Birthplace is commended for changing “through policy recommendations, the advice given to pregnancy women and practice” and for continuing “to produce findings that will likely translate into quantifiable safer and cost-effective births in England”.
The UKOSS study of pregnant women hospitalised with H1N1 infection in 2009 influenced policy and guidance updates during the pandemic, changed policy recommendations on seasonal immunisation for pregnant women and as a result led to a doubling of the number of pregnant women immunised against influenza in England between 2009 and 2015.
The report shows a slight fall in the rates of stillbirth and neonatal death in the UK compared with 2013, continuing the downward trend in rates seen since 2003. However, this overall trend masks variations in rates across the UK. These variations remain despite the fact that a novel method of analysis introduced by MBRRACE-UK takes into account aspects of case-mix to allow ‘fairer’ comparisons of mortality rates between services provided for high risk and low risk pregnancies. The new analytical method, which divides the figures for Trusts and Health Boards into five groups based on the services they deliver, also takes into account the random variation in rates which can occur because of small numbers of births in some areas.
Led by the MBRRACE-UK collaborators based in the Department of Health Sciences at the University of Leicester, the report also explores the effect of gestational age on perinatal mortality rates in more detail. This shows that around two thirds of stillbirths and neonatal deaths were born preterm, indicating that initiatives to reduce stillbirth and neonatal deaths must include a focus on reducing preterm birth as well as ensuring high quality care for all women whose pregnancies reach full term. Read the full report.
Between 2007 and 2010 the CORONIS trial recruited almost 16,000 women in Argentina, Chile, Ghana, India, Kenya, Pakistan and Sudan to compare different caesarean section techniques. Over 13,000 participants were followed up during 2011-14 to investigate longer term outcomes including pelvic pain, pain during sexual intercourse, hysterectomy and outcomes of subsequent pregnancies.
The results of the CORONIS follow-up study, published in the Lancet, indicate no evidence of a difference in the risk of any outcomes for the five intervention pairs. Overall, severe adverse outcomes were uncommon in these settings, limiting the power of the study to detect differences.
Since the study provides no evidence to favour one technique over another, other considerations, such as time and cost savings of the different approaches, can be used to determine clinical practice. Read the paper and associated commentary.
A study by NPEU researchers Kate Fitzpatrick, Ron Gray and Maria Quigley exploring smoking patterns during pre-conception, pregnancy and the postnatal period has been published in PloSOne. Analsying data on 10,768 mothers from the 2010 UK Infant Feeding Survey, the research found that smoking patterns were complex, but five distinct patterns were identified: "non-smokers" (74.1% of all women); "pregnancy-inspired quitters" who gave up during pregnancy and did not relapse postnatally (10.2%); "persistent smokers" who smoked before, during and after pregnancy (10.1%); "temporary quitters" who gave up during pregnancy and relapsed postnatally (4.4%); and "postnatal quitters" (1.1%). Being a persistent smoker or relapsing postnatally were more common in women who lived with a partner or other household member who smoked. For more details, read the paper.
Chronic lung disease is an ongoing challenge for neonatal medicine, affecting around 1450 preterm babies every year in the UK. High doses of dexamethasone (a corticosteroid) have been shown to improve lung function, but may be associated with longer term neurodevelopmental problems. The effectiveness of lower doses of dexamethasone is unknown.
Dr Helen Yates, lead clinician for the Minidex trial, has recently published an article exploring this controversial topic and discussing the role of the Minidex trial in resolving this debate. The Minidex trial will examine the efficacy of very low dose dexamethasone therapy, to explore whether a minimal dose can still provide improvements in lung function without the short term side effects associated with standard dose therapy. Read the abstract.
A collaborative study between the NPEU and an Indian University has shown the feasibility of using methods developed for the UK Obstetric Surveillance System (UKOSS) to establish a simple anonymous hospital-based obstetric surveillance and research system in the Indian state of Assam (IndOSS-Assam). This pilot study, published in BMJ Global Health, is a first step towards estimating the incidence and case-fatality of severe life-threatening complications during pregnancy and childbirth in Assam and showed a high incidence of eclampsia, postpartum haemorrhage, puerperal sepsis, septic abortion, uterine rupture and anaemic heart failure, along with a high case fatality rate. This suggests the need to focus research and policies to improve management of these conditions to reduce the burden of maternal mortality and morbidity in the state. For more details read the paper.
As maternal deaths become rarer, monitoring near-miss or severe maternal morbidity becomes important as a tool to measure changes in care quality. It has been suggested that routinely available hospital administration data could be used to monitor the quality of maternity care.
NPEU researchers Manisha Nair, Jenny Kurinczuk and Marian Knight carried out a study to investigate the feasibility of creating a National Maternal Morbidity Outcome Indicator using routinely available hospital maternity data in England. The study, published in PLoS One, used Health and Social care Information Centre (HSCIC) in-patient data from 6.39 million women giving birth in England from April 2003 to March 2013 and showed that a composite indicator to monitor trends in maternal morbidity outcomes during childbirth can be generated using routine English hospital data, but the quality and reliability of this monitoring indicator is dependent on the quality of the hospital data, which is currently inadequate.
New results from a large UK study, conducted by Sarah Payne and Maria Quigley, show that breastfeeding for at least 3 months may reduce the risk of hospitalisation for infection in babies. This reduction of risk was larger in babies who were initially exclusively breastfed. In settings such as the UK, where few babies are exclusively breastfed for 6 months, these results show that shorter durations of breastfeeding may still confer significant health benefits. For more details, read the abstract of the paper.