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Socioeconomic deprivation and minority ethnic background are risk factors for adverse pregnancy outcomes. We aimed to quantify the magnitude of these socioeconomic and ethnic inequalities at the population level in England.In this cohort study, we used data compiled by the National Maternity and Perinatal Audit, based on birth records from maternity information systems used by 132 National Health Service hospitals in England, linked to administrative hospital data. We included women who gave birth to a singleton baby with a recorded gestation between 24 and 42 completed weeks. Terminations of pregnancy were excluded. We analysed data on stillbirth, preterm birth (37 weeks of gestation), and fetal growth restriction (FGR; liveborn with birthweight3rd centile by the UK definition) in England, and compared these outcomes by socioeconomic deprivation quintile and ethnic group. We calculated attributable fractions for the entire population and specific groups compared with least deprived groups or White women, both unadjusted and with adjustment for smoking, body-mass index (BMI), and other maternal risk factors.We identified 1 233 184 women with a singleton birth between April 1, 2015, and March 31, 2017, of whom 1 155 981 women were eligible and included in the analysis. 4505 (0·4%) of 1 155 981 births were stillbirths. Of 1 151 476 livebirths, 69 175 (6·0%) were preterm births and 22 679 (2·0%) were births with FGR. Risk of stillbirth was 0·3% in the least socioeconomically deprived group and 0·5% in the most deprived group (p0·0001), risk of a preterm birth was 4·9% in the least deprived group and 7·2% in the most deprived group (p0·0001), and risk of FGR was 1·2% in the least deprived group and 2·2% in the most deprived group (p0·0001). Population attributable fractions indicated that 23·6% (95% CI 16·7-29·8) of stillbirths, 18·5% (16·9-20·2) of preterm births, and 31·1% (28·3-33·8) of births with FGR could be attributed to socioeconomic inequality, and these fractions were substantially reduced when adjusted for ethnic group, smoking, and BMI (11·6% for stillbirths, 11·9% for preterm births, and 16·4% for births with FGR). Risk of stillbirth ranged from 0·3% in White women to 0·7% in Black women (p0·0001); risk of preterm birth was 6·0% in White women, 6·5% in South Asian women, and 6·6% in Black women (p0·0001); and risk of FGR ranged from 1·4% in White women to 3·5% in South Asian women (p0·0001). 11·7% of stillbirths (95% CI 9·8-13·5), 1·2% of preterm births (0·8-1·6), and 16·9% of FGR (16·1-17·8) could be attributed to ethnic inequality. Adjustment for socioeconomic deprivation, smoking, and BMI only had a small effect on these ethnic group attributable fractions (13·0% for stillbirths, 2·6% for preterm births, and 19·2% for births with FGR). Group-specific attributable fractions were especially high in the most socioeconomically deprived South Asian women and Black women for stillbirth (53·5% in South Asian women and 63·7% in Black women) and FGR (71·7% in South Asian women and 55·0% in Black women).Our results indicate that socioeconomic and ethnic inequalities were responsible for a substantial proportion of stillbirths, preterm births, and births with FGR in England. The largest inequalities were seen in Black and South Asian women in the most socioeconomically deprived quintile. Prevention should target the entire population as well as specific minority ethnic groups at high risk of adverse pregnancy outcomes, to address risk factors and wider determinants of health.Healthcare Quality Improvement Partnership.

BACKGROUND: Some studies have suggested that women with SARS-CoV-2 infection during pregnancy are at increased risk of adverse pregnancy and neonatal outcomes, but these associations are still not clear. OBJECTIVE: This study aimed to determine the association between SARS-CoV-2 infection at the time of birth and maternal and perinatal outcomes. STUDY DESIGN: This is a population-based cohort study in England. The inclusion criteria were women with a recorded singleton birth between May 29, 2020, and January 31, 2021, in a national database of hospital admissions. Maternal and perinatal outcomes were compared between pregnant women with a laboratory-confirmed SARS-CoV-2 infection recorded in the birth episode and those without. Study outcomes were fetal death at or beyond 24 weeks' gestation (stillbirth), preterm birth (.05) in the rate of other maternal outcomes. The risk of neonatal adverse outcome (adjusted odds ratio, 1.45; 95% confidence interval, 1.27-1.66; P

