New NICE Diagnostics guidance [DG33] Biomarker tests to help diagnose preterm labour in women with intact membranes
Published date:
Showing posts with label obstetrics. Show all posts
Showing posts with label obstetrics. Show all posts
Wednesday, 11 July 2018
Wednesday, 13 June 2018
New NIHR Signal Balance of long-term benefits and risks of caesarean delivery explained
New NIHR Signal Balance of long-term benefits and risks of caesarean delivery explained
Published on 12 June 2018
Caesarean delivery has immediate known benefits and risks for those women who need help in childbirth. This review measures the long-term outcomes for the mothers’ health, the links to a higher risk of childhood illness and the chance of problems with future pregnancies.
From the NIHR Dissemination Centre
https://discover.dc.nihr.ac.uk/content/signal-000601/balance-of-long-term-benefits-and-risks-of-caesarean-delivery-explained
New NIHR Signal Plastic wraps or bags keep pre-term infants warm immediately after birth
New NIHR Signal Plastic wraps or bags keep pre-term infants warm immediately after birth
Published on 22 May 2018
Cheap and simple plastic wrapping used in the first 10 minutes after birth helps pre-term and low birth weight infants avoid hypothermia. Infants treated in this way are likely to be warmer when admitted to neonatal intensive care than those treated according to standard care. Pre-term infants are most likely to benefit.
From the NIHR Dissemination Centre
https://discover.dc.nihr.ac.uk/content/signal-00596/plastic-wraps-or-bags-keep-pre-term-infants-warm-immediately-after-birth
New NIHR Signal Cell salvage during caesarean section doesn’t reduce blood transfusions
New NIHR Signal Cell salvage during caesarean section doesn’t reduce blood transfusions
Published on 15 May 2018
In a large UK trial, cell salvage for women at risk of blood loss during caesarean did not reduce the need for donor blood transfusion, though few needed transfusion (2.5% compared with 3.5% among controls).
From the NIHR Dissemination Centre
https://discover.dc.nihr.ac.uk/content/signal-00592/cell-salvage-during-c-section-doesnt-reduce-blood-transfusions
Published on 15 May 2018
In a large UK trial, cell salvage for women at risk of blood loss during caesarean did not reduce the need for donor blood transfusion, though few needed transfusion (2.5% compared with 3.5% among controls).
From the NIHR Dissemination Centre
https://discover.dc.nihr.ac.uk/content/signal-00592/cell-salvage-during-c-section-doesnt-reduce-blood-transfusions
Tuesday, 12 June 2018
New NICE Interventional procedures guidance [IPG613] Percutaneous balloon valvuloplasty for fetal critical aortic stenosis
New NICE Interventional procedures guidance [IPG613] Percutaneous balloon valvuloplasty for fetal critical aortic stenosis
Published date:
Evidence-based recommendations on percutaneous balloon valvuloplasty for fetal critical aortic stenosis. This involves placing a catheter into the baby’s heart, while the baby is still in the womb. The aim is to help the heart develop properly.
For full guidance https://www.nice.org.uk/guidance/ipg613
Wednesday, 21 March 2018
NIHR Signal Imaging is the only way to diagnose blood clots in pregnancy
NIHR Signal Imaging is the only way to diagnose blood clots in pregnancy
No blood test can accurately tell if a pregnant or recently pregnant woman has a blood clot. All pregnant women with a suspected clot should continue to have imaging investigations as per current UK guidelines.
Published on 13 March 2018
read full document at https://discover.dc.nihr.ac.uk/portal/article/4000969/imaging-is-the-only-way-to-diagnose-blood-clots-in-pregnancy
No blood test can accurately tell if a pregnant or recently pregnant woman has a blood clot. All pregnant women with a suspected clot should continue to have imaging investigations as per current UK guidelines.
Published on 13 March 2018
read full document at https://discover.dc.nihr.ac.uk/portal/article/4000969/imaging-is-the-only-way-to-diagnose-blood-clots-in-pregnancy
Wednesday, 24 January 2018
Signal Single urine samples are just as good as 24-hour collections for diagnosing pre-eclampsia
The urine spot albumin-creatinine ratio (which is done on a single, on-the-spot sample) reliably identified 99% of pregnant women with high blood pressure who went on to develop severe pre-eclampsia. The spot protein-creatinine ratio, as currently recommended by NICE, was slightly less sensitive identifying over 90% of women. Both spot tests were good value for money.
