scholarly journals Provision of acute medicine services for pregnant women in UK hospitals: Data from the Society for Acute Medicine Benchmarking Audit 2019

2020 ◽  
pp. 1753495X2092950
Author(s):  
Catherine Atkin ◽  
Paarul Prinja ◽  
Anita Banerjee ◽  
Mark Holland ◽  
Dan Lasserson
Keyword(s):  
Pregnant Women ◽  
Medical Problems ◽  
Acute Medicine ◽  
Hospital Size ◽  
Obstetric Medicine ◽  
Provision Of Services ◽  
Timely Access ◽  
The Uk ◽  
Local Guideline ◽  
In Pregnancy

Background Medical problems during pregnancy are the leading cause of maternal mortality in the UK. Pregnant women often present through acute services to the medical team, requiring timely access to appropriate services, physicians trained to manage medical problems in pregnancy, with locally agreed guidance available. Methods Data were collected through the Society for Acute Medicine Benchmarking Audit, a national audit of service delivery and patient care in acute medicine over a 24 hour period. Results One hundred and thirty hospitals participated: 5.5% had an acute medicine consultant trained in obstetric medicine, and 38% of hospitals had a named lead for maternal medicine. This was not related to hospital size (p = 0.313). Sixty-four units had local guidelines for medical problems in pregnancy; 43% had a local guideline for venous thromboembolism in pregnancy. Centres with a named lead had more guidelines (p = 0.019). Conclusion Current provision of services within acute medicine for pregnant women does not meet national recommendations.

scholarly journals Obstetric medical care and training in the United Kingdom

2016 ◽  
Vol 10 (1) ◽  
pp. 40-42 ◽  
Author(s):  
Adam D Jakes ◽  
Ingrid Watt-Coote ◽  
Matthew Coleman ◽  
Catherine Nelson-Piercy
Keyword(s):  
Core Curriculum ◽  
Contributory Factor ◽  
Medical Conditions ◽  
Medical Problems ◽  
Maternal Deaths ◽  
Obstetric Medicine ◽  
Physician Role ◽  
The Uk ◽  
Maternal Medicine ◽  
In Pregnancy

The UK confidential enquiry into maternal deaths identified poor management of medical problems in pregnancy to be a contributory factor to a large proportion of indirect maternal deaths. Maternal (obstetric) medicine is an exciting subspecialty that encompasses caring for both women with pre-existing medical conditions who become pregnant, as well as those who develop medical conditions in pregnancy. Obstetrics and gynaecology trainees have some exposure to maternal medicine through their core curriculum and can then complete an advanced training skills module, subspecialise in maternal–fetal medicine or take time out to complete the Royal College of Physicians membership examination. Physician training has limited exposure to medical problems in pregnancy and has therefore prompted expansion of the obstetric physician role to ensure physicians with adequate expertise attend joint physician–obstetrician clinics. This article describes the role of an obstetric physician in the UK and the different career pathways available to physicians and obstetricians interested in maternal medicine.

Obstetric emergencies

2016 ◽  
Keyword(s):  
Emergency Department ◽  
Pregnant Women ◽  
Early Pregnancy ◽  
Urgent Care ◽  
Medical Problems ◽  
Nursing Assessment ◽  
Care Services ◽  
Obstetric Emergencies ◽  
In Pregnancy

Women often present to emergency and urgent care services with problems or concerns relating to their pregnancy. Additionally, women who are pregnant may also present with acute medical problems or suffer from a range of injuries. Problems in early pregnancy are common and are often a reason for attendance to the emergency department. This chapter provides detailed information regarding the assessment of pregnant women and the differences to that of non-pregnant patients. A range of emergency obstetric problems are covered, including emergency delivery. The nursing assessment and management of medical problems in pregnancy are also covered.

