternal and neonatal care identifies opportunities to improve fetal/neonatal outcomes associated with SMM at multiple points on the perinatal continuum of care. [ABSTRACT FROM AUTHOR]

Background: Timely detection of small for gestational age (SGA) fetuses is important for reducing severe perinatal morbidity and mortality, and better tools are needed to detect SGA in maternity care. Aim: We evaluated the effect of the introduction of the Perinatal Institute's Growth Assessment Protocol (GAP) in the Counties Manukau Health region, South Auckland, New Zealand, on antenatal detection of SGA and maternal and perinatal outcomes. Materials and Methods: Uncontrolled before and after study in women booked under hospital community midwife care with a singleton, non‐anomalous pregnancy. Antenatal detection of SGA (birthweight <10th customised centile) was compared pre‐GAP (2012, N = 1105) and post‐GAP (2017, N = 1082). Composite adverse neonatal outcome was defined as neonatal unit admission >48 h, five‐minute Apgar score <7, and/or any ventilation. Analyses were adjusted for maternal age, body mass index, deprivation, smoking and ethnicity. Results: SGA rates were similar across epochs (13.8% vs 12.9%) but antenatal detection of SGA increased from 22.9% (35/153) to 57.9% (81/140) post‐GAP (adjusted odds ratio (aOR) = 4.8, 95% CI 2.82–8.18). Rates of induction of labour and caesarean section increased between epochs but were similar in SGA, non‐SGA, and detected and non‐detected SGA subgroups. Among SGA babies, there was some evidence that antenatal detection of SGA may be associated with lower composite adverse neonatal outcome (detected SGA: aOR 0.44 95% CI 0.17–1.15; non‐detected SGA: aOR = 1.81 95% CI 0.73–4.48; interaction P = 0.03). Pre‐term birth did not appear to be influenced by GAP. Conclusion: Implementation of GAP was associated with a nearly five‐fold increase in SGA detection without increasing obstetric intervention for SGA. [ABSTRACT FROM AUTHOR]