Disparities In Access to the Northwest Ambulance Service During Pregnancy, Birth and Postpartum Period and Its Association With Neonatal and Maternal Outcomes

NCT07049263 | Active Not Recruiting

• 2 other identifiers: G90058NIHR206378
• Study Type: observational
• Target: 18,000
• Locations: 1 country
• Sites: 1

Brief Summary

This study is the first in the United Kingdom (UK) to look at how women and families from different backgrounds use ambulance services during the 'perinatal period' - through pregnancy, birth, and shortly after having a baby. The researchers want to understand whether all women have the same access to urgent and emergency maternity care, and whether there are differences in health outcomes for mothers and babies who use ambulance services. The study has two parts (called Work-Packages): Work Package One will look at data from women who were taken by ambulance to a Manchester University National Health Service (NHS) Foundation Trust (MFT) maternity unit during the perinatal period, compared with those who had a baby at MFT but were not taken there by ambulance. It will look at the differences between the two groups and their health outcomes. Work Package Two will look closely at the text written by paramedics within ambulance records for some women from Work Package One, especially those at increased risk of a poor outcome. The researchers will study what happened during their care journey and look for anything that happens repeatedly within the text to better understand their experiences. By combining the results from both work packages, the study aims to give a detailed picture of how different women access emergency maternity care and outcomes for themselves and their babies. This will help identify ways to improve services, especially for women who may face barriers to getting the care they need, helping to make sure that maternity care is safe, fair, and more effective for everyone.

Conditions

Emergency Maternity Care; Health Inequalities in Maternity Care Access; Disparities in Access to Maternity Care; Deprivation; Ethnicity; Ambulances; Pre-hospital

Keywords

Emergency maternity care; Pre-hospital maternity care; Health disparities; Health inequalities; Perinatal period; Maternity care access; Ethnicity; Deprivation; Data linkage; Retrospective cohort study; Mixed methods; Pre-hospital

Outcome Measures

Primary Outcomes (2)

• Severe neonatal morbidity (composite)

  Including stillbirth, neonatal death, admission to neonatal intensive care unit, APGAR score \<7 at 5 minutes, fetal growth restriction, low arterial cord pH, early preterm birth (\<34 weeks), birth injuries and Hypoxic Ischemic Encephalopathy (HIE) diagnosis.

  Up to 6 weeks postpartum.

• Severe maternal morbidity (composite)

  Including maternal death, admission to high dependency or intensive care areas, postnatal hospital readmission, major postpartum haemorrhage (PPH), obstetric anal sphincter injury (OASI), unplanned hysterectomy, placental abruption, eclampsia and Hemolysis Elevated Liver Enzymes and Low Platelets (HELLP) syndrome.

  Up to 6 weeks pospartum

Secondary Outcomes (40)

• Mode of birth

  Up to 6 weeks postpartum.

• Postpartum Haemorrhage

  Up to 6 weeks postpartum

• Episiotomy

  Up to 6 weeks postpartum

• Length of stay in hospital after birth (maternal and neonatal)

  Up to 6 weeks postpartum

• Number of antenatal visits and ultrasound scans

  Up to 6 weeks postpartum

Study Arms (2)

NWAS Cohort

A cohort of women who were transferred to Manchester University NHS Foundation Trust during the perinatal period by North West Ambulance Services, between August 2022 and August 2024.

MFT Cohort

A cohort of women who attended Manchester University NHS Foundation Trust for birth between August 2022 and August 2024, but were not transferred by North West Ambulance Services.

Eligibility Criteria

• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Attended a Manchester University NHS Foundation Trust (MFT) maternity unit.

You may qualify if:

• North West Ambulance Service (NWAS) Cohort:
• Had at least one pregnancy start and/or gave birth between 1st August 2022 to 31st August 2024
• Accessed NWAS service in the perinatal period between 1st August 2022 to 31st August 2024, and were subsequently transferred to an Manchester University NHS Foundation Trust (MFT) maternity unit by ambulance (either to Saint Mary's Oxford Road, Saint Mary's Wythenshawe or Saint Mary's North Manchester sites)
• Can be linked to the HIVE electronic patient record (EPR) database
• Has an electronic delivery record on the MFT HIVE database
• Has not opted out of NHS national data opt-out usage.
• Comparison Manchester University NHS Foundation Trust (MFT) Cohort:
• Had at least one pregnancy start and/or gave birth between 1st August 2022 to 31st August 2024
• Not transferred by ambulance to an MFT maternity unit after contacting NWAS during the perinatal period
• Attended MFT maternity unit for birth (either Saint Marys Oxford Road, Saint Marys Wythenshawe or Saint Mary's North Manchester Sites) and therefore has an electronic birth record on the MFT HIVE EPR database
• Has not opted out of NHS national data opt-out usage.
• Work Package 1

You may not qualify if:

• Opted out of NHS national data usage
• No pregnancy start or end date recorded/imputed
• No birth record on the MFT HIVE EPR database
• Was conveyed by ambulance to a non-MFT maternity unit/site.
• Work Package 2
• Female
• Had at least one pregnancy and/or gave birth between August 2022 to August 2024
• Accessed NWAS service in the perinatal period between August 2022 to August 2024, and subsequently transferred to an MFT maternity unit by ambulance (either St Marys Oxford Road, St Marys Wythenshawe or North Manchester Sites)
• Has not opted out of NHS national data opt-out usage.
• Work Package 2
• \- Opted out of NHS national data usage.

Sponsors & Collaborators

• Manchester University NHS Foundation Trust: lead

Study Sites (1)

Manchester University NHS Foundation Trust

Manchester, United Kingdom

Location

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Chief Investigator and Consultant Midwife (North West Ambulance Service NHS Foundation Trust)

Study Record Dates

• First Submitted: June 20, 2025
• First Posted: July 3, 2025
• Study Start: September 1, 2024
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): June 2, 2026
• Last Updated: October 2, 2025

Record last verified: 2025-09

Data Sharing

• IPD Sharing: Will not share

Locations

GB (1)