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Key content: The perinatal period confers an elevated risk of both relapses and new onset of mental illness. Suboptimal treatment can have a profound impact on maternal mortality and morbidity, neonatal outcomes and longer term child development.Most psychotropic medication can be used safely in pregnancy, with some notable exceptions.While decisions on the use of psychotropic medications in pregnancy are often complex and should be multidisciplinary, it is imperative that obstetricians and gynaecologists familiarise themselves with current literature to provide evidence‐based counselling and care.Existing guidelines on the use of psychotropic medication are largely aimed at psychiatrists, and to date there has been a lack of concise, digestible information with a focus on core knowledge for obstetricians and gynaecologists.We summarise existing evidence on the use of antidepressants, antipsychotics, mood stabilisers and sedatives in the perinatal period. For each drug class we describe the teratogenicity, impact on pregnancy, breastfeeding and the newborn. Learning objectives: To be familiar with common psychotropic medication used in pregnancy and the postpartum period.To understand key evidence on the safety profile of psychiatric medication in the perinatal period and apply this to individualised counselling. [ABSTRACT FROM AUTHOR]

Objective: To create a sensorised surgical glove that can accurately identify obstetric anal sphincter injury to facilitate timely repair, reduce complications and aid training. Design: Proof‐of‐concept. Setting: Laboratory. Sample: Pig models. Methods: Flexible triboelectric pressure/force sensors were mounted onto the fingertips of a routine surgical glove. The sensors produce a current when rubbed on materials of different characteristics which can be analysed. A per rectum examination was performed on the intact sphincter of pig cadavers, analogous to routine examination for obstetric anal sphincter injuries postpartum. An anal sphincter defect was created by cutting through the vaginal mucosa and into the external anal sphincter using a scalpel. The sphincter was then re‐examined. Data and signals were interpreted. Main Outcome Measures: Sensitivity and specificity of the glove in detecting anal sphincter injury. Results: In all, 200 examinations were performed. The sensors detected anal sphincter injuries in a pig model with sensitivities between 98% and 100% and a specificity of 100%. The current produced when examining an intact sphincter and sphincter with a defect was significantly different (p < 0.001). Conclusion: In this preliminary study, the sensorised glove accurately detected anal sphincter injury in a pig model. Future plans include its clinical translation, starting with an in‐human study on postpartum women, to determine whether it can accurately detect different types of obstetric anal sphincter injury in vivo. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of maternal Coronavirus disease 2019 (COVID‐19) infection on placental histopathological findings in an unselected population and evaluate the potential effect on the fetus, including the possibility of vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Design: Retrospective cohort comparative study of placental histopathological findings in patients with COVID‐19, compared with controls. Setting: During the COVID‐19 pandemic, placentas were studied from women at University College Hospital London who reported and/or tested positive for COVID‐19. Population: Of 10 508 deliveries, 369 (3.5%) women had COVID‐19 during pregnancy, with placental histopathology available for 244 women. Methods: Retrospective review of maternal and neonatal characteristics, where placental analysis had been performed. This was compared with available, previously published, histopathological findings from placentas of unselected women. Main outcome measures: Frequency of placental histopathological findings and relevant clinical outcomes. Results: Histological abnormalities were reported in 117 of 244 (47.95%) cases, with the most common diagnosis being ascending maternal genital tract infection. There was no statistically significant difference in the frequency of most abnormalities compared with controls. There were four cases of COVID‐19 placentitis (1.52%, 95% CI 0.04%–3.00%) and one possible congenital infection, with placental findings of acute maternal genital tract infection. The rate of fetal vascular malperfusion (FVM), at 4.5%, was higher compared with controls (p = 0.00044). Conclusions: In most cases, placentas from pregnant women infected with SARS‐CoV‐2 virus do not show a significantly increased frequency of pathology. Evidence for transplacental transmission of SARS‐CoV‐2 is lacking from this cohort. There is a need for further study into the association between FVM, infection and diabetes. [ABSTRACT FROM AUTHOR]

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]

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. [ABSTRACT FROM AUTHOR]

