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3. CRADLE-5: a stepped-wedge type 2 hybrid implementation-effectiveness cluster randomised controlled trial to evaluate the real-world scale-up of the CRADLE Vital Signs Alert intervention into routine maternity care in Sierra Leone—study protocol

Author

Ridout, Alexandra E., Moses, Francis L., Herm-Singh, Simren, Turienzo, Cristina Fernandez, Seed, Paul T., Goodhart, Venetia, Vousden, Nicola, Sam, Betty, Momoh, Mariama, Kamara, Daniel, Kuhrt, Katy, Samura, Sorie, Beoku-Betts, Candace, Hurrell, Alice, Bramham, Kate, Kenneh, Sartie, Smart, Francis, Chappell, Lucy, Sandall, Jane, and Shennan, Andrew

Published
2023
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4. Planned delivery or expectant management for late preterm pre-eclampsia in low-income and middle-income countries (CRADLE-4): a multicentre, open-label, randomised controlled trial

Author

Kopeka, Mercy, Miti, Josephine, Jere, Christine, Hamweemba, Chipo, Mubiana, Sandra, Ntamba Mukosa, Louise, Tembo, Aaron, Gondwe, Philip, Mallapur, Ashalata, Ramadurg, Umesh, Kittur, Sahaja, Wari, Prakash, Gudadinni, Muttu R, Methapati, Sangamesh, Charki, Siddu, Hunter, Rachael, Beardmore-Gray, Alice, Vousden, Nicola, Seed, Paul T, Vwalika, Bellington, Chinkoyo, Sebastian, Sichone, Victor, Kawimbe, Alexander B, Charantimath, Umesh, Katageri, Geetanjali, Bellad, Mrutyunjaya B, Lokare, Laxmikant, Donimath, Kasturi, Bidri, Shailaja, Goudar, Shivaprasad, Sandall, Jane, Chappell, Lucy C, and Shennan, Andrew H

Published
2023
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5. Evaluation of the introduction of a novel vital sign device in the management of hypertension and shock in pregnancy in low and middle income countries

Author

Vousden, Nicola Jayne, Shennan, Andrew Hoseason, and Chappell, Lucy Charlotte

Subjects
618.3
Abstract

Background: In 2015, over 800 women died in pregnancy and childbirth every day. There are effective treatments for the leading causes of maternal death, but they require early detection by measurement of vital signs, and timely administration to save lives. The CRADLE-Vital Sign Alert accurately measures blood pressure and pulse and calculates shock index. Results are displayed on a traffic light early warning system. This aim of this thesis was to evaluate the impact of this intervention on maternal mortality and morbidity in low and middle-income countries. Methods: A pragmatic, stepped-wedge randomised-controlled trial with a nested mixed-methods process evaluation was undertaken. This was preceded by a mixed-method feasibility study. The intervention was introduced into every level of routine maternity care across 10 clusters in Africa, India and Haiti. The primary composite outcome was at least one of eclampsia, emergency hysterectomy and maternal death per 10,000 deliveries. Delivery of the intervention, its uptake and potential mechanism of action were measured and integrated with qualitative findings and measures of resources and staffing in each cluster. Findings: Between April 1st 2016 and November 30th 2017, among 536,223 deliveries, the primary outcome occurred in 4067 women. There was an 8% decrease in the primary outcome from 79.4/10,000 deliveries pre-intervention to 72.8/10,000 post-intervention. After planned adjustments for variation in event rates between and within clusters over time, the unexpected degree of variability meant we were unable to judge the benefit or harms of the intervention (OR 1.22, 95% CI 0.73-2.06a p=0.45). Overall, the intervention was delivered with reasonable fidelity and improved the availability of vital signs equipment and number of women with BP measurements (79.2%-s. 97.6%a OR 1.30, 95% CI 1.29 - 1.31). Therewere significant differences in the effect of the intervention between 8 individual clusters which could not be explained by the measures of implementation or local context. Interpretation: The acceptability and feasibility of the intervention has been demonstrated. Despite the rigorous trial design, effectiveness of the intervention at reducing mortality and morbidity has not been shown. Measuring implementation alongside effectiveness was feasible and beneficial in describing differences between clusters in maternal health. In this case, these differences could not explain the difference in the effect of the intervention between individual clusters. Stepped-wedge trials across multiple countries ha -e considerable methodological challenges and should be powered to demonstrate an effect of the intervention in each country. Further research in the selection and integration of process measures in low and middle -income countries is required.

