One of Scotland's largest health boards ordered investigations into the deaths of three newborn babies before a fatal accident inquiry into other fatalities was announced.

The Lord Advocate, Dorothy Bain QC, has asked a sheriff to examine the deaths of three other babies, Leo Lamont, Ellie McCormick, and Mirabelle Bosch, as they all “occurred in circumstances giving rise to serious public concern”.

The Fatal Accident Inquiry (FAI), which is due to get underway in December, is expected to hear health officials and families give details about Leo and Ellie, who were born in February and March 2019, and Mirabelle, who was born in July last year.

It involves NHS Lanarkshire, NHS Greater Glasgow and Clyde and the Scottish Ambulance Service. 

It has emerged that NHS Lanarkshire ordered internal inquiries into the deaths of three other infants, born within the same time period.

READ MORE: Two spikes in neonatal deaths in Scotland to be investigated 

A new method of assessing the clinical urgency of mothers with pregnancy related complications is being introduced according to the reports.

A freedom of information request lodged by the Herald states that five Significant Adverse Event Reviews (SAERs) were carried out after the deaths of babies born from 2019 to 2021.

The health board said two of the deaths were now subject to an FAI and no details were provided. NHS Greater Glasgow and Clyde is understood to be more heavily involved in the third case.

In two other deaths, failings were identified but according to the health board did not contribute to the outcome. However, the conclusion of the other SAER was that issues "were identified which may have caused or contributed" to the infant's death.

The report is heavily redacted due to data protection laws but states that concerns about the labour "were not escalated to senior obstetric staff".

A midwife at the un-named hospital recognised that there was a problem and contacted the on-call obstetric consultant but they were "unable to attend."

The baby was transferred to the neonatal unit for emergency care but later died. 

READ MORE: Covid vaccines ruled out as cause of neonatal death spikes - but mothers' vaccine status not checked 

The report states: "Despite the [redacted] having being classed as [redacted] there appears to be lack of senior review having being sought."

The review team is also critical that a fetal scalp electrode was not used to provide a more accurate assessment of the baby's heart rate.

This is a clip that attaches to the baby's head and is used if there are challenges monitoring heart rate through the mother's abdomen.

The report concludes that a "lack of recognition and further questioning" was a possible missed opportunity to detect the problem but described the findings as uncertain.

It makes a series of recommendations and says action is already underway following a previous SAER to review triage processes and introduce the Birmingham symptom- specific Obstetric Triage System (BSOTS). 

It was developed to improve the assessment of pregnant women who attend hospital with pregnancy related complications or concerns.

Experts say there is no standardised system within maternity to treat pregnant women who attend with pregnancy related complications or concerns and women are often seen in the order in which they arrive.

The system involves completion of a standard clinical triage assessment by a midwife within 15 minutes of the woman’s attendance which defines clinical urgency using a 4-category scale.

The health board also states that weekly training sessions should be arranged for midwifery and medical staff on top of annual core training.

The other death involved a mother who was said to have had an uncomplicated pregnancy and labour.

The inquiry found that due to changes as a result of Covid, one face-to-face appointment took place "later than usual" and an ultrasound scan "that would be carried out in these circumstances"did not take place. However, the review concluded that this did not affect the outcome.

In the other case a baby died at University Hospital Wishaw after a pregnancy that was also deemed low risk.

The inquiry resulted in a recommendation that all women in labour have a formal fetal risk assessment performed on admission.

NHS Lanarkshire declined to comment ahead of the forthcoming FAI.

Separately, a spike in neonatal death rates this year is to be reviewed, the Scottish Government has announced. 

The Herald reported that alarms were sounded after 18 infants died within four weeks of birth in March this year.

It saw the mortality rate to breach an upper warning threshold or 'control limit', which was also seen in September of 2021 when 21 neonatal deaths were registered. 

Healthcare Improvement Scotland has been commissioned to lead the review.