Dear Mr Hinchliffe , Thank you for your letter of 25 April 2016,and | do apologise for the delay in replying; have taken the opportunity to seek the views of the RCM Advisory Forum as are very helpful with strategic issues and of course all practice within the context of contemporary midwifery practice: response is therefore based on this information and my own experience of best practice across the UK For information purposes the forum is comprised of midwives, students and maternity support workers who are clinically working within maternity services across the UK: Given the view ofthe RCM Advisory forum and what believe to be best practice, entirely agree with your recommendations to this particular NHS Trust: would have expected that for any baby compromised in labour or requiring transfer to the Neonatal Unit the advice would be to have the placenta retained and safely stored and therefore available should there be a demise in the baby and a need for a post mortem examination at a future point in time. For further information have included below information regarding current practice, disposal and reasons to store placenta within the NHS as it stands today: MAy 2016 they they My

Current_placental disposal following the majority of_births is a5 follows All placentas are disposed of post- delivery by sealing them in a sharps guard anatomical plastic and transferred into a permanently sealed plastic pot for incineration following examination by the midwife or clinician post birth_ Exceptions to the above:_retaining_the placenta for pathology purposes Stillbirth Late fetal loss Significant fetal compromise in labour Baby with a low Apgar score Baby transferred to Neonatal Unit Baby who has had extensive resuscitation Baby with abnormalities Prematurity Some maternity units_keep and examine placenta_in_the following cases Intra uterine growth restriction i.e. birthweight below the 3rd centile Placental abruption Rhesus isoimmunisation Morbidly adherent placenta Multiple births Abnormal placental shape vessel cord Prolonged rupture of membranes >36 hours Maternal group B streptococcus eclampsia/maternal hypertension Maternal substance misuse Gestational diabetes Maternal coagulopathy In addition it is worth noting that some women do take care of their own placenta by taking them home from the maternity unit or birth centre_ On a final note one of the biggest challenges within maternity care is safe storage of placenta should we hold large numbers in case of neonatal deterioration, do this information is helpful but please do contact me if you require any further information.

Dear Mr Hinchliff Re: Inquest Touching the Death of Angus Jonathan Labofski West (Deceased) Thank you for your recent letter regarding the findings in this inquest and the Regulation 28 Report to Prevent Future Deaths which you have issued as a consequence of these findings: As indicated in my acknowledgement of this notification, have shared this with the Clinical Director for Obstetrics and Gynaecology and the Risk Management team: The Trust have liaised with The Royal College of Obstetrics and Gynaecology and neighbouring Trusts (principally Leeds Teaching Hospitals NHS Trust) seeking advice on this matter: am also grateful for the copy of the response from the Royal College of Midwives which you have forwarded. As a consequence of the tragic outcome in this case and the inquest findings we undertake to institute the following standard operating procedure in respect to retention of placenta following childbirth: Points a) and b) are current standard practice and the remaining points are to be instituted by September
2016. a) The placenta and all its appendices are routinely inspected at all deliveries. b) All placentas from stillborn infants or intra partum deaths are sent for detailed histopathology examination at our neighbouring trust (The Leeds Teaching Hospital NHS Trust) , with necessary consent from the parents. c) All placentas and their appendices from all live births are bagged, labelled and dated and kept refrigerated on labour ward for a period of 24 hours

If the baby is born in good condition and remains well and there are no further concerns, the placenta will be disposed of, with the appropriate permission from the mother, after 24hrs. If the baby is born in poor condition, or extremely preterm, or deteriorates soon after birth (within 24 hours) then we intend that the placenta will be retained for further storage and will be sent to the histopathology department locally at York for a period of 30 days. If during this time the baby goes on to die, at that point the (stored) placenta with its appendices will be sent for formal histopathology examination at Leeds This will either be along with the infant post- mortem request or separate from this, depending on the necessary consent the parents: hope that this undertaking alleviates the concerns raised during the recent inquest and reassures you that all reasonable steps have been taken to prevent a similar occurrence in the future_ would be happy to write to you after the proposed implementation date to confirm that the Trust has complied with these undertakings Should VOu require any further information do not hesitate to contact myself or Deputy Medical Director: