All posts by dbhcurrentawareness

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

pregnant- Pixabay 2635034_1280
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

fetus Pixabay -1788082_1280
Image Source: Pixabay

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

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

Pregnant woman wikimedia
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

NHS commits to better care for expectant and new mums with mental health

The Chief Executive of NHS England has announced four new Mother and Baby Units which will allow women to stay with their babies while receiving the specialist care they need. These new units will provide in-patient support for women and their babies with the most complex and severe needs who require hospital care, who are experiencing severe mental health crisis including very serious conditions like post-partum psychosis

“Having a baby should be one of happiest, most life-changing experiences and every mum should have the opportunity to bond with her baby, while receiving the care she needs and remaining as close to her families as possible”

Simon Stephens, Chief Executive at NHS England

Read the full press release here