Objective To determine the association between ethnic group and likelihood of admission to intensive care in pregnancy and the postnatal period. Design Cohort study. Setting Maternity and intensive care units in England and Wales. Population or sample A total of 631 851 women who had a record of a registerable birth between 1 April 2015 and 31 March 2016 in a database used for national audit. Methods Logistic regression analyses of linked maternity and intensive care records, with multiple imputation to account for missing data. Main outcome measures Admission to intensive care in pregnancy or postnatal period to 6 weeks after birth. Results In all, 2.24 per 1000 maternities were associated with intensive care admission. Black women were more than twice as likely as women from other ethnic groups to be admitted (odds ratio [OR] 2.21, 95% CI 1.82-2.68). This association was only partially explained by demographic, lifestyle, pregnancy and birth factors (adjusted OR 1.69, 95% CI 1.37-2.09). A higher proportion of intensive care admissions in Black women were for obstetric haemorrhage than in women from other ethnic groups. Conclusions Black women have an increased risk of intensive care admission that cannot be explained by demographic, health, lifestyle, pregnancy and birth factors. Clinical and policy intervention should focus on the early identification and management of severe illness, particularly obstetric haemorrhage, in Black women, in order to reduce inequalities in intensive care admission. Tweetable abstract Black women are almost twice as likely as White women to be admitted to intensive care during pregnancy and the postpartum period; this risk remains after accounting for demographic, health, lifestyle, pregnancy and birth factors.

While the aviation industry is dominated by narratives of smooth, unending growth and future planning, in practice it is profoundly striated and asymmetrical. Through an ethnographic study of how air traffic controllers, pilots, and operations staff in Nepal experience “air pressure,” this article demonstrates how understandings of the uneven geography of aviation infrastructure are framed in terms of time. Nepali airports are often perceived as “lagging behind” or “quaint” in comparison to other airports around the world, and air traffic congestion in Nepal can create bottlenecks that in turn have massive implications for the wider system. Yet some kinds of disruption—such as unpredictable weather—reconfigure familiar hierarchies, bringing the value of Nepali aviators’ knowledge of how to manage difficult skies to the forefront of aviation futures. Aviation personnel highlight and expose severe inequalities in global aviation infrastructure systems while also contributing to them in ways that reveal specific ideas about the future of the nation. Unravelling these “tangles of temporalities” may provide a better understanding of how global temporal regimes are harnessed so as to shape lives. सारांश उड्डयन उद्योग सहज तथा निरन्तर वृद्धि हुने र भावी योजना बनिरहने क्षेत्र हो भन्ने भाष्य हावी छ, तर व्यवहारमा यो अत्यन्त खण्डित र विषम छ । नेपालका हवाई ट्राफिक नियन्त्रक, विमान चालक, र हवाई सेवा सञ्चालन कर्मचारीहरूले कसरी “हवाई चाप” लाई अनुभव गर्छन् भन्ने विषयको एथ्नोग्राफिक अध्ययनको आधारमा यो लेखले उड्डयन पूर्वाधारको असमान धरातललाई कसरी कालिक ढाँचामा बुझ्ने गरिन्छ भन्ने देखाउन खोजेको छ । विश्वका अरू विमानस्थलहरूको तुलनामा नेपालका विमानस्थलहरू “पिछडिएका” र “विचित्रका” मानिए पनि, नेपालमा हवाई ट्राफिकको घुइँचोले विभिन्न अवरोधहरू सिर्जना गर्न सक्छन्, जसले सिङ्गो प्रणालीमा बृहत् प्रभाव पार्न सक्ने कुराको सङ्केत गर्छ । अप्रत्याशित मौसम परिवर्तन जस्ता केही अवरोधले उड्डयन उद्योगमा विद्यमान श्रेणीयताहरू (हायरार्की) को पुनर्विन्यास गरिदिन्छन्, जसले नेपाली उड्डयन कर्मचारीहरूले विषम परिस्थितिमा गर्दै आएको हवाई ट्राफिक व्यवस्थापनको ज्ञानको महत्त्वलाई उड्डयन भविष्य बजारको अग्रपङ्तिमा ल्याइदिन्छ । उड्डयन कर्मचारीहरूले वैश्विक उड्डयन पूर्वाधार प्रणालीहरूमा रहेका गम्भीर असमानताहरू झल्काउनका साथै ती असमानताहरू सिर्जना गर्नमा पनि योगदान गर्छन्, र राष्ट्रको भविष्य बारेका निश्चित विचारहरूलाई उद्घाटित गर्छन् । यी “कालिकताहरूका गुजुल्टा” को फुकाइले कसरी जनजीवनलाई प्रभाव पार्न वैश्विक कालिक व्यवस्थालाई उपयोगमा ल्याइन्छ भन्ने बारे अझ राम्ररी बुझ्न मद्दत गर्न सक्छ ।

