All posts by dbhcurrentawareness

NIHR Signal: Waiting at home after inducing labour mechanically may be an option for low-risk women

Maternal or fetal complications, following the insertion of a balloon catheter to induce labour, are rare. Pain or discomfort was most common affecting around 1 in 400 women. Balloon displacement, bleeding or abnormal fetal heart rate affected less than 1 in 1,000.

The catheter is a device inserted through the cervix, where inflated balloons on the end of a tube put pressure on the cervix helping it to “ripen” and start contractions. Prostaglandin drugs are the current recommended induction method, but uterine (womb) overstimulation, where contractions become too frequent or long, is a recognised side effect.

Individual trials have indicated that catheter induction could be a safer alternative. This review is the first to gather the available evidence from 26 studies including 8,292 women that have reported the adverse event rate for catheters.

It supports balloon catheters as an induction method for low-risk pregnancies that could allow women to stay at home, benefiting the mother and saving NHS resources.

“This review provides encouraging evidence for the safety of balloon catheter cervical ripening in an outpatient setting. Adopting this technique for low-risk pregnancies could significantly improve women’s birth experience as well as economically benefiting the NHS. Is it time we reconsidered our induction methods?”

Sally Collins, Consultant Obstetrician & Subspecialist in Maternal & Fetal Medicine, Oxford University Hospitals NHS Foundation Trust; Associate Professor, Nuffield Department of Women’s & Reproductive Health, University of Oxford; Lecturer in Medical Sciences, St Anne’s College, University of Oxford

Diederen M, Gommers J, Wilkinson C, et al. Safety of the balloon catheter for cervical ripening in outpatient care: complications during the period from insertion to expulsion of a balloon catheter in the process of labour induction: a systematic review. BJOG. 2017. [Epub ahead of print].


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NICE Diagnostics consultation: Biomarker tests to help diagnose preterm labour in women with intact membranes

Preterm baby - pixabay
Image Source: pixabay

The National Institute for Health and Care Excellence (NICE) is producing guidance on using biomarker tests (Actim Partus, PartoSure and the Rapid fFN 10Q Cassette Kit) in the NHS in England. The diagnostics advisory committee has considered the evidence base and the views of clinical and patient experts.

The advisory committee is interested in receiving comments on the following:

  • Has all of the relevant evidence been taken into account?
  • Are the summaries of clinical and cost effectiveness reasonable interpretations of the evidence?
  • Are the provisional recommendations sound, and a suitable basis for guidance to the NHS?

The consultation will close on 3rd April.  More details available from NICE here

Best start in life: cost-effective commissioning

Public Health England has produced Best start in life: return on investment tool.  This tool aims to help local commissioners provide cost-effective interventions for children aged up to 5 years old and pregnant women.  It pulls together evidence on the effectiveness and associated costs for a number of interventions aimed at providing children with the best start in life.  It is accompanied by a report providing details on how the tool was constructed.

Download the report and tool here

Don’t push it: why the formula milk industry must clean up its act

Image Source: NHS Photolibrary

This report from Save the Children looks at the scale and impact of the marketing activities of six global formula milk companies that together own more than 50% of the market in breast-milk substitutes. It sets out recommendations for change, with the aim of benefiting millions of children and mothers’ health.

To download the summary report, full report, and to see responses to Save the Children from major formula milk companies click here

Eating disorders in pregnancy – animation

eating disorders
Image source: IHV

Eating disorders affect approximately 7.5% of pregnant women and can impact on maternal and infant outcomes. Researchers at King’s College London have translated research on eating disorders during pregnancy and motherhood into practical training resources to help healthcare professionals provide the best care for pregnant women and mothers. This animation aims to raise awareness of eating disorders amongst all health professionals working with women in the perinatal period.

For more information and to see the animation visit the Institute of Health Visiting here

NIHR Signal: Imaging is the only way to diagnose blood clots in pregnancy

No blood test can accurately tell if a pregnant or recently pregnant woman has a blood clot. All pregnant women with a suspected clot should continue to have imaging investigations as per current UK guidelines.

This NIHR-funded study recruited 328 pregnant or postpartum women with a suspected blood clot in the lung (pulmonary embolism) or leg (deep vein thrombosis). They had a blood test to measure the levels of 13 biomarkers, such as the D-dimer, to see if they could rule a blood clot in or out. It was hoped that this could reduce the number of women who would need confirmation from a scan, and so decrease their exposure to radiation.

None of the tests were accurate enough. The range of levels for each biomarker overlapped between women with and without a clot.

Hunt BJ, Parmar K, Horspool K, et al. The DiPEP (Diagnosis of PE in Pregnancy) biomarker study: An observational cohort study augmented with additional cases to determine the diagnostic utility of biomarkers for suspected venous thromboembolism during pregnancy and puerperium. Br J Haematol. 2018;180(5):694-704.

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Breastfeeding Friend chatbot via Alexa

Alexa breastfeeding
Image source:

The Breastfeeding Friend chatbot created by Public Health England’s Start4Life programme is now available via Amazon Alexa’s voice service. Breastfeeding Friend is already freely available on a number of platforms, including Facebook Messenger, but the new offer will provide a voice service that mothers can interact with even when their hands are full. The service is designed to provide mothers with 24 hour breastfeeding support with advice tailored to the age of the baby. The Breastfeeding Friend chatbot is just one of the services available to encourage and support mothers to breastfeed.

More information available here