Published
2019

9. Ethnicity, disadvantage and pregnancy outcomes in the UK.

Author

Vousden, Nicola and Knight, Marian

Subjects
ETHNIC groups, HEALTH services accessibility, COMMUNITY support, COMMUNITY health services, CORPORATE culture, SOCIAL determinants of health, OCCUPATIONAL roles, INSTITUTIONAL racism, AT-risk people, PREGNANCY outcomes, PSYCHOLOGY of women, INFORMATION services, HEALTH equity, MEDICALLY underserved persons, PSYCHOSOCIAL factors
Abstract

Inequalities in maternal and perinatal outcomes related to ethnicity and socioeconomic deprivation are widening. Being of Black and Asian ethnicity independently increases the risk of maternal mortality and severe morbidity, as does living in the most deprived areas. Since a higher proportion of women of Asian and Black ethnicity live in the most deprived areas, this effect is compounded. Individual risks, such as obesity, are influenced by health and cultural beliefs and behaviour, social networks and norms, the environments in which we live, and access to and experience of healthcare, which are all intertwined with ethnicity and socioeconomic status. Clinicians can listen to women's and communities needs around ethnicity, race, and social determinants of health. Clinicians can also identify and use networks of community support and promote awareness within their practice and teams. Institutions can employ and retain diverse teams, measure health equity of services and develop an anti-discriminatory institutional culture. [ABSTRACT FROM AUTHOR]

Published
2024
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12. Effect of a novel vital sign device on maternal mortality and morbidity in low-resource settings: a pragmatic, stepped-wedge, cluster-randomised controlled trial

Author

Kachinjika, Monice, Bukani, Doreen, Makwakwa, Jane, Makonyola, Grace, Brown, Adrian, Toussaint, Paul, Vixama, Adeline, Greene, Grace, Hill, Carwyn, Nakiriija, Emily, Birungi, Doreen, Kalyowa, Noela, Namakula, Dorothy, Byamugisha, Josaphat, Nakimuli, Annettee, Mackayi Odeke, Nathan, Ditai, James, Wandabwa, Julius, Momodou, Fatmata, Sesay, Margaret, Sandi, Patricia, Conteh, Jeneba, Kamara, Jesse, Clarke, Matthew, Best, Rebecca, Miti, Josephine, Kopeka, Mercy, Vwalika, Bellington, Chima, Martina, Musonda, Thokozile, Jere, Christine, Chinkoyo, Sebastian, Mambo, Violet, Guchale, Yonas, Yadeta, Lomi, Surur, Feiruz, Mungarwadi, Geetanjali M, Mastiholi, Sphoorthi S, Karadiguddi, Chandrappa C, Charantimath, Umesh, Bellad, Mrutyunjaya, Hezelgrave, Natasha, Duhig, Kate E, Vousden, Nicola, Lawley, Elodie, Nathan, Hannah L, Seed, Paul T, Gidiri, Muchabayiwa Francis, Goudar, Shivaprasad, Sandall, Jane, Chappell, Lucy C, and Shennan, Andrew H

Published
2019
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14. CRADLE-5: A stepped-wedge type 2 hybrid implementation-effectiveness randomised controlled trial to evaluate the real-world scale-up of the CRADLE Vital Signs Alert into routine maternity care in Sierra Leone: study protocol

Author

Ridout, Alexandra, primary, Moses, Francis, additional, Singh, Simren Herm, additional, Turienzo, Cristina Fernandez, additional, Seed, paul T, additional, Goodhart, Venetia, additional, Vousden, Nicola, additional, Sam, Betty, additional, Momoh, Mariama, additional, Kamara, Daniel, additional, Kuhrt, Katy, additional, Samura, Sorie, additional, Beoku-Bett, Candace, additional, Hurrell, Alice, additional, Bramham, Kate, additional, Kenneh, Sarie, additional, Smart, Francis, additional, Chappell, Lucy, additional, Sandall, Jane, additional, and Shennan, Andrew, additional

