RCOG Scientific Impact Paper - Antenatal and Postnatal Analgesia
The RCOG has released a scientific impact paper on antenatal and postnatal analgesia to help clarify advice on pain relief. The paper covers paracetamol, Nonsteroidal anti‐inflammatory drugs (NSAIDs), Codeine, Dihydrocodeine (DHC), Tramadol and Morphine.
Considered safe for use throughout pregnancy and during breastfeeding.
Where possible avoid use throughout pregnancy. If clinically indicated lowest effective dose for shortest possible period advised if required before 30 weeks. Recommended to avoid after 30 weeks. Ibuprofen and diclofenac preferred choice for postnatal analgesia but should be avoided in certain circumstances.
Can be used during pregnancy and breastfeeding short term to treat moderate to severe pain when paracetamol not effective. Recommends the lowest possible dose for shortest possible period. Important to inform neonatal team if intrapartum women have received long term opioids as it can lead to neonatal respiratory issues. Postnatal use of opioid analgesics appropriate if woman in more severe pain.
Specifically, for postnatal analgesia codeine has been associate with some reported fetal complications. DHC, Tramadol and morphine can all be used but lowest effective dose for shortest possible period is recommended.
The paper summarises:
‘Analgesics should be used at the lowest effective dose for the shortest possible duration to minimise any potential risks to the mother, developing fetus or neonate. When stronger analgesia is required, DHC should be used in preference to codeine because of the concerns regarding toxicity, as detailed in the case reports published.’
The full paper can be access here.
PReCePT programme Eligible mothers receiving Magnesium sulphate – A mum’s perspective
The PReCePT programme is aiming to ensure at least 85% of all eligible mothers are receiving magnesium sulphate across all maternity hospitals in England by 2020. The project is designed to help reduce the number of babies with cerebral palsy by providing mothers with magnesium sulphate to mothers during preterm labour. The video below is with a mother who received magnesium sulphate explaining why she supports the programme.
US Maternal Mortality
The ACOG presidents blog has recently published 2 posts on the rising rates of maternal mortality and how it can be reversed.
One titled Critical Steps to Reverse Rising U.S. Maternal Mortality Rates highlights the progress towards the passing of the ‘Preventing Maternal Deaths Act’ in the US and how it will help with the creation or expansion of maternal mortality review committees in all states. It also discusses the Alliance for Innovation in Maternal Health (AIM) and the expansion of that programme.
The second post ACOG Battles Maternal Mortality in Texas Through Maternal Site Surveys outlines the launch of the Levels of Maternal Care programme in Texas. As part of the programme facilities that provide maternal care underwent surveys to received level of maternal care designations. Observations from the survey include:
The two posts highlight the work being done to combat maternal mortality but also recognise that there is still much more to do.
60% of planned caesareans performed before 39 weeks without medical indication – Australian Atlas of Healthcare Variation Series 2018
The Third Australian Atlas of Healthcare Variation 2018 has been published. The report explores variations in healthcare across Australia investigating unwarranted variations and providing actions to reduce variation.
The report this year has looked at neonatal and paediatric health amongst other topics including information on early planned caesarean sections without a medical or obstetric indication. The Atlas highlights recent research showing increases in both short-term and long-term effects for children born via caesarean section before 39 weeks. It is the recommendation of certain organisations and Australian states to wait until 39 weeks gestation if there are no medical reasons for earlier birth. Data of sufficient quality was available from 4 states on the topic.
The atlas found that:
‘between 42% and 60% of planned caesarean sections performed before 39 weeks’ gestation did not have a medical or obstetric indication, and between 10% and 22% of caesarean sections performed before 37 weeks did not have a medical or obstetric indication.’
The rates were generally higher for privately funded patients compared to publicly funded.
There are 7 recommendations in the atlas relating to early planned caesarean section without medical indication including:
The full list of recommendation and the remainder of the atlas can be view here.
Labour outcomes in caseload midwifery and standard care: a register-based cohort study
A study has been published by BMC Pregnancy and Childbirth looking at labour outcomes in caseload midwifery. The study conducted in North Denmark looked at births allocated to caseload midwifery over a 3 year period. Out of 13,115 births there were 2679 allocated to caseload midwives.
Findings of the study include:
The study concludes:
‘We found that most outcomes were equal across models of care but there seemed to be a small but unexpected finding of more augmentation and adverse neonatal outcomes in caseload midwifery.’
The full study can be read here.
RCOG 2018 Workforce report
The RCOG has published its latest workforce report providing an update on recommendations and actions to address workforce issues.
The report highlights that 9 out of 10 obstetric units have a gap in their middle-grade rota, there is a 30% attrition rate from the O&G training programme, 54% of those on O&G specialist register are international medical graduates and there are disproportionate litigation rates for those working in O&G. The report also highlights high rates of bullying and undermining.
Included in the report is an update on recommendations from the 2017 report including:
Also provided is an update on the work of the RCOG supporting our doctors task group which includes work on a peer to peer support service, development of workplace behavior champions network and complaints handling work.
The full report can be viewed here.
Experience of young mums
A short film has been produced by a young mum after her experiences during her pregnancy. The film aims to encourage medical professionals to provide more support to young mums. Watch it below
Each baby counts: Learn and support
The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists are working together to launch a new programme to work with local maternity units to support multi-professional learning helping to improve joint working.
The partnership will be supported and funded by the Department of Health and Social Care and will support the implementation of recommendations from each baby counts reports to support the provision of safe maternity care.
The full report can be found here.