12 results on '"Merriel A"'
Search Results
2. SARS‐CoV‐2—Placental effects and association with stillbirth.
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Merriel, Abi, Fitzgerald, Brendan, and O'Donoghue, Keelin
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SARS-CoV-2 , *STILLBIRTH , *COVID-19 pandemic , *COVID-19 , *ALPHA rhythm , *ABRUPTIO placentae - Abstract
SARS‐CoV‐2 has had a significant impact on pregnancy outcomes due to the effects of the virus and the altered healthcare environment. Stillbirth has been relatively hidden during the COVID‐19 pandemic, but a clear link between SARS‐CoV‐2 and poor fetal outcome emerged in the Alpha and Delta waves. A small minority of women/birthing people who contracted COVID‐19 developed SARS‐CoV‐2 placentitis. In many reported cases this was linked to intrauterine fetal death, although there are cases of delivery just before imminent fetal demise and we shall discuss how some cases are sub‐clinical. What is surprising, is that SARS‐CoV‐2 placentitis is often not associated with severe maternal COVID‐19 infection and this makes it difficult to predict. The worst outcomes seem to be with diffuse placental disease which occurs within 21 days of COVID‐19 diagnosis. Poor outcomes are often pre‐dated by reduced fetal movements but are not associated with ultrasound changes. In some cases, there has also been maternal thrombocytopenia, or coagulation abnormalities, which may provide a clue as to which pregnancies are at risk of fetal demise if a further variant of concern is to emerge. In future, multidisciplinary collaboration and cross‐boundary working must be prioritised, to identify quickly such a phenomenon and provide clinicians with clear guidance for reducing fetal death and associated poor outcomes. While we wait to see if COVID‐19 brings a future variant of concern, we must focus on appropriate future management of women who have had SARS‐CoV‐2 placentitis. As a placental condition with an infectious aetiology, SARS‐CoV‐placentitis is unlikely to recur in a subsequent pregnancy and thus a measured approach to subsequent pregnancy management is needed. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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- View/download PDF
3. Interventions, outcomes and outcome measurement instruments in stillbirth care research: A systematic review to inform the development of a core outcome set.
- Author
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Bakhbakhi, Danya, Siassakos, Dimitrios, Davies, Anna, Merriel, Abi, Barnard, Katie, Stead, Emma, Shakespeare, Clare, Duffy, James M. N., Hinton, Lisa, McDowell, Karolina, Lyons, Anna, Fraser, Abigail, Burden, Christy, Redshaw, Maggie, Flenady, Vicki, Heazell, Alexander, Timlin, Laura, Lynch, Mary, Downe, Soo, and Slade, Pauline
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STILLBIRTH ,MULTIPLE pregnancy ,EVIDENCE gaps ,SOCIAL support ,POSTNATAL care - Abstract
Background: A core outcome set could address inconsistent outcome reporting and improve evidence for stillbirth care research, which have 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: Forty randomised and 200 non‐randomised studies were included. Fifty‐eight 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). A total of 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. A total of 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. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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4. Development of the FAST‐M maternal sepsis bundle for use in low‐resource settings: a modified Delphi process
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Helen Marie Williams, João Paulo Souza, Abi Merriel, Chisale Mhango, Bejoy Nambiar, Address Malata, Lumbani Banda, Thomson Chirwa, Jeffrey M. Smith, Ron Daniels, Niranjan Kissoon, Adam J. Devall, Edward Mhango, James Cheshire, Victoria Lwesha, Laura Munthali, Charles Makwenda, Fatima Taki, Arri Coomarasamy, Mercedes Bonet, Catherine Dunlop, Julia Hussein, Ioannis D. Gallos, David Lissauer, and A. Wilson
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Consensus ,Process management ,Delphi Technique ,Low resource ,Process (engineering) ,International Cooperation ,Sepsis bundle ,Population ,Maternal Medicine ,Modified delphi ,Psychological intervention ,DELPHI (LINGUAGEM DE PROGRAMAÇÃO) ,Medically Underserved Area ,Computer-assisted web interviewing ,World Health Organization ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Health care ,Humans ,Medicine ,Pregnancy Complications, Infectious ,education ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Maternal sepsis ,Neonatal sepsis ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,low resource setting ,medicine.disease ,Patient Care Management ,Bundle ,Health Resources ,care bundle ,Delphi process ,Female ,Medical emergency ,maternal sepsis ,business ,Patient Care Bundles - Abstract