Published
2023
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15. Planned early delivery versus expectant management to reduce adverse pregnancy outcomes in pre-eclampsia in a low- and middle-income setting: study protocol for a randomised controlled trial (CRADLE-4 Trial)

Author

Beardmore-Gray, Alice, Vousden, Nicola, Charantimath, Umesh, Katageri, Geetanjali, Bellad, Mrutyunjaya, Kapembwa, Kunda, Chinkoyo, Sebastian, Vwalika, Bellington, Clark, Matthew, Hunter, Rachael, Seed, Paul, Goudar, Shivaprasad, Chappell, Lucy C., and Shennan, Andrew

Published
2020
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18. Planned delivery or expectant management for late preterm pre-eclampsia in low-income and middle-income countries (CRADLE-4): a multicentre, open-label, randomised controlled trial

Author

Beardmore-Gray, Alice, primary, Vousden, Nicola, additional, Seed, Paul T, additional, Vwalika, Bellington, additional, Chinkoyo, Sebastian, additional, Sichone, Victor, additional, Kawimbe, Alexander B, additional, Charantimath, Umesh, additional, Katageri, Geetanjali, additional, Bellad, Mrutyunjaya B, additional, Lokare, Laxmikant, additional, Donimath, Kasturi, additional, Bidri, Shailaja, additional, Goudar, Shivaprasad, additional, Sandall, Jane, additional, Chappell, Lucy C, additional, Shennan, Andrew H, additional, Kopeka, Mercy, additional, Miti, Josephine, additional, Jere, Christine, additional, Hamweemba, Chipo, additional, Mubiana, Sandra, additional, Ntamba Mukosa, Louise, additional, Tembo, Aaron, additional, Gondwe, Philip, additional, Mallapur, Ashalata, additional, Ramadurg, Umesh, additional, Kittur, Sahaja, additional, Wari, Prakash, additional, Gudadinni, Muttu R, additional, Methapati, Sangamesh, additional, Charki, Siddu, additional, and Hunter, Rachael, additional

Published
2023
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19. Exploring the effect of implementation and context on a stepped-wedge randomised controlled trial of a vital sign triage device in routine maternity care in low-resource settings

Author

Vousden, Nicola, Lawley, Elodie, Seed, Paul T., Gidiri, Muchabayiwa Francis, Charantimath, Umesh, Makonyola, Grace, Brown, Adrian, Yadeta, Lomi, Best, Rebecca, Chinkoyo, Sebastian, Vwalika, Bellington, Nakimuli, Annettee, Ditai, James, Greene, Grace, Chappell, Lucy C., Sandall, Jane, Shennan, Andrew H., and on behalf of the CRADLE Trial Collaborative Group

Published
2019
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20. Variations across Europe in hospitalization and management of pregnant women with SARS-CoV-2 during the initial phase of the pandemic:Multi-national population-based cohort study using the International Network of Obstetric Survey Systems (INOSS)

Author

de Bruin, Odette, Engjom, Hilde, Vousden, Nicola, Ramakrishnan, Rema, Aabakke, Anna J.M., Äyräs, Outi, Donati, Serena, Jónasdóttir, Eva, Knight, Marian, Overtoom, Evelien M., Salvatore, Michele A., Sturkenboom, Miriam C.J.M., Svanvik, Teresia, Varpula, Reetta, Vercoutere, An, Bloemenkamp, Kitty W.M., de Bruin, Odette, Engjom, Hilde, Vousden, Nicola, Ramakrishnan, Rema, Aabakke, Anna J.M., Äyräs, Outi, Donati, Serena, Jónasdóttir, Eva, Knight, Marian, Overtoom, Evelien M., Salvatore, Michele A., Sturkenboom, Miriam C.J.M., Svanvik, Teresia, Varpula, Reetta, Vercoutere, An, and Bloemenkamp, Kitty W.M.

