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Emergency Maternity CareDIAASNCT07049263

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

An observational study of Emergency Maternity Care and Health Inequalities in Maternity Care Access, run by Manchester University NHS Foundation Trust at 1 site in United Kingdom.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial 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. Read more about this study

Who is it for?
Any age, women only
How many people
18,000 participants
Where
1 siteUnited Kingdom
Study dates
1 Sep 2024to 2 Jun 2026
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • Women only
  • No healthy volunteers
  • Child, Adult, Older adult

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

Who may be able to join

  • 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.
Show all 17Show fewer
  • 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
  • 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

Who cannot join

  • 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
  • Opted out of NHS national data usage.

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • Manchester University NHS Foundation Trust

    Manchester

Other trials in United Kingdom

About this study

Official title: Disparities In Access to the Northwest Ambulance Service During Pregnancy, Birth and Postpartum Period and Its Association With Neonatal and Maternal Outcomes [DIAAS]

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):

Read more

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.

Read the detailed description

Background:

This study will be the first United Kingdom (UK)-based study to investigate access to ambulance services for women and families from diverse backgrounds during pregnancy, birth and early postpartum period. The study will explore relevant maternal and infant outcomes for families who seek help from the ambulance service to explore health disparities in accessing urgent and emergency care. Findings from this study will inform local and national policy aimed at reducing maternal and perinatal mortality and morbidity. This will contribute to the identification of access challenges experienced by seldom-heard women in a crucially important, but under investigated area of unscheduled urgent and emergency maternity care.

Methods:

A mixed methods approach including two work packages (WP). WP1 includes a retrospective comparative cohort study (WP1) to describe the characteristics of and outcomes for pregnant women and their neonates who are transferred via ambulance to Manchester University National Health Service (NHS) Foundation Trust (MFT) and those that are not. Descriptive statistics with comparative analyses will be presented. WP2 includes a qualitative framework analysis of a purposive sub-sample of routinely collected free-text digital records documented by paramedics for women who arrived at the unit via ambulance. Purposive sampling will be undertaken for women who are identified at an increased risk of poor maternal and/or neonatal outcomes following WP1 analyses. The patient journey will be mapped, and patient profiles constructed. An explanatory mixed methods approach will be undertaken for triangulation of data for insight.

Discussion:

The study aims to provide an in-depth understanding of access to emergency maternity care to allow investigation of opportunities for alternative clinical decision making and review of current service provision. This also helps to identify women with increased risk factors for accessing urgent and emergency care as a gateway to maternity services. This will help to address timely access to the most appropriate services, reducing risk factors for adverse maternity and neonatal outcomes and associated impact upon the emergency services. Findings will be used to inform local and national interventions for at risk populations who access ambulance services during pregnancy, birth, and early postpartum. Findings will also support system conversations around the reasons for seeking help from the ambulance service in the perinatal period and ways to improve access and care provisions for underserved communities.

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

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT07049263
Study groupRoleWhat they receive
NWAS CohortA 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 CohortA 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.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 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.

    Measured: Up to 6 weeks postpartum.

  2. 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.

    Measured: Up to 6 weeks pospartum

Secondary outcomes (40)
  1. Mode of birth

    Maternal. Spontaneous vaginal birth, breech birth, instrumental birth (forceps, kiwi or ventouse) or Caesarean section birth.

    Measured: Up to 6 weeks postpartum.

  2. Postpartum Haemorrhage

    Maternal. 500ml - 2000ml

    Measured: Up to 6 weeks postpartum

  3. Episiotomy

    Maternal.

    Measured: Up to 6 weeks postpartum

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

    Maternal and neonatal. Days.

    Measured: Up to 6 weeks postpartum

  5. Number of antenatal visits and ultrasound scans

    Maternal.

    Measured: Up to 6 weeks postpartum

  6. Need for blood transfusion

    Maternal.

    Measured: Up to 6 weeks postpartum

  7. Fetal loss <24 weeks' gestation

    Maternal.

    Measured: Up to 6 weeks postpartum

  8. Maternal death

    Maternal.

    Measured: Up to 6 weeks postpartum

  9. Admitted to Intensive Care Unit or High Dependency Unit

    Maternal. During the perinatal period.

    Measured: Up to 6 weeks postpartum

  10. Unplanned hysterectomy

    Maternal.