Nearly 1,000 women, suspected of having pre-eclampsia, took part in this NIHR-funded study, in 36 UK obstetric units. They had high blood pressure and protein detected in their urine (by dipstick) beyond 20 weeks of pregnancy. The study compared the diagnostic accuracy of newer ways of ‘spot’ testing a single sample of urine for predicting severe pre-eclampsia with traditional tests on a urine sample taken over 24-hours.
From the NIHR Dissemination Centre
Nearly 1,000 women, suspected of having pre-eclampsia, took part in this NIHR-funded study, in 36 UK obstetric units. They had high blood pressure and protein detected in their urine (by dipstick) beyond 20 weeks of pregnancy. The study compared the diagnostic accuracy of newer ways of ‘spot’ testing a single sample of urine for predicting severe pre-eclampsia with traditional tests on a urine sample taken over 24-hours.
From the NIHR Dissemination Centre
Friday, 22 December 2017
Womb natural killer cell discovery could lead to screening for miscarriage risk
eLife (2017). DOI: 10.7554/eLife.31274
Although it has long been known that the lining of the womb harbours dynamic uterine natural killer cells, no functions have so far been given to these cells outside of pregnancy.
The new study Clearance of senescent decidual cells by uterine natural killer cells in cycling human endometrium which is published in eLife shows two functions of the cells not previously known.
For the first time the functions of natural killer cells in the womb have been identified.
Researchers at the University of Warwick and University Hospitals Coventry and Warwickshire (UHCW) NHS Trust have discovered the role that they play in preparing the womb for pregnancy.Although it has long been known that the lining of the womb harbours dynamic uterine natural killer cells, no functions have so far been given to these cells outside of pregnancy.
The new study Clearance of senescent decidual cells by uterine natural killer cells in cycling human endometrium which is published in eLife shows two functions of the cells not previously known.
Tuesday, 19 December 2017
NIHR Signal Lying on one’s side in labour with an epidural is safe and leads to more spontaneous births
Women who lie on their side in the second stage of labour after a low-dose epidural are more likely to give birth spontaneously than those who remain upright when actively contracting. Lying down on either side doesn’t appear to be harmful to mothers or babies. This means that 17 of these women would need to lie on their side instead of maintaining an upright position for one more of them to have an unassisted or “spontaneous” birth.
From the NIHR Dissemination Centre
From the NIHR Dissemination Centre
Wednesday, 13 December 2017
NIHR Signal Lying on one’s side in labour with an epidural is safe and leads to more spontaneous births
Women who lie on their side in the second stage of labour after a low-dose epidural are more likely to give birth spontaneously than those who remain upright when actively contracting. Lying down on either side doesn’t appear to be harmful to mothers or babies. This means that 17 of these women would need to lie on their side instead of maintaining an upright position for one more of them to have an unassisted or “spontaneous” birth.
This UK trial looked at how position in labour affects the type of birth in first-time mothers after a low-dose epidural.
From the NIHR Dissemination Centre
This UK trial looked at how position in labour affects the type of birth in first-time mothers after a low-dose epidural.
From the NIHR Dissemination Centre
NIHR Signal Fewer large babies are born to pregnant woman with type 1 diabetes if their glucose was monitored continuously
Pregnant women with type 1 diabetes who used a continuous glucose monitoring system were half as likely to have a large baby compared with those using standard finger prick blood glucose measurements. Only 15% of infants needed intensive care admissions due to low blood glucose in the continuous glucose monitoring group, compared with 28% born to mothers in the standard finger prick control group.
Pregnant women using continuous monitoring spent 7% more time in the target glucose range than those on standard measurements. However, their HbA1c levels, which indicate diabetic control over 12 weeks, only improved slightly. This may be unsurprising because HbA1c results are less reliable in pregnancy and women found it hard to stick to the continuous monitoring protocol.
From the NIHR Dissemination Centre
Pregnant women using continuous monitoring spent 7% more time in the target glucose range than those on standard measurements. However, their HbA1c levels, which indicate diabetic control over 12 weeks, only improved slightly. This may be unsurprising because HbA1c results are less reliable in pregnancy and women found it hard to stick to the continuous monitoring protocol.
From the NIHR Dissemination Centre
Friday, 8 December 2017
NIHR Signal Caesarean section is better for extremely premature breech babies but not necessarily for their mothers
Delivering extremely preterm breech babies (23 to 27 weeks) by caesarean reduced the risk of infant death or brain bleeds by around 40% compared with vaginal delivery.
Choice of delivery is a balance of risks for mother and baby. There are immediate risks to the mother associated with anaesthesia and surgery but also risks in subsequent pregnancies following surgery on the immature uterus. In this review, there was limited information on outcomes for the mothers.
