Perinatal Positivity Film – Raising awareness of perinatal mental healthA short film has been released that shares families experiences of perinatal mental health. The film was produced following research into families experiences, interviewing people in-depth and involved close work with health care professionals. The project hopes by sharing stories people will be more aware of perinatal mental health, talk about it and be more able to find help. Highlighting that mental wellbeing difficulties surrounding childbirth and pregnancy can affect both mums and dad. The website – perinatalpositivity.org – has resources for professionals as well as people experiencing mental wellbeing issues. The video can be viewed below. Maternal mortality after cesarean section in the Netherlands – Study A study conducted in the Netherlands has sought to examine the incidence of maternal mortality related to cesarean section. Medical records of cases reported to the Dutch Maternal Mortality and Severe Morbidity Audit Committee were assessed covering the period between January 1999 and December 2013.
The results found the risk of death cesarean section was 21.9 per 100.000 cesarean sections versus 3.8 deaths per 100.000 vaginal births. With the study concluding: ‘Compared to vaginal birth, maternal mortality after cesarean section was three times higher following exclusion of deaths that had no association with surgery. In approximately one in ten deaths after cesarean section, surgery did in fact initiate the chain of morbid events.’ The full study can be viewed here.
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Hyperemesis gravidarum does not usually recur in each pregnancy An article written on Ob/Gyn Updated has summarised the findings of a study into the reoccurrence of severe morning sickness for women. Results of the study showed 3 out of 4 women who suffered from Hyperemesis gravidarum did not experience it in a subsequent pregnancy. The article highlights that the incidence of hyperemesis is 0.5-2.0% and is the most common cause of first-trimester hospital admissions. Read the full article here. Trends and Disparities in Delivery Hospitalizations Involving Severe Maternal Morbidity, 2006-2015 The Healthcare Cost and Utilization Project (HCUP) has published data into hospitalisations involving severe maternal morbidity in the US from 2006 to 2015. The data shows the rate of severe maternal morbidity at delivery increased by 45% with the most common indicators including blood transfusion and hysterectomy. Other findings include:
Women from the youngest and oldest age group, those paid by medicare and women from lower income communities were more likely to have deliveries with severe maternal morbidity. Full findings can be viewed here.  Non-clinical interventions to reduce unnecessary caesarean section A research article titled ‘Non-clinical interventions to reduce unnecessary caesarean section targeted at organisations, facilities and systems: Systematic review of qualitative studies’ has been published looking into stakeholder views on the barriers to non-clinical interventions for reducing unnecessary caesarean sections.
The study, a systematic review, included 25 studies from 17 countries including over 1500 stakeholders. Stakeholders were policy makers, managers, health professionals, women, family members and community representatives. Studies included looked at midwife staffing models, financial strategies and organisational culture. Three key themes were identified:
Highlighting that initiatives to reduce unnecessary caesarean sections are more likely to succeed if they ‘address stakeholder concerns about power, workloads and responsibilities’ including teamwork, training, supportive culture and safety and quality of care. The study concludes: ‘The global concern on the unprecedented increase of caesarean section has translated into societal willingness to change this trend by implementing interventions to optimize the use of caesarean section. This systematic review presents the evidence-based for critical structural, health system and organizational factors that will require careful local consideration in the design and implementation of such interventions.’ The full study can be read here. Identifying and managing decreased fetal movements Safer Care Victoria is launching a campaign to help women report decreased fetal movements and reduce the number of potentially preventable stillbirths. They have provided a number of resources including best practice guidance and online learning along with a webinar covering current best practice in identifying and managing decreased fetal movements. The key messages are: ‘When a woman reports decreased fetal movements, please undertake an assessment of the woman and her baby as soon as possible, preferably within two hours. Make sure you provide your pregnant women with information about baby movements at every clinic visit.’ The resources can be accessed here.  Loading Videos... Cervical dilatation threshold of 1 cm/hour throughout labour is unrealistic for most women, regardless of parity – Study A study published in the international journal of Obstetrics & Gynaecology has looked at gaining a better understanding into the natural progression of labour. The study titled ‘Cervical dilatation patterns of ‘low‐risk’ women with spontaneous labour and normal perinatal outcomes: a systematic review’ aimed to look into the available data on the cervical dilation patterns during spontaneous labour of ‘low‐risk’ women with normal perinatal outcomes. Included were 7 observational studies covering 99 971 women finding that the median time to advance by 1cm in nulliparous women was longer than 1 hour until a dilation of 5cm was reached with similar patterns in parous women. The study concluded: ‘An expectation of a minimum cervical dilatation threshold of 1 cm/hour throughout the first stage of labour is unrealistic for most healthy nulliparous and parous women. Our findings call into question the universal application of clinical standards that are conceptually based on an expectation of linear labour progress in all women.’ The full study can be viewed here. ACOG Guidance: Antibiotic Prophylaxis during Labor and Delivery ACOG have released a practice bulletin on the role of prophylactic antibiotics in labour and delivery. The OBG Project has provided a useful summary of the guidance providing key points and guidance including use in caesarean section and other obstetric procedures.