Objective To develop a sepsis care bundle for the initial management of maternal sepsis in low resource settings. Design Modified Delphi process. Setting Participants from 34 countries. Population Healthcare practitioners working in low resource settings (n = 143; 34 countries), members of an expert panel (n = 11) and consultation with the World Health Organization Global Maternal and Neonatal Sepsis Initiative technical working group. Methods We reviewed the literature to identify all potential interventions and practices around the initial management of sepsis that could be bundled together. A modified Delphi process, using an online questionnaire and in‐person meetings, was then undertaken to gain consensus on bundle items. Participants ranked potential bundle items in terms of perceived importance and feasibility, considering their use in both hospitals and health centres. Findings from the healthcare practitioners were then triangulated with those of the experts. Main outcome measure Consensus on bundle items. Results Consensus was reached after three consultation rounds, with the same items deemed most important and feasible by both the healthcare practitioners and expert panel. Final bundle items selected were: (1) Fluids, (2) Antibiotics, (3) Source identification and control, (4) Transfer (to appropriate higher‐level care) and (5) Monitoring (of both mother and neonate as appropriate). The bundle was given the acronym ‘FAST‐M’. Conclusion A clinically relevant maternal sepsis bundle for low resource settings has been developed by international consensus. Tweetable abstract A maternal sepsis bundle for low resource settings has been developed by international consensus., Tweetable abstract A maternal sepsis bundle for low resource settings has been developed by international consensus.
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- 2019
5. The FAST‐M complex intervention for the detection and management of maternal sepsis in low‐resource settings: a multi‐site evaluation
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Cheshire, J, primary, Jones, L, additional, Munthali, L, additional, Kamphinga, C, additional, Liyaya, H, additional, Phiri, T, additional, Parry‐Smith, W, additional, Dunlop, C, additional, Makwenda, C, additional, Devall, AJ, additional, Tobias, A, additional, Nambiar, B, additional, Merriel, A, additional, Williams, HM, additional, Gallos, I, additional, Wilson, A, additional, Coomarasamy, A, additional, and Lissauer, D, additional
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- 2021
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6. Development of the FAST‐M maternal sepsis bundle for use in low‐resource settings: a modified Delphi process
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Lissauer, D, primary, Cheshire, J, additional, Dunlop, C, additional, Taki, F, additional, Wilson, A, additional, Smith, JM, additional, Daniels, R, additional, Kissoon, N, additional, Malata, A, additional, Chirwa, T, additional, Lwesha, VM, additional, Mhango, C, additional, Mhango, E, additional, Makwenda, C, additional, Banda, L, additional, Munthali, L, additional, Nambiar, B, additional, Hussein, J, additional, Williams, HM, additional, Devall, AJ, additional, Gallos, I, additional, Merriel, A, additional, Bonet, M, additional, Souza, JP, additional, and Coomarasamy, A, additional
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- 2019
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7. Global women's health: current clinical trials in low- and middle-income countries
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Hoda Harb, Abi Merriel, Helen M Williams, Arri Coomarasamy, and Richard J. Lilford
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medicine.medical_specialty ,media_common.quotation_subject ,Population ,Alternative medicine ,Developing country ,Fertility ,Disease ,Global Health ,Health intervention ,Pregnancy ,medicine ,Humans ,Maternal Health Services ,education ,Developing Countries ,Randomized Controlled Trials as Topic ,media_common ,Gynecology ,education.field_of_study ,business.industry ,Obstetrics and Gynecology ,Pregnancy Complications ,Clinical trial ,Reproductive Health ,Clinical research ,Family medicine ,Women's Health ,Female ,business ,Genital Diseases, Female - Abstract
Background: Clinical trials in low- and middle-income countries (LMICs) are necessary to develop evidence-based approaches to improve women's health. Understanding what research is currently being conducted will allow the identification of research gaps, avoidance of duplication, planning of future studies, collaboration amongst research groups, and geographical targeting for research investments. Objectives:To provide an overview of active women's health trials in LMICs. Search strategy: The World Health Organization's International Clinical Trials Registry Platform was searched for trials registered between 1 April 2012 and 31 March 2014. Selection criteria: Selected trials were randomised, conducted in LMICs, active, and with a women's health intervention or a significant outcome for the woman. Data collection and analysis: Two reviewers extracted data. Analysis included geographical spread, speciality areas, pre-enrolment registration, study size, and funders. Main results: Of the 8966 records, 509 were eligible for inclusion. Gynaecology trials made up 57% of the research, whereas the remaining 43% of trials were in obstetrics. Research activity focused on fertility (17%), the antenatal period (15%), benign gynaecology (14%), intrapartum care (9%), and pre-invasive disease and cancers (8%). The majority of trials (84%) took place in middle-income countries (MICs). In low-income countries (LICs) 83% of research investigated obstetrics, and in MICs 60% of research investigated gynaecology. Most trials (80%) had a sample size of 500 or fewer participants. The median size of trials in LICs was 815 compared with 128 in MICs. Pre-enrolment registration occurred in 54% of trials. The majority (62%) of trials were funded locally. Authors' conclusions: Many LMICs are active in women's health research. The majority of registered trials are located in MICs; however, the trials in LICs are often larger. The focus of research in MICs may be driven by local priorities and funding, with fertility being highly researched. In LICs, pregnancy is the focus, perhaps reflecting the international prioritisation of maternal health.