This is particularly pertinent to the complex procedure of rotational vaginal birth, including Kielland forceps. Both non-rotational and rotational instrumental deliveries, including the use of Kielland forceps, are among the techniques taught. Matsubara et al.[1] posed the question if Kielland forceps are for the exclusive use of doctors from the UK following a recent meta-analysis by Giacchino et al.[2] This meta-analysis found that Kielland forceps are safe for the management of malposition of the fetal head in the second stage of labour. [Extracted from the article]

Abstract: Background: Experiencing stillbirth is devastating and leaves parents searching for causes. Autopsy is the gold standard for investigation, but deciding to consent to this procedure is very difficult for parents. Decision support in the form of clear, consistent, and parent‐centered information is likely to be helpful. The aims of this study were to understand the influences on parents’ decisions about autopsy after stillbirth and to identify attributes of effective decision support that align with parents’ needs. Methods: Framework analysis using the Decision Drivers Model was used to analyze responses from 460 Australian and New Zealand (ANZ) mothers who took part in a multi‐country online survey of parents’ experiences of stillbirth. The main outcomes examined were factors influencing mothers’ decisions to consent to autopsy after stillbirth. Results: Free‐text responses from 454 ANZ mothers referenced autopsy, yielding 1221 data segments for analysis. The data confirmed the difficult decision autopsy consent entails. Mothers had a strong need for answers coupled with a strong need to protect their baby. Four “decision drivers” were confirmed: preparedness for the decision; parental responsibility; possible consequences; and role of health professionals. Each had the capacity to influence decisions for or against autopsy. Also prominent were the “aftermath” of the decision: receiving the results; and decisional regret or uncertainty. Conclusions: The influences on decisions about autopsy are diverse and unpredictable. Effective decision support requires a consistent and structured approach that is built on understanding of parents’ needs. [ABSTRACT FROM AUTHOR]

Linked article: This is a mini commentary on Giacchino et al., pp. 856–864 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.17402. [ABSTRACT FROM AUTHOR]

We describe lessons for safety from a synthesis of seven studies of teamwork, leadership and team training across a healthcare region. Two studies identified successes and challenges in a unit with embedded team training: a staff survey demonstrated a positive culture but a perceived need for greater senior presence; training improved actual emergency care, but wide variation in team performance remained. Analysis of multicenter simulation records showed that variation in patient safety and team efficiency correlated with their teamwork but not individual knowledge, skills or attitudes. Safe teams tended to declare the emergency earlier, hand over in a more structured way, and use closed-loop communication. Focused and directed communication was also associated with better patient-actor perception of care. Focus groups corroborated these findings, proposed that the capability and experience of the leader is more important than seniority, and identified teamwork and leadership issues that require further research. [ABSTRACT FROM AUTHOR]

Key content The importance of guideline development., The gap between knowledge and practice., Evidence for implementation strategies., Learning objectives To understand how simple guidelines fail to promote change., To understand the evidence for implementation tools., To understand the range of implementation tools, such as: integrated care pathways, care bundles (venous thromboembolism [VTE] risk assessment), equipment boxes (e.g. eclampsia), decision stickers (e.g. cardiotocography [CTG] analysis), safety briefings/structured ward rounds., How to go about designing an implementation project., How to effect change. [ABSTRACT FROM AUTHOR]

Context Poor interprofessional relationships in maternity units have resulted in a number of suboptimal outcomes: students are reluctant to pursue careers in obstetrics and gynaecology (O&G); trainees feel bullied, and poor communication between professionals results in avoidable adverse events. Interprofessional learning has been advocated to improve interprofessional relationships, but recent interventions have not been successful at undergraduate level. This study aimed to address this issue locally and then to disseminate our lessons, successes and challenges. Methods A strategy for interprofessional team-working was developed in a large maternity unit in the UK, with a variety of interprofessional interventions spanning the attachment and opportunities to participate in specific task or research teams. These interventions were evaluated before the strategy proceeded to large-scale implementation, with a validated attitudes questionnaire (Pollard) and a reaction survey. Results Interprofessional relationships improved significantly ( P < 0.05) after the O&G attachment. There was also some improvement of borderline significance ( P = 0.05) in interprofessional teamwork and communication, as well as a non-significant improvement in perceptions of interprofessional interactions. Most (17/27, 63%) students stated that O&G was their primary career intention after the attachment. They did not witness any bullying or interprofessional difficulties. Conclusions Contrary to findings in other studies, in which initial idealism has been reported to have collapsed after working with students from other professions, we achieved a positive reaction to the O&G attachment, harnessing students’ initial positivity towards interprofessional learning and cementing it into real optimism. Our promising initial results suggest that more work is needed to further increase the impact of such strategies and to determine whether the improvements in attitudes translate to improved clinical behaviour and thence patient outcomes. [ABSTRACT FROM AUTHOR]

