Obstetrics and Gynaecology

The OBS UK Dashboard: an interactive tool for representative trial site selection to facilitate equality and diversity in maternity research (2024)

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Type of publication:

Journal article

Author(s):

*Elsmore, Amy; Rai, Tanvi; Pallmann, Philip; Townson, Julia; Kotecha, Sarah; Black, Mairead; Sanders, Julia; Collis, Rachel; Collins, Peter; Karunakaran, Bala; Wu, Pensee; Bell, Sarah; *Parry-Smith, William

Citation:

Trials. 25(1):629, 2024 Sep 27.

Abstract:

BACKGROUND: Obstetric Bleeding Study UK (OBS UK) (award ID: 152057) is a National Institute for Health and Care Research (NIHR)-funded stepped wedge cluster randomised controlled trial of a complex intervention for postpartum haemorrhage. This was developed in Wales and evaluated in a feasibility study, with improvements in maternal outcomes observed. Generalisability of the findings is limited by lack of control data and limited ethnic diversity in the Welsh obstetric patient population compared to the United Kingdom (UK): 94% of the Welsh population identifies as White, versus 82% in the UK. Non-White ethnicity and socioeconomic deprivation are linked to increased risk of adverse maternal outcomes. traditionally, decisions regarding site selection are based on desire to complete trials on target in 'tried and tested' research active institutions. To ensure widespread applicability of the results and investigate the impact of ethnicity and social deprivation on trial outcomes, maternity units were recruited that represent the ethnic diversity and social deprivation profiles of the UK. METHOD: Using routinely collected, publicly available data, an interactive dashboard was developed that demonstrates the demographics of the population served by each maternity unit in the UK, to inform site recruitment. Data on births per year, ethnic and socioeconomic group of the population for each maternity unit, across the UK, were integrated into the dashboard. RESULTS: The dashboard demonstrates that OBS UK trial sites reflect the ethnic and socioeconomic diversity of the UK (study vs UK population ethnicity: White 79.2% vs 81.7%, Asian 10.5% vs 9.3%, Black 4.7% vs 4.0%, Mixed 2.5% vs 2.9%, Other 3.0% vs 2.1%) with variation in site demography, size and location. Missing data varied across sites and nations and is presented. CONCLUSION: The NIHR equality, diversity and inclusion strategy states studies must widen

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Clinical decision support systems for maternity care: a systematic review and meta-analysis. (2024)

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Type of publication:
Journal article

Author(s):
Cockburn N.; Osborne C.; Withana S.; *Elsmore A.; *Nanjappa R.; South M.; *Parry-Smith W.; Taylor B.; Chandan J.S.; Nirantharakumar K.

Citation:
eClinicalMedicine. 76 (no pagination), 2024. Article Number: 102822. Date of Publication: October 2024.

Abstract:
Background: The use of Clinical Decision Support Systems (CDSS) is increasing throughout healthcare and may be able to improve safety and outcomes in maternity care, but maternity care has key differences to other disciplines that complicate the use of CDSS. We aimed to identify evaluated CDSS and synthesise evidence of their impact on maternity care. Method(s): We conducted a systematic review for articles published before 24th May 2024 that described i) CDSS that ii) investigated the impact of their use iii) in maternity settings. Medline, CINAHL, CENTRAL and HMIC were searched for articles relating to evaluations of CDSS in maternity settings, with forward- and backward-citation tracing conducted for included articles. Risk of bias was assessed using the Mixed Methods Assessment Tool, and CDSS were described according to the clinical problem, purpose, design, and technical environment. Quantitative results from articles reporting appropriate data were meta-analysed to estimate odds of a CDSS achieving its desired outcome using a multi-level random effects model, first by individual CDSS and then across all CDSS. PROSPERO ID: CRD42022348157. Finding(s): We screened 12,039 papers and included 87 articles describing 47 unique CDSS. 24 articles (28%) described randomised controlled trials, 30 (34%) described non-randomised interventional studies, 10 (11%) described mixed methods studies, 10 (11%) described qualitative studies, 7 (8%) described quantitative descriptive studies, and 7 (8%) described economic evaluations. 49 (56%) were in High-Income Countries and 38 (44%) in Low- and Middle-Income countries, with no CDSS trialled in both income categories. Meta-analysis of 35 included studies found an odds ratio for improved outcomes of 1.69 (95% confidence interval 1.24-2.30). There was substantial variation in effects, aims, CDSS types, context, study designs, and outcomes. Interpretation(s): Most CDSS evaluations showed improvements in outcomes, but there was heterogeneity in all aspects of design and evaluation of systems. CDSS are increasingly important in delivering healthcare, and Electronic Health Records and mHealth will increase their availability, but traditional epidemiological methods may be limited in guiding design and demonstrating effectiveness due to rapid CDSS development lifecycles and the complex systems in which they are embedded. Development methods that are attentive to context, such as Human Centred Design, will help to meet this need.

