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Third-trimester stillbirth affects approximately 2.6 million women worldwide each year. Although most stillbirths (98%) occur in low- and middle-income countries, most of the research on the impact of stillbirth and bereavement care has come from high-income countries. The impact of stillbirth ranges from stigma to disenfranchised grief, broken relationships, clinical depression, chronic pain, substance use, increased use of health services, employment difficulties, and debt. Appropriate bereavement care following a stillbirth is essential to minimise the negative socio-economic impact on parents and their families. This article presents the best practice points in stillbirth bereavement care, including taking an individualised and flexible approach. The latest published research, guidelines, and best practice points from high-income countries will be used and will highlight the gaps in the research which urgently need to be addressed. Research and investment in appropriate, respectful aftercare is needed to minimise the negative impact for parents. [ABSTRACT FROM AUTHOR]

Accurate and consistent classification of causes and associated conditions for perinatal deaths is essential to inform strategies to reduce the five million which occur globally each year. With the majority of deaths occurring in low- and middle-income countries (LMICs), their needs must be prioritised. The aim of this paper is to review the classification of perinatal death, the contemporary classification systems including the World Health Organization's International Classification of Diseases - Perinatal Mortality (ICD-PM), and next steps. During the period from 2009 to 2014, a total of 81 new or modified classification systems were identified with the majority developed in high-income countries (HICs). Structure, definitions and rules and therefore data on causes vary widely and implementation is suboptimal. Whereas system testing is limited, none appears ideal. Several systems result in a high proportion of unexplained stillbirths, prompting HICs to use more detailed systems that require data unavailable in low-income countries. Some systems appear to perform well across these different settings. ICD-PM addresses some shortcomings of ICD-10 for perinatal deaths, but important limitations remain, especially for stillbirths. A global approach to classification is needed and seems feasible. The new ICD-PM system is an important step forward and improvements will be enhanced by wide-scale use and evaluation. Implementation requires national-level support and dedicated resources. Future research should focus on implementation strategies and evaluation methods, defining placental pathologies, and ways to engage parents in the process. [ABSTRACT FROM AUTHOR]

Triboelectric nanogenerators (TENGs) with an ability to harvest mechanical energy from natural and human activities, have shown tremendous potential to realise self-powered electronic devices and sensors. However, in order for optimum utilization of biomechanical energy, TENGs need to have body or tissue mimicking properties without compromising performance. Herein, a new hydrogel based all-soft, self-healing and stretchable TENG is introduced which exhibits outstanding power generation capability surpassing existing competitors. This unique TENG is realized by using gold nanoparticles doped semi-transparent hydrogel as an electrode and Ecoflex as the triboelectric layer which integrates multifunctional properties including rapid self-healing in < 2 min, 900% stretchability, high conductivity, transparency and excellent biocompatibility with human dermal fibroblasts. The use of a gel electrode with both ionic and electronic conductivities underlines the importance of gold nanoparticles in enhancing the performance of soft TENGs. A 5 cm2 device exhibits a prodigious power density of 1680 mWm−2 with an energy conversion efficiency of ≈ 26%, which is the highest achieved so far in contemporary hydrogel based TENGs. The moldable components allow easy fabrication of devices with tunable shapes and sizes that conforms to the human body and can power multiple electrical devices directly from body movements thus opening up possibilities for next generation self-powered wearable or implanted devices. [Display omitted] • In situ synthesis of gold nanoparticle doped hydrogel. • Soft, stretchable, self-healing, conducting and biocompatible electrode. • High power density (1680 mWm−2) and efficiency (26%) of hydrogel based triboelectric nanogenerator. • Demonstration of energy harvesting from different human body movements. [ABSTRACT FROM AUTHOR]

Abstract: Effective training has been shown to improve perinatal care and outcome, decrease litigation claims and reduce midwifery sick leave. To be effective, training should be incentivised, in a realistic context, and delivered to inter-professional teams similar to those delivering actual care. Teamwork training is a useful addition, but it should be based on the characteristics of effective teamwork as derived from the study of frontline teams. Implementation of simulation and teamwork training is challenging, with constraints on staff time, facilities and finances. Local adoption and adaptation of effective programmes can help keep costs down, and make them locally relevant whilst maintaining effectiveness. Training programmes need to evolve continually in line with new evidence. To do this, it is vital to monitor outcomes and robustly evaluate programmes for their impact on patient care and outcome, not just on participants. [Copyright &y& Elsevier]

Abstract: Objectives: To determine whether team performance in a simulated emergency is related to generic teamwork skills and behaviours. Methods: Design – Cross-sectional analysis of data from the Simulation and Fire-drill Evaluation (SaFE) randomised controlled trial. Setting – Six secondary and tertiary Maternity Units in Southwest England. Participants – 140 healthcare professionals, in 24 teams. Assessment – Blinded analysis of recorded simulations. Main outcome measures – Correlation of team performance (efficiency conducting key clinical actions, including the administration of an essential drug, magnesium), and generic teamwork scores (using a validated tool that assesses skills and behaviours, by Weller et al.). Results: There was significant positive correlation between clinical efficiency and teamwork scores across all three dimensions; skills (Kendall''s taub =0.54, p <0.001), behaviours (taub =0.41, p =0.001), and overall score (taub =0.51, p <0.001). Better teams administered the essential drug 2½min more quickly (Mann–Whitney U, p <0.001). Conclusions: The clinical conduct of a simulated emergency was strongly linked to generic measures of teamwork. Further studies are needed to elucidate which aspects of team working are critical for team performance, to better inform training programs for multi-professional team working. [Copyright &y& Elsevier]

