609 results on '"Heazell, A."'
Search Results
2. The United Kingdom and the Netherlands maternity care responses to COVID-19: A comparative study
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Lauri M.M. van den Berg, Marie-Clare Balaam, Rebecca Nowland, Gill Moncrieff, Anastasia Topalidou, Suzanne Thompson, Gill Thomson, Ank de Jonge, Soo Downe, George Ellison, Alan Fenton, Alexander Heazell, Carol Kingdon, Zoe Matthews, Alexandra Severns, Alison Wright, Naseerah Akooji, Jo Cull, Lauri van den Berg, Nicola Crossland, Claire Feeley, Beata Franso, Steph Heys, Arni Sarian, Maria Booker, Jane Sandall, Jim Thornton, Tisian Lynskey-Wilkie, Vanessa Wilson, Rebecca Abe, Tinuke Awe, Toyin Adeyinka, Ruth Bender-Atik, Lia Brigante, Rebecca Brione, Franka Cadée, Elizabeth Duff, Tim Draycott, Duncan Fisher, Annie Francis, Arie Franx, M.C. Erasmus, Lucy Frith, Louise Griew, Clea Harmer, Caroline Homer, Marian Knight, Amanda Mansfield, Neil Marlow, Trixie Mcaree, David Monteith, Keith Reed, Yana Richens, Lucia Rocca-Ihenacho, Mary Ross-Davie, Seana Talbot, Myles Taylor, Maureen Treadwell, Midwifery Science, APH - Personalized Medicine, APH - Quality of Care, Amsterdam Reproduction & Development (AR&D), and Amsterdam Reproduction & Development
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Infection Control ,Policy Drivers ,COVID-19 ,Obstetrics and Gynecology ,HN ,HM ,B720 ,United Kingdom ,QR ,RA0421 ,Newborn Care ,Maternity and Midwifery ,Maternal Health Services ,RG ,Netherlands - Abstract
Background: The national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how similarities and differences occurred in these two contexts could inform optimal care in normal circumstances, and during future crises. Aim: To compare the UK and Dutch COVID-19 maternity and neonatal care responses in three key domains: choice of birthplace, companionship, and families in vulnerable situations. Method: A multi-method study, including documentary analysis of national organisation policy and guidance on COVID-19, and interviews with national and regional stakeholders. Findings: Both countries had an infection control focus, with less emphasis on the impact of restrictions. Differences included care providers’ fear of contracting COVID-19; the extent to which personalised care was embedded in the care system before the pandemic; and how far multidisciplinary collaboration and service-user involvement were prioritised. Conclusion: We recommend that countries should 1) make a systematic plan for crisis decision-making before a serious event occurs, and that this must include authentic service-user involvement, multidisciplinary collaboration, and protection of staff wellbeing 2) integrate women’s and families’ values into the maternity and neonatal care system, ensuring equitable inclusion of the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics, or other unexpected large-scale events.
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- 2023
3. ‘Moving towards understanding’, acceptability of investigations following stillbirth in <scp>sub‐Saharan</scp> Africa: A grounded theory study
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Carol Bedwell, Valentina Actis Danna, Kutemba Lyangenda, Khuzuet Tuwele, Flora Kuzenza, Debora Kimaro, Happiness Shayo, Chisomo Petross, Isabella Chisuse, Alexander Heazell, Suresh Victor, Bellington Vwalika, and Tina Lavender
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Obstetrics and Gynecology - Published
- 2022
4. Antenatal, peripartum and intrapartum assessment of the fetus
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Zoe Thurlwell and Alexander Heazell
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Anesthesiology and Pain Medicine ,Critical Care and Intensive Care Medicine - Published
- 2022
5. Evolving pattern of fetal movements throughout a healthy pregnancy
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Lauren O'Connell and Alexander E. P. Heazell
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Adult ,Male ,medicine.medical_specialty ,Placenta ,Pregnancy Trimester, Third ,Case Report ,Miscarriage ,03 medical and health sciences ,Viable pregnancy ,0302 clinical medicine ,Obstetrics and gynaecology ,Pregnancy ,medicine ,Humans ,030212 general & internal medicine ,Fetal Movement ,Fetus ,030219 obstetrics & reproductive medicine ,Placental abruption ,business.industry ,Obstetrics ,General Medicine ,Stillbirth ,medicine.disease ,First trimester ,Pregnancy Trimester, First ,Gestation ,Female ,business - Abstract
A 31-year-old woman with a history of stillbirth due to placental abruption at 29 weeks’ gestation and one first trimester miscarriage documented a continuous record of her perceived fetal movements from 28 to 38 weeks’ gestation. Repeated ultrasound examinations confirmed a viable pregnancy, with normal growth, liquor volume and Doppler profile. She delivered a healthy male infant at 38 weeks and 3 days’ gestation. The data collected give a detailed record of fetal activity in a healthy pregnancy. Perceived fetal activity increased as pregnancy progressed and was greatest in the evenings. We also found that clusters of movements, which have previously been reported as protective against stillbirth, were felt earlier on in pregnancy.
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- 2023
6. Support after stillbirth: Findings from the Parent Voices Initiative Global Registry Project
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Vicki Ponce Hardy, Alexandra Beedle, Sam Murphy, Claire Storey, Neelam Aggarwal, Rakhi Dandona, Alka Dev, Patricia Doherty, Alexander Heazell, Mary Kinney, Sara Nam, Paula Quigley, Sue Steen, Linda A. Vanotoo, Susannah Leisher, and Hannah Blencowe
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The need for respectful bereavement care following a stillbirth has been poorly recognised within global public health initiatives. To date, there has been no comprehensive cataloguing of providers that support parents after stillbirth, nor any review of the challenges they face. We aimed to identify providers (organisations and point persons) that support bereaved parents worldwide and to investigate the challenges they face. A systematic global online search was conducted to identify providers of support after stillbirth. Subsets of providers were surveyed and interviewed. These were purposively sampled to achieve diversity in geography, organisation size and point person role. Challenges in providing support in six key areas – stigma, funding, reach, policy, workforce, and advocacy – were analysed thematically. Overall, 621 providers from 75 countries were identified. No support providers were identified in 123 countries, and in the 6 countries that carry almost half of the global burden of stillbirths, only 8 support providers were found. Support providers faced challenges in accessing funding, reaching key populations, and training and retaining staff, while complex policies hampered bereavement care. Support providers were challenged by silence and stigma around stillbirth. Overcoming these challenges requires collaboration, effort, and political will at local and international scales.
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- 2023
7. Risk of stillbirth after a previous caesarean delivery: A Swedish nationwide cohort study
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Sukainah Al Khalaf Y, Alexander Heazell, Marius Kublickas, Karolina Kublickiene, and Ali Khashan
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Objectives To investigate the risk of stillbirth in relation to; 1) a previous CD compared to those following a vaginal birth (VB); and 2) vaginal birth after caesarean (VBAC) compared to a repeat CD. Design Population-based cohort study. Setting The Swedish Medical Birth registry Population Women with their first and second singletons between 1982 and 2012. Methods Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the association between CD in the first pregnancy and stillbirth in the second pregnancy and the association between VBAC and stillbirth. Sub-group analyses were performed by types of CD and timing of stillbirth (antepartum and intrapartum). Main outcome measures Stillbirth (antepartum and intrapartum fetal death). Results Of the 1,771,700 singleton births from 885,850 women,117,114 (13.2%) women had a CD in the first pregnancy, and 51,755 had VBAC in the second pregnancy. We found a 37% increased odds of stillbirth (aOR:1.37 [95% CI, 1.23–1.52]) in women with a previous CD compared to VB. The odds of intrapartum stillbirth was higher in previous pre-labour CD group (aOR:2.72 [95% CI, 1.51–4.91]) than the previous in-labour CD group (aOR:1.35 [95% CI, 0.76–2.40,]), although not statistically significant in the latter case. No increased odds was found for intrapartum stillbirth in women who had VBAC (aOR:0.99 [95% CI, 0.48–2.06]) compared to women who had a repeat CD, whereas women with antepartum stillbirth were more likely to have a VBAC (aOR:4.49 [95% CI, 3.55–5.67]). Conclusions This study confirms that a CD is associated with an increased risk of subsequent stillbirth, with a greater risk among pre-labour CD. This association is not solely mediated by increases in intrapartum asphyxia, uterine rupture or attempted VBAC. Further research is needed to understand this association, but these findings might help health care providers to reach optimal decisions regarding mode of birth, particularly when CD is unnecessary.
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- 2023
8. Placental expression of estrogen-related receptor gamma is reduced in fetal growth restriction pregnancies and is mediated by hypoxia
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Zhiyong Zou, Lynda K Harris, Karen Forbes, and Alexander E P Heazell
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Fetal Growth Retardation ,Reproductive Medicine ,Pregnancy ,Placenta ,Humans ,Estrogens ,Female ,Cobalt ,RNA, Messenger ,Cell Biology ,General Medicine ,Hypoxia - Abstract
Fetal growth restriction (FGR) describes a fetus which has not achieved its genetic growth potential; it is closely linked to placental dysfunction and uteroplacental hypoxia. Estrogen-related receptor gamma (ESRRG) is regulated by hypoxia and is highly expressed in the placenta. We hypothesized ESRRG is a regulator of hypoxia-mediated placental dysfunction in FGR pregnancies. Placentas were collected from women delivering appropriate for gestational age (AGA; n = 14) or FGR (n = 14) infants. Placental explants (n = 15) from uncomplicated pregnancies were cultured for up to 4 days in 21% or 1% O2, or with 200 μM cobalt chloride (CoCl2), or treated with the ESRRG agonists DY131 under different oxygen concentrations. RT-PCR, Western blotting, and immunochemistry were used to assess mRNA and protein levels of ESRRG and its localization in placental tissue from FGR or AGA pregnancies, and in cultured placental explants. ESRRG mRNA and protein expression were significantly reduced in FGR placentas, as was mRNA expression of the downstream targets of ESRRG, hydroxysteroid 11-beta dehydrogenase 2 (HSD11B2), and cytochrome P-450 (CYP19A1.1). Hypoxia-inducible factor 1-alpha protein localized to the nuclei of the cytotrophoblasts and stromal cells in the explants exposed to CoCl2 or 1% O2. Both hypoxia and CoCl2 treatment decreased ESRRG and its downstream genes’ mRNA expression, but not ESRRG protein expression. DY131 increased the expression of ESRRG signaling pathways and prevented abnormal cell turnover induced by hypoxia. These data show that placental ESRRG is hypoxia-sensitive and altered ESRRG-mediated signaling may contribute to hypoxia-induced placental dysfunction in FGR. Furthermore, DY131 could be used as a novel therapeutic approach for the treatment of placental dysfunction.
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- 2022
9. Pregnant women and their partners' views and experiences of reduced fetal movements: a narrative literature review
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Kushupika Dube, Rebecca Smyth, Alexander Heazell, and Tina Lavender
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General Medicine - Abstract
Background/Aims Globally, 2 million stillbirths occur annually, 98% of which occur in low-income settings. In low-income settings, stillbirth may be associated with maternal perception of reduced fetal movements. However, little is known about maternal experiences of reduced fetal movements and subsequent engagement with health services in low-income settings. This narrative literature review initially aimed to improve understanding of views and experiences of reduced fetal movements in pregnant women in low-income settings using information synthesised from international studies. However, only a small number of articles from low-resource settings were found. Methods The literature reviewed qualitative, quantitative and mixed-method studies guided by a systematic approach. The findings were discussed narratively. Results A total of 40 studies were identified, only four of which were from low-income settings. The four main themes identified were: maternal perception of fetal movements, facilitators and barriers to seeking healthcare, reduced fetal movements as a predictor of fetal outcomes and knowledge of fetal movements and management strategies. Conclusions A variety of factors may influence maternal perception of reduced fetal movements and experience of care. As most studies were conducted in high-income settings, it is imperative to describe women's experiences of reduced fetal movements in low-income settings.