scholarly journals Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: a cost-effectiveness analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038505
Author(s):  
Susie Huntington ◽  
Georgie Weston ◽  
Farah Seedat ◽  
John Marshall ◽  
Heather Bailey ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Pregnant Women ◽  
Neonatal Death ◽  
Cost Effective ◽  
Screening Strategy ◽  
Base Case ◽  
Scenario Analyses ◽  
The Uk ◽  
The Cost ◽  
In Pregnancy

ObjectivesTo assess the cost-effectiveness of universal repeat screening for syphilis in late pregnancy, compared with the current strategy of single screening in early pregnancy with repeat screening offered only to high-risk women.DesignA decision tree model was developed to assess the incremental costs and health benefits of the two screening strategies. The base case analysis considered short-term costs during the pregnancy and the initial weeks after delivery. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted to assess the robustness of the results.SettingUK antenatal screening programme.PopulationHypothetical cohort of pregnant women who access antenatal care and receive a syphilis screen in 1 year.Primary and secondary outcome measuresThe primary outcome was the cost to avoid one case of congenital syphilis (CS). Secondary outcomes were the cost to avoid one case of intrauterine fetal demise (IUFD) or neonatal death and the number of women needing to be screened/treated to avoid one case of CS, IUFD or neonatal death. The cost per quality-adjusted life year gained was assessed in scenario analyses.ResultsBase case results indicated that for pregnant women in the UK (n=725 891), the repeat screening strategy would result in 5.5 fewer cases of CS (from 8.8 to 3.3), 0.1 fewer cases of neonatal death and 0.3 fewer cases of IUFD annually compared with the single screening strategy. This equates to an additional £1.8 million per case of CS prevented. When lifetime horizon was considered, the incremental cost-effectiveness ratio for the repeat screening strategy was £120 494.ConclusionsUniversal repeat screening for syphilis in pregnancy is unlikely to be cost-effective in the current UK setting where syphilis prevalence is low. Repeat screening may be cost-effective in countries with a higher syphilis incidence in pregnancy, particularly if the cost per screen is low.

scholarly journals The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: a national cohort study using the UK Obstetric Surveillance System (UKOSS)

2021 ◽  
Author(s):  
◽  
Nicola Vousden ◽  
Kathryn Bunch ◽  
Edward Morris ◽  
Nigel Simpson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Surveillance System ◽  
Absolute Risk ◽  
Preterm Births ◽  
Incidence Rates ◽  
Minority Ethnic Group ◽  
Symptom Status ◽  
The Uk ◽  
In Pregnancy