Abstract

Introduction: The majority of data on COVID-19 in pregnancy are not from sound population-based active surveillance systems. Material and methods: We conducted a multi-national study of population-based national or regional prospective cohorts using standardized definitions within the International Network of Obstetric Survey systems (INOSS). From a source population of women giving birth between March 1 and August 31, 2020, we included pregnant women admitted to hospital with a positive SARS-CoV-2 PCR test ≤7 days prior to or during admission and up to 2 days after birth. The admissions were further categorized as COVID-19-related or non-COVID-19-related. The primary outcome of interest was incidence of COVID-19-related hospital admission. Secondary outcomes included severe maternal disease (ICU admission and mechanical ventilation) and COVID-19-directed medical treatment. Results: In a source population of 816 628 maternities, a total of 2338 pregnant women were admitted with SARS-CoV-2; among them 940 (40%) were COVID-19-related admissions. The pooled incidence estimate for COVID-19-related admission was 0.59 (95% confidence interval 0.27–1.02) per 1000 maternities, with notable heterogeneity across countries (I2 = 97.3%, P = 0.00). In the COVID-19 admission group, between 8% and 17% of the women were admitted to intensive care, and 5%–13% needed mechanical ventilation. Thromboprophylaxis was the most frequent treatment given during COVID-19-related admission (range 14%–55%). Among 908 infants born to women in the COVID-19-related admission group, 5 (0.6%) stillbirths were reported. Conclusions: During the initial months of the pandemic, we found substantial variations in incidence of COVID-19-related admissions in nine European countries. Few pregnant women received COVID-19-directed medical treatment. Several barriers to rapid surveillance were identified. Investment in robust surveillance should be prioritized to prepare for future pandemics.

Published
2023

21. Variations across Europe in hospitalization and management of pregnant women with SARS-CoV-2 during the initial phase of the pandemic: Multi-national population-based cohort study using the International Network of Obstetric Survey Systems (INOSS).

Author

de Bruin, Odette, Engjom, Hilde, Vousden, Nicola, Ramakrishnan, Rema, Aabakke, Anna J M, Äyräs, Outi, Donati, Serena, Jónasdóttir, Eva, Knight, Marian, Overtoom, Evelien, Salvatore, Michele MA, Sturkenboom, Miriam MCJM, Svanvik, Teresia, Varpula, Reetta, Vercoutere, An, Bloemenkamp, Kitty W M, INOSS COVID-19 Working Group, de Bruin, Odette, Engjom, Hilde, Vousden, Nicola, Ramakrishnan, Rema, Aabakke, Anna J M, Äyräs, Outi, Donati, Serena, Jónasdóttir, Eva, Knight, Marian, Overtoom, Evelien, Salvatore, Michele MA, Sturkenboom, Miriam MCJM, Svanvik, Teresia, Varpula, Reetta, Vercoutere, An, Bloemenkamp, Kitty W M, and INOSS COVID-19 Working Group

Abstract

The majority of data on COVID-19 in pregnancy are not from sound population-based active surveillance systems., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2023

24. Planned Delivery or Expectant Management for Late Preterm Pre-eclampsia in Low-Income and Middle-Income Countries (CRADLE-4): A Multicentre, Open-Label, Randomized Controlled Trial.

Author

Beardmore-Gray, Alice, Vousden, Nicola, Seed, Paul T., Vwalika, Bellington, Chinkoyo, Sebastian, Sichone, Victor, Kawimbe, Alexander B., Charantimath, Umesh, Katageri, Geetanjali, Bellad, Mrutyunjaya B., Lokare, Laxmikant, Donimath, Kasturi, Bidri, Shailaja, Goudar, Shivaprasad, Sandall, Jane, Chappell, Lucy C., Shennan, Andrew H., and A. B. C.