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- 2022
10. Strengthening open disclosure after incidents in maternity care: a realist synthesis of international research evidence
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Mary Adams, Julie Hartley, Natalie Sanford, Alexander Edward Heazell, Rick Iedema, Charlotte Bevan, Maria Booker, Maureen Treadwell, and Jane Sandall
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Health Policy - Abstract
Background Open Disclosure (OD) is open and timely communication about harmful events arising from health care with those affected. It is an entitlement of service-users and an aspect of their recovery, as well as an important dimension of service safety improvement. Recently, OD in maternity care in the English National Health Service has become a pressing public issue, with policymakers promoting multiple interventions to manage the financial and reputational costs of communication failures. There is limited research to understand how OD works and its effects in different contexts. Methods Realist literature screening, data extraction, and retroductive theorisation involving two advisory stakeholder groups. Data relevant to families, clinicians, and services were mapped to theorise the relationships between contexts, mechanisms, and outcomes. From these maps, key aspects for successful OD were identified. Results After realist quality appraisal, 38 documents were included in the synthesis (22 academic, 2 training guidance, and 14 policy report). 135 explanatory accounts were identified from the included documents (with n = 41 relevant to families; n = 37 relevant to staff; and n = 37 relevant to services). These were theorised as five key mechanism sets: (a) meaningful acknowledgement of harm, (b) opportunity for family involvement in reviews and investigations, (c) possibilities for families and staff to make sense of what happened, (d) specialist skills and psychological safety of clinicians, and (e) families and staff knowing that improvements are happening. Three key contextual factors were identified: (a) the configuration of the incident (how and when identified and classified as more or less severe); (b) national or state drivers, such as polices, regulations, and schemes, designed to promote OD; and (c) the organisational context within which these these drivers are recieived and negotiated. Conclusions This is the first review to theorise how OD works, for whom, in what circumstances, and why. We identify and examine from the secondary data the five key mechanisms for successful OD and the three contextual factors that influence this. The next study stage will use interview and ethnographic data to test, deepen, or overturn our five hypothesised programme theories to explain what is required to strengthen OD in maternity services.
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- 2023
11. Risk factors for late preterm and term stillbirth: A secondary analysis of an individual participant data meta‐analysis
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R. A. Thompson, J. M. D. Thompson, J. Wilson, R. S. Cronin, E. A. Mitchell, C. H. Raynes‐Greenow, M. Li, T. Stacey, A. E. P. Heazell, L. M. O‘Brien, L. M. E. McCowan, and N. H. Anderson
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Obstetrics and Gynecology - Published
- 2023
12. Ending Preventable Stillbirths and Improving Bereavement Care: A Scorecard for High- and Upper-Middle Income Countries
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Esti Charlotte de Graaff, Susannah Hopkins Leisher, Hannah Blencowe, Harriet Lawford, Jillian Cassidy, Paul Cassidy, Elizabeth S Draper, Alexander E P Heazell, Mary Kinney, Paula Quigley, Claudia Ravaldi, Claire Storey, Alfredo Vannacci, the EPS in High-Resource Countries Scorecard Collaboration Group, and Vicki Flenady
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Background: Despite progress, stillbirth rates in many high- and upper-middle income countries remain high, and the majority of these deaths are preventable. We introduce the Ending Preventable Stillbirths (EPS) Scorecard for High- and Upper Middle-Income Countries, a tool to track progress against the Lancet’s 2016 EPS Series Call to Action, fostering transparency, consistency and accountability. Methods: The Scorecard for EPS in High- and Upper-Middle Income Countries was adapted from the Scorecard for EPS in Low-Income Countries which includes 20 indicators to track progress against the eight Call to Action targets. The Scorecard for High- and Upper-Middle Income Countries includes 23 indicators tracking progress against these same Call to Action targets. For this inaugural version of the Scorecard, 13 high- and upper-middle income countries supplied data. Data were collated and compared between and within countries. Results: Data were complete for 15 of 23 indicators (65%). Five key issues were identified: (1) there is wide variation in stillbirth rates and related perinatal outcomes, (2) definitions of stillbirth and related perinatal outcomes vary widely across countries, (3) data on key risk factors for stillbirth are often missing and equity is not consistently tracked, (4) most countries lack guidelines and targets for critical areas for stillbirth prevention and care after stillbirth and have not set a national stillbirth rate target, and (5) most countries do not have mechanisms in place for reduction of stigma or guidelines around bereavement care. Conclusions: This inaugural version of the Scorecard for High- and Upper-Middle Income Countries highlights important gaps in performance indicators for stillbirth both between and within countries. The Scorecard provides a basis for future assessment of progress and can be used to help holding individual countries accountable, especially for reducing stillbirth inequities for disadvantaged groups.
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- 2023
13. Computerized cardiotocography and <scp>Dawes‐Redman</scp> criteria: how should we interpret criteria not‐met?
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T. Stampalija, A. Bhide, A. E. P. Heazell, A. Sharp, and C. Lees
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Reproductive Medicine ,Radiological and Ultrasound Technology ,Obstetrics and Gynecology ,Radiology, Nuclear Medicine and imaging ,General Medicine - Published
- 2023
14. Information about fetal movements and stillbirth trends: Analysis of time series data
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Alexander E. P. Heazell, Fiona Holland, and Jack Wilkinson
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Obstetrics and Gynecology - Published
- 2023
15. Effect of encouraging awareness of reduced fetal movement and subsequent clinical management on pregnancy outcome:a systematic review and meta-analysis
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Dexter J.L. Hayes, Jo C. Dumville, Tanya Walsh, Lucy E. Higgins, Margaret Fisher, Anna Akselsson, Melissa Whitworth, and Alexander E.P. Heazell
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placenta ,ultrasound ,maternal health services ,kick counting ,Obstetrics and Gynecology ,General Medicine ,infant, newborn ,female ,perinatal death ,labor, obstetric ,stillbirth ,pregnancy ,fetal movement ,humans - Abstract
Objective: Reduced fetal movement, defined as a decrease in the frequency or strength of fetal movements as perceived by the mother, is a common reason for presentation to maternity care. Observational studies have demonstrated an association between reduced fetal movement and stillbirth and fetal growth restriction related to placental insufficiency. However, individual intervention studies have described varying results. This systematic review and meta-analysis aimed to determine whether interventions aimed at encouraging awareness of reduced fetal movement and/or improving its subsequent clinical management reduce the frequency of stillbirth or other important secondary outcomes.Data sources: Searches were conducted in MEDLINE, Embase, CINAHL, The Cochrane Library, Web of Science, and Google Scholar. Guidelines, trial registries, and gray literature were also searched. Databases were searched from inception to January 20, 2022.Study eligibility criteria: Randomized controlled trials and controlled nonrandomized studies were eligible if they assessed interventions aimed at encouraging awareness of fetal movement or fetal movement counting and/or improving the subsequent clinical management of reduced fetal movement. Eligible populations were singleton pregnancies after 24 completed weeks of gestation. The primary review outcome was stillbirth; a number of secondary maternal and neonatal outcomes were specified in the review.Methods: Risk of bias was assessed using the Cochrane Risk of Bias 2 and Risk of Bias in Non-Randomized Studies I tools for randomized controlled trials and nonrandomized studies, respectively. Variation caused by heterogeneity was assessed using I 2. Data from studies employing similar interventions were combined using random effects meta-analysis. Results: A total of 1609 citations were identified; 190 full-text articles were evaluated against the inclusion criteria, 18 studies (16 randomized controlled trials and 2 nonrandomized studies) were included. The evidence is uncertain about the effect of encouraging awareness of fetal movement on stillbirth when compared with standard care (2 studies, n=330,084) with a pooled adjusted odds ratio of 1.19 (95% confidence interval, 0.96-1.47). Interventions for encouraging awareness of fetal movement may be associated with a reduction in neonatal intensive care unit admissions and Apgar scores of Conclusion: The effect of interventions for encouraging awareness of reduced fetal movement alone or in combination with subsequent clinical management on stillbirth is uncertain. Encouraging awareness of fetal movement may be associated with reduced adverse neonatal outcomes without an increase in interventions in labor. The meta-analysis was hampered by variations in interventions, outcome reporting, and definitions. Individual studies are frequently underpowered to detect a reduction in severe, rare outcomes and no studies were included from high-burden settings. Studies from such settings are needed to determine whether interventions can reduce stillbirth.
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- 2023
16. Additional file 1 of Strengthening open disclosure after incidents in maternity care: a realist synthesis of international research evidence
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Adams, Mary, Hartley, Julie, Sanford, Natalie, Heazell, Alexander Edward, Iedema, Rick, Bevan, Charlotte, Booker, Maria, Treadwell, Maureen, and Sandall, Jane
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Additional file 1: Appendix 1. Two-stage search strategy for realist synthesis.
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- 2023
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17. Additional file 2 of Strengthening open disclosure after incidents in maternity care: a realist synthesis of international research evidence
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Adams, Mary, Hartley, Julie, Sanford, Natalie, Heazell, Alexander Edward, Iedema, Rick, Bevan, Charlotte, Booker, Maria, Treadwell, Maureen, and Sandall, Jane
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Additional file 2: Appendix 2. Document appraisal for realist synthesis.
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- 2023
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18. Additional file 1 of A qualitative exploration of influences on eating behaviour throughout pregnancy
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Rockliffe, Lauren, Smith, Debbie M., Heazell, Alexander E. P., and Peters, Sarah
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Supplementary Material 1
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- 2023
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19. Covid-19: Outcomes for Sleep, Maternity care, a GlObal pregnancy Study (COSMOS)
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Heazell, Alexander, Warland, Jane, O'Brien, Louise, Wimmer, Lindsey, and Libsack, Shauna
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Obstetrics and gynaecology - Abstract
This is the study protocol for an international, online survey to determine women's experiences of maternity care and practices during the COVID pandemic. It was developed from questions used for the STARS study (https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0602-4).
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- 2023
- Full Text
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20. Rainbow Clinic Learning and Sharing Event Abstract Booklet
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Heazell, Alexander, Bailey, Emilie, Barron, Rebecca, Smith, Debbie, Obst, Kate, Tamber, Kajal, Kemp, Bryn, Al-Khalaf, Sukainah, Stone, Joanne, House, Sophie, Gibson, Beth, Tomlinson, Lucy, and Javaid, Khalida
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Obstetrics and gynaecology ,Foetal development and medicine - Abstract
This document is the conference abstract booklet from the National Rainbow Clinic Learning and Sharing Event on 17th April 2023. It includes abstracts from the keynote speakers (Dr Kate Obst and Dr Debbie Smith) and the other presenters. This has been shared to allow the information to be more widely accessed and to allow relevant data to be shared.
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- 2023
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21. Stillbirths preceded by reduced fetal movements are more frequently associated with placental insufficiency
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Jan Jaap H. M. Erwich, Alexander E. P. Heazell, Madeleine Ter Kuile, and Reproductive Origins of Adult Health and Disease (ROAHD)
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medicine.medical_specialty ,placenta ,decreased fetal movement ,Decreased fetal movement ,Placental insufficiency ,CLASSIFICATION ,03 medical and health sciences ,absent fetal movement ,0302 clinical medicine ,Placenta ,Medicine ,Humans ,030212 general & internal medicine ,Fetal Movement ,Retrospective Studies ,Pregnancy ,Fetus ,030219 obstetrics & reproductive medicine ,Fetal Growth Retardation ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Retrospective cohort study ,Odds ratio ,Stillbirth ,medicine.disease ,Placental Insufficiency ,Confidence interval ,medicine.anatomical_structure ,PREGNANCY ,perinatal mortality ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
Objectives Maternal report of reduced fetal movements (RFM) is a means of identifying fetal compromise in pregnancy. In live births RFM is associated with altered placental structure and function. Here, we explored associations between RFM, pregnancy characteristics, and the presence of placental abnormalities and fetal growth restriction (FGR) in cases of stillbirth. Methods A retrospective cohort study was carried out in a single UK tertiary maternity unit. Cases were divided into three groups: 109 women reporting RFM, 33 women with absent fetal movements (AFM) and 159 who did not report RFM before the diagnosis of stillbirth. Univariate and multivariate logistic regression was used to determine associations between RFM/AFM, pregnancy characteristics, placental insufficiency and the classification of the stillbirth. Results AFM or RFM were reported prior to diagnosis of stillbirth in 142 (47.2%) of cases. Pregnancies with RFM prior to diagnosis of stillbirth were independently associated with placental insufficiency (Odds Ratio (OR) 2.79, 95% Confidence Interval (CI) 1.84, 5.04) and were less frequently associated with maternal proteinuria (OR 0.16, 95% CI 0.07, 0.62) and previous pregnancy loss Conclusions The association between RFM and placental insufficiency was confirmed in cases of stillbirth. This provides further evidence that RFM is a symptom of placental insufficiency. Therefore, investigation after RFM should aim to identify placental dysfunction.