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- 2014
8. Parents’ and healthcare professionals’ experiences of care after stillbirth in low‐ and middle‐income countries: a systematic review and meta‐summary
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Shakespeare, C, primary, Merriel, A, additional, Bakhbakhi, D, additional, Baneszova, R, additional, Barnard, K, additional, Lynch, M, additional, Storey, C, additional, Blencowe, H, additional, Boyle, F, additional, Flenady, V, additional, Gold, K, additional, Horey, D, additional, Mills, T, additional, and Siassakos, D, additional
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- 2018
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9. Parents' and healthcare professionals' experiences of care after stillbirth in low- and middle-income countries: a systematic review and meta-summary.
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Shakespeare, C, Merriel, A, Bakhbakhi, D, Baneszova, R, Barnard, K, Lynch, M, Storey, C, Blencowe, H, Boyle, F, Flenady, V, Gold, K, Horey, D, Mills, T, and Siassakos, D
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STILLBIRTH , *SYSTEMATIC reviews , *META-analysis , *BEREAVEMENT , *MEDICAL personnel-caregiver relationships , *PERINATAL death & psychology , *ATTITUDE (Psychology) , *MEDICAL personnel , *PSYCHOLOGY of parents , *POSTNATAL care , *STEREOTYPES , *QUALITATIVE research ,DEVELOPING countries - Abstract
Background: Stillbirth has a profound impact on women, families, and healthcare workers. The burden is highest in low- and middle-income countries (LMICs). There is need for respectful and supportive care for women, partners, and families after bereavement.Objective: To perform a qualitative meta-summary of parents' and healthcare professionals' experiences of care after stillbirth in LMICs.Search Strategy: Search terms were formulated by identifying all synonyms, thesaurus terms, and variations for stillbirth. Databases searched were AMED, EMBASE, MEDLINE, PsychINFO, BNI, CINAHL.Selection Criteria: Qualitative, quantitative, and mixed method studies that addressed parents' or healthcare professionals' experience of care after stillbirth in LMICs.Data Collection and Analysis: Studies were screened, and data extracted in duplicate. Data were analysed using the Sandelowski meta-summary technique that calculates frequency and intensity effect sizes (FES/IES).Main Results: In all, 118 full texts were screened, and 34 studies from 17 countries were included. FES range was 15-68%. Most studies had IES 1.5-4.5. Women experience a broad range of manifestations of grief following stillbirth, which may not be recognised by healthcare workers or in their communities. Lack of recognition exacerbates negative experiences of stigmatisation, blame, devaluation, and loss of social status. Adequately developed health systems, with trained and supported staff, are best equipped to provide the support and information that women want after stillbirth.Conclusions: Basic interventions could have an immediate impact on the experiences of women and their families after stillbirth. Examples include public education to reduce stigma, promoting the respectful maternity care agenda, and investigating stillbirth appropriately.Tweetable Abstract: Reducing stigma, promoting respectful care and investigating stillbirth have a positive impact after stillbirth for women and families in LMICs. [ABSTRACT FROM AUTHOR]- Published
- 2019
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10. Global women's health: current clinical trials in low- and middle-income countries
- Author
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Merriel, A, primary, Harb, HM, additional, Williams, H, additional, Lilford, R, additional, and Coomarasamy, A, additional
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- 2014
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11. Global women's health: current clinical trials in low- and middle-income countries.