From the NIHR Dissemination Centre
Choice of delivery is a balance of risks for mother and baby. There are immediate risks to the mother associated with anaesthesia and surgery but also risks in subsequent pregnancies following surgery on the immature uterus. In this review, there was limited information on outcomes for the mothers.
From the NIHR Dissemination Centre
Thursday, 16 November 2017
RCOG position on PLOS Medicine study: Inducing first-time mothers aged 35 and over earlier could reduce stillbirths and neonatal deaths
A study published in PLOS Medicine has found that inducing first-time mothers aged 35 and over at 40 weeks could reduce the risk of stillbirth and neonatal death (the death of a baby 7 days after birth), when compared to current guidelines which recommend induction of labour between 41 and 42 weeks for all women regardless of age.
Commenting on the study, Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said:
“This large study supports emerging research which suggests that moving forward the offer of induction to 40 weeks may play a role in reducing the proportion of stillbirths and neonatal deaths, but it should be emphasised that this study is the first to focus on a specific patient group – first time mothers aged 35 and over...
Commenting on the study, Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said:
“This large study supports emerging research which suggests that moving forward the offer of induction to 40 weeks may play a role in reducing the proportion of stillbirths and neonatal deaths, but it should be emphasised that this study is the first to focus on a specific patient group – first time mothers aged 35 and over...
Monday, 13 November 2017
WHO recommendation on tranexamic acid for the treatment of postpartum haemorrhage
Postpartum haemorrhage (PPH) is a major cause of mortality, morbidity and long term disability related to pregnancy and childbirth. Effective interventions to prevent and treat PPH exist and can largely reduce the burden of this life-threatening condition.
Given the availability of new scientific evidence related to the use of tranexamic acid in the prevention and treatment of PPH, this document updates previous WHO recommendations.
Given the availability of new scientific evidence related to the use of tranexamic acid in the prevention and treatment of PPH, this document updates previous WHO recommendations.
Monday, 6 November 2017
NIHR Signal Vaginal cleansing before caesarean delivery reduces risk of infections
Cleaning the vagina with an antiseptic solution before a caesarean delivery halves the risk of subsequent womb infection. This evidence applies mainly to women who are having a caesarean delivery when already in labour or if their waters have broken.
Womb infections can occur up to six weeks after giving birth and are more common after caesarean delivery. Symptoms include fever, pain and increased vaginal discharge.
This review included 4,837 women who had a planned or unplanned caesarean delivery. It provides evidence of the benefits of this simple, low-cost procedure. Though it is not yet recommended in UK guidance, in theory it could prevent serious illness and future fertility problems secondary to infection.
From the NIHR Dissemination Centre
Womb infections can occur up to six weeks after giving birth and are more common after caesarean delivery. Symptoms include fever, pain and increased vaginal discharge.
This review included 4,837 women who had a planned or unplanned caesarean delivery. It provides evidence of the benefits of this simple, low-cost procedure. Though it is not yet recommended in UK guidance, in theory it could prevent serious illness and future fertility problems secondary to infection.
From the NIHR Dissemination Centre
NIHR Signal Aspirin reduces a woman’s chance of developing pre-eclampsia in pregnancy
Giving low dose aspirin to high-risk women reduced their risk of pre-eclampsia before 37 weeks of pregnancy. Preterm pre-eclampsia developed in 1.6% of women given 150mg aspirin daily compared with 4.3% who took a placebo.
Pre-eclampsia is a condition which can harm mother and baby. In the mother, it causes high blood pressure and protein in the urine, which can show in pregnancy after 20 weeks. Women with risk factors, such as previous pre-eclampsia, diabetes or high blood pressure, are often prescribed 75mg aspirin from 12 weeks onwards. This study aimed to test double this dose (still classified as a `low dose’) after using a new risk assessment with additional clinical tests to better identify those at high risk of the condition. Aspirin did not affect other pregnancy outcomes and didn’t increase the risk of adverse effects.
This research adds to current knowledge about the range of doses that is effective and refines the definition and detection of women at high risk. The research did not compare 75mg with 150mg doses.
From the NIHR Dissemination Centre
Pre-eclampsia is a condition which can harm mother and baby. In the mother, it causes high blood pressure and protein in the urine, which can show in pregnancy after 20 weeks. Women with risk factors, such as previous pre-eclampsia, diabetes or high blood pressure, are often prescribed 75mg aspirin from 12 weeks onwards. This study aimed to test double this dose (still classified as a `low dose’) after using a new risk assessment with additional clinical tests to better identify those at high risk of the condition. Aspirin did not affect other pregnancy outcomes and didn’t increase the risk of adverse effects.