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- 2022
22. Development of a core outcome set (COS) for studies relating to awareness and clinical management of reduced fetal movement: study protocol
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Dexter J. L. Hayes, Declan Devane, Jo C. Dumville, Valerie Smith, Tanya Walsh, and Alexander E. P. Heazell
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Medicine (General) ,Consensus ,Fetal Growth Retardation ,Delphi Technique ,Medicine (miscellaneous) ,Core outcome set ,Stillbirth ,Study Protocol ,Treatment Outcome ,R5-920 ,Research Design ,Pregnancy ,Outcome Assessment, Health Care ,Humans ,Female ,Pharmacology (medical) ,Fetal Movement ,Reduced fetal movement ,Systematic Reviews as Topic - Abstract
BackgroundConcerns regarding reduced fetal movements (RFM) are reported in 5–15% of pregnancies, and RFM are associated with adverse pregnancy outcomes including fetal growth restriction and stillbirth. Studies have aimed to improve pregnancy outcomes by evaluating interventions to raise awareness of RFM in pregnancy, such as kick counting, evaluating interventions for the clinical management of RFM, or both. However, there is not currently a core outcome set (COS) for studies of RFM. This study aims to create a COS for use in research studies that aim to raise awareness of RFM and/or evaluate interventions for the clinical management of RFM.MethodsA systematic review will be conducted, to identify outcomes used in randomised and non-randomised studies with control groups that aimed to raise awareness of RFM (for example by using mindfulness techniques, fetal movement counting, or other tools such as leaflets or mobile phone applications) and/or that evaluated the clinical management of RFM.An international Delphi consensus will then be used whereby stakeholders will rate the importance of the outcomes identified in the systematic review in (i) awareness and (ii) clinical management studies. The preliminary lists of outcomes will be discussed at a consensus meeting where one final COS for awareness and management, or two discrete COS (one for awareness and one for management), will be agreed upon.DiscussionA well-developed COS will provide researchers with the minimum set of outcomes that should be measured and reported in studies that aim to quantify the effects of interventions.
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- 2021
23. Current approach and attitudes toward neonatal near‐miss and perinatal audits: An exploratory international survey
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Poliana de Barros Medeiros, Helen Liley, Christine Andrews, Adrienne Gordon, Alexander E.P. Heazell, Alison L. Kent, Susannah H. Leisher, and Vicki Flenady
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Obstetrics and Gynecology ,General Medicine - Abstract
Combined with perinatal mortality review, neonatal near-miss (NNM) audit has the potential to inform strategies to better prevent adverse perinatal outcomes. Nonetheless, there is lack of standardised definitions of NNM and limited evidence of implementation of NNM audits.To describe definitions of NNM and assess current approaches and attitudes toward perinatal mortality and morbidity audit.Online survey from December 2021 to February 2022, with a mix of Likert scales, polar, pool, multi-choice, and open-ended questions, disseminated through national and international organisations to perinatal healthcare workers from high-income countries.One hundred and twenty participants came from Australia (n = 86), New Zealand (n = 18), Canada (n = 7), USA (n = 4), Netherlands (n = 2), other countries (n = 3). Neonatologists (35%), midwives (21.7%), obstetricians (12.5%), neonatal nurse practitioners (11.7%) and others (23.3%) responded. Most respondents thought the main characteristics to define NNM were birth asphyxia needing therapeutic hypothermia (68.3%), unexpected resuscitation at birth (67.5%), need for intubation/chest compression/adrenaline (65.0%) and metabolic acidosis at birth (60.0%). There were 97.5% of participants who considered NNM important for identifying cases for perinatal morbidity audits. However, only 10.0% of their institutions used a NNM definition. Overall, 98.4% of participants considered perinatal mortality and morbidity audits important to prevent adverse outcomes.Neonatal near-miss audit is viewed as a valuable tool to reduce adverse neonatal outcomes. There was reasonable consensus that NNM encompassed evidence of birth asphyxia and/or advanced neonatal resuscitation. Data from this international survey identifies a starting point for a consensus definition of NNM, which can be used for perinatal audits to identify opportunities for improvement.
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- 2022
24. The role of ethnicity in high level obstetric clinical incidents: a review of cases from a large UK NHS maternity unit
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Kimberley Farrant, David Faluyi, Kylie Watson, Sarah Vause, Heather Birds, Shirley Rowbotham, and Alexander EP Heazell
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Pregnancy ,Leadership and Management ,Health Policy ,Ethnicity ,Public Health, Environmental and Occupational Health ,Humans ,Female ,Minority Groups ,State Medicine ,United Kingdom ,Retrospective Studies - Abstract
IntroductionWomen from ethnic minority groups are at more risk of adverse outcomes in pregnancy compared with those from white British groups; suboptimal care may contribute to this increased risk. This study aimed to examine serious clinical incidents at two maternity units to explore causative factors for women from ethnic minorities and determine whether these differed from white women.MethodsA retrospective review was conducted of all serious incidents (n=36) occurring in a large National Health Service maternity provider (~14 000 births per annum) between 2018 and 2020. Data were collected from case records for variables which could mediate the association between ethnicity and adverse outcome. The incident reviews were blinded and reviewed by two independent investigators and data regarding root causes and contributory factors were extracted.ResultsFourteen of the 36 incidents (39%) occurred in women from minority ethnic groups, which is comparable to the maternity population. Women involved in serious clinical incidents frequently had pre-existing medical or obstetric complications. Booking after 12 weeks’ gestation occurred more frequently in women from minority ethnic groups than in the background population. There were differences in root causes of serious incidents between groups, a lack of situational awareness was the most frequent cause in white women and staff workload was most frequent in women from minority ethnic groups. Communication issues and detection of deterioration were similar between the two groups.DiscussionAlthough there was no difference in the proportion of serious incidents between the groups, there were differences in medical and pregnancy-related risk factors between groups and in the root causes identified. Efforts are needed to ensure equity of early access to antenatal care and to ensure that there is adequate staffing to ensure that women’s needs are met; this is particularly cogent when there are complex medical or social needs.
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- 2022
25. Stillbirth
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Margaret M. Murphy, Rakhi Dandona, Hannah Blencowe, Paula Quigley, Susannah Hopkins Leisher, Claire Storey, Dimitrios Siassakos, Alexander Heazell, and Vicki Flenady
- Abstract
Stillbirth, the death of a baby at or before the time of birth, affects at least 2 million families around the world each year. The global burden of stillbirth is borne unequally, with families in Sub-Saharan Africa, South East Asia, and South America most affected. Although similar to the numbers of newborn deaths, stillbirth is only recently being addressed as a global public health issue. Utilizing a systems-thinking approach to stillbirth is necessary to address the inherent complexities in reducing its burden. This chapter discusses addressing the complexities of stillbirth using the WHO Health Systems Framework and provides salient examples from global partners who are all working to reduce the ongoing deaths from stillbirth.
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- 2022
26. Fetal movements: A framework for antenatal conversations
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Billie F. Bradford, Robin S. Cronin, Jane Warland, Anna Akselsson, Ingela Rådestad, Alexander EP Heazell, Christopher J.D. McKinlay, Tomasina Stacey, John M.D. Thompson, Lesley M.E. McCowan, Bradford, Billie F, Cronin, Robin S, Warland, Jane, Akselsson, Anna, Rådestad, Ingela, Heazell, Alexander E P, McKinlay, Christopher J D, Stacey, Tomasina, Thompson, John M D, and McCowan, Lesley M E
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prenatal ,pregnancy outcome ,Maternity and Midwifery ,Obstetrics and Gynecology ,fetal movements ,pregnancy ,foetal ,antenatal - Abstract
usc Background: Presentations for decreased fetal movements comprise a significant proportion of acute antenatal assessments. Decreased fetal movements are associated with increased likelihood of adverse pregnancy outcomes including stillbirth. Consensus-based guidelines recommend pregnant women routinely receive information about fetal movements, but practice is inconsistent, and the information shared is frequently not evidence-based. There are also knowledge gaps about the assessment and management of fetal movement concerns. Women have indicated that they would like more accurate information about what to expect regarding fetal movements. Discussion: Historically, fetal movement information has focussed on movement counts. This is problematic, as the number of fetal movements perceived varies widely between pregnant women, and no set number of movements has been established as a reliable indicator of fetal wellbeing. Of late, maternity care providers have also advised women to observe their baby’s movement pattern, and promptly present if they notice a change. However, normal fetal movement patterns are rarely defined. Recently, a body of research has emerged relating to maternal perception of fetal movement features such as strength, presence of hiccups, and diurnal pattern as indicators of fetal wellbeing in addition to frequency. Conclusion: Sharing comprehensive and gestation-appropriate information about fetal movements may be more satisfying for women, empowering women to identify for themselves when their baby is doing well, and importantly when additional assessment is needed. We propose a conversational approach to fetal movement information sharing, focusing on fetal movement strength, frequency, circadian pattern, and changes with normal fetal development, tailored to the individual. Refereed/Peer-reviewed
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- 2022
27. Protocol for the development of a core outcome set for stillbirth care research (iCHOOSE Study)
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Bakhbakhi, Danya, Fraser, Abigail, Siasakos, Dimitris, Hinton, Lisa, Davies, Anna, Merriel, Abi, Duffy, James M N, Redshaw, Maggie, Lynch, Mary, Timlin, Laura, Flenady, Vicki, Heazell, Alexander Edward, Downe, Soo, Slade, Pauline, Brookes, Sara, Wojcieszek, Aleena, Murphy, Margaret, de Oliveira Salgado, Heloisa, Pollock, Danielle, Aggarwal, Neelam, Attachie, Irene, Leisher, Susannah, Kihusa, Wanijiru, Mulley, Kate, Wimmer, Lindsey, Burden, Christy, Thorne, Lisa, Hatton, Will, Keating, Carla Mereu, Coombs, Heather Jane, Coombs, Dave, Fischer, Michelle, Fischer, Ali, Morton, Fraser, Hepworth, Naomi, UK iCHOOSE parent involvement group, Bakhbakhi, Danya [0000-0003-1906-5069], Hinton, Lisa [0000-0002-6082-3151], Redshaw, Maggie [0000-0001-5506-3330], Heazell, Alexander Edward [0000-0002-4303-7845], Wojcieszek, Aleena [0000-0001-8099-6087], Apollo - University of Cambridge Repository, and group, UK iCHOOSE parent involvement
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Parents ,fetal medicine ,Consensus ,protocols & guidelines ,Delphi Technique ,Experiences ,education ,B720 ,quality in health care ,Pregnancy ,Surveys and Questionnaires ,Outcome Assessment, Health Care ,Think ,Obstetrics and gynaecology ,Humans ,Behavior ,maternal medicine ,obstetrics ,Subsequent ,General Medicine ,Stillbirth ,Death ,Research Design ,Medicine ,Female ,qualitative research ,Systematic Reviews as Topic - Abstract
INTRODUCTION: Stillbirth is associated with significant physical, psychosocial and economic consequences for parents, families, wider society and the healthcare system. There is emerging momentum to design and evaluate interventions for care after stillbirth and in subsequent pregnancies. However, there is insufficient evidence to inform clinical practice compounded by inconsistent outcome reporting in research studies. To address this paucity of evidence, we plan to develop a core outcome set for stillbirth care research, through an international consensus process with key stakeholders including parents, healthcare professionals and researchers. METHODS AND ANALYSIS: The development of this core outcome set will be divided into five distinct phases: (1) Identifying potential outcomes from a mixed-methods systematic review and analysis of interviews with parents who have experienced stillbirth; (2) Creating a comprehensive outcome long-list and piloting of a Delphi questionnaire using think-aloud interviews; (3) Choosing the most important outcomes by conducting an international two-round Delphi survey including high-income, middle-income and low-income countries; (4) Deciding the core outcome set by consensus meetings with key stakeholders and (5) Dissemination and promotion of the core outcome set. A parent and public involvement panel and international steering committee has been convened to coproduce every stage of the development of this core outcome set. ETHICS AND DISSEMINATION: Ethical approval for the qualitative interviews has been approved by Berkshire Ethics Committee REC Reference 12/SC/0495. Ethical approval for the think-aloud interviews, Delphi survey and consensus meetings has been awarded from the University of Bristol Faculty of Health Sciences Research Ethics Committee (Reference number: 116535). The dissemination strategy is being developed with the parent and public involvement panel and steering committee. Results will be published in peer-reviewed specialty journals, shared at national and international conferences and promoted through parent organisations and charities. PROSPERO REGISTRATION NUMBER: CRD42018087748., National Institute of Health Research
