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 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.

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 Acceptability of HCV screening and potential use of DAAs during pregnancy in women attending antenatal care in Egypt, Pakistan and Ukraine

2021 ◽  
Author(s):  
Karen Scott ◽  
Elizabeth Chappell ◽  
Aya Mostafa ◽  
Alla Volokha ◽  
Nida Najmi ◽  
...  
Keyword(s):  
Vertical Transmission ◽  
Post Partum ◽  
Hiv Status ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Safety And Efficacy ◽  
Maternity Hospitals ◽  
Hcv Screening ◽  
The Uk ◽  
In Pregnancy

AbstractBackgroundThe risk of vertical transmission of hepatitis C virus (HCV) is ≈6%, and evidence suggests HCV negatively affects pregnancy and infant outcomes. Despite this, universal antenatal HCV screening is not available in most settings, and direct acting antivirals (DAA) are yet to be approved for use in pregnancy or breastfeeding period. Larger safety and efficacy trials are needed. At current there is limited understanding of the acceptability of routine HCV screening and use of DAAs in pregnancy but only among women in high HCV burden countries.MethodsWe conducted a cross-sectional survey of pregnant or post-partum (<6 months since delivery) women attending antenatal clinics or maternity hospitals in Egypt, Pakistan and Ukraine. In Ukraine, this included one HIV clinic. Acceptability of free universal antenatal HCV screening and potential uptake of DAA treatment in the scenario of DAAs being approved for use in pregnancy was assessed. Results were stratified by HCV status and in Ukraine by HIV status. Descriptive statistics were used to explore differences in acceptability of treatment in pregnancy by country.FindingsAmong 630 women (n=210 per country) who participated, the median age was 30 [interquartile range (IQR) 26, 34] years, 73% were pregnant and 27% postpartum, and 27% ever HCV antibody or PCR positive. 40% of women in Ukraine were living with HIV. Overall 93% of women supported free universal HCV screening in pregnancy, with no difference by country. 88% would take DAAs in pregnancy if approved for use: 92%, 98% and 73% among women in Egypt, Pakistan and Ukraine, respectively. Motivation for use of DAAs in pregnancy (to avert vertical transmission or for maternal HCV cure) varied by country, HCV status and HIV status (in Ukraine). No predictors for acceptability of DAAs were identified.InterpretationOur survey across 3 high burden countries found very high acceptability of free universal HCV screening and DAAs if approved for use in pregnancy. Clinical trials to evaluate the safety and efficacy of DAAs during pregnancy and breastfeeding are urgently required.FundingThis survey was conducted as part of the “HCVAVERT” study, funded by the UK Medical Research Council (ref MR/R019746/1).

scholarly journals EXPRESS: Pulmonary arterial hypertension in pregnancy – a systematic review of outcomes in the modern era

2021 ◽  
pp. 204589402110136
Author(s):  
Ting Ting Low ◽  
Nita Guron ◽  
Robin Ducas ◽  
Kenichiro Yamamura ◽  
Pradeepkumar Charla ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Mortality Rate ◽  
Arterial Hypertension ◽  
Maternal Mortality ◽  
Post Partum ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Maternal Mortality Rate ◽  
Pulmonary Arterial ◽  
In Pregnancy

Background: Pregnancy is hazardous with pulmonary arterial hypertension (PAH), but the risks may have improved in recent years. We sought to systematically evaluate PAH and pregnancy-related outcomes in the last decade. Methods: We searched for articles describing outcomes in pregnancy cohorts published between 2008-2018. 3658 titles were screened and 13 studies included for analysis. Pooled incidences and percentages of maternal and perinatal outcomes were calculated.  Results: Out of 272 pregnancies, 214 pregnancies advanced beyond 20 gestational weeks. The mean maternal age was 28±2 years, mean pulmonary artery systolic pressure on echocardiogram was 76±19mmHg. Aetiologies include idiopathic PAH 22%, congenital heart disease 64%, and others 15%. Majority (74%) had good functional class I/II. Only 48% of women received PAH-specific therapy. Premature deliveries occur in 58% of pregnancies at mean of 34±1 weeks, most (76%) had caesarean section. Maternal mortality rate was 12% overall (n=26); even higher for idiopathic PAH aetiology alone (20%). Reported causes of death included right heart failure, cardiac arrest, PAH crises, pre-eclampsia and sepsis. 61% of maternal deaths occur at 0-4 days post-partum. Stillbirths rate was 3% and neonatal mortality rate 1%. Conclusions: PAH in pregnancy continues to be perilous with high maternal mortality rate. Continued prospective studies are needed.

