118 research outputs found
International collaboration is needed to preserve the use of Kielland's forceps in modern obstetrics
No full textImproving health outcomes for pregnant women with metabolic risk factors
No full textPhDThe epidemic of maternal obesity is increasing worldwide. Simple, effective and acceptable interventions are needed to combat obesity and improve pregnancy outcomes in women with metabolic risk factors such as dyslipidaemia and obesity. Dietary and lifestyle interventions reduce gestational weight gain, however, their effect on maternal and fetal outcomes is not clearly known. I conducted a large pragmatic randomised trial to evaluate the effectiveness of a Mediterranean-based dietary intervention to reduce the risk of adverse maternal and fetal outcomes in pregnant women with metabolic risk factors (The ESTEEM trial). The intervention significantly reduced gestational diabetes and gestational weight gain by an average of 1.2 Kg with some protective effect on fetal outcomes. I analysed the methodological challenges encountered in the trial and discussed applied solutions.
I conducted a systematic review on the commonly used dietary assessment tools in trials involving pregnant women to assess their characteristics, validity, and applicability. Self-reporting dietary tools were the most commonly used to assess dietary intake in pregnancy such as food frequency questionnaires. Only 8% of studies validated the chosen tools and applied a defined adherence criterion. I applied the findings of this review to develop and validate a custom designed food frequency questionnaire, and a short 12 items questionnaire, to assess the participants’ adherence in the ESTEEM study. I assessed the dietary intake in a randomised cohort from the ESTEEM study and compared the questionnaires’ accuracy to 24 hour dietary recalls as the reference method. Both the FFQ and the short questionnaire performed well for assessing the adherence to and the intake of key foods in the Mediterranean diet.
I systematically reviewed available online information sources on the risks and management of obesity in pregnancy in the English language. I assessed 53 websites for their information credibility, accuracy, readability, content and technological quality. Overall I found that non-governmental funded websites that are obesity-spBart’s charity for the ESTEEM study (grant number 732/2029)
Stillbirth and gestational diabetes : two linked health issues in need of a global response
No full textInterventions to reduce the rates of stillbirths in high‐income countries have had little success to date (Lancet 2016;387:691–702). Still, effective antenatal screening and mitigation of risk factors for stillbirth offer hope to identify at‐risk populations and deliver targeted interventions improving pregnancy outcomes.
The paper by Stacey et al. (BJOG 2019; https://doi.org/10.1111/1471-0528.15659) offers an important insight into the role of effective screening for gestational diabetes (GDM) in reducing the associated risks for stillbirth in affected and at‐risk women. Receiving specialist multidisciplinary care reduced the established risk for stillbirth to similar levels in a low‐risk population. The association between fasting plasma glucose levels and the risk for stillbirth was linear, emphasising the importance of early detection and treatment.
However, consensus is lacking among international health regulators on the appropriate thresholds for the diagnosis of GDM and the detection of ‘overt diabetes’ (McIntyre et al. Diabetes Care 2016;39:53–4). The current diagnostic criteria for GDM supported by the IADPSG and the WHO carries a significant economic burden and could impact healthcare provision, potentially leading to suboptimal outcomes. Similarly, more relaxed criteria might fail to deliver the needed impact to reduce stillbirth (Hanna et al. Clin Med 2017;17:108–13). Careful evaluation of locally available resources and healthcare delivery systems, guided by involved stakeholders, is warranted to conform to the international drive to optimise perinatal health.
Other important questions remain, such as the timing of screening in pregnancy, the value of universal screening, and the association with other predisposing risk factors (International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Diabetes Care 2010;33:676–82).
Interventions to address the association between GDM and stillbirth should be considered as a continuum, from pre‐conception to postpartum care in planning for future pregnancy (Ratner et al. J Clin Endocrinol Metab 2008;93:4774–9). Stillbirth prevention should not be addressed as a stand‐alone issue and requires an integrated programmatic approach. With many interventions currently being evaluated in randomised trials, accurate reporting on stillbirth and other key offspring outcomes is essential to attenuate this persistent epidemic. An ultimate strategy of individualised prediction and targeted intervention to mitigate reversible risk factors requires significant institutional engagement from major health funders.
Both GDM and stillbirth are truly global health challenges with a significant impact on the wellbeing of society. Coordinated wide‐scale interventions driven by quality evidence synthesis are urgently needed to address these important health issues
Quality of life measurement tools for women with heavy menstrual bleeding: A systematic review and quality assessment study
No full textWhat are the available standardised assessment tools that could be used to evaluate quality of life measures of women with heavy menstrual bleeding? What domains they cover? What is their quality, validity and reliability
Evaluating the value of intrapartum fetal scalp blood sampling to predict adverse neonatal outcomes : a UK multicentre observational study
No full textObjective: To evaluate the value of fetal scalp blood sampling (FBS) as an adjunct test to cardiotocography, to predict adverse neonatal outcomes.
Study design: A multicentre service evaluation observational study in forty-four maternity units in the UK. We collected data retrospectively on pregnant women with singleton pregnancy who received FBS in labour using a standardised data collection tool. The primary outcome was prediction of neonatal acidaemia diagnosed as umbilical cord arterial pH<7.05, the secondary outcomes were the prediction of Apgar scores<7 at 1st and 5th minutes and admission to the neonatal intensive care unit (NICU). We evaluated the correlation between the last FBS blood gas before birth and the umbilical cord blood and adjusted for time intervals. We constructed 2x2 tables to calculate the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) and generated receiver operating curves to report on the Area Under the Curve (AUC).