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- 2022
28. External validation of prognostic models to predict stillbirth using International Prediction of Pregnancy Complications (IPPIC) Network database: individual participant data meta-analysis
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Allotey, J., Whittle, R., Snell, K. I. E., Smuk, M., Townsend, R., von Dadelszen, P., Heazell, A. E. P., Magee, L., Smith, G. C. S., Sandall, J., Thilaganathan, B., Zamora, J., Riley, R. D., Khalil, A., Thangaratinam, S., Coomarasamy, A., Kwong, A., Savitri, A. I., Salvesen, K. A., Bhattacharya, S., Uiterwaal, C. S. P. M., Staff, A. C., Andersen, L. B., Olive, E. L., Redman, C., Sletner, L., Daskalakis, G., Macleod, M., Abdollahain, M., Ramirez, J. A., Masse, J., Audibert, F., Magnus, P. M., Jenum, A. K., Baschat, A., Ohkuchi, A., Mcauliffe, F. M., West, J., Askie, L. M., Mone, F., Farrar, D., Zimmerman, P. A., Smits, L. J. M., Riddell, C., Kingdom, J. C., van de Post, J., Illanes, S. E., Holzman, C., van Kuijk, S. M. J., Carbillon, L., Villa, P. M., Eskild, A., Chappell, L., Prefumo, F., Velauthar, L., Seed, P., van Oostwaard, M., Verlohren, S., Poston, L., Ferrazzi, E., Vinter, C. A., Nagata, C., Brown, M., Vollebregt, K. C., Takeda, S., Langenveld, J., Widmer, M., Saito, S., Haavaldsen, C., Carroli, G., Olsen, J., Wolf, H., Zavaleta, N., Eisensee, I., Vergani, P., Lumbiganon, P., Makrides, M., Facchinetti, F., Sequeira, E., Gibson, R., Ferrazzani, S., Frusca, T., Norman, J. E., Figueiro, E. A., Lapaire, O., Laivuori, H., Lykke, J. A., Conde-Agudelo, A., Galindo, A., Mbah, A., Betran, A. P., Herraiz, I., Trogstad, L., Smith, G. G. S., Steegers, E. A. P., Salim, R., Huang, T., Adank, A., Zhang, J., Meschino, W. S., Browne, J. L., Allen, R. E., Costa, F. D. S., Klipstein-Grobusch Browne, K., Crowther, C. A., Jorgensen, J. S., Forest, J. -C., Rumbold, A. R., Mol, B. W., Giguere, Y., Kenny, L. C., Ganzevoort, W., Odibo, A. O., Myers, J., Yeo, S. A., Goffinet, F., Mccowan, L., Pajkrt, E., Teede, H. J., Haddad, B. G., Dekker, G., Kleinrouweler, E. C., Lecarpentier, E., Roberts, C. T., Groen, H., Skrastad, R. B., Heinonen, S., Eero, K., Anggraini, D., Souka, A., Cecatti, J. G., Monterio, I., Pillalis, A., Souza, R., Hawkins, L. A., Gabbay-Benziv, R., Crovetto, F., Figuera, F., Jorgensen, L., Dodds, J., Patel, M., Aviram, A., Papageorghiou, A., Khan, K., Clinicum, HUS Gynecology and Obstetrics, Department of Obstetrics and Gynecology, HUS Children and Adolescents, Lastentautien yksikkö, Children's Hospital, Allotey, J, Whittle, R, Snell, K, Smuk, M, Townsend, R, von Dadelszen, P, Heazell, A, Magee, L, Smith, G, Sandall, J, Thilaganathan, B, Zamora, J, Riley, R, Khalil, A, Thangaratinam, S, Coomarasamy, A, Kwong, A, Savitri, A, Salvesen, K, Bhattacharya, S, Uiterwaal, C, Staff, A, Andersen, L, Olive, E, Redman, C, Sletner, L, Daskalakis, G, Macleod, M, Abdollahain, M, Ramirez, J, Masse, J, Audibert, F, Magnus, P, Jenum, A, Baschat, A, Ohkuchi, A, Mcauliffe, F, West, J, Askie, L, Mone, F, Farrar, D, Zimmerman, P, Smits, L, Riddell, C, Kingdom, J, van de Post, J, Illanes, S, Holzman, C, van Kuijk, S, Carbillon, L, Villa, P, Eskild, A, Chappell, L, Prefumo, F, Velauthar, L, Seed, P, van Oostwaard, M, Verlohren, S, Poston, L, Ferrazzi, E, Vinter, C, Nagata, C, Brown, M, Vollebregt, K, Takeda, S, Langenveld, J, Widmer, M, Saito, S, Haavaldsen, C, Carroli, G, Olsen, J, Wolf, H, Zavaleta, N, Eisensee, I, Vergani, P, Lumbiganon, P, Makrides, M, Facchinetti, F, Sequeira, E, Gibson, R, Ferrazzani, S, Frusca, T, Norman, J, Figueiro, E, Lapaire, O, Laivuori, H, Lykke, J, Conde-Agudelo, A, Galindo, A, Mbah, A, Betran, A, Herraiz, I, Trogstad, L, Steegers, E, Salim, R, Huang, T, Adank, A, Zhang, J, Meschino, W, Browne, J, Allen, R, Costa, F, Klipstein-Grobusch Browne, K, Crowther, C, Jorgensen, J, Forest, J, Rumbold, A, Mol, B, Giguere, Y, Kenny, L, Ganzevoort, W, Odibo, A, Myers, J, Yeo, S, Goffinet, F, Mccowan, L, Pajkrt, E, Teede, H, Haddad, B, Dekker, G, Kleinrouweler, E, Lecarpentier, E, Roberts, C, Groen, H, Skrastad, R, Heinonen, S, Eero, K, Anggraini, D, Souka, A, Cecatti, J, Monterio, I, Pillalis, A, Souza, R, Hawkins, L, Gabbay-Benziv, R, Crovetto, F, Figuera, F, Jorgensen, L, Dodds, J, Patel, M, Aviram, A, Papageorghiou, A, Khan, K, Tampere University, Obstetrics and Gynaecology, APH - Quality of Care, Amsterdam Reproduction & Development (AR&D), APH - Personalized Medicine, APH - Digital Health, and Obstetrics and gynaecology
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Calibration (statistics) ,Perinatal Death ,Overfitting ,Cohort Studies ,Fetal Development ,0302 clinical medicine ,Discriminative model ,3123 Gynaecology and paediatrics ,Models ,Pregnancy ,GROWTH RESTRICTION ,Statistics ,Medicine ,Prenatal ,030212 general & internal medicine ,Ultrasonography ,RISK ,030219 obstetrics & reproductive medicine ,PRETERM ,Radiological and Ultrasound Technology ,LOW-DOSE ASPIRIN ,DIAGNOSIS TRIPOD ,Obstetrics and Gynecology ,General Medicine ,Statistical ,Stillbirth ,Prognosis ,Pregnancy Complication ,external validation ,individual participant data ,intrauterine death ,prediction model ,stillbirth ,Female ,Humans ,Infant, Newborn ,Models, Statistical ,Pregnancy Complications ,Regression Analysis ,Risk Assessment ,Ultrasonography, Prenatal ,3. Good health ,PREECLAMPSIA ,Meta-analysis ,Human ,Cohort study ,Prognosi ,MEDLINE ,Regression Analysi ,WEEKS GESTATION ,03 medical and health sciences ,VELOCIMETRY ,Radiology, Nuclear Medicine and imaging ,RECURRENCE ,business.industry ,Infant ,Newborn ,R1 ,HYPERTENSIVE DISORDERS ,Reproductive Medicine ,Sample size determination ,Cohort Studie ,RG ,business ,RA ,Predictive modelling - Abstract
Objective Stillbirth is a potentially preventable complication of pregnancy. Identifying women at high risk of stillbirth can guide decisions on the need for closer surveillance and timing of delivery in order to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none has yet been validated externally. In this study, we externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. Methods MEDLINE, EMBASE, DH-DATA and AMED databases were searched from inception to December 2020 to identify studies reporting stillbirth prediction models. Studies that developed or updated prediction models for stillbirth for use at any time during pregnancy were included. IPD from cohorts within the International Prediction of Pregnancy Complications (IPPIC) Network were used to validate externally the identified prediction models whose individual variables were available in the IPD. The risk of bias of the models and cohorts was assessed using the Prediction study Risk Of Bias ASsessment Tool (PROBAST). The discriminative performance of the models was evaluated using the C-statistic, and calibration was assessed using calibration plots, calibration slope and calibration-in-the-large. Performance measures were estimated separately in each cohort, as well as summarized across cohorts using random-effects meta-analysis. Clinical utility was assessed using net benefit. Results Seventeen studies reporting the development of 40 prognostic models for stillbirth were identified. None of the models had been previously validated externally, and the full model equation was reported for only one-fifth (20%, 8/40) of the models. External validation was possible for three of these models, using IPD from 19 cohorts (491 201 pregnant women) within the IPPIC Network database. Based on evaluation of the model development studies, all three models had an overall high risk of bias, according to PROBAST. In the IPD meta-analysis, the models had summary C-statistics ranging from 0.53 to 0.65 and summary calibration slopes ranging from 0.40 to 0.88, with risk predictions that were generally too extreme compared with the observed risks. The models had little to no clinical utility, as assessed by net benefit. However, there remained uncertainty in the performance of some models due to small available sample sizes. Conclusions The three validated stillbirth prediction models showed generally poor and uncertain predictive performance in new data, with limited evidence to support their clinical application. The findings suggest methodological shortcomings in their development, including overfitting. Further research is needed to further validate these and other models, identify stronger prognostic factors and develop more robust prediction models. (c) 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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- 2022
29. Determinants of eclampsia in women with severe preeclampsia at Mpilo Central Hospital, Bulawayo, Zimbabwe
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Alexander E. P. Heazell, Solwayo Ngwenya, Brian Jones, Hausitoe Nare, and Desmond Mwembe
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Adult ,Zimbabwe ,medicine.medical_specialty ,Adolescent ,Referral ,Logistic regression ,Severity of Illness Index ,Preeclampsia ,Young Adult ,Pre-Eclampsia ,Pregnancy ,Risk Factors ,Prenatal Diagnosis ,Internal Medicine ,medicine ,Humans ,reproductive and urinary physiology ,Eclampsia ,Obstetrics ,business.industry ,Pregnancy Outcome ,Obstetrics and Gynecology ,Odds ratio ,medicine.disease ,female genital diseases and pregnancy complications ,Confidence interval ,Blood pressure ,Female ,Complication ,business - Abstract
OBJECTIVE Globally, preeclampsia is a significant contributor to adverse maternal outcomes. Once women develop eclampsia, they face considerable risks especially in countries with limited resources to deal with such a life-threatening complication. This study was carried out to investigate determinants of eclampsia in pregnant mothers with severe preeclampsia. STUDY DESIGN This institutional based study was completed at Mpilo Central Hospital, a quaternary referral unit from 1st January 2016 - 31st December 2018. In this study, pregnant women with severe preeclampsia/eclampsia were the study participants. The independent variables included socio-demographic and clinical characteristics, and maternal outcomes. Multivariable logistic regression analyses were used to determine independent association with p
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- 2021
30. Assessing safe and personalised maternity and neonatal care through a pandemic: a case study of outcomes and experiences in two Trusts in England using the ASPIRE COVID-19 framework
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Neal, Sarah, Stone, Lucy, Moncrieff, Gill, Matthews, Zoë, Kingdon, Carol, Topalidou, Anastasia, Balaam, Marie-Clare, Cordey, Sarah, Crossland, Nicola, Feeley, Claire, Powney, Deborah, Sarian, Arni, Fenton, Alan, Heazell, Alexander E. P., de Jonge, Ank, Severns, Alexandra, Thomson, Gill, and Downe, Soo
- Abstract
Background: The COVID-19 pandemic has resulted in profound and far-reaching impacts on maternal and newborn care and outcomes. As part of the ASPIRE COVID-19 project, we describe processes and outcome measures relating to safe and personalised maternity care in England which we map against a pre-developed ASPIRE framework to establish the potential impact of the COVID-19 pandemic for two UK trusts. Methods: We undertook a mixed-methods system-wide case study using quantitative routinely collected data and qualitative data from two Trusts and their service users from 2019 to 2021 (start and completion dates varied by available data). We mapped findings to our prior ASPIRE conceptual framework that explains pathways for the impact of COVID-19 on safe and personalised care. Results: The ASPIRE framework enabled us to develop a comprehensive, systems-level understanding of the impact of the pandemic on service delivery, user experience and staff wellbeing, and place it within the context of pre-existing challenges. Maternity services experienced some impacts on core service coverage, though not on Trust level clinical health outcomes (with the possible exception of readmissions in one Trust). Both users and staff found some pandemic-driven changes challenging such as remote or reduced antenatal and community postnatal contacts, and restrictions on companionship. Other key changes included an increased need for mental health support, changes in the availability and uptake of home birth services and changes in induction procedures. Many emergency adaptations persisted at the end of data collection. Differences between the trusts indicate complex change pathways. Staff reported some removal of bureaucracy, which allowed greater flexibility. During the first wave of COVID-19 staffing numbers increased, resolving some pre-pandemic shortages: however, by October 2021 they declined markedly. Trying to maintain the quality and availability of services had marked negative consequences for personnel. Timely routine clinical and staffing data were not always available and personalised care and user and staff experiences were poorly captured. Conclusions: The COVID-19 crisis magnified pre-pandemic problems and in particular, poor staffing levels. Maintaining services took a significant toll on staff wellbeing. There is some evidence that these pressures are continuing. There was marked variation in Trust responses. Lack of accessible and timely data at Trust and national levels hampered rapid insights. The ASPIRE COVID-19 framework could be useful for modelling the impact of future crises on routine care.
