The aim of this review was to investigate the existing evidence regarding specialist preterm clinics for women who are at risk of preterm birth. Reem Malouf and Maggie Redshaw found eleven studies which looked at the effect of the clinic with regards to preterm birth and other important outcomes.
The evidence from the five randomised controlled trials showed that there was no significant difference between care at a specialist clinic and standard care for most of the neonatal outcomes. However, these studies were conducted before 1990 and the intervention was limited to increasing the number of antenatal visits in addition to educating the women about signs and symptoms of preterm labour. In contrast, the five most recent cohort studies in which new tests are used such as the foetal Fibronectin screening test (fFN), showed some positive neonatal outcomes.
In this review we only found one qualitative study where women expressed their anxiety about being labelled as high-risk of preterm birth and being reassured about interventions and treatments received in the clinic. In this study, women reported that their partners were struggling to cope emotionally. Further clarification is necessary on the optimal referral and standardized management plan in the clinic.
“Saving Lives, Improving Mothers’ Care - Surveillance of maternal deaths in the UK 2012-14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-14”
Led by the MBRRACE-UK team at the National Perinatal Epidemiology Unit at the University of Oxford this report details the findings of maternal mortality surveillance 2012 to 2014 in the UK and the lessons learned from the confidential enquiries into maternal deaths from cardiovascular causes, blood pressure disorders of pregnancy, early pregnancy causes together with messages for critical care.
For women in the United Kingdom, giving birth remains safer than ever - less than 9 in every 100,000 women die in pregnancy and around childbirth. Overall the maternal mortality rate in the UK continues to fall although the reduction reported this year is smaller than previously. Deaths from ‘indirect’ causes remain the largest group of deaths; these are deaths from conditions not directly due to pregnancy but existing conditions which are exacerbated by pregnancy, for example, women with heart problems. Given the very gradual rate of decline and the complexity of medical conditions now experienced by women during pregnancy, achieving the Government’s ambition to reduce maternal deaths by 20% by 2020 and 50% by 2030 presents a major challenge for the health service which will require co-ordination of care across multiple specialities.
The care of more than 150 women who died from heart disease during pregnancy or in the year after giving birth between 2009 and 2014 was reviewed in detail. Heart disease is the leading cause of maternal death during or up to six weeks after the end of pregnancy. The enquiry found that in some cases diagnosis of heart disease in young women was overlooked and for others who knew they had heart disease, care was fragmented. Preventing women from dying from heart disease is essential to efforts to continue to reduce the number of women dying.
Despite blood pressure problems – pre-eclampsia and related complications - being very common in pregnancy, maternal deaths from these conditions are at their lowest rate ever. Now in the UK less than one woman in every million women dies from a blood pressure disorder of pregnancy. This is less than one woman every year compared with more than one woman every hour globally who dies from this condition. This is a great success of maternity care in the UK.
The report also contains messages for the future care of women with early pregnancy conditions including ectopic pregnancy and those women in pregnancy or soon after who require critical care.
Clear pointers for improving services and care by individual practitioners were identified and these are discussed in detail alongside the findings in the full report which can be download here.
There have been many changes in maternity care policy and practice over the last 20 years and women’s experience and satisfaction with care have become more important over this period. This study used secondary analysis of data collected in four postal surveys of maternity care experiences in 1995, 2006, 2010 and 2014 to see how women's experiences have changed. Jane Henderson and Maggie Redshaw found that, in the antenatal period, an increasing proportion of women had early first contact with a healthcare professional, screening for Down’s syndrome, both dating and anomaly scans, and the total number of ultrasound scans increased over the period. Rates of intervention during labour and birth have increased and women were less likely to be cared for by a known midwife. In the postnatal period, length of hospital stay declined over time but the proportion of women who considered their length of stay too short remained constant. The number of postnatal home visits also declined and there was a substantial increase in the proportion of women who would have liked more visits. Overall satisfaction with care remained high especially for care during pregnancy, labour and birth.
The protocol for the Poppi Trial (Procedural Pain in Premature Infants) has been published on the Wellcome Open Research platform. The protocol documents the background, rationale, methods and design of the trial. The Poppi trial, which aims to establish whether oral morphine provides effective analgesia for procedural pain in infants, is led by Dr Eleri Adams and Dr Rebeccah Slater in collaboration with the NPEU and the Paediatric and Infant Pain & Anaesthesia (PiPA) group. You can read the protocol now for more details about the trial. Our congratulations go out to the entire Poppi Trial team.
A study exploring the association between father involvement in children’s early upbringing and behavioural outcomes in the pre-adolescent years has been published in the BMJ Open. The study by Charles Opondo, Maggie Redshaw, Emily Savage-McGlynn and Maria Quigley identified over 6,000 children in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort who were reported to be living with both parents during infancy. The researchers found evidence that greater paternal involvement in the children’s early months was associated with fewer signs of behavioural problems in the children’s pre-teen years. Specifically, fathers’ emotional response and confidence in their new role were most strongly associated with lower odds of behavioural problems when their children reached 9 and 11 years of age.
Children who are born very preterm (before 32 weeks gestation) have an increased risk of cognitive impairment compared with their full term peers. However, it is unclear whether these risks remain as the child gets older.
New research from Alyssa Fitzpatrick and Jennifer Carter and Maria Quigley suggests that by the time the children reach age 11, they still have a higher risk of impaired working memory, but they do not have a higher risk of verbal delay, indicating a possible catch-up effect. The results are based on more than 11,000 children in the Millennium Cohort Study.
Evidence suggests hundreds of babies develop a serious bowel problem called necrotising enterocolitis (NEC) each year in the UK. Babies with NEC need urgent treatment, often involving emergency surgery. Sadly, many babies with NEC lose their lives and some of those who survive suffer long-term complications, such as persistent bowel problems, poor growth and learning difficulties. Researchers at the Universities of Oxford and Southampton, led by Associate Professor Ed Juszczak, are investigating how different milk feeds and food supplements affect babies’ chances of developing NEC, in the hope of better understanding why so many babies still develop this devastating condition.
Read more about this research, which is funded by Action Medical Research.
Since January 2016, midwives in midwifery units across the UK have been reporting data for the UK Midwifery Study System (UKMidSS) Severe Obesity Study, investigating outcomes in severely obese women admitted to midwifery units.