​Author(s): Schram C.M.H.
Source: Obstetrician and Gynaecologist; 2018; vol. 20 (no. 2); p. 125-131
Publication Date: 2018
Publication Type(s): Article
Available  at The Obstetrician & Gynaecologist -  from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Key content: Appraisal is a formative and developmental process; annual appraisals are the cornerstones of revalidation. Supporting information for an appraisal should cover the whole scope of work of an obstetrician and gynaecologist, including any educational, managerial or academic work over a 5-year revalidation cycle. The quality of supporting information, including reflection, is more important than the quantity. Supporting information for an appraisal can be found in many day-to-day clinical activities. Learning objectives: To be familiar with the guiding principles of appraisal and revalidation. To appreciate how to provide supporting information that satisfies appraisal and revalidation requirements. To know how to prepare efficiently and effectively for appraisal and revalidation.Copyright © 2018 Royal College of Obstetricians and Gynaecologists
Database: EMBASE

​Author(s): Johnson, Sarah
Source: MIDIRS Midwifery Digest; Jun 2018; vol. 28 (no. 2); p. 176-183
Publication Date: Jun 2018
Publication Type(s): Academic Journal
Database: CINAHL

Author(s): Krishnamoorthy U.; Waddington T.; Choudhry S.
Source: BJOG: An International Journal of Obstetrics and Gynaecology; Mar 2018; vol. 125 ; p. 129-130
Publication Date: Mar 2018
Publication Type(s): Conference Abstract
Available  at BJOG: An International Journal of Obstetrics and Gynaecology -  from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Introduction Post coital bleeding (PCB) consists of spotting or bleeding that occurs during or after sexual intercourse can be alarming for patients as is a cardinal symptom of cervical cancer although mostly due to benign causes. There is ambiguity in management of PCB and paucity of national/college guidance. Given the anxiety it evokes in patients and association with cervical cancer, there is the need for streamlined National pathway. Objectives Review aimed to improve standard of care provided for management of PCB. Objectives were to evaluate current management and extrapolate audit results and evidence from literature guide development and implementation of PCB Care pathway locally. 
Database: EMBASE
 

Author(s): Blease, Megan; Williamson, Maria; Carter, Sarah; Parker-Evans, Gillian; Darwin, Joanne

Source: Practising Midwife; Jun 2017; vol. 20 (no. 6); p. 1-3

Publication Date: Jun 2017

Publication Type(s): Academic Journal

Available in print  at  -  from THE PRACTISING MIDWIFE
Available in full text at Practising Midwife, The -  from The Practising Midwife ; Notes: Contact library for username and password - 84312
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Abstract:Most women within their lifetime will experience pregnancy, birth and motherhood. Despite this almost universal experience, the process is far from uniform. Throughout the childbirth continuum, expectations and experiences of women are diverse and ever-changing (van Teijlingen et al 2017). This article explores an innovative idea, well placed within this 'Shiny roads' edition of The Practising Midwife. It explores the birth of the EMPOWER project within a NHS trust. EMPOWER was developed to empower mothers and provide options, education and relaxation for pregnancy, birth and the postnatal period.
Database: CINAHL

Author(s): Hills S.; Cox A.; Martindale E.

Source: BJOG: An International Journal of Obstetrics and Gynaecology; Mar 2017; vol. 124 ; p. 104
Publication Date: Mar 2017

Publication Type(s): Conference Abstract

Abstract:Introduction Obesity in pregnancy presents an ever increasing challenge to those working in maternity services. The prevalence has risen from 10% in the early 1990's to almost 20% in the 2000's. One of the risks of maternal obesity is abnormal foetal growth as either macrosomia or intra-uterine growth restriction (IUGR). Serial growth scans are generally used to monitor foetal growth in those with risk factors. However, in the obese population, this can be technically difficult, and can be of debatable clinical value. Within East Lancashire Hospitals Trust, local guidelines do not currently specify performing scans on women above a certain BMI. As a result, there is variation in the requesting of serial growth scans in women with a BMI of 35-40. In the current financial climate, it is imperative that resources are targeted appropriately. Therefore, the aim of this project was to investigate the clinical usefulness and accuracy of serial growth scans in those with BMI between 35 and 40 in order to potentially reduce unnecessary burden on scanning services in the department. Methods Women with a BMI of 35-40 and no other risk factors for IUGR were compared based on whether they received growth scans or not. This was then compared with the birthweight centile of the baby to examine whether growth scans could accurately predict a birthweight (within a 15% margin of error) and also whether a normal symphysio-fundal height (SFH) picture predicted a normal birthweight centile.
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Database: EMBASE

Author(s): Brook A.; Martindale E.; Hamer F.; Choudhari Y.

Source: BJOG: An International Journal of Obstetrics and Gynaecology; Mar 2017; vol. 124 ; p. 55