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- 2022
31. Better maternity care pathways in pregnancies after stillbirth or neonatal death: a feasibility study
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Tracey A. Mills, Stephen A. Roberts, Elizabeth Camacho, Alexander E. P. Heazell, Rachael N. Massey, Cathie Melvin, Rachel Newport, Debbie M. Smith, Claire O. Storey, Wendy Taylor, and Tina Lavender
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Perinatal Death ,Infant, Newborn ,wa_900 ,Obstetrics and Gynecology ,Prenatal Care ,Stillbirth ,Midwifery ,wa_310 ,State Medicine ,Cohort Studies ,ws_420 ,Pregnancy ,wq_500 ,Critical Pathways ,Feasibility Studies ,Humans ,wq_330 ,Female ,Maternal Health Services ,Perinatal Death/prevention & control ,Prospective Studies ,Midwifery/methods ,Prenatal Care/methods ,Stillbirth/psychology - Abstract
Background Around 1 in 150 babies are stillborn or die in the first month of life in the UK. Most women conceive again, and subsequent pregnancies are often characterised by feelings of stress and anxiety, persisting beyond the birth. Psychological distress increases the risk of poor pregnancy outcomes and longer-term parenting difficulties. Appropriate emotional support in subsequent pregnancies is key to ensure the wellbeing of women and families. Substantial variability in existing care has been reported, including fragmentation and poor communication. A new care package improving midwifery continuity and access to emotional support during subsequent pregnancy could improve outcomes. However, no study has assessed the feasibility of a full-scale trial to test effectiveness in improving outcomes and cost-effectiveness for the National Health Service (NHS). Methods A prospective, mixed-methods pre-and post-cohort study, in two Northwest England Maternity Units. Thirty-eight women, (≤ 20 weeks’ gestation, with a previous stillbirth, or neonatal death) were offered the study intervention (allocation of a named midwife care coordinator and access to group and online support). Sixteen women receiving usual care were recruited in the 6 months preceding implementation of the intervention. Outcome data were collected at 2 antenatal and 1 postnatal visit(s). Qualitative interviews captured experiences of care and research processes with women (n = 20), partners (n = 5), and midwives (n = 8). Results Overall recruitment was 90% of target, and 77% of women completed the study. A diverse sample reflected the local population, but non-English speaking was a barrier to participation. Study processes and data collection methods were acceptable. Those who received increased midwifery continuity valued the relationship with the care coordinator and perceived positive impacts on pregnancy experiences. However, the anticipated increase in antenatal continuity for direct midwife contacts was not observed for the intervention group. Take-up of in-person support groups was also limited. Conclusions Women and partners welcomed the opportunity to participate in research. Continuity of midwifery care was supported as a beneficial strategy to improve care and support in pregnancy after the death of a baby by both parents and professionals. Important barriers to implementation included changes in leadership, service pressures and competing priorities. Trial registration ISRCTN17447733 first registration 13/02/2018.
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- 2022
32. Women’s experiences of a pregnancy whilst attending a specialist antenatal service for pregnancies after stillbirth or neonatal death: a qualitative interview study
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Debbie M. Smith, Suzanne Thomas, Louise Stephens, Tracey A. Mills, Christine Hughes, Joanna Beaumont, and Alexander E. P. Heazell
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Perinatal Death ,Infant, Newborn ,Obstetrics and Gynecology ,Prenatal Care ,Stillbirth ,wa_310 ,bf023de6 ,Psychiatry and Mental health ,Clinical Psychology ,Reproductive Medicine ,Pregnancy ,wq_500 ,Humans ,wq_330 ,Female ,Pregnant Women ,Qualitative Research ,wq_175 - Abstract
Aim: Pregnancy after the death of a baby is associated with numerous, varied psychological challenges for pregnant women. This study aimed to explore women’s experiences of pregnancy whilst attending a specialist antenatal service for pregnancies after a perinatal death.\ud \ud Methods: Semi-structured interviews with twenty women in a subsequent pregnancy after a perinatal death were conducted and analyzed taking an inductive thematic analysis approach.\ud \ud Results: All women expressed a heightened “awareness of risk”. Two subthemes demonstrated how increased awareness of risk affected their experience and their desire regarding antenatal and postnatal support. Women talked about stillbirth being a “quiet, unspoken subject” causing them internal conflict as they had an awareness of pregnancy complications that other people did not. Navigating subsequent pregnancies relied on them “expecting the worst and hoping for the best” in terms of pregnancy outcomes. Women viewed specialist antenatal care in pregnancy after perinatal loss favorably, as it enabled them to receive tailored care that met their needs stemming from their increased awareness of and personal expectations of risk.\ud \ud Conclusion: Women’s experiences can be used to develop models of care but further studies are required to determine to identify which components are most valued.
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- 2022
33. Factors influencing health behaviour change during pregnancy: a systematic review and meta-synthesis
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Alexander E. P. Heazell, Debbie M Smith, Lauren Rockliffe, and Sarah Peters
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Alcohol Drinking ,media_common.quotation_subject ,Health Behavior ,MEDLINE ,Qualitative property ,PsycINFO ,Developmental psychology ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Perception ,medicine ,Humans ,030212 general & internal medicine ,Exercise ,Life Style ,media_common ,Meta synthesis ,030505 public health ,Study quality ,Smoking ,Health behaviour ,medicine.disease ,Psychiatry and Mental health ,Clinical Psychology ,Female ,0305 other medical science ,Psychology - Abstract
Pregnancy is an opportune time for women to make healthy changes to their lifestyle, however, many women struggle to do so. Multiple reasons have been posited as to why this may be. This review aimed to synthesise this literature by identifying factors that influence women's health behaviour during pregnancy, specifically in relation to dietary behaviour, physical activity, smoking, and alcohol use. Bibliographic databases (MEDLINE, PsycINFO, CINAHL-P, MIDIRS) were systematically searched to retrieve studies reporting qualitative data regarding women's experiences or perceptions of pregnancy-related behaviour change relating to the four key behaviours. Based on the eligibility criteria, 30,852 records were identified and 92 studies were included. Study quality was assessed using the CASP tool and data were thematically synthesised. Three overarching themes were generated from the data. These were (1) A time to think about 'me', (2) Adopting the 'good mother' role, and (3) Beyond mother and baby. These findings provide an improved understanding of the various internal and external factors influencing women's health behaviour during the antenatal period. This knowledge provides the foundations from which future pregnancy-specific theories of behaviour change can be developed and highlights the importance of taking a holistic approach to maternal behaviour change in clinical practice.
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- 2021
34. Worth the Paper it’s Written on? A Cross-sectional Study of Medical Certificate of Stillbirth Accuracy in the United Kingdom
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Michael P, Rimmer, Ian, Henderson, William, Parry-Smith, Olivia, Raglan, Jennifer, Tamblyn, Alexander E P, Heazell, Lucy E, Higgins, and C L M, Wyeth
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Epidemiology ,General Medicine - Abstract
Background The Medical Certificate of Stillbirth (MCS) records data about a baby’s death after 24 weeks of gestation but before birth. Major errors that could alter interpretation of the MCS were widespread in two UK-based regional studies. Methods A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. A systematic case-note review of stillbirths was conducted by Obstetric and Gynaecology trainees, generating individual ‘ideal MCSs’ and comparing these to the actual MCS issued. Anonymized central data analysis described rates and types of error, agreement and factors associated with major errors. Results There were 1120 MCSs suitable for assessment, with 126 additional submitted data sets unsuitable for accuracy analysis (total 1246 cases). Gestational age demonstrated ‘substantial’ agreement [K = 0.73 (95% CI 0.70–0.76)]. Primary cause of death (COD) showed ‘fair’ agreement [K = 0.26 (95% CI 0.24–0.29)]. Major errors [696/1120; 62.1% (95% CI 59.3–64.9%)] included certificates issued for fetal demise at Conclusion This study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case-note review, with particular attention on the fetal growth trajectory.
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- 2022
35. Interventions, outcomes and outcome measurement instruments in stillbirth care research: A systematic review to inform the development of a core outcome set
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Danya Bakhbakhi, Dimitrios Siassakos, Anna Davies, Abi Merriel, Katie Barnard, Emma Stead, Clare Shakespeare, James Duffy, Lisa Hinton, Karolina McDowell, Anna Lyons, Margaret Redshaw, Vicki Flenady, Alexander Heazell, Laura Timlin, Mary Lynch, Soo Downe, Pauline Slade, Lisa Thorne, Heatherjane Coombs, Aleena Wojcieszek, Margaret Murphy, Heloisa Salgado, Lindsey Wimmer, Danielle Pollock, Neelam Aggarwal, Susannah Leisher, Kate Mulley, Irene Attachie, Bethany Atkins, Christy Burden, and Abigail Fraser
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Stillbirth care research ,Stillbirth - Abstract
Background A core outcome set could address inconsistent outcome reporting and improve evidence for stillbirth care research, which has been identified as an important research priority. Objectives To identify outcomes and outcome measurement instruments reported by studies evaluating interventions after the diagnosis of a stillbirth. Search strategy Amed, BNI, CINAHL, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO, and WHO ICTRP from 1998 to August 2021. Selection criteria Randomised and non-randomised comparative or non-comparative studies reporting a stillbirth care intervention. Data collection and analysis Interventions, outcomes reported, definitions and outcome measurement tools were extracted. Main results 40 randomised and 200 non-randomised studies were included. 58 different interventions were reported, labour and birth care (52 studies), hospital bereavement care (28 studies), clinical investigations (116 studies), care in a multiple pregnancy (2 studies), psychosocial support (28 studies) and care in a subsequent pregnancy (14 studies). 391 unique outcomes were reported and organised into 14 outcome domains: labour and birth; postpartum; delivery of care; investigations; multiple pregnancy; mental health; emotional functioning; grief and bereavement; social functioning; relationship; whole person; subsequent pregnancy; subsequent children and siblings and economic. 242 outcome measurement instruments were used, with 0-22 tools per outcome. Conclusions Heterogeneity in outcome reporting, outcome definition and measurement tools in care after stillbirth exists. Considerable research gaps on specific intervention types in stillbirth care were identified. A core outcome set is needed to standardise outcome collection and reporting for stillbirth care research.
