Anaphylaxis in pregnancy : a population-based multinational European study

Anaphylaxis in pregnancy is a rare but severe complication for both mother and infant. Population-based data on anaphylaxis in pregnancy are lacking from mainland European countries. This multinational study presents the incidence, causative agents, management and maternal and infant outcomes of anaphylaxis in pregnancy. This descriptive multinational study used a combination of retrospective (Finnish medical registries) and prospective population-based studies (UK, France, Belgium and the Netherlands) to identify cases of anaphylaxis. Sixty-five cases were identified among 4,446,120 maternities (1.5 per 100,000 maternities; 95%CI 1.1-1.9). The incidence did not vary between countries. Approximately three-quarters of reactions occurred at the time of delivery. The most common causes were antibiotics in 27 women (43%), and anaesthetic agents in 11 women (17%; including neuromuscular blocking drugs, 7), which varied between countries. Anaphylaxis had very poor outcomes for one in seven mothers and one in seven babies; the maternal case fatality rate was 3.2% (95%CI 0.4-11.0) and the neonatal encephalopathy rate was 14.3% (95%CI 4.8-30.3). Across Europe, anaphylaxis related to pregnancy is rare despite having a multitude of causative agents and different antibiotic prophylaxis protocols.Peer reviewe

Anaphylaxis in pregnancy : a population-based multinational European study

Funding Information: M‐P B, OA, and GV had equal contributions to this study. We thank T. Schapp, J. Zwart and E. Overtoom in the NethOSS team; C. Daoui from the French SFAR Research Network; the B.OSS team and Belgian maternity units involved in this study. The work was funded by the Medical Research Council (MRC) and the Nuffield Department of Population Health. The views expressed in this publication are those of the authors and not necessarily those of the MRC. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the article. Permission for the use and sharing of registry and medical records was obtained from the National Institute for Health and Welfare (THL), Finland. Approval was acquired from the B.OSS and NethOSS steering committee for the data collection and sharing of anonymous data for this anaphylaxis study. The French Data Protection Authority approved the collection of the data (CNIL 1985389). All the women in France were informed of anonymised data collection during the study. B.oSS gained approval for data collection from the Ghent University Ethics Committee as central EC (2015/1470, amendment 23/06/2016, B670201526875), and gained informed consent of all women included in the study. The Central University Research Ethics Committee, University of Oxford gave approval to complete this prospective observational study (Reference R46400/RE001). Data sharing statement: Data cannot be shared publicly due to confidentiality issues arising from small numbers of cases in mainland European countries. Requests for access to the UK dataset will be considered by the National Perinatal Epidemiology Unit Data Sharing committee. Access to the data can be requested from [email protected] . No other external funding or competing interests declared. Publisher Copyright: © 2020 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Peer reviewedPublisher PD

Lessons learnt from anonymized review of cases of peripartum hysterectomy by international experts: A qualitative pilot study

Severe obstetric complications are not extensively studied and individual cases are used too little and inappropriately in quality improvement activities, due to limited numbers and prioritization of quantitative research. Nordic and European experts performed a qualitative pilot study using anonymized cases of peripartum hysterectomy. It was feasible to anonymize narratives and we learned lessons in the form of themes for improved clinical care and future research. Therefore, we plan a Nordic anonymized review of the care of women who have undergone peripartum hysterectomy based on narratives. The qualitative outcomes of clinically relevant themes for quality improvement and research will add value to the quantitative analyses from the Nordic medical birth registries. In the longer term, we believe that qualitative audits should be essential part of the process of continuing improvement in maternity care. This article is protected by copyright. All rights reserved

Geochemical analysis of soil in the central Barents Region

This atlas is the culmination of one of the most comprehensive environmental geochemical studies ever undertaken on a regional scale. It covers some of the most polluted, and some of the most pristine areas in Europe. It provides data for many elements for which the media concerned have not previously been analysed on a large regional scale and demonstrates that many of these are part of the emission spectra from industries within the area covered. It casts light on many processes governing the distribution of elements in the biosphere, pedosphere and geosphere, questioning some established theories and confirming others. It represents both an end and a beginning, in that the data are now available for use in studies related to toxicological impacts on plants, animals and humans, remediation of polluted areas, the scientific basis for action levels, baseline assessments for new development projects and other fields