This research adds to current knowledge about the range of doses that is effective and refines the definition and detection of women at high risk. The research did not compare 75mg with 150mg doses.
From the NIHR Dissemination Centre
Wednesday, 1 November 2017
Report shows prevalence of key conditions across England
Figures released by NHS Digital provide information on the prevalence of 21 conditions, including asthma, hypertension, dementia, diabetes, and depression.
The annual report, Quality and Outcomes Framework (QOF) - Prevalence, Achievements and Exceptions Report, England 2016-17 also identifies how the prevalence of these conditions has changed since the previous year.
The annual report, Quality and Outcomes Framework (QOF) - Prevalence, Achievements and Exceptions Report, England 2016-17 also identifies how the prevalence of these conditions has changed since the previous year.
Monday, 16 October 2017
Tissue pathway for histopathological examination of the placenta
This tissue pathway from the Royal College of Pathologists aims to provide guidance on the range of indications for referral of aplacenta for histopathological examination and minimum standards for pathologists
undertaking placental examinations. Variations to the standard pathway for singleton
placentas, relating to pregnancies from multiple gestations, are also included. Please note
that products of conception (1st trimester) have been included in the tissue pathways for
gynaecological pathology.
Friday, 13 October 2017
Study suggests epidural does not slow second stage of labour
A study published in the journal Obstetrics & Gynaecology, showed that the use of epidural analgesia in the second stage of labour made no difference to duration of labour, and suggests that the practise of minimising pain management in labour may be outdated.
The results show epidural also had no effect on normal vaginal delivery rate, incidence of episiotomy, the position of the fetus at birth or any other measures of fetal well-being. The study compared the effects of catheter-infused, low-concentration epidural anesthetic to a catheter-infused saline placebo in this double-blinded, randomized trial of 400 women.
The results show epidural also had no effect on normal vaginal delivery rate, incidence of episiotomy, the position of the fetus at birth or any other measures of fetal well-being. The study compared the effects of catheter-infused, low-concentration epidural anesthetic to a catheter-infused saline placebo in this double-blinded, randomized trial of 400 women.
Friday, 6 October 2017
Loss of Endometrial Sodium Glucose Cotransporter SGLT1 is Detrimental to Embryo Survival and Fetal Growth in Pregnancy
Sci Rep. 2017 Oct 3;7(1):12612. doi: 10.1038/s41598-017-11674-3.
Embryo implantation requires a hospitable uterine environment. A key metabolic change that occurs during the peri-implantation period, and throughout early pregnancy, is the rise in endometrial glycogen content. Glycogen accumulation requires prior cellular uptake of glucose. Here we show that both human and murine endometrial epithelial cells express the high affinity Na+-coupled glucose carrier SGLT1. Ussing chamber experiments revealed electrogenic glucose transport across the endometrium in wild type (Slc5a1 +/+) but not in SGLT1 deficient (Slc5a1 -/-) mice. Endometrial glycogen content, litter size and weight of offspring at birth were significantly lower in Slc5a1 -/- mice. In humans, SLC5A1 expression was upregulated upon decidualization of primary endometrial stromal cells. Endometrial SLC5A1 expression during the implantation window was attenuated in patients with recurrent pregnancy loss when compared with control subjects. Our findings reveal a novel mechanism establishing adequate endometrial glycogen stores for pregnancy. Disruption of this histiotrophic pathway leads to adverse pregnancy outcome.
UHCW Research: Durairaj RRP and Barros FSV
Embryo implantation requires a hospitable uterine environment. A key metabolic change that occurs during the peri-implantation period, and throughout early pregnancy, is the rise in endometrial glycogen content. Glycogen accumulation requires prior cellular uptake of glucose. Here we show that both human and murine endometrial epithelial cells express the high affinity Na+-coupled glucose carrier SGLT1. Ussing chamber experiments revealed electrogenic glucose transport across the endometrium in wild type (Slc5a1 +/+) but not in SGLT1 deficient (Slc5a1 -/-) mice. Endometrial glycogen content, litter size and weight of offspring at birth were significantly lower in Slc5a1 -/- mice. In humans, SLC5A1 expression was upregulated upon decidualization of primary endometrial stromal cells. Endometrial SLC5A1 expression during the implantation window was attenuated in patients with recurrent pregnancy loss when compared with control subjects. Our findings reveal a novel mechanism establishing adequate endometrial glycogen stores for pregnancy. Disruption of this histiotrophic pathway leads to adverse pregnancy outcome.
UHCW Research: Durairaj RRP and Barros FSV
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