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- 2022
36. Responding to the Ockenden Review: Safe care for all needs evidence-based system change - and strengthened midwifery
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Mary J Renfrew, Helen Cheyne, Alicia Burnett, Kenda Crozier, Soo Downe, Alexander Heazell, Vanora Hundley, Billie Hunter, Kay King, Jayne E Marshall, Christine McCourt, Alison McFadden, Kade Mondeh, Pippa Nightingale, Jane Sandall, Marlene Sinclair, Susan Way, Lesley Page, and Jenny Gamble
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Pregnancy ,1110 Nursing, 1114 Paediatrics and Reproductive Medicine, 1117 Public Health and Health Services ,Maternity and Midwifery ,Humans ,Obstetrics and Gynecology ,Female ,Nursing ,Midwifery - Abstract
First paragraph: The Final Report of the Ockenden Review examined the care of 1486 families who experienced adverse outcomes in one hospital Trust in England, the majority of whom received care between 2000 and 2020 (Ockenden 2022). It describes the damaging outcomes and experiences caused by poor care for women and babies in pregnancy, labour and birth. Multiple individual actions recommended by the report are resulting in immediate and extensive changes across the maternity services in England. The report findings are relevant across the whole UK, and to international efforts to improve safety and quality in maternal and newborn care systems.
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- 2022
37. Cardiac ion channels associated with unexplained stillbirth - an immunohistochemical study
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Susana Quesado Branco, Gauri Batra, Gemma Petts, Ainslie Hancock, Alan Kerby, Chloe Anne Brady, and Alexander E.P. Heazell
- Subjects
Pregnancy ,Case-Control Studies ,Pediatrics, Perinatology and Child Health ,KCNQ1 Potassium Channel ,Obstetrics and Gynecology ,Eosine Yellowish-(YS) ,Humans ,Infant ,Channelopathies ,Female ,Stillbirth ,Hypoxia - Abstract
Objectives Despite the use of post-mortem investigations, approximately 20% of stillbirths remain unexplained. Cardiac ion channelopathies have been identified as a cause of death in Sudden Infant Death Syndrome (SIDS) and could be associated with unexplained stillbirths. This study aimed to understand if the expression or localisation of cardiac ion channels associated with channelopathies were altered in cases of unexplained stillbirths. Methods A case control study was conducted using formalin-fixed cardiac tissue from 20 cases of unexplained stillbirth and a control group of 20 cases of stillbirths from intrapartum hypoxia. 4 µm tissue sections were stained using haematoxylin and eosin, Masson’s trichrome (MT) and Elastic van Gieson (EVG). Immunohistochemistry (IHC) was performed using antibodies against CACNA1G, KCNJ2, KCNQ1, KCNH2 and KCNE1. The cardiac conduction system in samples stained with MT and EVG could not be identified. Therefore, the levels of immunoperoxidase staining were quantified using QuPath software. Results The nuclear-cytoplasmic ratio of sections stained with haematoxylin and eosin was higher for the hypoxia group (hypoxia median 0.13 vs. 0.04 unexplained, p Conclusions Two ion channels associated with channelopathies demonstrated lower levels of expression in cases of unexplained stillbirth. Further genetic studies using human tissue should be performed to understand the association between channelopathies and otherwise unexplained stillbirths.
- Published
- 2022
38. Parents’ experiences of care offered after stillbirth: An international online survey of high and middle‐income countries
- Author
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Margaret M. Murphy, Jan Jaap H. M. Erwich, Alexander E. P. Heazell, Alfredo Vannacci, Claudia Ravaldi, Katherine J. Gold, Mechthild M. Gross, Frances M. Boyle, Claire Storey, Susannah Hopkins Leisher, Aleena M. Wojcieszek, Vicki Flenady, Dell Horey, Paul Cassidy, Jillian Cassidy, and Dimitrios Siassakos
- Subjects
Parents ,030219 obstetrics & reproductive medicine ,Perinatal bereavement ,business.industry ,Middle income countries ,Obstetrics and Gynecology ,Odds ratio ,Stillbirth ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Surveys and Questionnaires ,Humans ,Social consequence ,Medicine ,Female ,030212 general & internal medicine ,Bereavement Care ,business ,Developing Countries ,High income countries ,Bereavement ,Demography - Abstract
Background Stillbirth, the death of a baby before birth, is associated with significant psychological and social consequences that can be mitigated by respectful and supportive bereavement care. The absence of high-level evidence to support the broad scope of perinatal bereavement practices means that offering a range of options identified as valued by parents has become an important indicator of care quality. This study aimed to describe bereavement care practices offered to parents across different high-income and middle-income countries. Methods An online survey of parents of stillborn babies was conducted between December 2014 and February 2015. Frequencies of nine practices were compared between high-income and middle-income countries. Differences in proportions of reported practices and their associated odds ratios were calculated to compare high-income and middle-income countries. Results Over three thousand parents (3041) with a self-reported stillbirth in the preceding five years from 40 countries responded. Fifteen countries had atleast 40 responses. Significant differences in the prevalence of offering nine bereavement care practices were reported by women in high-income countries (HICs) compared with women in middle-income countries (MICs). All nine practices were reported to occur significantly more frequently by women in HICs, including opportunity to see and hold their baby (OR = 4.8, 95% CI 4.0-5.9). The widespread occurrence of all nine practices was reported only for The Netherlands. Conclusions Bereavement care after stillbirth varies between countries. Future research should look at why these differences occur, their impact on parents, and whether differences should be addressed, particularly how to support effective communication, decision-making, and follow-up care.
- Published
- 2021
39. The potential role of the E SRRG pathway in placental dysfunction
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Lynda K. Harris, Alexander E. P. Heazell, Karen Forbes, and Zhiyong Zou
- Subjects
0301 basic medicine ,Embryology ,Placenta Diseases ,medicine.drug_class ,Placenta ,Biology ,Preeclampsia ,Andrology ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Pregnancy ,microRNA ,medicine ,Humans ,reproductive and urinary physiology ,Fetal Growth Retardation ,030219 obstetrics & reproductive medicine ,Obstetrics and Gynecology ,Placentation ,Trophoblast ,Cell Biology ,Fetal Growth Retardation/etiology ,Hypoxia (medical) ,medicine.disease ,female genital diseases and pregnancy complications ,Trophoblasts ,030104 developmental biology ,medicine.anatomical_structure ,Reproductive Medicine ,Estrogen ,embryonic structures ,Female ,medicine.symptom ,Function (biology) - Abstract
Normal placental development and function is of key importance to fetal growth. Conversely aberrations of placental structure and function are evident in pregnancy complications including fetal growth restriction (FGR) and preeclampsia. Although trophoblast turnover and function is altered in these conditions, their underlying aetiologies and pathophysiology remains unclear, which hampers development of therapeutic interventions. Here we review evidence that supports a role for estrogen related receptor-gamma (ESRRG) in the development of placental dysfunction in FGR and preeclampsia. This relationship deserves particular consideration because ESRRG is highly expressed in normal placenta, is reduced in FGR and preeclampsia and its expression is altered by hypoxia, which is thought to result from deficient placentation seen in FGR and preeclampsia. Several studies have also found microRNA (miRNA) or other potential upstream regulators of ESRRG negatively influence trophoblast function which could contribute to placental dysfunction seen in FGR and preeclampsia. Interestingly, miRNAs regulate ESRRG expression in human trophoblast. Thus, if ESRRG is pivotally associated with the abnormal trophoblast turnover and function it may be targeted by microRNAs or other possible upstream regulators in the placenta. This review explores altered expression of ESRRG and upstream regulation of ESRRG-mediated pathways resulting in the trophoblast turnover, placental vascularisation, and placental metabolism underlying placental dysfunctions. This demonstrates that the ESRRG pathway merits further investigation as a potential therapeutic target in FGR and preeclampsia.
- Published
- 2021
40. Development and validation of risk prediction models for adverse maternal and neonatal outcomes in severe preeclampsia in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe
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Brian Jones, Solwayo Ngwenya, Hausitoe Nare, Desmond Mwembe, and Alexander E. P. Heazell
- Subjects
Adult ,Zimbabwe ,medicine.medical_specialty ,Abdominal pain ,Birth weight ,Gestational Age ,Logistic regression ,Risk Assessment ,Sensitivity and Specificity ,Pre-Eclampsia ,Pregnancy ,Internal Medicine ,medicine ,Humans ,Vaginal bleeding ,Poverty ,Retrospective Studies ,Obstetrics ,business.industry ,Pregnancy Outcome ,Obstetrics and Gynecology ,Gestational age ,medicine.disease ,Cross-Sectional Studies ,Logistic Models ,ROC Curve ,Cohort ,Population study ,Female ,medicine.symptom ,business - Abstract
Hypertensive disorders of pregnancy are major causes of global maternal and neonatal morbidity and mortality. This study aimed to develop and validate models to predict composite adverse maternal and neonatal outcome in severe preeclampsia in low-resource settings.A retrospective cross-sectional study of women with severe preeclampsia giving birth in a tertiary referral centre in Zimbabwe between 01/01/2014-31/12/2018. Candidate variables identified from univariable logistic regression (p 0.2) were entered into stepwise backward elimination logistic regression models to predict composite adverse maternal and neonatal outcomes. Models' performance was assessed by the area under the curve of the receiver operator characteristic (AUC ROC). The models were validated internally using bootstrap-based methods and externally using the Preeclampsia Integrated Estimate of RiSk dataset.The co-primary outcomes were composite adverse maternal outcome and composite adverse neonatal outcome.549 women had severe preeclampsia from whom 567 neonates were born. The predictive model for composite adverse maternal outcome included maternal age, gestational age on admission, epigastric pain, vaginal bleeding with abdominal pain, haemoglobin concentration and platelets; the AUC ROC was 0.796 (95% CI 0.758-0.833). External validation showed poor discrimination (AUC ROC 0.494, 95% CI 0.458-0.552). The model for composite adverse neonatal outcome included: gestational age, platelets, alanine transaminase and birth weight; the AUC ROC was 0.902 (95% CI 0.876-0.927).While the models accurately predicted composite adverse maternal and neonatal outcomes in the study population, they did not in another cohort. Understanding factors which affect model performance will help optimize prediction of adverse outcomes in severe preeclampsia.