- Author
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Merriel, A, Harb, HM, Williams, H, Lilford, R, and Coomarasamy, A
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WOMEN'S health , *CLINICAL trials , *LOW-income countries , *MIDDLE-income countries , *GYNECOLOGY , *OBSTETRICS , *INTERNATIONAL cooperation - Abstract
Background Clinical trials in low- and middle-income countries ( LMICs) are necessary to develop evidence-based approaches to improve women's health. Understanding what research is currently being conducted will allow the identification of research gaps, avoidance of duplication, planning of future studies, collaboration amongst research groups, and geographical targeting for research investments. Objectives To provide an overview of active women's health trials in LMICs. Search strategy The World Health Organization's International Clinical Trials Registry Platform was searched for trials registered between 1 April 2012 and 31 March 2014. Selection criteria Selected trials were randomised, conducted in LMICs, active, and with a women's health intervention or a significant outcome for the woman. Data collection and analysis Two reviewers extracted data. Analysis included geographical spread, speciality areas, pre-enrolment registration, study size, and funders. Main results Of the 8966 records, 509 were eligible for inclusion. Gynaecology trials made up 57% of the research, whereas the remaining 43% of trials were in obstetrics. Research activity focused on fertility (17%), the antenatal period (15%), benign gynaecology (14%), intrapartum care (9%), and pre-invasive disease and cancers (8%). The majority of trials (84%) took place in middle-income countries ( MICs). In low-income countries ( LICs) 83% of research investigated obstetrics, and in MICs 60% of research investigated gynaecology. Most trials (80%) had a sample size of 500 or fewer participants. The median size of trials in LICs was 815 compared with 128 in MICs. Pre-enrolment registration occurred in 54% of trials. The majority (62%) of trials were funded locally. Authors' conclusions Many LMICs are active in women's health research. The majority of registered trials are located in MICs; however, the trials in LICs are often larger. The focus of research in MICs may be driven by local priorities and funding, with fertility being highly researched. In LICs, pregnancy is the focus, perhaps reflecting the international prioritisation of maternal health. [ABSTRACT FROM AUTHOR]
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- 2015
- Full Text
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12. Systematic Review of Clinical Prediction Models for the Risk of Emergency Caesarean Births.
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Hunt, Alexandra, Bonnett, Laura, Heron, Jon, Lawton, Michael, Clayton, Gemma, Smith, Gordon, Norman, Jane, Kenny, Louise, Lawlor, Deborah, and Merriel, Abi
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PROGNOSTIC models , *MATERNAL age , *PREDICTION models , *CINAHL database , *GESTATIONAL age - Abstract
ABSTRACT Background Objectives Search Strategy Selection Criteria Data Collection and Analysis Results Conclusion Globally, caesarean births (CB), including emergency caesareans births (EmCB), are rising. It is estimated that nearly a third of all births will be CB by 2030.Identify and summarise the results from studies developing and validating prognostic multivariable models predicting the risk of EmCBs. Ultimately understanding the accuracy of their development, and whether they are operationalised for use in routine clinical practice.Studies were identified using databases: MEDLINE, CINAHL, Cochrane Central and Scopus with a search strategy tailored to models predicting EmCBs.Prospective studies developing and validating clinical prediction models, with two or more covariates, to predict risk of EmCB.Data were extracted onto a proforma using the Prediction model Risk Of Bias ASsessment Tool (PROBAST).In total, 8083 studies resulted in 56 unique prediction modelling studies and seven validating studies, with a total of 121 different predictors. Frequently occurring predictors included maternal height, maternal age, parity, BMI and gestational age. PROBAST highlighted 33 studies with low overall bias, and these all internally validated their model. Thirteen studies externally validated; only eight of these were graded an overall low risk of bias. Six models offered applications that could be readily used, but only one provided enough time to offer a planned caesarean birth (pCB). These well‐refined models have not been recalibrated since development. Only one model, developed in a relatively low‐risk population, with data collected a decade ago, remains useful at 36 weeks for arranging a pCB.To improve personalised clinical conversations, there is a pressing need for a model that accurately predicts the timely risk of an EmCB for women across diverse clinical backgrounds.
Trial Registration: PROSPERO registration number: CRD42023384439. [ABSTRACT FROM AUTHOR]- Published
- 2024
- Full Text
- View/download PDF
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