I Sir i , We welcome the recent I BJOG i Perspectives article from Ravi and colleagues advocating for universal inclusion of stillbirth in UK medical school curricula and their thoughtful discussion about opportunities for medical students to contribute to perinatal bereavement care.[1] We support their conclusions and provide additional emphasis on two particular aspects of care after stillbirth: first, ensuring that care is culturally appropriate, and second, acknowledging the specific needs of fathers. Why stillbirth deserves a place on the medical school curriculum: Stillbirth-related teaching in UK medical schools. [Extracted from the article]

The article offers information on the systematic review registrations by the International Prospective Register of Systematic Reviews (PROSPERO) in Great Britain. The author mentions that the new registration initiative is geared at encouraging registration. Moreover, the rationale behind the new policy of systematic registration review are also mentioned.

An introduction is presented in which the editor discusses several articles published within issue on topics including use of labour management guidelines for preventing stillbirths, findings around maternal sleep position, and private versus public care outcomes and antenatal care practices.

Objective Methods Results Conclusion To evaluate the accuracy of combined models of maternal biophysical factors, ultrasound, and biochemical markers for predicting stillbirths.A retrospective cohort study of pregnant women undergoing first‐trimester pre‐eclampsia screening at 11–13 gestational weeks was conducted. Maternal characteristics and history, mean arterial pressure (MAP) measurement, uterine artery pulsatility index (UtA‐PI) ultrasound, maternal ophthalmic peak ratio Doppler, and placental growth factor (PlGF) serum were collected during the visit. Stillbirth was classified as placental dysfunction‐related when it occurred with pre‐eclampsia or birth weight <10th percentile. Combined prediction models were developed from significant variables in stillbirths, placental dysfunction‐related, and controls. We used the area under the receiver‐operating‐characteristics curve (AUC), sensitivity, and specificity based on a specific cutoff to evaluate the model's predictive performance by measuring the capacity to distinguish between stillbirths and live births.There were 13 (0.79%) cases of stillbirth in 1643 women included in the analysis. The combination of maternal factors, MAP, UtA‐PI, and PlGF, significantly contributed to the prediction of stillbirth. This model was a good predictor for all (including controls) types of stillbirth (AUC 0.879, 95% CI: 0.799–0.959, sensitivity of 99.3%, specificity of 38.5%), and an excellent predictor for placental dysfunction‐related stillbirth (AUC 0.984, 95% CI: 0.960–1.000, sensitivity of 98.5, specificity of 85.7).Screening at 11–13 weeks' gestation by combining maternal factors, MAP, UtA‐PI, and PlGF, can predict a high proportion of stillbirths. Our model has good accuracy for predicting stillbirths, predominantly placental dysfunction‐related stillbirths. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Preventable prematurity and fetal loss from IVF twins depend on embryo transfer policies" by Susan Bewley.

In this article, the author focuses on teaming of the periodical with The Obstetrician and Gynaecologist (TOG), the continuing professional development (CPD) Journal of the RCOG.

The author discusses the participation of public and patient in stillbirth research and research ethics. The authors are critical on the significant of well-being of public/patient collaboration in sensitive research that might recall bad memories. Also examined is the major role of public/patient expert to support and assist representative of a patient panel for maternity research.

A letter to the editor is presented in response to the article "Creating a Collaborative Culture in Maternity Care," by S. Downe and colleagues, published in a 2010 issue of the periodical.