Access the summary from OBG Project here. Birthrights research highlights postcode lottery for maternal request caesarean in the UKResearch recently published by Birthrights has highlighted the differences in treatment of women who request a caesarean section. A caesarean section is requested by women for a number of possible reasons. The report suggests the primary reason being previous traumatic birth followed by underlying medical conditions such as symphysis pubis dysfunction. The research found that:
NICE guidance states: ‘'For women requesting a caesarean section, if after discussion and offer of support… a vaginal birth is still not an acceptable option (Trusts should) offer a planned cesarean section.’ Findings suggest that for women the process can often be lengthy, difficult or inconsistent adding anxiety and distress for the women. The report highlights what a good maternal request caesarean guideline should look like and offers perspectives from healthcare professionals to support better support of maternal request caesarean. The full report can be read here. Consent to research at the time of obstetric emergency A study has looked into the methods used to obtain women’s consent and women’s thoughts on these methods. The study interviewed women who did and did not give consent at their time of recruitment for the World Maternal Antifibrinolytic (WOMAN) Trial in the UK.
The WOMAN trial was researching treatment for heavy bleeding, consent was being sought in some cases at the time of the bleed. The study was the first in the UK to use the option of waiver of informed consent. The result of the study suggests: ‘what is important is not so much the consent process used or a signature on a form, but the way in which consent is obtained. Clinicians who successfully negotiate consent to research during childbirth emergencies engage in a ‘humane choreography’ of words and actions.’ It seems that of most importance influence on the good or bad experiences of women is the use of actions and words by the birth attendants. Full study available here. 1 in 3 Western Australia babies are delivered by caesarean - is that too high?An ABC radio show has examined if doctors have become too risk averse, the push for more midwifery led care and concerns that some midwives have deskilled because of the decline of natural births. The show hears from a mother who had interventions during labour, an obstetrician and a midwife exploring the high rate of caesarean deliveries. Listen to the full discussion below. In which groups of pregnant women can the caesarean delivery rate likely be reduced safely in the USA? A multicentre cross-sectional studyA study has looked into caesarean rates to determine areas where it may be reduced without compromising safety. 19 hospital participated in the study with 228 562 deliveries between 2002 and 2008. The study concluded: ‘women with repeat CD, term non-cephalic presentation, term twins or other multiple gestation and preterm births may be the potential targets for safely reducing prelabour CD rate, while nulliparas or multiparas with spontaneous or induced labour, women with repeat CD, term non-cephalic presentation, term twins or other multiple gestation and preterm births are potential targets for reducing intrapartum CD rate without compromising maternal and neonatal safety in the USA. On the other hand, CD may still be associated with better perinatal outcomes in women with singleton preterm breech presentation or preterm twins with the first twin in non-cephalic presentation.’ Read the full paper here. Safety and Quality of Maternal and Neonatal Pathway: Implementation of the Modified WHO Safe Childbirth Checklist in Two Hospitals of the Tuscany Center Trust, Italy
Starting a conversation about baby loss Sands has produced this video that shares ways you can start a conversation about baby loss and help someone who has lost a baby. The video includes tips on:
Study: ‘Labor Induction versus Expectant Management in Low-Risk Nulliparous Women' A study has looked into the consequences of induction of labour at 39 weeks. The multicentre trial involved over 6000 women. They were randomly assigned to labour induction at 39 weeks or to expectant management. The study looked to measure primarily perinatal death or severe neonatal complications with caesarean delivery a secondary measure. Results of the study show the primary outcome occurred in 4.3% of neonates in the induction group and in 5.4% in the expectant-management group. The frequency of caesarean delivery was significantly lower in the induction group than in the expectant-management group (18.6% vs. 22.2%). The study concluded: ‘Induction of labor at 39 weeks in low-risk nulliparous women did not result in a significantly lower frequency of a composite adverse perinatal outcome, but it did result in a significantly lower frequency of cesarean delivery.’ Full study available here. Study - The International Network of Obstetric Survey Systems study of uterine rupture: a descriptive multi‐country population‐based study A study has found that the prevalence of complete uterine rupture is higher in countries with low previous CS and high trial of labour after CS rates.
The international study merged individual data collected from 9 studies into ‘women with complete uterine rupture, defined as complete disruption of the uterine muscle and the uterine serosa, regardless of symptoms and rupture of fetal membranes.’ The study aimed to measure prevalence of complete uterine rupture, regional variation and correlation with rates of caesarean section and trial of labour after CS (TOLAC). In 2,625,017 deliveries there were 864 complete uterine ruptures identified. The overall prevalence was 3.3 per 10,000 deliveries with 22 in women with and 0.6 in women without previous CS. Prevalence in women with previous Uterine rupture resulted in hysterectomy in 10% of women and in a perinatal death in 116 of 874 infants whose mother had uterine rupture. The study concluded: ‘Higher prevalence of complete uterine ruptures per TOLAC was observed in countries with low previous CS and high TOLAC rates. Rates of hysterectomy and perinatal death are about 10% following complete uterine rupture, but in women undergoing TOLAC the rates are extremely low (only 2.2 and 3.2 per 10 000 TOLACs, respectively.)’ Full study available here. Study shows personal convenience and risk of litigation factors influencing decision making for caesarean sectionA review of 34 studies involving 7785 obstetricians and 1197 midwives from 20 countries has identified several factors influencing the decision for caesarean sections. Factors included:
A clinicians personal beliefs was identified as the key driver for decision making. Decision was influenced by their perception of risk and the belief that caesarean was a ‘safe option’. Beliefs relating to a women’s request for caesarean also influenced decision making. Healthcare systems were also found to affect decision making. Fear of litigation was found to be a common influenced in the decision to perform caesarean. In addition to availability of resources, type of coverage and guidelines/management policy. Finally, clinician characteristics were found to influence the decision making. Personal convenience was described as being an influencing factor with a scheduled caesarean being more convenient. Lack of confidence and skills in vaginal birth was also identified as a contributing factor. The study suggests that with the increase in number of caesareans performed it is important to look into the factors that effect decision making. Full study can be viewed here. 600 stillbirths could be prevented each year in England NHS England has released a report into the impact of the Saving babies lives care bundle. The implementation of the guidance across 19 maternity units has helped to save more the 160 babies. It is estimated that if the guidance is rolled out across all units 600 stillbirths could be prevented. Key successes identified in the report were:
Full report available here ISUOG Intrapartum ultrasound guideline The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) has published a new practice guideline on intrapartum ultrasound. The below video accompanies the guideline which can be access here. Each Baby Counts Themed Report – Anaesthetic Care Each baby counts has published a report following analysis of the anaesthetic care given to mothers of babies reported to each baby counts between 2015 – 17. The report is supported by the Royal College of Anaesthetists and Obstetric Anaesthetists Association. Key findings highlight:
The report highlights a number of key recommendations including:
The full report is available here. NHS hospitals not following NICE guidelines on twin & triplet pregnancies leading to deaths of up to 55 babies A report by TAMBA (twins & multiple births association) has concluded that if all hospital were to follow nice guidelines for twin, triplet & more pregnancies then 55 baby deaths could be prevented each year.
