Care of the critically ill woman in childbirth; enhanced maternal care

Royal College of Anaesthetists, Royal College of Obstetricians & Gynaecologists, The Royal College of Midwives,  Intensive Care Society, & The Faculty of Intensive Care Medicine | August 2018 | Care of the critically ill woman in childbirth; enhanced maternal care

Providing equity of critical and maternity care for the critically-ill pregnant or recently pregnant woman was published in 2011, by a multidisciplinary group from several royal colleges, including obstetricians, anaesthetists, intensivists, midwives and critical care nurses. The current document is an update of the 2011 version and is the outcome of interdisciplinary discussions over the past six years; it replaces the former Joint Standing Committee 2011 standards document: Providing equity of critical and maternity care for the critically-ill pregnant or recently pregnant woman. 

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The aim of this document is to make recommendations regarding collaborative working between maternity units and critical care units alongside other specialist support (e.g. psychologists, paediatrics in case of teenage pregnancy). It outlines how women who become acutely unwell during pregnancy, labour or the postnatal period should have immediate access to critical care, of the same standard as other sick patients, delivered by teams skilled in providing critical care to the acutely deteriorating obstetric patient (Source: Royal College of Anaesthetists et al.

The report is available from Royal College of Anaesthetists (RCOA)

Children and young people’s mental health: focus group research

Department of Health and Social Care| August 2018 | Children and young people’s mental health: focus group research

The Department for Education and the Department of Health and Social Care (DHSC) funded  research into children and young people’s mental health.  DHSC funded  3 organisations: Youth Access, Young Minds and the National Children’s Bureau  to research the views of young people, parents and carers, and professionals about the proposals in the green paper.
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This research was conducted as part of a 13 week consultation between December 2017 to March 2018, it received over 2,700 responses (Source: DHSC) .

The documents are available here:

Young Minds: student insights report on green paper proposals

Youth Access: consultations with young people on the green paper

National Children’s Bureau: Transforming mental health provision for children and young people

 

NHS action plan can prevent over 600 still births a year says NHS England

NHS England | July 2018 | NHS action plan can prevent over 600 still births a year says NHS England

An independent evaluation of nineteen NHS Trusts in England shows that stillbirths fell by a fifth at the maternity units where national guidance, known as the Saving Babies Lives Care Bundle, had been implemented. The best practice guidance is now being introduced across the country and has the potential if these findings were replicated, to prevent an estimated 600 stillbirths.

The report from researchers at the University of Manchester describes the results of a comprehensive evaluation involving nineteen NHS Trusts in England that have been implementing the Saving Babies’ Lives Care Bundle (SBLCB) since April 2015, which aims to reduce the incidence of stillbirth by implementing best practice in four aspects of maternity care. This report describes the degree of implementation, the clinical and service outcomes and the economic impact(s) following a maximum two year implementation period in these early adopter Trusts and crucially, whether implementation of SBLCB translates into fewer stillbirths.

Key successes

  • Increase in the detection of small babies – there was a 59 per cent increase detection attributed to better monitoring and scanning in pregnancy
  • Better awareness of a baby’s movement in pregnancy – with a high number of women attending hospital due to reduced movement.
  • Carbon monoxide testing for smoking in pregnancy was almost universal – Smoking is strongly associated with stillbirth. A 1 per cent increase in smoking rates increases the chances of stillbirth by 1.7 per cent. Alongside carbon monoxide monitoring there has been a decline in the number of women smoking, at time of booking.

University of Manchester Evaluation of the implementation of the Saving
Babies’ Lives Care Bundle in early adopter NHS Trusts in England 
NHS England news release NHS action plan can prevent over 600 still births a year says NHS England

World Breastfeeding Week 2018

WHO | August 2018 | World Breastfeeding Week 2018 

This week 1 August – 7 August 2018 marks World Breastfeeding week. The theme of this year’s World Breastfeeding Week is “Breastfeeding: Foundation for Life” — a recognition of the importance of breastfeeding to a baby’s future.
Unicef
Image source: who.int
WHO recommends exclusive breastfeeding starting within one hour after birth until a baby is 6 months old. Nutritious complementary foods should then be added while continuing to breastfeed for up to 2 years or beyond. Establishing exclusive breastfeeding – feeding infants nothing but breastmilk for the first six months of life — helps young children grow, preventing undernutrition, promoting brain development, and reducing the risk that children will become overweight.
(Source: WHO).
 
 
Full details are available from WHO 

Twins and Multiple Births Association (TAMBA) Maternity Engagement Project Interim report findings

TAMBA | July 2018 | TAMBA

The Twins and Multiple Births Association (TAMBA) established a Maternity Engagement programme to ensure pregnant women expecting twins, triplets or more are treated in accordance with the NICE multiple pregnancy guidelines, as it is proven this could save lives. Their  report shows if all Maternity Units performed the same as the best performing units in the group of 30 Tamba worked with, then 55 babies lives could be saved every year. Reducing the number of babies from a multiple pregnancy needing neonatal care
could save the NHS in England £3.82 million a year (Source: TAMBA).

