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4. Strategies to manage postpartum haemorrhage

Author

Parry-Smith, William Rhys

Subjects
RG Gynecology and obstetrics
Abstract

Postpartum haemorrhage (PPH) is a global problem and the solutions to reducing it are complex. This thesis uses a mixture of research methods to investigate strategies that might improve the burden of blood loss following childbirth. The main findings are: 1. The use of contraception medication prior to pregnancy warrants further research as progesterone only contraception in particular might be associated with an increase in the risk of subsequent PPH; 2. The use of antidepressant medication during late pregnancy does not appear to increase the risk of PPH; 3. Following childbirth, a preventative uterotonic drug may not need to be given immediately; a delay of up to 5 minutes does not appear to increase the risk of bleeding; 4. There is little evidence to recommend the use of oxytocin, carbetocin, or misoprostol over each other for use as a first line drug to treat PPH; 5. Less than half of patients who had a PPH of 500mL received treatment uterotonic medication; 6. There is no appreciable long-term effect of PPH on mental health, but there is an increased risk of developing postnatal depression and post traumatic stress disorder; 7. There is no appreciable effect of PPH on cardiovascular health.

Published
2020

5. Effectiveness of a web-based virtual journal club to promote medical education (Web-Ed): protocol of a multicentre pragmatic randomised trial

Author

Rimmer, Michael, primary, Elfaki, Nagla, additional, Dunlop, Cheryl, additional, Coleburt, Damien, additional, Cowan, Neil, additional, Raglan, Olivia, additional, Teh, Jhia Jiat, additional, Fisher, Maria, additional, Mcrobbie, Sarah, additional, Murugesu, Nilaani, additional, Ramcharn, Meera, additional, Abdelrahman, Mohamed, additional, Jibrel, Yazid, additional, Wood, Matthew, additional, Parry-Smith, William, additional, and Al Wattar, Bassel H, additional

Published
2022
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13. Uterotonic agents for first-line treatment of postpartum haemorrhage: a network meta-analysis

Author

Parry Smith, William R, additional, Papadopoulou, Argyro, additional, Thomas, Eleanor, additional, Tobias, Aurelio, additional, Price, Malcolm J, additional, Meher, Shireen, additional, Alfirevic, Zarko, additional, Weeks, Andrew D, additional, Hofmeyr, G Justus, additional, Gülmezoglu, Ahmet Metin, additional, Widmer, Mariana, additional, Oladapo, Olufemi T, additional, Vogel, Joshua P, additional, Althabe, Fernando, additional, Coomarasamy, Arri, additional, and Gallos, Ioannis D, additional

Published
2020
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18. First-line uterotonics for treating postpartum haemorrhage: a systematic review and network meta-analysis

Author

Parry Smith, William R, primary, Gallos, Ioannis D, additional, Williams, Helen M, additional, Widmer, Mariana, additional, Angolkar, Mubashir, additional, Tobias, Aurelio, additional, Price, Malcolm J, additional, Alfirevic, Zarko, additional, Weeks, Andrew, additional, Hofmeyr, G Justus, additional, Gülmezoglu, A Metin, additional, and Coomarasamy, Arri, additional

Published
2017
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22. Worth the paper it's written on? A cross-sectional study of Medical Certificate of Stillbirth accuracy in the UK.

Author

Rimmer, Michael P, Henderson, Ian, Parry-Smith, William, Raglan, Olivia, Tamblyn, Jennifer, Heazell, Alexander E P, Higgins, Lucy E, and authors, the UKARCOG NESTT working group

Subjects
STILLBIRTH, NEONATAL death, PROOF & certification of death, CAUSES of death, CROSS-sectional method
Abstract

Background The Medical Certificate of Stillbirth (MCS) records data about a baby's death after 24 weeks of gestation but before birth. Major errors that could alter interpretation of the MCS were widespread in two UK-based regional studies. Methods A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. A systematic case-note review of stillbirths was conducted by Obstetric and Gynaecology trainees, generating individual 'ideal MCSs' and comparing these to the actual MCS issued. Anonymized central data analysis described rates and types of error, agreement and factors associated with major errors. Results There were 1120 MCSs suitable for assessment, with 126 additional submitted data sets unsuitable for accuracy analysis (total 1246 cases). Gestational age demonstrated 'substantial' agreement [K = 0.73 (95% CI 0.70–0.76)]. Primary cause of death (COD) showed 'fair' agreement [K = 0.26 (95% CI 0.24–0.29)]. Major errors [696/1120; 62.1% (95% CI 59.3–64.9%)] included certificates issued for fetal demise at <24 weeks' gestation [23/696; 3.3% (95% CI 2.2–4.9%)] or neonatal death [2/696; 0.3% (95% CI 0.1–1.1%)] or incorrect primary COD [667/696; 95.8% (95% CI 94.1–97.1%)]. Of 540/1246 [43.3% (95% CI 40.6–46.1%)] 'unexplained' stillbirths, only 119/540 [22.0% (95% CI 18.8–25.7%)] remained unexplained; the majority were redesignated as either fetal growth restriction [FGR: 195/540; 36.1% (95% CI 32.2–40.3%)] or placental insufficiency [184/540; 34.1% (95% CI 30.2–38.2)]. Overall, FGR [306/1246; 24.6% (95% CI 22.3–27.0%)] was the leading primary COD after review, yet only 53/306 [17.3% (95% CI 13.5–22.1%)] FGR cases were originally attributed correctly. Conclusion This study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case-note review, with particular attention on the fetal growth trajectory. [ABSTRACT FROM AUTHOR]

Published
2023
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26. Massive Hemorrhage

Author

Moores, Karen Louise, primary, Parry‐Smith, William, additional, and Underwood, Martyn, additional

Published
2016
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30. A dedicated undergraduate gynaecology teaching clinic: The Keele experience.

Author

Katali, Hamza Mahamadu, Parry-Smith, William Rhys, Eliot, Rees L, and O'Mahony, Fidelma

Subjects
*GYNECOLOGY education, *MEDICAL education, *CLINICAL medical education, *MEDICAL students, *EDUCATION, *OUTPATIENT medical care, *CLINICAL competence, *GYNECOLOGY, *OUTPATIENT services in hospitals, *SELF-efficacy, STUDY & teaching of medicine
Abstract

Much discussion in the literature centres on how best to teach medical students the intricacies of gynaecological assessment and the subsequent formulation of a management plan. At Keele University skills are initially developed in a simulated setting and then transferred to the workplace where students continue to develop their skills. A dedicated undergraduate gynaecology teaching clinic has been developed and comprises of 2–3 students and a tutor. All 38 students rotating through the department between January and June 2013 were invited to complete an anonymous questionnaire to evaluate this clinic and 36 (95%) of them responded. Respondents felt significantly more comfortable taking a gynaecology history, ensuring privacy during examination and formulating a management plan post-clinic (allp< 0.001), with female students feeling significantly more comfortable than their male counterparts (p= 0.04). The use of this clinic shows great promise to help students learn an unfamiliar and challenging skill. [ABSTRACT FROM PUBLISHER]

Published
2016
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