Published
2024
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26. Evaluation of a novel vital sign device to reduce maternal mortality and morbidity in low-resource settings: a mixed method feasibility study for the CRADLE-3 trial

Author

Vousden, Nicola, Lawley, Elodie, Nathan, Hannah L., Seed, Paul T., Brown, Adrian, Muchengwa, Tafadzwa, Charantimath, Umesh, Bellad, Mrutyunjaya, Gidiri, Muchabayiwa Francis, Goudar, Shivaprasad, Chappell, Lucy C., Sandall, Jane, Shennan, Andrew H., and on behalf of the CRADLE Trial Collaborative Group

Published
2018
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27. Evaluation of a novel device for the management of high blood pressure and shock in pregnancy in low-resource settings: study protocol for a stepped-wedge cluster-randomised controlled trial (CRADLE-3 trial)

Author

Nathan, Hannah L., Duhig, Kate, Vousden, Nicola, Lawley, Elodie, Seed, Paul T., Sandall, Jane, Bellad, Mrutyunjaya B., Brown, Adrian C., Chappell, Lucy C., Goudar, Shivaprasad S., Gidiri, Muchabayiwa F., Shennan, Andrew H., and the CRADLE-3 Trial Collaboration Group

Published
2018
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29. Severity of maternal SARS-CoV-2 infection and perinatal outcomes of women admitted to hospital during the omicron variant dominant period using UK Obstetric Surveillance System data: prospective, national cohort study

Author

Engjom, Hilde M, primary, Ramakrishnan, Rema, additional, Vousden, Nicola, additional, Bunch, Kathryn, additional, Morris, Eddie, additional, Simpson, Nigel A B, additional, Gale, Chris, additional, O'Brien, Patrick, additional, Quigley, Maria, additional, Brocklehurst, Peter, additional, Kurinczuk, Jennifer J, additional, and Knight, Marian, additional

Published
2022
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30. Incidence of eclampsia and related complications across 10 low- and middle-resource geographical regions: Secondary analysis of a cluster randomised controlled trial

Author

Vousden, Nicola, Lawley, Elodie, Seed, Paul T., Gidiri, Muchabayiwa Francis, Goudar, Shivaprasad, Sandall, Jane, Chappell, Lucy C., and Shennan, Andrew H.

Subjects
Maternal mortality -- Health aspects, Hypertension -- Statistics -- Complications and side effects -- Patient outcomes, Eclampsia -- Statistics -- Complications and side effects -- Patient outcomes, Health care disparities -- Statistics, Mortality, Health care reform, Stillbirth, Magnesium sulfate, Infant mortality, Gender equality, Newborn infants, Health education, Equality, Morbidity, Pregnancy, Sulfates, Medical personnel training, Magnesium compounds, Novels, Biological sciences
Abstract

Background In 2015, approximately 42,000 women died as a result of hypertensive disorders of pregnancy worldwide; over 99% of these deaths occurred in low- and middle-income countries. The aim of this paper is to describe the incidence and characteristics of eclampsia and related complications from hypertensive disorders of pregnancy across 10 low- and middle-income geographical regions in 8 countries, in relation to magnesium sulfate availability. Methods and findings This is a secondary analysis of a stepped-wedge cluster randomised controlled trial undertaken in sub-Saharan Africa, India, and Haiti. This trial implemented a novel vital sign device and training package in routine maternity care with the aim of reducing a composite outcome of maternal mortality and morbidity. Institutional-level consent was obtained, and all women presenting for maternity care were eligible for inclusion. Data on eclampsia, stroke, admission to intensive care with a hypertensive disorder of pregnancy, and maternal death from a hypertensive disorder of pregnancy were prospectively collected from routine data sources and active case finding, together with data on perinatal outcomes in women with these outcomes. In 536,233 deliveries between 1 April 2016 and 30 November 2017, there were 2,692 women with eclampsia (0.5%). In total 6.9% (n = 186; 3.47/10,000 deliveries) of women with eclampsia died, and a further 51 died from other complications of hypertensive disorders of pregnancy (0.95/10,000). After planned adjustments, the implementation of the CRADLE intervention was not associated with any significant change in the rates of eclampsia, stroke, or maternal death or intensive care admission with a hypertensive disorder of pregnancy. Nearly 1 in 5 (17.9%) women with eclampsia, stroke, or a hypertensive disorder of pregnancy causing intensive care admission or maternal death experienced a stillbirth or neonatal death. A third of eclampsia cases (33.2%; n = 894) occurred in women under 20 years of age, 60.0% in women aged 20-34 years (n = 1,616), and 6.8% (n = 182) in women aged 35 years or over. Rates of eclampsia varied approximately 7-fold between sites (range 19.6/10,000 in Zambia Centre 1 to 142.0/10,000 in Sierra Leone). Over half (55.1%) of first eclamptic fits occurred in a health-care facility, with the remainder in the community. Place of first fit varied substantially between sites (from 5.9% in the central referral facility in Sierra Leone to 85% in Uganda Centre 2). On average, magnesium sulfate was available in 74.7% of facilities (range 25% in Haiti to 100% in Sierra Leone and Zimbabwe). There was no detectable association between magnesium sulfate availability and the rate of eclampsia across sites (p = 0.12). This analysis may have been influenced by the selection of predominantly urban and peri-urban settings, and by collection of only monthly data on availability of magnesium sulfate, and is limited by the lack of demographic data in the population of women delivering in the trial areas. Conclusions The large variation in eclampsia and maternal and neonatal fatality from hypertensive disorders of pregnancy between countries emphasises that inequality and inequity persist in healthcare for women with hypertensive disorders of pregnancy. Alongside the growing interest in improving community detection and health education for these disorders, efforts to improve quality of care within healthcare facilities are key. Strategies to prevent eclampsia should be informed by local data. Trial registration ISRCTN: 41244132., Author(s): Nicola Vousden 1,*, Elodie Lawley 1, Paul T. Seed 1, Muchabayiwa Francis Gidiri 2, Shivaprasad Goudar 3, Jane Sandall 1, Lucy C. Chappell 1, Andrew H. Shennan 1, on [...]