ABSTRACTBackgroundEvidence on risk factors, incidence and impact of SARS-CoV-2 infection in pregnant mothers and their babies has rapidly expanded but there is a lack of population level data to inform accurate incidence rates and unbiased descriptions of characteristics and outcomes. The primary aim of this study was to describe the incidence, characteristics and outcomes of hospitalized pregnant women with symptomatic and asymptomatic SARS-CoV-2 in the UK compared to pregnant women without SARS-CoV-2 in order to inform future clinical guidance and management.Methods and FindingsWe conducted a national, prospective cohort study of all hospitalized pregnant women with confirmed SARS-CoV-2 from 1st March 2020 to 31st August 2020 using the UK Obstetric Surveillance System (UKOSS) across all 194 hospitals in the UK with a consultant-led maternity unit. Incidence was estimated using the latest national maternity data. Overall, 1148 hospitalized women had confirmed SARS-CoV-2 in pregnancy, 63% of which were symptomatic. Therefore, the estimated incidence of hospitalization with symptomatic SARS-CoV-2 was 2.0 per 1000 maternities (95% CI 1.9-2.2) and for asymptomatic SARS-CoV-2 was 1.2 per 1000 maternities (95% CI 1.1-1.4). Compared to pregnant women without SARS-CoV-2, women hospitalized with symptomatic SARS-CoV-2 were more likely to be overweight or obese (adjusted OR 1.86, 95% CI 1.39-2.48 and aOR 2.07, 95% CI 1.53-2.29 respectively), to be of Black, Asian or Other minority ethnic group (aOR 6.24, 95% CI 3.93-9.90, aOR 4.36, 95% CI 3.19-5.95 and aOR 12.95, 95% CI 4.93-34.01 respectively), and to have a relevant medical comorbidity (aOR 1.83, 95% CI 1.32-2.54). Compared to pregnant women without SARS-CoV-2, hospitalized pregnant women with symptomatic SARS-CoV-2 were more likely to be admitted to intensive care (aOR 57.67, 95% CI 7.80-426.70) but the absolute risk of poor outcomes was low. Cesarean births and neonatal unit admission were increased regardless of symptom status (symptomatic aOR 2.60, 95% CI 1.97-3.42 and aOR 3.08, 95% CI 1.99-4.77 respectively; asymptomatic aOR 2.02, 95% CI 1.52-2.70 and aOR 1.84, 95% 1.12-3.03 respectively). Iatrogenic preterm births were more common in women with symptomatic SARS-CoV-2 (aOR 11.43, 95% CI 5.07-25.75). The risks of stillbirth or neonatal death were not significantly increased, regardless of symptom status but numbers were small. The limitations of this study include the restriction to women hospitalized with SARS-CoV-2, who may by nature of their admission have been at greater risk of adverse outcome.ConclusionsWe have identified factors that increase the risk of symptomatic and asymptomatic SARS-CoV-2 in pregnancy. The increased risks of cesarean and iatrogenic preterm birth provide clear evidence of the indirect impact of SARS-CoV-2 on mothers and maternity care in high income settings. Clinicians can be reassured that the majority of women do not experience severe complications of SARS-CoV-2 in pregnancy and women with mild disease can be discharged to continue their pregnancy safely.

Obstetric Medicine

2020 ◽  
Author(s):  
Charlotte J. Frise ◽  
Sally Collins
Keyword(s):  
Pregnant Women ◽  
Management Strategies ◽  
Chronic Illnesses ◽  
Evidence Based ◽  
Advanced Training ◽  
Medical Problems ◽  
Comprehensive Overview ◽  
Medical Specialties ◽  
Obstetric Medicine ◽  
Maternal Medicine

Pregnant women regularly present with medical problems to many different medical specialties, and as their physiology is changed by the pregnancy, so too is the way in which many chronic illnesses behave. This new specialist handbook, Obstetric Medicine, provides a comprehensive overview of medical conditions in the pregnant woman, and covers the syllabus for both the RCOG Advanced Training Skills Module (ATSM) and sub-specialty training in maternal medicine. This is an essential new addition to the literature for all physicians who work with pregnant women in their practice. It contains links to national and international guidelines, and provides evidence-based management strategies for both chronic and acute illnesses.

scholarly journals Maternal mortality in the developed world: lessons from the UK confidential enquiry

2008 ◽  
Vol 1 (1) ◽  
pp. 7-10
Author(s):  
Michael de Swiet
Keyword(s):  
Maternal Mortality ◽  
De Novo ◽  
Post Partum ◽  
Further Education ◽  
Medical Problems ◽  
The Uk ◽  
Developed World ◽  
Current Report ◽  
Ruptured Uterus ◽  
In Pregnancy

The UK confidential maternal mortality enquiry shows that not only has maternal mortality decreased since 1952, the year of the first enquiry, but also the pattern of maternal mortality has changed markedly. Major surgical causes of death, such as post-partum haemorrhage and ruptured uterus, are no longer as important as medical causes such as heart disease. The ‘Top Ten’ recommendations in the current report for the years 2003–2005 emphasise the need for health care practitioners to be aware of the risks that medical conditions, both pre-existing and those arising de novo in pregnancy, impose on the expectant and newly delivered mother. Training and further education programmes should emphasise the importance of medical problems in pregnancy without omitting the knowledge and skills in basic obstetrics that have made such an impact on maternal mortality in the past.

scholarly journals A protocol for the economic evaluation of the smoking Cessation in Pregnancy Incentives Trial III (CPIT III)