If mums of multiples are able to have a discussion by 24 weeks with a multidisciplinary team about risks of preterm labour and possible outcomes of preterm birth it correlates to a lower stillbirth rate. If all recommendation from the report are adopted it is thought lives could be saved and fewer babies would need neonatal care. Find out more on the TAMBA website. NHS Resolution publish annual figures – Greatest value of claims for ObstetricsNHS Resolution has published its annual report for the period of 2017/2018. In total the value of payments was £2.2 billion. Focusing specifically on maternity claims it is reported that only 10% of clinical claims relate to obstetrics however they accounted for 48% of the total value of new claims reported, a value of £2.1 billion. The value for claims relating to cerebral palsy and brain damage continues to rise despite the number of claims falling by 20. It is estimated that the projected costs of obstetric payments to be made in 2018/19 could be £735.7 million. NHS resolution is working on a number of initiatives to help improve care in maternity including informing the development of Rapid Resolution and Redress, a thematic review of cerebral palsy cases, incentivising safer care in maternity, further development of the Early Notification scheme and work to support the Getting it Right First Time (GIRFT) team at NHS Improvement. The full report is available here with maternity information beginning on page 74.  Australian stillbirth rates – 56% reduction in road deaths but stillbirth rates remain unchanged Data from 1996 to 2015 has shown that over the period road deaths have reduced by 56% but the rate of still births remains unchanged with twice as many stillborn compared to the number of people dying on the road. Six babies are stillborn in Australia each day a rate that has remained relatively unchanged for a number of years. This article looks into why there is such limited awareness and draws on the work being conducted in the UK that has the potential to be applied across all higher income countries. Cochrane Review – Vaginal preparation with antiseptic solution before caesarean section for preventing postoperative infections The results of a Cochrane review into the use of antiseptic solution to prepare the vagina before caesarean section have been published. 11 randomised controlled studies were included involving 3403 women undergoing caesarean section. The study conclude:
‘Vaginal preparation with povidone-iodine or chlorhexidine solution compared to saline or not cleansing immediately before cesarean delivery probably reduces the risk of post-cesarean endometritis. Subgroup analysis could not rule out larger reductions in endometritis with antiseptics in women who were in labor or in women whose membranes had ruptured when antiseptics were used.’ It suggested that it was a simple, inexpensive way of lowering a women's chance of developing infection following caesarean section. Full review available here. Preventing cerebral palsy in babies – A Case Study Prevention of Cerebral Palsy in PreTerm Labour (PReCePT) is a scheme developed from a neonatologists proposal to increase use of magnesium sulphate as a treatment to protect the brain in pre-term babies. Up to 1 in 5 extremely preterm babies will develop cerebral palsy. A 2009 study showed magnesium sulphate was effective in reducing cerebral palsy. The scheme across 3 NHS trusts has increased uptake of magnesium sulphate from 30% to 85% with estimates that it will reduce cerebral palsy in 15 – 20 children per year. Find out more here. Alterations in maternally perceived fetal movement and their association with late stillbirth – Study A study covering 41 maternity units in the UK has looked into the association between maternally perceived fetal movements and late still birth. The study concluded ‘Increased strength of fetal movements and fetal hiccups is associated with decreased risk of stillbirth. Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. Clinical guidance should be updated to reflect that increase in strength and frequency of fetal movements is associated with the lowest risk of stillbirth, and that decreased fetal movements are associated with stillbirth.’ The full study can be accessed here. Finding the root cause – video This video from the National Perinatal Epidemiology Unit highlights how to address contributory factors that are identified at perinatal mortality review. The video uses examples to identify causes and strategies that are needed to effectively address them. It focuses on fetal growth scans in cases where small gestational age has not been identified antenatally. |
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