Publication Date: Mar 2017

Publication Type(s): Conference Abstract

Abstract:Introduction Oxytocin (Syntocinon) may be associated with a rise in primary postpartum haemorrhage (PPH) compared with oxytocin-ergometrine (Syntometrine). The Royal College of Obstetricians and Gynaecologists has endorsed oxytocin as single agent in the active management of the third stage. We evaluated the local PPH incidence after vaginal delivery to coincide with a change in practice from oxytocin-ergometrine to oxytocin. Methods Data was extracted from an electronic record of deliveries. The change to 10 units IM oxytocin as third stage agent was introduced mid-August 2016. We scrutinized clinically significant PPH (>1000 ml) occurring both pre- and postintervention. Results 1414 vaginal deliveries occurred from June-October 2016. Median blood loss was 350 ml (50-4000). Overall, 99 cases of PPH occurred with median blood loss 1507 ml (1000-4000). PPH incidence at baseline was 7%, increasing to 9% in the 2 months after switchover. This would account for an additional 28 cases of PPH (>1000 ml) in the period and 168 additional cases per annum in our unit. Oxytocin was associated with a significant increase in PPH risk when compared to oxytocin-ergometrine (58/595 9.7% versus 39/549 7.1%; chi2 P = 0.03). Need for additional oxytocics increased following the change and was lower in those receiving syntometrine (14.7 versus 19.4%; chi2 P = 0.01). Multiple binary logistic regression revealed that choice of oxytocic was a significant determinant of PPH (B 0.636; P = 0.015). Conclusion Although national guidelines endorse oxytocin rather than oxytocin-ergometrine for an active third stage, local experience suggests a significant impact on PPH risk.
Database: EMBASE

Author(s): Schram C.

Source: BJOG: An International Journal of Obstetrics and Gynaecology; Mar 2017; vol. 124 ; p. 62-63

Publication Date: Mar 2017

Publication Type(s): Conference Abstract

Abstract:The 2015 Montgomery versus Lanarkshire decision made it clear that it is incumbent on obstetricians to provide information that is 'material' to the woman's decision making in pregnancy and childbirth, providing her with all the information and options to make an informed choice. We audited 132 pregnancy records (all in 2015) of women who had a breech presentation at term. The audit demonstrated that in our busy district general unit (+/-7000 births/year), nearly a third of breech presentations were not diagnosed prior to labour commencing. Of those that were diagnosed before labour, nearly three quarters were diagnosed because they had a scan for another reason, usually growth. Two thirds of the women in our audit, in whom the breech was not diagnosed until labour, opted for caesarean section. In the other third, two thirds delivered vaginally, compared with half diagnosed before labour. However, documentation of counselling regarding mode of delivery was poor, e.g. there was little documented evidence of information from the Term Breech Trial, or regarding the increased risks of a CS during active labour. Of those planning a vaginal birth, no information was provided regarding the success rate in our unit. Should we now provide information to women about the lack of sensitivity of clinical examination for breech presentation, the increased risks of emergency caesarean versus elective caesarean, and counsel those women in active labour, about the lack of clarity about the benefits of an emergency caesarean section for an uncomplicated breech presentation in labour.
Database: EMBASE

Author(s): Khan Z.; Martindale E.

Source: BJOG: An International Journal of Obstetrics and Gynaecology; Mar 2017; vol. 124 ; p. 80

Publication Date: Mar 2017

Publication Type(s): Conference Abstract

Abstract:Introduction The rate of caesarean section deliveries in 2013-2014 has increased to 26.2% by 0.7% since 2011. (Source: The NHS maternity statistics, England, January 2015). Predictors of success in vaginal birth after caesarean section (VBAC) include favourable pelvic examination, spontaneous onset of labour and reduced use of oxytocin infusions. It is not known whether ethnic differences have any bearing on the success of VBAC. This retrospective study explores the characteristics of successful VBAC including ethnic differences. Methods Records from 2015-2016 were explored using K2 Athena maternity database. Selection criteria included those who had one prior caesarean section and one subsequent pregnancy (n = 195). Women who opted for planned caesarean (n = 86) were analysed separately to prevent confounding effects. Women with incomplete clinical information were excluded. Data was analysed using MS Excel. Results Of 195 women initially analysed; 78 were Asian and 114 were of white origin. Those opting for planned caesarean section were more likely to be White than of Asian ethnicity (66% versus 31% respectively). The success of VBAC in this study was 66%. A greater proportion of Asian women (70%) succeeded in VBAC than White women (57%). This effect was independent of the method of induction. Further analyses on women's biometric data, age, medical co-morbidities and obstetric history will be explored in this study to reveal any significant associations. This information would be useful in counselling women appropriately on their chances of VBAC success to guide safer and autonomous decision making.
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Database: EMBASE

Author(s): Haresnape C.; Maher M.

Source: BJOG: An International Journal of Obstetrics and Gynaecology; Mar 2017; vol. 124 ; p. 138

Publication Date: Mar 2017

Publication Type(s): Conference Abstract

Abstract:Introduction Echogenic bowel is diagnosed in 0.2-1.4% of all second trimester scans. Although often a normal variant, it is associated with a fivefold increase of chromosomal abnormalities and IUGR. In particular it is a known soft marker for trisomy 21. This study investigates the antenatal management and pregnancy outcomes of patients given a diagnosis of echogenic bowel at Lancashire Women and Newborn Centre (LWNC). Methods The case notes of all women given a diagnosis of fetal echogenic bowel in 2015 were reviewed. A proforma was designed to extract information about diagnosis, associated abnormalities, antenatal screening, delivery details and pregnancy outcome. Results There were 12 diagnoses of echogenic bowel made at LWNC in 2015. Associations with bleeding in pregnancy and maternal TORCH infections, particularly CMV were noted. No association was demonstrated with Down's syndrome however, this may be due to a low uptake of antenatal screening. Two cases resulted in small-for-gestational-age babies. There was one case of FDIU observed. The fetus had a normal XX karyotype and placental insufficiency was identified on pathological testing. Conclusion All cases were managed appropriately and it is evident that good outcomes can be achieved with appropriate antenatal care. Women with a diagnosis of fetal echogenic bowel should be offered antenatal Down's Syndrome, Cystic Fibrosis and TORCH infection screening with serial growth scans. As this study has a small sample population, it would be beneficial to continue to collect data over the next 5 years to observe for further trends.
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Database: EMBASE