Published
2019
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31. COVID-19 infection and medications in pregnancy: pooled analysis of INOSS population-based studies

Author

RCOG World Congress, De Bruin, Odette, Engjom, Hilde, Vousden, Nicola, Knight, Marian, Donati, S., Aabakke, Anna, Äyräs, Outi, Overtoom, Evelien, Vercoutere, An, Jonasdottir, Eva, Bloemenkamp, Kitty, RCOG World Congress, De Bruin, Odette, Engjom, Hilde, Vousden, Nicola, Knight, Marian, Donati, S., Aabakke, Anna, Äyräs, Outi, Overtoom, Evelien, Vercoutere, An, Jonasdottir, Eva, and Bloemenkamp, Kitty

Abstract

info:eu-repo/semantics/published

Published
2022

32. Severity of maternal SARS-CoV-2 infection and perinatal outcomes during the Omicron variant dominant period: UK Obstetric Surveillance System national cohort study

Author

Engjom, Hilde Marie, primary, Ramakrishnan, Rema, additional, Vousden, Nicola, additional, Bunch, Kathryn, additional, Morris, Edward, additional, Simpson, Nigel, additional, Gale, Chris, additional, O’Brien, Pat, additional, Quigley, Maria, additional, Brocklehurst, Peter, additional, Kurinczuk, Jennifer J, additional, and Knight, Marian, additional

Published
2022
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34. Management and implications of severe COVID ‐19 in pregnancy in the UK : data from the UK Obstetric Surveillance System national cohort

Author

Vousden, Nicola, primary, Ramakrishnan, Rema, additional, Bunch, Kathryn, additional, Morris, Edward, additional, Simpson, Nigel, additional, Gale, Christopher, additional, O’Brien, Pat, additional, Quigley, Maria, additional, Brocklehurst, Peter, additional, Kurinczuk, Jennifer J., additional, and Knight, Marian, additional

Published
2022
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35. Severity of maternal infection and perinatal outcomes during periods of SARS-CoV-2 wildtype, alpha, and delta variant dominance in the UK: prospective cohort study

Author

Vousden, Nicola, primary, Ramakrishnan, Rema, additional, Bunch, Kathryn, additional, Morris, Eddie, additional, Simpson, Nigel A B, additional, Gale, Christopher, additional, O'Brien, Patrick, additional, Quigley, Maria, additional, Brocklehurst, Peter, additional, Kurinczuk, Jennifer J, additional, and Knight, Marian, additional

Published
2022
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37. Additional file 2 of Planned early delivery for late preterm pre-eclampsia in a low- and middle-income setting: a feasibility study

Author

Beardmore-Gray, Alice, Vousden, Nicola, Silverio, Sergio A., Charantimath, Umesh, Katageri, Geetanjali, Bellad, Mrutyunjaya, Chinkoyo, Sebastian, Vwalika, Bellington, Goudar, Shivaprasad, Sandall, Jane, Chappell, Lucy C., and Shennan, Andrew H.