Quantifying Pregnant Women’s Knowledge of Educational Components of Antenatal Care in Lesotho

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Tabeta Seeiso ◽  
Mamutle M. Todd-Maja
Keyword(s):  
Antenatal Care ◽  
Maternal Mortality ◽  
Pregnant Women ◽  
Rural Areas ◽  
Geographic Location ◽  
Sub Saharan Africa ◽  
World Health ◽  
Cross Sectional ◽  
Danger Signs ◽  
In Pregnancy

Antenatal care (ANC) literacy is particularly important for pregnant women who need to make appropriate decisions for care during their pregnancy and childbirth. The link between inadequate health literacy on the educational components of ANC and maternal mortality in sub-Saharan Africa (SSA) is undisputable. Yet, little is known about the ANC literacy of pregnant women in SSA, with most studies inadequately assessing the four critical components of ANC literacy recommended by the World Health Organization, namely danger signs in pregnancy; true signs of labour; nutrition; and preparedness for childbirth. Lesotho, a country with one of the highest maternal mortality rates in SSA, is also underexplored in this research area. This cross-sectional study explored the levels of ANC literacy and the associated factors in 451 purposively sampled women in two districts in Lesotho using a structured questionnaire, making recourse to statistical principles. Overall, 16.4 per cent of the participants had grossly inadequate ANC literacy, while 79.8 per cent had marginal levels of such knowledge. The geographic location and level of education were the most significant predictors of ANC literacy, with the latter variable further subjected to post hoc margins test with the Bonferroni correction. The participants had the lowest scores on knowledge of danger signs in pregnancy and true signs of labour. Adequate ANC literacy is critical to reducing maternal mortality in Lesotho. Improving access to ANC education, particularly in rural areas, is recommended. This study also provides important recommendations critical to informing the national midwifery curriculum.

Low back pain in pregnancy and post-partum period. Principles for medical rehabilitation

2018 ◽  
Vol 1 (19) ◽  
pp. 22
Author(s):  
Iulia Filipescu ◽  
Mihai Berteanu ◽  
George Alexandru Filipescu ◽  
Radu Vlădăreanu
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Post Partum ◽  
Medical Rehabilitation ◽  
Low Back ◽  
Post Partum Period ◽  
In Pregnancy

Institutional developments, standards and river quality: a UK history and some lessons for industrialising countries

1996 ◽  
Vol 33 (3) ◽  
pp. 211-222 ◽  
Author(s):  
D. W. M. Johnstone ◽  
N. J. Horan
Keyword(s):  
Middle Ages ◽  
Aquatic Environment ◽  
Industrial Revolution ◽  
Integrated Management ◽  
Sewage Treatment ◽  
Lessons Learned ◽  
Process Manufacturing ◽  
Treatment And Disposal ◽  
The Uk ◽  
Developed World

From the middle ages until the early part of the nineteenth century the streets of European cities were foul with excrement and filth to the extent that aristocrats often held a clove-studded orange to their nostrils in order to tolerate the atmosphere. The introduction in about 1800 of water-carriage systems of sewage disposal merely transferred the filth from the streets to the rivers. The problem was intensified in Britain by the coming of the Industrial Revolution and establishment of factories on the banks of the rivers where water was freely available for power, process manufacturing and the disposal of effluents. As a consequence the quality of most rivers deteriorated to the extent that they were unable to support fish life and in many cases were little more than open sewers. This was followed by a period of slow recovery, such that today most of these rivers have been cleaned with many having good fish stocks and some even supporting salmon. This recovery has not been easy nor has it been cheap. It has been based on the application of good engineering supported by the passing and enforcement of necessary legislation and the development of suitable institutional capacity to finance, design, construct, maintain and operate the required sewerage and sewage treatment systems. Such institutional and technical systems not only include the disposal of domestic sewage but also provisions for the treatment and disposal of industrial wastewaters and for the integrated management of river systems. Over the years a number of institutional arrangements and models have been tried, some successful other less so. Although there is no universally applicable approach to improving the aquatic environment, many of the experiences encountered by the so-called developed world can be learned by developing nations currently attempting to rectify their own aquatic pollution problems. Some of these lessons have already been discussed by the authors including some dangers of copying standards from the developed world. The objective of this paper is to trace the steps taken over many years in the UK to develop methods and systems to protect and preserve the aquatic environment and from the lessons learned to highlight what is considered to be an appropriate and sustainable approach for industrialising nations. Such an approach involves setting of realistic and attainable standards, providing appropriate and affordable treatment to meet these standards, establishment of the necessary regulatory framework to ensure enforcement of the standards and provision of the necessary financial capabilities to guarantee successful and continued operation of treatment facilities.

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