Antiplatelet agents for preventing pre‐eclampsia and its complications – Cochrane review

Review (77 trials; n=40,249) found that administering low‐dose aspirin to pregnant women led to small‐to‐moderate benefits, including reductions in pre‐eclampsia, preterm birth, baby being born small‐for‐gestational age and foetal/neonatal death.

Duley  L, Meher  S, Hunter  KE, Seidler  AL, Askie  LM. Antiplatelet agents for preventing pre‐eclampsia and its complications. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD004659. DOI: 10.1002/14651858.CD004659.pub3.

Read the full article here

HSIB National report highlights life threatening risk posed by delay in group B strep treatment

Report compiled warns that delay or failure to give preventative antibiotics to mothers can leave newborn babies at risk of death or severe injury from group B strep infection. Report suggests links to 6 neonatal deaths, 6 intrapartum stillbirths and 3 severe brain injuries.

Read the HSIB press release here & download the report here

Progesterone to prevent miscarriage in women with early pregnancy bleeding: the PRISM RCT

National Institute of Health Research funded RCT (n=4153 from 48 UK hospitals) found progesterone therapy in first trimester of pregnancy did not result in a significantly higher rate of live births among women with threatened miscarriage overall compared with placebo (live birth rate 75% vs. 72%, respectively; p = 0.08).

Coomarasamy A, Harb HM, Devall AJ, Cheed V, Roberts ET, Goranitis I, et al. Progesterone to prevent miscarriage in women with early pregnancy bleeding: the PRISM RCT. Health Technol Assess 2020;24(33)

Link to the full article here

 

NHS boosts support for pregnant black and ethnic minority women

England’s most senior midwife, Jacqueline Dunkley-Bent, has written to all maternity units in the country calling on them to take four specific actions which will minimise the additional risk of COVID-19 for BAME women and their babies.

1. Increasing support of at-risk pregnant women – e.g. making sure clinicians have a lower threshold to review, admit and consider multidisciplinary escalation in women from a BAME background.
2. Reaching out and reassuring pregnant BAME women with tailored communications.
3. Ensuring hospitals discuss vitamins, supplements and nutrition in pregnancy with all women. Women low in vitamin D may be more vulnerable to coronavirus so women with darker skin or those who always cover their skin when outside may be at particular risk of vitamin D insufficiency and should consider taking a daily supplement of vitamin D all year.
4. Ensuring all providers record on maternity information systems the ethnicity of every woman, as well as other risk factors, such as living in a deprived area (postcode), co-morbidities, BMI and aged 35 years or over, to identify those most at risk of poor outcomes.

A press release from NHS England on 27 June explains the government’s response to a recent study published in the BMJ which found that 55% of the pregnant women admitted to hospital with COVID-19 are from a BAME background, even though they only make up a quarter of the births in England and Wales.

Read the NHS England press release here and read the full BMJ article here:

Knight Marian, Bunch Kathryn, Vousden Nicola, Morris Edward, Simpson Nigel, Gale Chris et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study BMJ 2020; 369 :m2107

Coronavirus (COVID-19) infection and abortion care v3

RCOG have updated their guidance on 3 June 2020.  updates include Ultrasound scanning section re-formatted and additional information on gestation assessment and ectopic pregnancy included, with new evidence added from American guideline and literature review.

Read the full guideline here and the corresponding “COVID-19: Information for women requiring abortion” here

Coronavirus (COVID-19) infection and pregnancy v10.1

RCOG updated their Coronavirus (COVID-19) infection and pregnancy guidance on 19 June.  Updates include new advice on face masks, visitors and advice for women who are clinically deteriorating modified to include government recommendations based on the interim results of the RECOVERY trial.
View the updated guidance here and the corresponding updated Information for pregnant women and their families Q&As here