Results: In total, 1422 samples were included in the analysis; pH values showed no correlation (r=0.001, p=0.9) in samples obtained within an hour (n=314), or within half an hour from birth (n=115) (r=-0.003, p=0.9). A suboptimal FBS pH value (<7.25) had a poor sensitivity (22%) and PPV (4.9%) to predict neonatal acidaemia with high specificity (87.3%) and NPV (97.4%). Similar performance was noted to predict Apgar scores <7 at 1st (sensitivity 14.5%, specificity 87.5%, PPV 23.4%, NPV 79.6%) and 5th minute (sensitivity 20.3%, specificity 87.4%, PPV 7.6%, NPV 95.6%), and admission to NICU (sensitivity 20.3%, specificity 87.5%, PPV 13.3%, NPV 92.1%). The AUC for FBS pH to predict neonatal acidaemia was 0.59 (95%CI 0.59-0.68, p=0.3) with similar performance to predict Apgar scores<7 at 1st minute (AUC 0.55, 95%CI 0.51-0.59, p=0.004), 5th minute (AUC 0.55, 95%CI 0.48-0.62, p=0.13), and admission to NICU (AUC 0.58, 95%CI 0.52-0.64, p=0.002)
Forty-one neonates had acidaemia (2.8%, 41/1422) at birth. There was no significant correlation in pH values between the FBS and the umbilical cord blood in this subgroup adjusted for sampling time intervals (r= 0.03, p=0.83).
Conclusions: As an adjunct tool to cardiotocography, FBS offered limited value to predict neonatal acidaemia, low Apgar Scores and admission to NICU
The effect of intermittent fasting on metabolic outcomes in women with polycystic ovary syndrome: A pilot interventional study.
No full textThe aim of this study is to evaluate the effectiveness, feasibility, and acceptability of the PCO-FAST dietary lifestyle intervention based on the principles of intermittent fasting and low-glycaemic-index diet on the anthropometric, metabolic, reproductive, and quality of life outcomes in anovulatory women with polycystic ovary syndrome
The effect of intermittent fasting on metabolic outcomes in women with polycystic ovary syndrome: A pilot interventional study.
No full textThe aim of this study is to evaluate the effectiveness, feasibility, and acceptability of the PCO-FAST dietary lifestyle intervention based on the principles of intermittent fasting and low-glycaemic-index diet on the anthropometric, metabolic, reproductive, and quality of life outcomes in anovulatory women with polycystic ovary syndrome
Provision of obstetrics and gynaecology services during the COVID19 pandemic : a survey of junior doctors in the UK National Health Service
No full textObjective: The COVID-19 pandemic is disrupting health services worldwide. We aimed to evaluate the provision of obstetrics and gynaecology services in the UK during the acute-phase of the COVID-19 pandemic.
Design: Interview-based national survey.
Setting: Women’s healthcare units in the National Health Service.
Population: Junior doctors in obstetrics and gynaecology.
Methods: Participants were interviewed by members of the UKARCOG trainees’ collaborative between 28th March and 7th of April 2020. We used a quantitative analysis for closed-ended questions and a thematic framework analysis for open comments.
Results: We received responses from 148/155 units (95%), majority of the participants were in years 3-7 of training (121/148, 82%). Most completed specific training drills for managing obstetric and gynaecological emergencies in women with COVID-19 (89/148, 60.1%) and two-persons donning and doffing of Personal Protective Equipment (PPE) (96/148, 64.9%). The majority of surveyed units implemented COVID-19 specific protocols (130/148, 87.8%), offered adequate PPE (135/148, 91.2%) and operated dedicated COVID-19 emergency theatres (105/148, 70.8%).
Most units reduced face-to-face antenatal clinics (117/148, 79.1%), and suspended elective gynaecology services (131/148, 88.5%). The two-week referral pathway for oncology gynaecology was not affected in half of the units (76/148, 51.4%), while half reported a planned reduction in oncology operating (82/148, 55.4%).
Conclusion: The provision of obstetrics and gynaecology services in the UK during the acute phase of the COVID-19 pandemic seems to be in line with current guidelines, but strategic planning is needed to restore routine gynaecology services and ensure safe access to maternity care on the longterm
Spotlight on… training
No full textTraining in obstetrics and gynaecology has evolved significantly over the past two decades, offering thrilling opportunities to progress women’s health and, at the same time, presenting various challenges to both trainees and trainers. In this Spotlight, we highlight the changes in training reflected in past issues of The Obstetrician and Gynaecologist (TOG) from 2001 until now, initially with the implementation of the Modernising Medical Careers (MMC) training scheme, moving on to the introduction of new subspecialty training and finally the focus on team learning and non‐technical skills. We now recognise the importance of human factors, self‐reflection, and learning from Serious Incidents Requiring Investigation (SIRI) as an integral part of the development of an obstetrician and gynaecologist. We explore the issues of alternative training opportunities allowing doctors to pursue the Certificate of Eligibility for Specialist Registration (CESR) accreditation as an alternative to Certificate of Completion of Training (CCT). In this Spotlight, we also confront the high attrition (Br J Hosp Med 2017;78(6):334–8) and undermining rates reported by trainees, as well as the increasing physician burnout in our speciality
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