RCOG Understanding the Relationship Between Social Determinants of Health and Maternal Mortality (Scientific Impact Paper No. 67)

Social determinants are the social conditions in which people are born, grow, live, work and age. These factors can be individual, institutional/structural and legal, and shape a person’s health, their exposure to illness and access to care. The worse social and economic positions people are in, the worse their health outcomes are likely to be.

The evidence suggests a strong relationship between social determinants and poor maternal outcomes, including an increased risk of maternal death. Despite the provision of free reproductive and maternity services, current models of care are still failing those pregnant women living in adverse social circumstances prior to, during and after pregnancy.

Healthcare professionals have limited power on their own to modify social determinants of health, but this paper concludes with recommendations to improve the maternal outcomes of vulnerable pregnant women residing in the UK and proposes improvements to the collection and reporting of maternal outcome data, with further investment in prevention and intervention measures to better support these women. This Scientific Impact Paper was developed prior to the emergence of the COVID-19 coronavirus. Access the full SIP here

RCOG Antenatal corticosteroids to reduce neonatal morbidity and mortality (Green-top Guideline No. 74)

Maternal administration of antenatal corticosteroids before anticipated preterm birth is one of the most important interventions to improve neonatal outcomes.

They are effective in reducing neonatal respiratory morbidity and other complications of prematurity.

The aim of this guideline is to provide evidence-based recommendations on the use of antenatal corticosteroids in women at risk of preterm birth or undergoing caesarean birth at term. Access the full guideline here

RCOG Cervical cerclage (Green-top Guideline No. 75)

Cervical insufficiency is an imprecise clinical diagnosis frequently applied to women with such a history, where it is assumed that the cervix is ‘weak’ and unable to remain closed during the pregnancy. Recent evidence suggests that, rather than being a dichotomous variable, cervical integrity is likely to be a continuum influenced by factors related not solely to the intrinsic structure of the cervix but also to processes driving premature effacement and dilatation. While cerclage may provide a degree of structural support to a ‘weak’ cervix, its role in maintaining the cervical length and the endocervical mucus plug as a mechanical barrier to ascending infection may be more important.

There is lack of consensus on the optimal cerclage technique, timing of suture placement, the role of amniocentesis before emergency cerclage insertion and optimal care following insertion. Complications are not well documented and often difficult to separate from risks inherent to the underlying condition. The purpose of this guideline is to review the literature and provide evidence-based guidance on the use of cerclage in women at risk of preterm birth and second trimester loss. Access the full guideline here

Latest data reinforces the safety of COVID-19 vaccinations in pregnant women

The latest data from UKHSA shows that vaccinated women who gave birth between January and October 2021 had a very similar low risk of stillbirth, low birthweight and premature birth compared to women who were not vaccinated in pregnancy. Read more facts and figures in the press release here.

COVID-19 antivirals: reporting to the UK COVID-19 Antivirals Pregnancy Registry

As the safety of COVID-19 antivirals in pregnancy has not been established, MHRA requests reports of any pregnancies which occur during use of an antiviral, including paternal use, to the UK COVID-19 Antivirals Pregnancy Registry. This advice applies to molnupiravir (Lagevrio▼), the combination of PF-07321332 (nirmatrelvir) plus ritonavir (Paxlovid▼), and remdesivir (Veklury▼). Full details here

NICE consults on draft guideline on preterm labour and birth

DRAFT guideline covers care of women at increased risk of, or with symptoms and signs of, preterm labour (<37 weeks), and women having planned preterm birth. It aims to reduce risks of preterm birth for baby and describes treatments to prevent or delay early labour and birth. Read the draft guideline here and see the rest of the documents needed for feedback here. Consultation closes on 17th March, new guideline expected to be published in June 2022

CQC Maternity survey 2021

Results of this national survey show the majority of women who gave birth in February 2021 were positive about the care they received. But the impact of the pandemic has led to poorer experiences for some, and exacerbated concerns around the quality of postnatal care.

View the report and Trust benchmark data here