Subjects
Data_FILES
Abstract

Additional file 2. Interview topic guide.

Published
2021
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38. Additional file 1 of Planned early delivery for late preterm pre-eclampsia in a low- and middle-income setting: a feasibility study

Author

Beardmore-Gray, Alice, Vousden, Nicola, Silverio, Sergio A., Charantimath, Umesh, Katageri, Geetanjali, Bellad, Mrutyunjaya, Chinkoyo, Sebastian, Vwalika, Bellington, Goudar, Shivaprasad, Sandall, Jane, Chappell, Lucy C., and Shennan, Andrew H.

Abstract

Additional file 1. Focus group discussion guide example (women).

Published
2021
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39. Impact of SARS-CoV-2 variant on the severity of maternal infection and perinatal outcomes: Data from the UK Obstetric Surveillance System national cohort

Author

Vousden, Nicola, primary, Ramakrishnan, Rema, additional, Bunch, Kathryn, additional, Morris, Edward, additional, Simpson, Nigel, additional, Gale, Christopher, additional, O’Brien, Patrick, additional, Quigley, Maria, additional, Brocklehurst, Peter, additional, Kurinczuk, Jennifer J, additional, and Knight, Marian, additional

Published
2021
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40. The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: A national cohort study using the UK Obstetric Surveillance System (UKOSS)

Author

Vousden, Nicola, primary, Bunch, Kathryn, additional, Morris, Edward, additional, Simpson, Nigel, additional, Gale, Christopher, additional, O’Brien, Patrick, additional, Quigley, Maria, additional, Brocklehurst, Peter, additional, Kurinczuk, Jennifer J., additional, and Knight, Marian, additional

Published
2021
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41. Incidence, risk factors and impact of seasonal influenza in pregnancy: A national cohort study

Author

Vousden, Nicola, Bunch, Kathryn, and Knight, Marian

Subjects
Pregnancy, medicine.medical_specialty, business.industry, Obstetrics, Incidence (epidemiology), medicine.disease, Seasonal influenza, Intensive care, Pandemic, Medicine, Complication, business, Cohort study, Asthma
Abstract

BackgroundPregnant women are particularly vulnerable to severe infection from influenza resulting in poor neonatal outcomes. The majority of evidence relates to pandemic 2009 A/H1N1 influenza. The objective of this study was to describe the characteristics and outcomes of pregnant women hospitalised with seasonal influenza.MethodsThis national, prospective, observational cohort study used the UK Obstetric Surveillance System (UKOSS) to identify all pregnant women admitted to hospital between 01/11/2016 and 31/10/2018 with laboratory confirmed influenza together with a comparison group of pregnant women. Baseline characteristics, immunisation status, maternal and perinatal outcomes were compared.ResultsThere were 405 women admitted to hospital with laboratory confirmed influenza in pregnancy: 2.7 per 10,000 maternities. Compared to 694 comparison women, women with influenza were less likely to be professionally employed (aOR 0.59, 95%CI 0.39-0.89) or immunised in the relevant season (aOR 0·59, 0·39-0·89) and more likely to have asthma (aOR 2.42, 1.30-4.49) or have had a previous pregnancy complication (aOR 2·47, 1·33-4·61). They were more likely to be admitted to intensive care (aOR 21.3, 2.78-163.1) and to have a caesarean birth (aOR 1·42, 1·02-1.98). Their babies were more likely to be admitted to neonatal intensive care (aOR 1.86, 1·01-3·42).ConclusionsImmunisation reduces the risk of hospitalisation with influenza in pregnancy which is associated with increased risk of morbidity for both the mother and baby. There is a continued need to increase awareness of safety and effectiveness of immunisation in pregnancy and provision within antenatal care settings, especially for high risk groups.Key pointsThe incidence of hospital admission with seasonal influenza in pregnancy in the UK is 2.7 per 10,000 maternities. Lack of immunisation increases risk of hospitalisation. Influenza in pregnancy increases risk of caesarean birth and neonatal admission to intensive care.

