NIHR Signal – Treating subclinical thyroid dysfunction in pregnancy probably has no benefit

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Image Source: Pixabay

Testing for and then treating pregnant women with mild or “subclinical” underactive thyroid did not improve pregnancy outcomes, newborn baby outcomes, or the child’s IQ at three to five years.

A clearly underactive thyroid (clinical hypothyroidism) in pregnancy has been linked with various adverse outcomes for the mother and baby, including pre-eclampsia, preterm birth, congenital defects and neurodevelopmental delay. This needs treatment. However, there has been debate around the harms and benefits from treating only mildly abnormal blood test results in women who do not show signs of thyroid problems, subclinical hypothyroidism.

These two linked trials randomised 1,203 women with borderline abnormal levels of thyroid-related hormones (but not “clinical” or “overt” hypothyroidism) to receive thyroid replacement treatment, with levothyroxine, or placebo. Treatment had no benefits for mother or baby, including the main outcome of child IQ by three to five years of age.

This supports current UK practice, which does not routinely screen all pregnant women for subclinical thyroid dysfunction.

Read the full document here

 

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Care after miscarriage

Baby loss

The Miscarriage Association has published preliminary findings from research conducted as part of the Death before birth project. This report provides an overview of the extent to which the Human Tissue Authority Guidance (2015) has been incorporated into hospital policies for the management and disposal of the remains of pregnancy.

McGuinness, S., & Kuberska, K. (2017) Report to the Human Tissue Authority on disposal of pregnancy remains (less than 24 weeks’ gestational stage). Available at https://deathbeforebirthproject.org/research/htareport2017/.

Download the full document here

Manual for prescribed specialised services 2017/18

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NHS England has published Manual for prescribed specialised services 2017/18.  This manual is the detailed technical document that describes which elements of specialised services are commissioned by NHS England and which by Clinical Commissioning Groups.

Specialist maternity care for women diagnosed with abnormally invasive placenta includes services provided by Specialist Maternal Care Centres including outreach when delivered as part of a provider network.

Download the full document here

Maternity Services Monthly Statistics, England – May 2017

This is a report on NHS-funded maternity services in England for May 2017, using data submitted to the Maternity Services Data Set (MSDS). The MSDS has been developed to help achieve better outcomes of care for mothers, babies and children.

The MSDS is a patient-level ‘secondary uses’ data set that re-uses clinical and operational data for purposes other than direct patient care, such as commissioning and clinical audit. It captures key information at each stage of the maternity service care pathway in NHS-funded maternity services, such as those provided by GP practices and hospitals. The data collected include mother’s demographics, booking appointments, admissions and re-admissions, screening tests, labour and delivery along with baby’s demographics, diagnoses and screening tests.

  • Of the births that had a recorded delivery method, 57 per cent were spontaneous vaginal births, 11 per cent had instrumental assistance, 13 per cent were elective caesarean sections and 15 per cent were emergency caesarean sections. The proportion of births by emergency caesarean was highest in the London Commissioning Region (17 per cent) and lowest in the Midlands and East of England Commissioning Region (14 per cent).

View the statistics here

Group B streptococcal disease RCOG Greentop No 36 updated

AGAR dish

The Royal College of Obstetricians and Gynaecologists has updated Group B Streptococcal Disease, Early-onset (Green-top Guideline No 36).  This guideline guidance for obstetricians, midwives and neonatologists on the prevention of early-onset (less than 7 days of age) neonatal group B streptococcal (EOGBS) disease.

GBS is recognised as the most frequent cause of severe early-onset infection in newborn infants. GBS is present in the bowel flora of 20–40% of adults (colonisation) and those who are colonised are called ‘carriers’. This includes pregnant women. There is variation in practice across the UK regarding the best strategies to prevent EOGBS disease.

Download the full guideline here

NICE Multiple Pregnancy (update): draft scope consultation

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Image Source: NHS Photolibrary

This guideline will update the NICE guideline on Multiple pregnancy: antenatal 5 care for twin and triplet pregnancies (CG129), and will also be used to update the NICE quality standard for 10 Multiple pregnancy: twin and triplet pregnancies (QS46).

The surveillance process identified that the topic of intrapartum care related to multiple pregnancy should be added.

The consultation will close on 3/10/17

Download the consultation documents and surveillance review from here

Under pressure? NHS maternity services in England

Briefing note
Image Source: IFS

The Institute of Fiscal Studies has published “Under pressure? NHS maternity services in England”. This briefing note discusses the causes and consequences of short-run and long-run pressures on NHS maternity services in England.  It finds the number of maternity cases has stabilised since 2010 but the case mix has changed.

  • The changing case mix explains all of the rise in the number of C-sections in England between 2006 and 2014. The number of C-sections performed by NHS hospitals in England each year increased by 23,000 between 2006 and 2014. We estimate that all of this growth can be explained by the changing case mix of mothers giving birth. There is no evidence of a change in medical practice leading to more C-sections.

Read the briefing note here
Download the full document here