- Published
- 2021
41. Universal third-trimester ultrasonic screening using fetal macrosomia in the prediction of adverse perinatal outcome: a systematic review and meta-analysis of diagnostic test accuracy
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Ulla Sovio, Norman Shreeve, Peter Brocklehurst, Alexander E. P. Heazell, Stephen C. Robson, Alexandros A Moraitis, Aris T. Papageorghiou, Gordon C. S. Smith, Jim G Thornton, Pajkrt, Eva, Moraitis, Alexandros A [0000-0003-4634-1129], Sovio, Ulla [0000-0002-0799-1105], Brocklehurst, Peter [0000-0002-9950-6751], Heazell, Alexander EP [0000-0002-4303-7845], Thornton, Jim G [0000-0001-9764-6876], Robson, Stephen C [0000-0001-7897-7987], and Apollo - University of Cambridge Repository
- Subjects
Epidemiology ,Physiology ,Maternal Health ,Likelihood ratios in diagnostic testing ,Fetal Macrosomia ,Diagnostic Radiology ,Mathematical and Statistical Techniques ,Pregnancy ,Ultrasound Imaging ,Medicine and Health Sciences ,Birth Weight ,Mass Screening ,Ultrasonics ,Prospective Studies ,Prospective cohort study ,Ultrasonography ,Obstetrics ,Radiology and Imaging ,Statistics ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,Metaanalysis ,Research Assessment ,Fetal Weight ,Physiological Parameters ,Meta-analysis ,Physical Sciences ,Medicine ,Female ,Research Article ,medicine.medical_specialty ,Systematic Reviews ,Imaging Techniques ,Noninvasive Prenatal Testing ,Pregnancy Trimester, Third ,Gestational Age ,Research and Analysis Methods ,Ultrasonography, Prenatal ,Shoulder dystocia ,Diagnostic Medicine ,medicine ,Fetal macrosomia ,Humans ,Statistical Methods ,Mass screening ,Retrospective Studies ,Diagnostic Tests, Routine ,business.industry ,Body Weight ,Parturition ,Biology and Life Sciences ,Neonates ,Retrospective cohort study ,medicine.disease ,Pregnancy Complications ,Health Care ,Medical Risk Factors ,Women's Health ,Health Statistics ,Morbidity ,business ,Mathematics ,Developmental Biology - Abstract
Background The effectiveness of screening for macrosomia is not well established. One of the critical elements of an effective screening program is the diagnostic accuracy of a test at predicting the condition. The objective of this study is to investigate the diagnostic effectiveness of universal ultrasonic fetal biometry in predicting the delivery of a macrosomic infant, shoulder dystocia, and associated neonatal morbidity in low- and mixed-risk populations. Methods and findings We conducted a predefined literature search in Medline, Excerpta Medica database (EMBASE), the Cochrane library and ClinicalTrials.gov from inception to May 2020. No language restrictions were applied. We included studies where the ultrasound was performed as part of universal screening and those that included low- and mixed-risk pregnancies and excluded studies confined to high risk pregnancies. We used the estimated fetal weight (EFW) (multiple formulas and thresholds) and the abdominal circumference (AC) to define suspected large for gestational age (LGA). Adverse perinatal outcomes included macrosomia (multiple thresholds), shoulder dystocia, and other markers of neonatal morbidity. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Meta-analysis was carried out using the hierarchical summary receiver operating characteristic (ROC) and the bivariate logit-normal (Reitsma) models. We identified 41 studies that met our inclusion criteria involving 112,034 patients in total. These included 11 prospective cohort studies (N = 9986), one randomized controlled trial (RCT) (N = 367), and 29 retrospective cohort studies (N = 101,681). The quality of the studies was variable, and only three studies blinded the ultrasound findings to the clinicians. Both EFW >4,000 g (or 90th centile for the gestational age) and AC >36 cm (or 90th centile) had >50% sensitivity for predicting macrosomia (birthweight above 4,000 g or 90th centile) at birth with positive likelihood ratios (LRs) of 8.74 (95% confidence interval [CI] 6.84–11.17) and 7.56 (95% CI 5.85–9.77), respectively. There was significant heterogeneity at predicting macrosomia, which could reflect the different study designs, the characteristics of the included populations, and differences in the formulas used. An EFW >4,000 g (or 90th centile) had 22% sensitivity at predicting shoulder dystocia with a positive likelihood ratio of 2.12 (95% CI 1.34–3.35). There was insufficient data to analyze other markers of neonatal morbidity. Conclusions In this study, we found that suspected LGA is strongly predictive of the risk of delivering a large infant in low- and mixed-risk populations. However, it is only weakly (albeit statistically significantly) predictive of the risk of shoulder dystocia. There was insufficient data to analyze other markers of neonatal morbidity., Gordon Smith and colleagues investigate the diagnostic effectiveness of universal ultrasonic fetal biometry in predicting infant macrosomia, Author summary Why was this study done? There is a debate regarding introducing universal third-trimester screening for macrosomia. An effective screening program requires two elements: an effective test at predicting a condition and an effective intervention. There is evidence that early-term induction of labor (IOL) could reduce the rates of shoulder dystocia. However, there is no high-quality evidence regarding the diagnostic effectiveness of fetal biometry at predicting macrosomia and associated morbidity. What did the researchers do and find? We searched more than 10,000 titles and identified 41 studies including 112,034 patients that offered third-trimester ultrasounds for the prediction of macrosomia as part of universal ultrasound screening or were done in low- and mixed-risk populations. The quality of the studies was variable, and only three studies blinded the ultrasound findings to the clinicians. We found that the two most common ultrasound markers, the estimated fetal weight (EFW) and the abdominal circumference (AC), could predict the majority of macrosomic infants at birth (sensitivity >50%) with high diagnostic performance (positive LRs between 7 and 10). However, the EFW could only predict about 1 in 5 cases of shoulder dystocia (22% sensitivity) with low diagnostic performance (positive likelihood ratio of about 2). There was insufficient data to analyze other markers of neonatal morbidity. What do these findings mean? Universal third-trimester ultrasound screening will identify more pregnancies with macrosomia. However, it will not have a clinically significant effect at predicting shoulder dystocia. There is not enough evidence on the effect of ultrasound screening on neonatal morbidity. We recommend caution prior to introducing universal third-trimester screening for macrosomia, as it would increase the rates of intervention, with potential iatrogenic harm, without clear evidence that it would reduce neonatal morbidity.
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- 2021
42. Care in pregnancies subsequent to stillbirth or perinatal death
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Alexander E. P. Heazell, Louise Stephens, and Nicole Graham
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medicine.medical_specialty ,Placental histopathology ,business.industry ,Obstetrics ,Medicine ,Small for gestational age ,Subsequent pregnancy ,business ,medicine.disease - Published
- 2020
43. Associations between social and behavioural factors and the risk of late stillbirth – findings from the Midland and North of England Stillbirth case‐control study
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Lesley M. E. McCowan, Robin S. Cronin, Alexander E. P. Heazell, John M. D. Thompson, Edwin A. Mitchell, Lucy K Smith, Jayne Budd, Tomasina Stacey, Devender Roberts, Minglan Li, and Billie Bradford
- Subjects
Adult ,Domestic Violence ,unemployment ,Adolescent ,perceived stress ,socio-economic status ,Population ,Perceived Stress Scale ,Gestational Age ,Domestic violence ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,Obstetrics and Gynaecology ,Humans ,risk factors ,Medicine ,Social determinants of health ,education ,Socioeconomic status ,Social stress ,Late Stillbirth ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Odds ratio ,Middle Aged ,Stillbirth ,Logistic Models ,England ,Socioeconomic Factors ,perinatal mortality ,Case-Control Studies ,social determinants of health ,Multivariate Analysis ,Female ,stillbirth ,business ,Stress, Psychological ,Demography - Abstract
OBJECTIVE To investigate behavioural and social characteristics of women who experienced a late stillbirth compared with women with ongoing live pregnancies at similar gestation. DESIGN Case-control study. SETTING 41 maternity units in the UK. POPULATION Women who had a stillbirth ≥28 weeks' gestation (n = 287) and women with an ongoing pregnancy at the time of interview (n = 714). METHODS Data were collected using an interviewer-administered questionnaire which included questions regarding women's behaviours (e.g. alcohol intake and household smoke exposure) and social characteristics (e.g. ethnicity, employment, housing). Stress was measured by the 10-item Perceived Stress Scale. MAIN OUTCOME MEASURE Late stillbirth. RESULTS Multivariable analysis adjusting for co-existing social and behavioural factors showed women living in the most deprived quintile had an increased risk of stillbirth compared with the least deprived quintile (adjusted odds ratio [aOR] 3.16; 95% CI 1.47-6.77). There was an increased risk of late stillbirth associated with unemployment (aOR 2.32; 95% CI 1.00-5.38) and women who declined to answer the question about domestic abuse (aOR 4.12; 95% CI 2.49-6.81). A greater number of antenatal visits than recommended was associated with a reduction in stillbirth (aOR 0.26; 95% CI 0.16-0.42). CONCLUSIONS This study demonstrates associations between late stillbirth and socio-economic deprivation, perceived stress and domestic abuse, highlighting the need for strategies to prevent stillbirth to extend beyond maternity care. Enhanced antenatal care may be able to mitigate some of the increased risk of stillbirth. TWEETABLE ABSTRACT Deprivation, unemployment, social stress & declining to answer about domestic abuse increase risk of #stillbirth after 28 weeks' gestation.
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- 2020
44. Prediction of stillbirth: an umbrella review of evaluation of prognostic variables
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Alexander E. P. Heazell, L. Jorgensen, Laura A. Magee, Julie Dodds, Filomena Giulia Sileo, V. B. Kim, R. Townsend, John Allotey, Gordon C. S. Smith, Shakila Thangaratinam, Asma Khalil, Ben W.J. Mol, B. Thilaganathan, Jane Sandall, and P. von Dadelszen
- Subjects
medicine.medical_specialty ,Prognostic variable ,MEDLINE ,Cochrane Library ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Pregnancy ,Risk Factors ,Prenatal Diagnosis ,Epidemiology ,medicine ,Humans ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Stillbirth ,Prognosis ,medicine.disease ,Systematic review ,Data extraction ,Female ,business ,Body mass index - Abstract
Background Stillbirth accounts for over 2 million deaths a year worldwide and rates remains stubbornly high. Multivariable prediction models may be key to individualised monitoring, intervention or early birth in pregnancy to prevent stillbirth. Objectives To collate and evaluate systematic reviews of factors associated with stillbirth in order to identify variables relevant to prediction model development. Search strategy MEDLINE, Embase, DARE and Cochrane Library databases and reference lists were searched up to November 2019. Selection criteria We included systematic reviews of association of individual variables with stillbirth without language restriction. Data collection and analysis Abstract screening and data extraction were conducted in duplicate. Methodological quality was assessed using AMSTAR and QUIPS criteria. The evidence supporting association with each variable was graded. Results The search identified 1198 citations. Sixty-nine systematic reviews reporting 64 variables were included. The most frequently reported were maternal age (n = 5), body mass index (n = 6) and maternal diabetes (n = 5). Uterine artery Doppler appeared to have the best performance of any single test for stillbirth. The strongest evidence of association was for nulliparity and pre-existing hypertension. Conclusion We have identified variables relevant to the development of prediction models for stillbirth. Age, parity and prior adverse pregnancy outcomes had a more convincing association than the best performing tests, which were PAPP-A, PlGF and UtAD. The evidence was limited by high heterogeneity and lack of data on intervention bias. Tweetable abstract Review shows key predictors for use in developing models predicting stillbirth include age, prior pregnancy outcome and PAPP-A, PLGF and Uterine artery Doppler.
- Published
- 2020
45. Pathologic Assessment of the Placenta
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Halit Pinar, Sanne J. Gordijn, David Grynspan, John Kingdom, Drucilla J. Roberts, Leslie Kerzner, Sara V. Bates, Chrystalle Katte Carreon, Kristen T. Leeman, Carolyn Salafia, Marta Cohen, Eumenia Castro, Sanjita Ravishankar, Harvey J. Kliman, Jane Dahlstrom, Bob Silver, and Alexander Heazell
- Subjects
Obstetrics and Gynecology - Published
- 2022
46. Awareness of fetal movements and care package to reduce fetal mortality (AFFIRM)::a trial-based and model-based cost-effectiveness analysis from a stepped wedge, cluster-randomised trial
- Author
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Elizabeth M. Camacho, Sonia Whyte, Sarah J. Stock, Christopher J. Weir, Jane E. Norman, and Alexander E. P. Heazell
- Subjects
Health Personnel ,Perinatal Death ,Cost-Benefit Analysis ,Health Personnel/education ,Obstetrics and Gynecology ,Prenatal Care ,Health Care Costs ,Northern Ireland ,Awareness ,Stillbirth ,Prenatal Care/economics ,United Kingdom ,Decision Support Techniques ,Patient Education as Topic ,Pregnancy ,Pregnant Women/education ,Critical Pathways ,Humans ,Female ,Perinatal Death/prevention & control ,Pregnant Women ,Fetal Movement ,Ireland - Abstract
Background The AFFIRM intervention aimed to reduce stillbirth and neonatal deaths by increasing awareness of reduced fetal movements (RFM) and implementing a care pathway when women present with RFM. Although there is uncertainty regarding the clinical effectiveness of the intervention, the aim of this analysis was to evaluate the cost-effectiveness. Methods A stepped-wedge, cluster-randomised trial was conducted in thirty-three hospitals in the United Kingdom (UK) and Ireland. All women giving birth at the study sites during the analysis period were included in the study. The costs associated with implementing the intervention were estimated from audits of RFM attendances and electronic healthcare records. Trial data were used to estimate a cost per stillbirth prevented was for AFFIRM versus standard care. A decision analytic model was used to estimate the costs and number of perinatal deaths (stillbirths + early neonatal deaths) prevented if AFFIRM were rolled out across Great Britain for one year. Key assumptions were explored in sensitivity analyses. Results Direct costs to implement AFFIRM were an estimated £95,126 per 1,000 births. Compared to standard care, the cost per stillbirth prevented was estimated to be between £86,478 and being dominated (higher costs, no benefit). The estimated healthcare budget impact of implementing AFFIRM across Great Britain was a cost increase of £61,851,400/year. Conclusions Perinatal deaths are relatively rare events in the UK which can increase uncertainty in economic evaluations. This evaluation estimated a plausible range of costs to prevent baby deaths which can inform policy decisions in maternity services. Trial registration The trial was registered with www.ClinicalTrials.gov, number NCT01777022.