Objective: To determine the economic impact of the introduction of carbetocin for the prevention of postpartum haemorrhage (PPH) at caesarean section, compared to oxytocin.Study Design: The model is a decision tree conducted from a UK National Health Service perspective. 1500 caesarean sections (both elective and emergency) were modelled over a 12 month period. Efficacy data was taken from a published Cochrane meta-analysis, and costs from NHS Reference costs, the British National Formulary and the NHS electronic Medicines Information Tool. A combination of hospital audit data and expert input from an advisory board of clinicians was used to inform resource use estimates. The main outcome measures were the incidence of PPH and total cost over a one year time horizon, as a result of using carbetocin compared to oxytocin for prevention of PPH at caesarean section.Results: The use of carbetocin compared to oxytocin for prevention of PPH at caesarean section was associated with a reduction of 30 (88 vs 58) PPH events (>500ml blood loss), and a cost saving of £27,518. In probabilistic sensitivity analysis, carbetocin had a 91.5% probability of producing better outcomes, and a 69.4% chance of being dominant (both cheaper and more effective) compared to oxytocin.Conclusion: At list price, the introduction of carbetocin appears to provide improved clinical outcomes along with cost savings, though this is subject to uncertainty regarding the underlying data in efficacy, resource use, and cost. [ABSTRACT FROM AUTHOR]

Objective: To determine the best management of retrograde ejaculation to optimize the chance of conception. Design: Systematic review. Setting: Tertiary reproductive medicine center. Patient(s): Subfertile men with retrograde ejaculation. Method(s): Systematic search of studies using search terms “management” or “therapy” or “treatment” and “retrograde ejaculation.” We excluded case reports and papers not in English. Main Outcome Measure(s): Pregnancy and live birth rates and rates of achievement of antegrade ejaculation. Result(s): Thirty-four studies met our criteria. Studies were mostly observational. Descriptions of predictive and confounding variables were often insufficient. The treatment options included urinary sperm retrieval and medical management with anticholinergics and sympathomimetics. Successful pregnancies and live births were also achieved using surgical techniques and electroejaculation; however, numbers were small. Conclusion(s): Many treatment options exist in the management of retrograde ejaculation; however, current literature is insufficient to allow firm comparisons between interventions. Treatment should be tailored, therefore, to the individual. Our findings support the need for further research in this area—including large randomized controlled trials. However, these would be difficult logistically and may not be possible. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to evaluate a prospective monitoring and quality improvement system for studying trends in the rates of an adverse neonatal outcome, the low Apgar scores (Apgar score <7). Study Design: A cumulative sum (CUSUM) chart-based system was used to monitor the rate of low Apgar scores over 2 years. Root cause analysis (RCA) was used to investigate for causes of periods of increased low Apgar score rates. Results: A period of deteriorated outcome (increased rates of low Apgar) occurred in August 2006. RCA identified deficiencies in cardiotocograph education, which were addressed by targeted training and mentoring. Prompt resolution followed, with the rates returning to baseline and staying within acceptable limits through to the end of evaluation in December 2007. Conclusion: Prospective and continuous monitoring of clinical outcomes using the CUSUM chart method is feasible and may be beneficial. Early detection of an adverse trend allows for timely corrective action, and may lead to overall improvements in performance. [Copyright &y& Elsevier]

Objective: Rotational forceps and manual rotation followed by direct forceps are techniques used in the management of malposition of the fetal head in the second stage of labor. However, there is widespread debate regarding their relative safety and utility. We aimed to compare the effectiveness and safety of rotational forceps with manual rotation followed by direct forceps, for management of fetal malposition at full dilation.Study Design: A retrospective cohort study in a single tertiary obstetric unit with >6000 births per year. We recorded and analysed outcomes of 104 sequential rotational forceps births over 21 months (Jan 2010-Sept 2012) and 208 matched chronologically sequential attempted manual rotations and direct forceps births (1:2 by number). Univariable and multivariable approaches used for statistical analysis. The main outcome measure was vaginal birth.Results: The rate of vaginal birth was significantly higher with rotational forceps than with manual rotation followed by direct forceps (88.5% vs 82.2%, RR 1.17, 95% CI 1.04-1.31, p=0.017). Births by rotational forceps were associated with a significantly higher rate of shoulder dystocia (19.2% vs 10.6%, RR 2.35, 95% CI 1.23-4.47, p=0.012), but not of neonatal injury. There were no significant differences in all other maternal and neonatal outcomes between the two modes of birth.Conclusions: The use of rotational forceps was associated with a statistically significantly higher rate of vaginal birth, but also of shoulder dystocia, compared to manual rotation followed by direct forceps. This is the first study to demonstrate a statistically significant increase in the rate of shoulder dystocia following rotational forceps birth. [ABSTRACT FROM AUTHOR]