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038827
Author(s):  
Nicola McMeekin ◽  
Lesley Sinclair ◽  
Linda Bauld ◽  
David Michael Tappin ◽  
Alex Mitchell ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Usual Care ◽  
Pregnant Women ◽  
Financial Incentives ◽  
Cost Effective ◽  
Good Opportunity ◽  
Link Type ◽  
The Uk ◽  
In Pregnancy

IntroductionSmoking results in an average 10-year loss of life, but smokers who permanently quit before age 40 can expect a near normal lifespan. Pregnancy poses a good opportunity to help women to stop; around 80% of women in the UK have a baby, most of whom are less than 40 years of age. Smoking prevalence during pregnancy is high: 17%–23% in the UK. Smoking during pregnancy causes low birth weight and increases the risk of premature birth. After birth, passive smoking is linked to sudden infant death syndrome, respiratory diseases and increased likelihood of taking up smoking. These risks impact the long-term health of the child with associated increase in health costs. Emerging evidence suggests that offering financial incentives to pregnant women to quit is highly cost effective.This protocol describes the economic evaluation of a multi-centre randomised controlled trial (Cessation in Pregnancy Incentives Trial III, CPIT III) designed to establish whether offering financial incentives, in addition to usual care, is effective and cost effective in helping pregnant women to quit.Methods and analysisThe economic evaluation will identify, measure and value resource use and outcomes from CPIT III, comparing participants randomised to either usual care or usual care plus up to £400 financial incentives. Within-trial and long-term analyses will be conducted from a National Health Service and Personal Social Services perspective; the outcome for both analyses will be quality adjusted life-years measured using EQ-5D-5L. Patient level data collected during the trial will be used for the within-trial analysis, with an additional outcome of cotinine validated quit rates at 34–38 weeks gestation and 6 months postpartum. The long-term model will be informed by data from the trial and published literature.Ethics and disseminationTrial registration numberISRCTN15236311; Pre-results (https://doi.org/10.1186/ISRCTN15236311).

scholarly journals Attitudes to E-Cigarettes and Cessation Support for Pregnant Women from English Stop Smoking Services: A Mixed Methods Study

2019 ◽  
Vol 16 (1) ◽  
pp. 110 ◽  
Author(s):  
Sue Cooper ◽  
Sophie Orton ◽  
Katarzyna A. Campbell ◽  
Michael Ussher ◽  
Naomi Coleman-Haynes ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Public Health Problem ◽  
Mixed Methods Study ◽  
Cigarette Use ◽  
Smoking In Pregnancy ◽  
Stop Smoking ◽  
Quitting Smoking ◽  
Stop Smoking Services ◽  
The Uk ◽  
In Pregnancy

Smoking in pregnancy remains a public health problem. In the UK e-cigarettes are the most popular aid to quitting smoking outside of pregnancy, but we don’t know the extent of e-cigarette use in pregnancy or how English Stop Smoking Services (SSS) respond to pregnant women who vape. In 2015 we surveyed SSS managers about cessation support for pregnant women and responses to clients who vaped. Subsequently we interviewed a sub-sample of managers to seek explanations for the SSS’ position on e-cigarettes; interviews were thematically analysed. Survey response rate was 67.8% (72/106); overall managers reported 2.2% (range 1.4–4.3%) of pregnant clients were using e-cigarettes. Most SSS reported supporting pregnant women who already vaped, but would not recommend e-cigarette use; for women that were still smoking and not using e-cigarettes, 8.3% of SSS were likely/very likely to advise using e-cigarettes, with 56.9% of SSS unlikely/very unlikely to advise using them. Fifteen respondents were interviewed; interviewees were generally positive about the potential of e-cigarettes for cessation in pregnancy although concerns about perceived lack of evidence for safety were expressed and most wanted research on this. Clear guidance on e-cigarette use informed by pregnancy specific research will assist SSS to provide consistent evidence-based support.

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