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Global prevalence of medicalised female genital mutilation: a systematic review (2024)

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Type of publication:
Conference abstract

Author(s):
*Andrew O.; Jones L.; *Farley A.;

Citation:
Archives of Disease in Childhood. Conference: Royal College of Paediatrics and Child Health Conference, RCPCH 2024. Birmingham United Kingdom. 109(Supplement 1) (pp A280), 2024. Date of Publication: August 2024.

Abstract:
Objectives Despite the ongoing efforts to eradicate female genital mutilation (FGM), the shift towards medicalised FGM is concerning. It is advocated that eliminating medicalised FGM is an important component in the holistic approach to end FGM. This review therefore aimed to systematically identify literatures to determine the global prevalence of medicalised FGM. Methods Studies included were cross-sectional studies that reported the prevalence of FGM in a female population of any age and the performer of the FGM to be a health care professional (HCP). Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature and a range of grey sources were searched between March and April 2020. In duplicates, eligible papers were screened, quality assessed using JBI tool and data extracted using a proforma. The main outcome extracted was the prevalence of medicalised FGM and this was defined as FGM performed by any category of HCP irrespective of the location. A meta-analysis using a random- effect model was carried out to synthesise the global prevalence of medicalised FGM. Subgroup analysis by country's level of income, study setting, continent and study date was undertaken to investigate heterogeneity (I2). Results Out of 4875 records obtained after a systematic search, 21 papers and one piece of grey literature were included, all describing medicalised FGM in 26 countries. Most of the studies (93.3%) were conducted in low and lowmiddle income countries. Overall, the global prevalence of medicalised FGM was 13% (95% confidence interval (CI) 7%-21%, I2 = 100%). The high heterogeneity observed was explored using subgroup analysis; however, there was little change in I2 value. Conclusion Amidst the high heterogeneity, this research highlights that the prevalence of medicalised FGM worldwide can be as high as 21% (~1 in 5 survivors). Further research is required to investigate the various context where the prevalence of medicalised FGM is high. Specific nationally representative data across several settings are necessary in all regions to ensure surveillance of the problem. There is need for interventions to prevent HCP from cutting women and girls thereby strengthening the path to eradicate FGM.

COVID Recovery Laparoscopic Simulation Program for Gynaecological Registrars-Trainee Perceptions of Regional Model (2024)

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Type of publication:
Journal article

Author(s):
Azeem, Zahra; Odendaal, Joshua; Ghosh, Donna; *Tapp, Andrew; Hassan, Ismail

Citation:
Journal of Minimally Invasive Gynecology. 2024 May 11.

Abstract:
STUDY OBJECTIVE: The acquisition of gynaecological operating skills can be challenging for trainees given the conflicting demands of clinical work. Alternative models of surgical skill training such as laparoscopic simulation is, therefore, required. This study demonstrates the development of a regional gynaecological surgery laparoscopic simulation program and trainee perceptions of such an approach. DESIGN: An intervention-based cohort study. SETTING: A regional model based in West Midlands training region. PATIENTS/PARTICIPANTS: Responses from sixty-four trainees in the training region who participated in his regional program were included. INTERVENTION: A three-stream curriculum was developed to deliver key training outcomes as required by the Royal College of Obstetricians and Gynaecologists (RCOG) core curriculum as a component of a Covid Recovery Program. Courses were held in seven teaching hospitals. Courses consisted of both theory and practical teaching. MEASUREMENTS: A structured feedback tool was used to collect trainee perceptions of the programme. Trainee satisfaction was measured on the Likert scale of 1-3. A qualitative thematic analysis was conducted with rank-order analysis of coded free-text responses. MAIN RESULTS: Overall, the majority of trainees 92% (n=58/64) were very satisfied with the course. Rank-order analysis demonstrated hands-on-practice to be the key perceived benefit of laparoscopic simulation amongst basic and intermediate trainees whilst feedback on procedural skills was felt most useful amongst advanced trainees. CONCLUSION: A regional approach to laparoscopic simulation training is both achievable and acceptable. Trainee perceptions of usefulness are altered by seniority and experience. This should be accounted for in the development of laparoscopic simulation programmes.

Are term breech babies who undergo successful external cephalic version still at increased risk of developmental dysplasia of the hip? (2024)

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Type of publication:
Journal article

Author(s):
*Stock, Joanne; *Deshpande, Sanjeev A.

Citation:
Archives of Disease in Childhood. 109(4):351-353, 2024 Mar 19.

Abstract:

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A Survey on the Type and Prevalence of Medical Interventions during Labor and Childbirth in Greek Pregnant Women (2023)

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Type of publication:
Journal article

Author(s):
*Papoutsis D.; Chatzipanagiotidou N.

Citation:
Clinical and Experimental Obstetrics and Gynecology. 50(12) (no pagination), 2023. Article Number: 258. Date of Publication: December 2023.