Published
2020
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42. Development and evaluation of a novel Vital Signs Alert device for use in pregnancy in low-resource settings

Author

Nathan, Hannah L, Vousden, Nicola, Lawley, Elodie, de Greeff, Annemarie, Hezelgrave, Natasha L, Sloan, Nicola, Tanna, Nina, Goudar, Shivaprasad S, Gidiri, Muchabayiwa F, Sandall, Jane, Chappell, Lucy C, and Shennan, Andrew H

Subjects
Medical Devices, obstetrics, hypertension, affordable, diagnostics, global Health
Abstract

© Author(s) (or their employer(s)) 2018. Objectives Haemorrhage, hypertension, sepsis and abortion complications (often from haemorrhage or sepsis) contribute to 60% of all maternal deaths. Each is associated with vital signs (blood pressure (BP) and pulse) abnormalities, and the majority of deaths are preventable through simple and timely intervention. This paper presents the development and evaluation of the CRADLE Vital Signs Alert (VSA), an accurate, low-cost and easy-To-use device measuring BP and pulse with an integrated traffic light early warning system. The VSA was designed to be used by all cadres of healthcare providers for pregnant women in low-resource settings with the aim to prevent avoidable maternal mortality and morbidity. Methods The development and the mixed-methods clinical evaluation of the VSA are described. Results Preliminary fieldwork identified that introduction of BP devices to rural clinics improved antenatal surveillance of BP in pregnant women. The aesthetics of the integrated traffic light system were developed through iterative qualitative evaluation. The traffic lights trigger according to evidence-based vital sign thresholds in hypertension and haemodynamic compromise from haemorrhage and sepsis. The VSA can be reliably used as an auscultatory device, as well as its primary semiautomated function, and is suitable as a self-monitor used by pregnant women. Conclusion The VSA is an accurate device incorporating an evidence-based traffic light early warning system. It is designed to ensure suitability for healthcare providers with limited training and may improve care for women in pregnancy, childbirth and in the postnatal period.

Published
2018

44. Effect of The CRADLE Vital Signs Alert Device Intervention on Referrals for Obstetric Haemorrhage in Low-Middle Income Countries: A Secondary Analysis of A Stepped-Wedge Cluster-Randomised Control Trial

Author

Giblin, Lucie, primary, Vousden, Nicola, additional, Nathan, Hannah, additional, Gidiri, Muchabayiwa Francis, additional, Goudar, Shivaprasad, additional, Sandall, Jane, additional, Seed, Paul, additional, Chappell, Lucy, additional, and Shennan, Andrew, additional

Published
2021
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46. A National Cohort Study and Confidential Enquiry to Investigate Ethnic Disparities in Maternal Mortality

Author

Knight, Marian, primary, Bunch, Kathryn, additional, Vousden, Nicola, additional, Banerjee, Anita, additional, Cox, Philippa, additional, Cross-Sudworth, Fiona, additional, Dhanjal, Mandish K., additional, Douglas, Jenny, additional, Girling, Joanna, additional, Kenyon, Sara, additional, Kotnis, Rohit, additional, Patel, Roshni, additional, Shakespeare, Judy, additional, Tuffnell, Derek, additional, Wilkinson, Meg, additional, and Kurinczuk, Jenny J., additional

Published
2021
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49. Characteristics and outcomes of pregnant women hospitalised with confirmed SARS-CoV-2 infection in the UK: a national cohort study using the UK Obstetric Surveillance System (UKOSS)

Author

Knight, Marian, primary, Bunch, Kathryn, additional, Vousden, Nicola, additional, Morris, Eddie, additional, Simpson, Nigel, additional, Gale, Chris, additional, O’Brien, Patrick, additional, Quigley, Maria, additional, Brocklehurst, Peter, additional, and Kurinczuk, Jennifer J, additional

Published
2020
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