- Published
- 2022
47. Investigating the utility of the COM-B and TM model to explain changes in eating behaviour during pregnancy: A longitudinal cohort study
- Author
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Lauren Rockliffe, Sarah Peters, Debbie M. Smith, Calvin Heal, and Alexander E. P. Heazell
- Subjects
Motivation ,psychological theory ,Health Behavior ,Feeding Behavior ,Health Promotion ,General Medicine ,eating ,Pregnancy ,surveys and questionnaires ,Humans ,longitudinal studies ,Female ,Longitudinal Studies ,pregnancy ,diet ,Applied Psychology - Abstract
Objectives: Pregnancy has been described as a ‘teachable moment’ for behaviour change, which presents an important opportunity for health promotion within antenatal care settings. However, no pregnancy-specific model has been developed or tested in the context of health behaviour change during pregnancy. This study aimed to investigate and compare the utility of the Capability-Opportunity-Motivation Behaviour (COM-B) and Teachable Moments (TM) models, to explain health behaviour change during pregnancy, within the context of eating behaviour. Design: Longitudinal cohort studyMethods: Five hundred and sixteen women completed a survey at between 12-16 weeks gestation (T1). Follow-up data were collected at 20-24 weeks (T2), 36-40 weeks (T3), and 6-12 weeks postnatally (T4). The primary outcome was eating behaviour. To assess the utility of the COM-B model, perceived capability, opportunity, and motivation to eat healthily were measured. To assess the utility of the TM model, risk perceptions, self-image, and affective response were measured. Results: Overall, the COM-B model explained 18.4% of the variance in eating behaviour, whilst the TM model explained 9%. Both models explained the most variance in eating behaviour at T1 and T3, compared with T2 and T4. Small changes were observed in eating behaviour and the model constructs over the time period studied, although these were not clinically meaningful. Conclusions: Neither the COM-B nor TM model provide a satisfactory explanation of eating behaviour during pregnancy, however the findings suggest that certain stages of pregnancy may create more salient opportunities for behaviour change. The findings also support claims that motivation may not play a key role in directing eating behaviour during pregnancy. Further research is needed to explore the role of timing in antenatal behaviour change. The development of a pregnancy-specific model is necessary to optimise understanding of pregnancy as a teachable moment for behaviour change.
- Published
- 2022
48. The prevalence of and risk factors for stillbirths in women with severe preeclampsia in a high-burden setting at Mpilo Central Hospital, Bulawayo, Zimbabwe
- Author
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Solwayo Ngwenya, Brian Jones, Desmond Mwembe, Hausitoe Nare, and Alexander E.P. Heazell
- Subjects
Zimbabwe ,Infant, Newborn ,Obstetrics and Gynecology ,Stillbirth ,Hospitals ,Cross-Sectional Studies ,Pre-Eclampsia ,Pregnancy ,Risk Factors ,Pediatrics, Perinatology and Child Health ,Prevalence ,Humans ,Female ,Retrospective Studies - Abstract
Objectives Stillbirth remains a global public health issue; in low-resource settings stillbirth rates remain high (>12 per 1,000 births target of Every Newborn Action Plan). Preeclampsia is major risk factor for stillbirths. This study aimed to determine the prevalence and risk factors for stillbirth amongst women with severe preeclampsia at Mpilo Central Hospital. Methods A retrospective cross-sectional study was conducted of women with severe preeclampsia from 01/01/2016 to 31/12/2018 at Mpilo Central Hospital, Bulawayo, Zimbabwe. Multivariable logistic regression was used to determine risk factors that were independently associated with stillbirths. Results Of 469 women that met the inclusion criteria, 46 had a stillbirth giving a stillbirth prevalence of 9.8%. The risk factors for stillbirths in women with severe preeclampsia were: unbooked status (adjusted odds ratio (aOR) 3.01, 95% (confidence interval) CI 2.20–9.10), frontal headaches (aOR 2.33, 95% CI 0.14–5.78), vaginal bleeding with abdominal pain (aOR 4.71, 95% CI 1.12–19.94), diastolic blood pressure ≥150 mmHg (aOR 15.04, 95% CI 1.78–126.79), platelet count 0–49 × 109/L (aOR 2.80, 95% CI 1.26–6.21), platelet count 50–99 × 109/L (aOR 2.48, 95% CI 0.99–6.18), antepartum haemorrhage (aOR 12.71, 95% CI 4.15–38.96), haemolysis elevated liver enzymes syndrome (HELLP) (aOR 6.02, 95% CI 2.22–16.33) and fetal sex (aOR 2.75, 95% CI 1.37–5.53). Conclusions Women with severe preeclampsia are at significantly increased risk of stillbirth. This study has identified risk factors for stillbirth in this high-risk population; which we hope could be used by clinicians to reduce the burden of stillbirths in women with severe preeclampsia.
- Published
- 2022
49. Placental Macrophages Following Maternal SARS-CoV-2 Infection in Relation to Placental Pathology
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Megan C. Sharps, Ainslie Garrod, Emmanuel Aneni, Carolyn J. P. Jones, Gauri Batra, and Alexander E. P. Heazell
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placenta ,SARS-CoV-2 ,histopathology ,COVID-19 ,Microbiology ,QR1-502 ,macrophages - Abstract
IntroductionIn December 2019, a novel coronavirus, SARS-CoV-2, was identified. Whilst pregnant women appear to be at risk of severe infection, pre-term birth, and stillbirth, it is unclear whether placental dysfunction is a consistent feature of maternal SARS-CoV-2 infection during pregnancy. We aim to describe the immune response in placentas of women who had COVID-19 infection during pregnancy and investigate whether there are any associated morphological changes.MethodsThe placentas of women testing positive for COVID-19 during their pregnancy were compared to contemporaneous controls who were not known to have had COVID-19 during pregnancy. Samples of each placenta were sent for histopathological analysis or underwent immunohistochemical staining for CD163, CD20, CD3, CD31, and SARS-CoV-2 spike protein. A subset of samples were sent for transmission electron microscopy.ResultsThere was a significant increase in the number of CD163+ macrophages in the Post COVID group (p = 0.0020). There was no difference in the percentage of CD3+, CD20+ cells, but there was an increase in placental vascularity in the Post COVID group compared to controls (p = 0.026).There were no structural differences observed between the samples sent for EM analysis. However, one of the placentas from the Post COVID group was seen to have several large sub-apical vacuoles in the syncytiotrophoblast. We did not observe any virions within the vacuoles and SARS-CoV-2 spike protein staining was negative for the sample. Histopathological investigations indicated that there was no specific placental pathology caused by maternal COVID-19 infection in this cohort of samples.ConclusionsThis study did not confirm previous studies which describe a possible increase in cases of both maternal and fetal vascular malperfusion, and placentitis in women who had COVID-19, which were seen in association with adverse pregnancy outcomes. It remains unclear whether observed abnormalities are caused by maternal infection, or whether maternal infection exacerbates existing placental pathology; understanding why some placentas generate these abnormalities is a key goal.
- Published
- 2022
50. Companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19: a mixed-methods analysis of national and organisational responses and perspectives
- Author
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Marian Knight, Neil Marlow, Alan Fenton, Carol Kingdon, Soo Downe, Arie Franx, Rebecca Nowland, Jane Sandall, Tim Draycott, Lucy Frith, Zoe Matthews, Amali Lokugamage, Alison Wright, Jim Thornton, Nicola Crossland, Yana Richens, Gill Thomson, Mary Ross-Davie, Alexander Heazell, Claire Feeley, Caroline Homer, Keith Reed, George Ellison, Marie-Claire Balaam, Rebecca Nowland (Harris), Gill Moncrieff, Stephanie Heys, Arni Sarian, Joanne Cull, Anastasia Topalidou, Ank de Jonge, Alexandra Severns, Naseerah Akooji, Marie-Clare Balaam, Lauri van den Berg, Beata Franso, Steph Heys, Maria Booker, Tisian Lynskey-Wilkie, Vanessa Wilson, Rebecca Abe, Tinuke Awe, Toyin Adeyinka, Ruth Bender-Atik, Lia Brigante, Rebecca Brione, Franka Cadée, Elizabeth Duff, Duncan Fisher, Annie Francis, Louise Griew, Clea Harmer, Amanda Mansfield, Trixie Mcaree, David Monteith, Lucia Rocca-Ihenacho, Seana Talbot, Myles Taylor, Maureen Treadwell, Knight, M, and Group, ASPIRE-COVID-19 Collaborative
- Subjects
SARS-CoV-2 ,organisational development ,gynaecology ,public health ,COVID-19 ,General Medicine ,B720 ,risk management ,England ,Pregnancy ,Obstetrics and Gynaecology ,Medicine ,Humans ,Female ,Maternal Health Services ,Pandemics ,qualitative research - Abstract
Objectives: To explore stakeholders’ and national organisational perspectives on companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19, as part of the ASPIRE COVID-19 study. \ud Setting: Maternity care provision in England. \ud Participants: Interviews were held with 26 national governmental, professional, and service-user organisation leads (July-Dec 2020). Other data included public-facing outputs logged from 25 maternity Trusts (Sept/Oct 2020) and data extracted from 78 documents from eight key governmental, professional, and service-user organisations that informed national maternity care guidance and policy (Feb-Dec 2020). \ud Results: Six themes emerged: ‘Postcode lottery of care’ highlights variations in companionship and visiting practices between trusts/locations, ‘Confusion and stress around ‘rules’’ relates to a lack of and variable information concerning companionship/visiting. ‘Unintended consequences’ concerns the negative impacts of restricted companionship or visiting on women/birthing people and staff, ‘Need for flexibility’ highlights concerns about applying companionship and visiting policies irrespective of need, ‘‘Acceptable’ time for support’ highlights variations in when and if companionship was ‘allowed’ antenatally and intrapartum; and 'Loss of human rights for gain in infection control’ emphasizes how a predominant focus on infection control was at a cost to psychological safety and human rights. \ud Conclusions: Policies concerning companionship and visiting have been inconsistently applied within English maternity services during the COVID-19 pandemic. In some cases, policies were not justified by the level of risk, and were applied indiscriminately regardless of need. There is an urgent need to determine how to sensitively and flexibly balance risks and benefits and optimise outcomes during the current and future crisis situations. \ud \ud Strengths and limitations of this study\ud • This is the first paper to consider links between policy and practice in companionship and visiting in maternity care during the COVID-19 pandemic.\ud • Data triangulation across national level stakeholders in policy and practice and public facing Trust documentation provides nuanced and context related perspectives on why and how companionship and visiting was impacted. \ud • Stakeholders included national representatives from all key agencies involved in maternity care. \ud • Practice related issues were collected from 25 Trusts websites and social media-based public facing information, which may or may not reflect actual care practices. \ud • The paper focuses on antenatal and intrapartum care, with postnatal (including neonatal) care to be the focus of future publications.\ud • The study does not include information directly reported by parents or healthcare professionals.
- Published
- 2022
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