 

NICE Works
Image source: tamba.org.uk

The press release from TAMBA is here 

The full report, NICE Works what we have learned so far, is available from TAMBA

Preconception care: making the case

Public Health England | July 2018 | Preconception care: making the case 

Public Health England has published new resources to help in planning and preparation for pregnancy, to improve outcomes for mothers and babies.

Preconception Health
Image source: Public Health England

Making the case for preconception care 

A report for Local Maternity Systems and their wider systems partners. It covers:

  • the impact of preconception health
  • ways to improve birth outcomes
  • ways to reduce inequalities through embedding preconception care

An infographic summary document is also available from PHE.

Health of women before and during pregnancy toolkit

A national report on risk factors and inequalities. It can be used at a local level to identify variation in women’s health, before and in the early stages of a pregnancy.

A preconception animation that shows:

  • how to provide preconception care with a person-centered approach
  • how to identify opportunities for intervention
  • key messages to communicate

Source: PHE

Depression in pregnancy rises by 51 % in a generation

University of Bristol | July 2018 | Depression in pregnancy rises in a generation

Findings of research undertaken by researchers at the University of Bristol  indicate that the rates of depression in expectant mothers has increased by 51 per cent in a generation.  Dr Rebecca Pearson, lecturer in Psychiatric Epidemiology at Bristol, makes a distinction between how young pregnant women are experiencing depression:

“These new data give a more accurate picture of what our current population of young pregnant women are facing.  But the “research shows that depression in today’s young women may be driven by rises in feeling overwhelmed and stress rather than feelings of being down and flat.”

The study, published in journal JAMA Open Network, shows depression is more prevalent in pregnant women today than in the 1990s: 25 per cent of the pregnant women experienced depression compared to 17 per cent of their mothers’ generation.

The cohort study used data from Avon Longitudinal Study of Parents and Children, with the participants the original mothers (the original sample) and their offspring. The scientists used the Edinburgh Postnatal Depression Scale to measure prenatal depression in self-reported surveys in both generations, with a score of 13 or more  on a scale of 0 to 30 indicated depressed mood (via University of Bristol).

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The research is particularly novel as it is the first time scientists have been able to compare mental health symptoms in pregnancy across generations. The research team found that if their mother was depressed in pregnancy, daughters were also more than three times as likely to be depressed in their pregnancy.

The full news release is available from the University of Bristol 
The article can be downloaded in full from JAMA Open Network 
Abstract

Importance  Depression during pregnancy (prenatal depression) is common and has important consequences for mother and child. Evidence suggests an increasing prevalence of depression, especially in young women. It is unknown whether this is reflected in an increasing prevalence of prenatal depression.

Objective  To compare the prevalence of depression during pregnancy in today’s young mothers with their mothers’ generation.

Design, Setting, and Participants  In a longitudinal cohort study, we compared prenatal depressive symptoms in 2 generations of women who participated in the Avon Longitudinal Study of Parents and Children. Participants were the original mothers (recruited when they were pregnant) and their female offspring, or female partners of male offspring, who became pregnant. Both groups were limited to the same age range (19-24 years). The first generation of pregnancies occurred in 1990 to 1992 (n = 2390) and the second in 2012 to 2016 (n = 180). In both generations, women were born in the same geographical area (southwest England).

Main Outcomes and Measures  Depressed mood measured prenatally using the Edinburgh Postnatal Depression Scale in self-reported surveys in both generations. A score of 13 or greater on a scale of 0 to 30 indicated depressed mood.

Results  Of 2390 pregnant women in the first generation who were included in analysis (mean [SD] age, 22.1 [2.5] years), 408 (17%) had high depressive symptom scores (greater than or equal to 13). Of 180 pregnant women in the second generation who were included in the analysis (mean [SD] age, 22.8 [1.3] years), 45 (25%) had high depressive symptom scores. Having high depressive symptom scores was more common in the second generation of young pregnant women than in their mothers’ generation, with imputation for missing confounding variable data and adjustment for age, parity, education, smoking, and body mass index not substantially changing this difference. Results were essentially the same when analyses were restricted to the 66 mother-offspring pairs. Maternal prenatal depression was associated with daughters’ prenatal depression.

Conclusions and Relevance  In this unique study of 2 generations of women who answered identical questionnaires in pregnancy, evidence was found that depressed mood may be higher in young pregnant women today than in their mothers’ generation. Because of the multiple and diverse consequences of prenatal depression, an increase in prevalence has important implications for families, health care professionals, and society.

Full reference:

Pearson R.M, Carnegie RE, Cree C, et al.| 2018|  Prevalence of Prenatal Depression Symptoms Among 2 Generations of Pregnant MothersThe Avon Longitudinal Study of Parents and Children | JAMA Network Open |1(3)| e180725| doi:10.1001/jamanetworkopen.2018.0725

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