Objectives To determine the rate of complicated birth at term in women classified at low risk according to the National Institute for Health and Care Excellence guideline for intrapartum care (no pre-existing medical conditions, important obstetric history, or complications during pregnancy) and to assess if the risk classification can be improved by considering parity and the number of risk factors. Design Cohort study using linked electronic maternity records. Participants 276 766 women with a singleton birth at term after a trial of labour in 87 NHS hospital trusts in England between April 2015 and March 2016. Main outcome measure A composite outcome of complicated birth, defined as a birth with use of an instrument, caesarean delivery, anal sphincter injury, postpartum haemorrhage, or Apgar score of 7 or less at five minutes. Results Multiparous women without a history of caesarean section had the lowest rates of complicated birth, varying from 8.8% (4879 of 55 426 women, 95% confidence interval 8.6% to 9.0%) in those without specific risk factors to 21.8% (613 of 2811 women, 20.2% to 23.4%) in those with three or more. The rate of complicated birth was higher in nulliparous women, with corresponding rates varying from 43.4% (25 805 of 59 413 women, 43.0% to 43.8%) to 64.3% (364 of 566 women, 60.3% to 68.3%); and highest in multiparous women with previous caesarean section, with corresponding rates varying from 42.9% (3426 of 7993 women, 41.8% to 44.0%) to 66.3% (554 of 836 women, 63.0% to 69.5%). Conclusions Nulliparous women without risk factors have substantially higher rates of complicated birth than multiparous women without a previous caesarean section even if the latter have multiple risk factors. Grouping women first according to parity and previous mode of birth, and then within these groups according to presence of specific risk factors would provide greater and more informed choice to women, better targeting of interventions, and fewer transfers during labour than according to the presence of risk factors alone.

Gaining approval for clinical research can be a long and drawn out process. For midwives considering clinical research the process of gaining access and approval needs to be explored well in advance. This article outlines the process of gaining approval and access based upon the author's experiences in a study currently being conducted on midwifery practice in the third stage of labour. This particular project involved approval from several institutions and individuals. Approval was required from the university where students who may be observed were studying, approval for the researcher to be released to conduct the research and approval from the NHS Trusts and Ethics Committee where observation of clients and interviews with midwives was to be conducted. The important issue of indemnity will also be explored

This paper suggests that midwives re-evaluate management strategies for the third stage of labour and reflect upon the widely-held belief that intervention at this time is an improvement on the normal physiological processes and is without risk. Midwives are challenged to embrace a normal rather than a risk focus in light of support from WHO, who suggest ‘definite conclusions about the value of active management of the third stage in healthy low-risk populations cannot yet be drawn’ (WHO, 1999). If midwives are to face this challenge they need to be proactive in normalising the third stage, developing expertise in expectant management and revisiting skills in detecting those women deviating from normal in whom an active third stage may be appropriate.