    Measured: Up to 6 weeks postpartum

  11. Readmission to hospital in postnatal period

    Maternal.

    Measured: Up to 6 weeks postpartum

  12. Major Postpartum Haemorrhage

    Maternal. >2000mls

    Measured: Up to 6 weeks postpartum

  13. Obstetric Anal Sphincter Injury (OASI)

    Maternal. Third or fourth degree perineal tear.

    Measured: Up to 6 weeks postpartum

  14. Placental abruption

    Maternal.

    Measured: Up to 6 weeks postpartum.

  15. Eclampsia

    Maternal.

    Measured: Up to 6 weeks postpartum

  16. Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP syndrome)

    Maternal

    Measured: Up to 6 weeks postpartum

  17. Stillbirth

    Neonatal

    Measured: Up to 6 weeks postpartum

  18. Neonatal Death

    Neonatal

    Measured: Up to 28 days after birth.

  19. APGAR score <7 at 5 minutes

    Neonatal

    Measured: Up to 6 weeks postpartum

  20. Fetal growth restriction

    Neonatal.

    Measured: Up to 6 weeks postpartum

  21. Low arterial cord pH at birth

    pH <7.05. Neonatal.

    Measured: Up to 6 weeks postpartum

  22. Admission to Neonatal Intensive Care Unit (NICU)

    Neonatal

    Measured: Up to 6 weeks postpartum

  23. Preterm birth

    Neonatal. <34 weeks gestation.

    Measured: Up to 6 weeks postpartum

  24. Birth-related injury

    Neonatal. Including brachial plexus injury, clavicular fractures.

    Measured: Up to 6 weeks postpartum

  25. Diagnosis of Hypoxic Ischemic Encephalopathy (HIE)

    Neonatal.

    Measured: Up to 6 weeks postpartum

  26. Cord prolapse

    Maternal

    Measured: Up to 6 weeks postpartum

  27. Birth before arrival at hospital (BBA)

    Neonatal.

    Measured: Up to 6 weeks postpartum

  28. Breastfeeding at discharge

    Neonatal.

    Measured: Up to 6 weeks postpartum

  29. Low birth weight (LBW)

    Neonatal. Grams.

    Measured: Up to 6 weeks postpartum

  30. High Birth Weight (HBW)

    Neonatal. Grams.

    Measured: Up to 6 weeks postpartum

  31. Gestational diabetes

    Maternal.

    Measured: Up to 6 weeks postpartum

  32. Pre-eclampsia

    Maternal.

    Measured: Up to 6 weeks postpartum

  33. Antepartum haemorrhage

    Maternal.

    Measured: Up to 6 weeks postpartum.

  34. Obstetric cholestasis

    Maternal.

    Measured: Up to 6 weeks postpartum

  35. Venous thromboembolism

    Maternal.

    Measured: Up to 6 weeks postpartum

  36. Gestational hypertension

    Maternal.

    Measured: Up to 6 weeks postpartum

  37. Small for Gestational Age (SGA)

    Neonatal.

    Measured: Up to 6 weeks postpartum

  38. Large for Gestational Age (LGA)

    Neonatal.

    Measured: Up to 6 weeks postpartum

  39. Low neonatal axillary temperature

    Neonatal. On admission. Celcius.

    Measured: Up to 6 weeks postpartum

  40. Admitted with COVID-19, RSV, Whooping Cough or Influenza

    Maternal.

    Measured: Up to 6 weeks postpartum.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Jul 2025
  2. Study start1 Sep 2024
  3. Primary completion1 Jun 2026 (estimated)
  4. Study completion2 Jun 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Retrospective
Enrolment
18,000 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07049263
Sponsor's protocol ID
G90058
Other IDs
NIHR206378
Acronym
DIAAS
Status last verified
Sep 2025
First submitted
20 Jun 2025
Last updated
2 Oct 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Data will be anonymised by the Manchester NHS Foundation Trust (MFT) Clinical Data Science Unit (CDSU) following NHS Data Opt-Out being applied. No personalised patient data will be handled by the DIAAS research team.

Questions about this trial

What is this clinical trial studying?

An observational study of Emergency Maternity Care and Health Inequalities in Maternity Care Access, run by Manchester University NHS Foundation Trust at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 17 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 2 Oct 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Severe neonatal morbidity (composite) (time frame: Up to 6 weeks postpartum.). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Oct 2025.

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