Abstract:
Background: The purpose of this study was to identify the type and prevalence of medical interventions during labor and birth in Greek pregnant women. Method(s): We constructed a 49-item web-based questionnaire to capture demographic data, obstetric data and the medical interventions performed during the most recent childbirth of participants. The questionnaire was posted on nationwide electronic media between November 2022 to January 2023. All women who had given birth at least once were eligible for the study, and results were stratified by the timing of their last birth. Result(s): There was a total of 954 women participating in the survey, with 809 women giving birth within the last 10 years and 145 women giving birth between 10 to 20 years ago. In those that gave birth within the past 10 years, the majority had a low-risk pregnancy (78.8%) and the overall cesarean section rate was 42.8%. During labor, women were allowed to change positions and to mobilize in about half of cases, whereas the lithotomy position at birth was reported by 81.4%. Almost 2 in 3 women reported a vaginal examination every hour or even more frequently, with approximately 30% sustaining more than 5 examinations intrapartum. Oxytocin use was reported in 36.9%, epidural use in 69.6%, and episiotomy in 47.3% of women. Women who had their last birth 10-20 years ago when compared to those who gave birth within the last 10 years seem to have experienced higher rates of medical interventions during labor and birth. Conclusion(s): The survey results demonstrate the medicalization of childbirth in Greek pregnant women over the past 20 years. These findings may serve as a benchmark against which to compare and identify possible changes in future birthing practices and to determine which measures to promote normality at birth should be implemented.

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Counselling and management of women with genetic predisposition to gynaecological cancers (2024)

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Type of publication:
Journal article

Author(s):
*Malik, Naushabah; *Sahu, Banchhita

Citation:
European Journal of Obstetrics, Gynecology, & Reproductive Biology. 294:44-48, 2024 Mar.

Abstract:
OBJECTIVE: To review the literature with reference to counselling and management of women with genetic predisposition to gynaecological cancers. METHODS: Histochemical analysis, ultrasound, blood investigations, genetic testing, screening and risk-reducing surgery (RRS) are important tools for the management of gynaecological cancers and mortality reduction. Counselling can assist in timely management of gynaecological cancers. Systematic reviews, review articles, observational studies and clinical trials on PubMed, published in the English language, were included in this review. RESULTS: The management of women with genetic predisposition to gynaecological cancers through screening tests and RRS has led to a significant decrease in the risk of malignancy through RRS in cases with BRCA1 and BRCA2 gene mutations. RRS and screening have also been found to reduce the mortality rate and increase the survival rate in women with BRCA1 and BRCA2 gene mutations. The efficacy of endometrial cancer surveillance in women with Lynch syndrome is still unproven. RRS has not been reported to be effective in women with Cowden syndrome. The risk of ovarian malignancies in individuals with germline mutations remains minimal in the general population in comparison with genetic mutations. CONCLUSION: Genetic testing and RRS should be implemented in addition to genetic counselling for proper management and mortality reduction of women predisposed to gynaecological cancers.

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Endocervical crypt involvement by high-grade cervical intraepithelial neoplasia and its association with high-grade histopathological recurrence after cervical excision in women with negative excision margins: a systematic review and meta-analysis (2024)

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Type of publication:
Journal article

Author(s):
*Papoutsis, Dimitrios; *Underwood, Martyn; *Parry-Smith, William; Tzavara, Chara.

Citation:
Archives of Gynecology & Obstetrics. 2023 Oct 11.

Abstract:
BACKGROUND: There is a growing body of evidence suggesting that endocervical crypt involvement by high-grade cervical intraepithelial neoplasia (CIN) may represent a risk factor for disease recurrence after cervical treatment. OBJECTIVES: To provide a systematic review and meta-analysis on whether endocervical crypt involvement by high-grade CIN on the excised cervical specimen is associated with high-grade histopathological recurrence during the follow-up of women after cervical excisional treatment. SEARCH STRATEGY: We searched the Medline, Scopus, Central, and Clinical Trials.gov databases from inception till May 2023. SELECTION CRITERIA: Studies that reported on women with a single cervical treatment with any method of excision for CIN2 or CIN3 lesion, negative excision margins, and whose recurrence was defined histopathologically were included. DATA COLLECTION AND ANYSIS: Two reviewers independently evaluated study eligibility. We used the fixed effects model for meta-analysis. MAIN RESULTS: There were 4 eligible studies included in the present systematic review that evaluated 1088 women treated with either large loop excision of the transformation zone (LLETZ) or with cold knife conization (CKC). We found no significant association of endocervical crypt involvement by CIN2-3 with high-grade histopathological recurrence at follow-up after cervical excision (OR 1.93; 95% CI 0.51-3.35). The subgroup analysis of women with LLETZ cervical excision showed again no significant association with high-grade histopathological recurrence at follow-up (OR 2.00; 95% CI 0.26-3.74). CONCLUSION: Endocervical crypt involvement by high-grade CIN does not seem to be a risk factor for high-grade histopathological recurrence after cervical excision with negative excision margins.

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