Objective: To create a sensorised surgical glove that can accurately identify obstetric anal sphincter injury to facilitate timely repair, reduce complications and aid training., Design: Proof-of-concept., Setting: Laboratory., Sample: Pig models., Methods: Flexible triboelectric pressure/force sensors were mounted onto the fingertips of a routine surgical glove. The sensors produce a current when rubbed on materials of different characteristics which can be analysed. A per rectum examination was performed on the intact sphincter of pig cadavers, analogous to routine examination for obstetric anal sphincter injuries postpartum. An anal sphincter defect was created by cutting through the vaginal mucosa and into the external anal sphincter using a scalpel. The sphincter was then re-examined. Data and signals were interpreted., Main Outcome Measures: Sensitivity and specificity of the glove in detecting anal sphincter injury., Results: In all, 200 examinations were performed. The sensors detected anal sphincter injuries in a pig model with sensitivities between 98% and 100% and a specificity of 100%. The current produced when examining an intact sphincter and sphincter with a defect was significantly different (p < 0.001)., Conclusion: In this preliminary study, the sensorised glove accurately detected anal sphincter injury in a pig model. Future plans include its clinical translation, starting with an in-human study on postpartum women, to determine whether it can accurately detect different types of obstetric anal sphincter injury in vivo., (© 2024 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Objective: To assess the impact of maternal Coronavirus disease 2019 (COVID-19) infection on placental histopathological findings in an unselected population and evaluate the potential effect on the fetus, including the possibility of vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)., Design: Retrospective cohort comparative study of placental histopathological findings in patients with COVID-19, compared with controls., Setting: During the COVID-19 pandemic, placentas were studied from women at University College Hospital London who reported and/or tested positive for COVID-19., Population: Of 10 508 deliveries, 369 (3.5%) women had COVID-19 during pregnancy, with placental histopathology available for 244 women., Methods: Retrospective review of maternal and neonatal characteristics, where placental analysis had been performed. This was compared with available, previously published, histopathological findings from placentas of unselected women., Main Outcome Measures: Frequency of placental histopathological findings and relevant clinical outcomes., Results: Histological abnormalities were reported in 117 of 244 (47.95%) cases, with the most common diagnosis being ascending maternal genital tract infection. There was no statistically significant difference in the frequency of most abnormalities compared with controls. There were four cases of COVID-19 placentitis (1.52%, 95% CI 0.04%-3.00%) and one possible congenital infection, with placental findings of acute maternal genital tract infection. The rate of fetal vascular malperfusion (FVM), at 4.5%, was higher compared with controls (p = 0.00044)., Conclusions: In most cases, placentas from pregnant women infected with SARS-CoV-2 virus do not show a significantly increased frequency of pathology. Evidence for transplacental transmission of SARS-CoV-2 is lacking from this cohort. There is a need for further study into the association between FVM, infection and diabetes., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

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., (© 2021 Wiley Periodicals LLC.)

Background: Experiencing stillbirth is devastating and leaves parents searching for causes. Autopsy is the gold standard for investigation, but deciding to consent to this procedure is very difficult for parents. Decision support in the form of clear, consistent, and parent-centered information is likely to be helpful. The aims of this study were to understand the influences on parents' decisions about autopsy after stillbirth and to identify attributes of effective decision support that align with parents' needs., Methods: Framework analysis using the Decision Drivers Model was used to analyze responses from 460 Australian and New Zealand (ANZ) mothers who took part in a multi-country online survey of parents' experiences of stillbirth. The main outcomes examined were factors influencing mothers' decisions to consent to autopsy after stillbirth., Results: Free-text responses from 454 ANZ mothers referenced autopsy, yielding 1221 data segments for analysis. The data confirmed the difficult decision autopsy consent entails. Mothers had a strong need for answers coupled with a strong need to protect their baby. Four "decision drivers" were confirmed: preparedness for the decision; parental responsibility; possible consequences; and role of health professionals. Each had the capacity to influence decisions for or against autopsy. Also prominent were the "aftermath" of the decision: receiving the results; and decisional regret or uncertainty., Conclusions: The influences on decisions about autopsy are diverse and unpredictable. Effective decision support requires a consistent and structured approach that is built on understanding of parents' needs., (© 2018 Wiley Periodicals, Inc.)