Study shows the way to improve safety in midwifery-led settings

Researchers in the NIHR Policy Research Unit in Maternal Health and Care in the NPEU, in collaboration with others from the Universities of Leicester and Birmingham, Bradford Royal Infirmary and the Royal College of Midwives, have published new research investigating deaths of babies in births planned in midwifery-led settings, which has found that improvements in care may have made a difference to the outcome in 75% of the deaths.
Read the NPEU press release here or view the study in BJOG (open access) here:

Rowe, R, Draper, ES, Kenyon, S, Bevan, C, Dickens, J, Forrester, M, Scanlan, R, Tuffnell, D, Kurinczuk, JJ. Intrapartum‐related perinatal deaths in births planned in midwifery‐led settings in Great Britain: findings and recommendations from the ESMiE confidential enquiry. BJOG 2020; https://doi.org/10.1111/1471-0528.16327. 00: 1– 11.

ANNB screening: supporting women with learning disabilities

Public Health England have developed new resources with input from health professionals to support women or parents with learning disabilities to access and understand antenatal and newborn (ANNB) screening.

Discussing aspects of ANNB screening with women or parents with learning disabilities can be challenging for health professionals who do not do this regularly. This guidance contains information and resources to help health professionals have conversations in an appropriate and sensitive way.  The guidance includes: advice and resources for local screening providers; barriers to screening; resources to support women’s and parents’ understanding of screening; making a best interest decision.

Download the guidance here

Guidance for antenatal and postnatal services in the evolving coronavirus (COVID-19) pandemic updated

RCOG have produced version 2.1 on Friday 19 June 2020.  Additions include the following statement;

‘When reorganising services, maternity services should be particularly cognisant of emerging evidence that black, Asian and minority ethnic group (BAME) individuals are at particular risk of developing severe and life-threatening COVID-19. There is already extensive evidence on the inequality of experience and outcomes for BAME women during pregnancy and birth in the UK. Particular consideration should be given to the experience of women of BAME background and women living with multiple deprivation when evaluating the potential or actual impact of any service change.’

Read the full updated guidance here

RCM Professional clinical guidance

The RCM has established a new Expert Clinical Advisory Group to develop rapid professional briefings during the pandemic. The group is made up of 12 members of the RCM team – including midwives with current and recent clinical experience, midwifery educationalists and researchers, supported by a librarian from MIDIRs. The team have developed a range of briefings, which are updated regularly to reflect current evidence as it evolves.

View the guidance and briefings here

Infectious diseases in pregnancy screening (IDPS): programme overview update

Public Health England have changed some text from ‘have a bisexual partner’ to ‘have a partner who is sexually active with another person’ in the list of circumstances where repeat testing is recommended.
Read the updated version here

How should severe vitamin B12 deficiency in pregnancy be managed?

The Specialist Pharmacy Service has updated its Q&A on severe vitamin B deficiency in pregnancy.

Summary 

• Although there are no published studies looking into congenital malformations following use of vitamin B₁₂ during pregnancy, there is no evidence that treatment with vitamin B₁₂ is associated with an increased risk of congenital malformations or other adverse foetal effects due to in utero exposure.
• There is evidence to suggest that maternal vitamin B₁₂ deficiency increases the risk of neural tube defects in the newborn.
• Hydroxocobalamin can be used during pregnancy to treat conditions caused by vitamin B₁₂ deficiency including megaloblastic anaemia, pernicious anaemia, and neurological problems.
• There are no specific UK guidelines for the treatment of vitamin B₁₂ deficiency during pregnancy and no specific UK dosing recommendations are available.
• Intramuscular hydroxocobalamin is the preferred treatment choice for clinical conditions caused by vitamin B₁₂ deficiency, including during pregnancy, and should usually be prescribed according to the current recommendations in the BNF. However, in pregnant women this should be reviewed on a case-by-case basis, particularly if there is a complex obstetric history.
• The use of vitamin B₁₂ at any stage in pregnancy would not usually be regarded as grounds for additional foetal monitoring.

Download the whole Q&A here