Cervical cerclage: A review

AbstractCervical cerclage is a common prophylactic intervention that has been used in the management of second trimester loss for several decades, yet it remains one of the more controversial surgical interventions in obstetrics. The diagnosis of cervical insufficiency is notoriously difficult to make, and is usually a retrospective one based on a history of recurrent second trimester loss (or early preterm delivery) following painless cervical dilatation in the absence of contractions, bleeding, or other causes of recurrent pregnancy loss. This article reviews the current literature regarding the efficacy of transvaginal cerclage (in both an elective and emergency setting), therapeutic cerclage (whereby a suture is inserted on the basis of ultrasound evidence of cervical shortening) and transabdominal cerclage

Effect of food intake during labour on obstetric outcome: randomised controlled trial

Objective To investigate the effect of feeding during labour on obstetric and neonatal outcomes

Long-Term Demographic Trends in Prehistoric Italy: Climate Impacts and Regionalised Socio-Ecological Trajectories

The Italian peninsula offers an excellent case study within which to investigate long-term regional demographic trends and their response to climate fluctuations, especially given its diverse landscapes, latitudinal range and varied elevations. In the past two decades, summed probability distributions of calibrated radiocarbon dates have become an important method for inferring population dynamics in prehistory. Recent advances in this approach also allow for statistical assessment of spatio-temporal patterning in demographic trends. In this paper we reconstruct population change for the whole Italian peninsula from the Late Mesolithic to the Early Iron Age (10,000–2800 cal yr BP). How did population patterns vary across time and space? Were fluctuations in human population related to climate change? In order to answer these questions, we have collated a large list of published radiocarbon dates (n = 4010) and use this list firstly to infer the demographic trends for the Italian peninsula as a whole, before addressing each of five sub-regions in turn (northern, central, and southern Italy, Sicily, Sardinia). We also compare population fluctuations with local paleoclimate proxies (cave, lake, marine records). At a pan-regional scale, the results show a general rapid and substantial increase in population in the Early Neolithic with the introduction of farming at around 8000 cal yr BP and further dramatic increases during the Bronze and Iron Age (~ 3800–2800 cal yr BP). However, different regional demographic trajectories exist across different regions of Italy, suggesting a variety of localised human responses to climate shifts. Population and climate appear to have been more closely correlated during the early–mid Holocene (Mesolithic–Neolithic), while later in the Holocene (Bronze–Iron Ages) they decouple. Overall, across the Holocene the population dynamics varied by region and depended on the long-term socio-ecological dynamics prevailing in a given area. Finally, we include a brief response to the paper ‘Radiocarbon dated trends and central Mediterranean prehistory’ by Parkinson et al. (J Word Prehist 34(3), 2021)—synchronously published by Journal of World Prehistory but wholly independently developed—indicating how our conclusions accord with or differ from one another

Holocene regional population dynamics and climatic trends in the Near East: a first comparison using archaeo-demographic proxies

This paper illustrates long-term trends in human population and climate from the Late Pleistocene to the Late Holocene (14,000-2500 cal. yr. BP) in order to assess to what degree climate change impacted human societies in the Near East. It draws on a large corpus of archaeodemographic data, including anthropogenic radiocarbon dates (n=10,653) and archaeological site survey (n=22,533), and 16 hydro-climatic records from cave speleothems and lake sediments. Where possible, inferred population dynamics and climatic trends have been made spatially congruent, and their relationships have been statistically tested. Demographic proxies and paleoclimatic records have been compared for the greater Near East as a whole and for seven major geo-cultural regions (Anatolia, Arabia, Cyprus, Iran, Levant, Mesopotamia, and South Caucasus). This approach allows us to identify regionalised patterns in population and climate trends. The results suggest a clear relationship between population and climate in the Late Pleistocene and Early Holocene (14,000-8326 cal. yr. BP) with population increasing in concomitance with wetter climatic conditions. During the Middle Holocene (8326-4200 cal. yr. BP) there is an increased regionalisation of demographic patterns, followed by marked interregional contrasts in the Late Holocene (4200-2500 cal. yr. BP). We identify a decoupling of demographic and climatic trends from the Middle Holocene onwards, and relate this to the existence of more complex societies. These were less vulnerable to gradual climatic shifts due to their logistical infrastructure, social organisation and technological capacity. We also assess the impact of five Rapid Climate Changes (RCC) which occurred during the study period on population levels. Although all five RCC (the so-called 10.2 k, 9.2 k, 8.2 k, 4.2 k, and 3.2 k cal. yr. BP events) are visible to some degree in our palaeoclimatic and demographic proxies, there are marked regional variations in magnitude and duration

Preterm Premature Rupture of the Membranes (PPROM):a study of patient experiences and support needs

BackgroundPreterm prelabour rupture of membranes (PPROM) is a common obstetric condition but outcomes can vary depending on gestation. Significant maternal and fetal complications occur including preterm birth, infection, abruption, cord prolapse, pulmonary hypoplasia and even death. Although the need for psychological support is recognised it is unclear how much is actually offered to women and their families. This study aimed to survey the views of women and their families who have undergone PPROM in order to understand the care and psychological burden these families face.MethodsAn online survey was conducted, recruiting women via social media with collaboration from the patient advocacy support group Little Heartbeats. Responses were collated where fields were binary or mean and standard deviations calculated. Framework analysis was used to identify and analyse themes in free text responses. Results180 PPROM pregnancies were described from 177 respondents. Although care was variable and respondents were from across the world there were common themes. Five themes were highlighted which were: a lack of balanced information regarding the condition, support in decision making and support with the process, specific psychological support and ongoing psychological consequences of PPROM.ConclusionThis survey highlights areas in which care needs to be improved for women with PPROM. Previous studies have shown that providing good care during the antenatal period reduces long term psychological morbidity for the whole family. The need for support, with regard both to information provided to women and their families and their psychological support needs to be addressed urgently.<br/

Protocol for the IMPART study: IMplementation of the preterm birth surveillance PAthway – a RealisT evaluation

Introduction New guidance, from NHS England (Saving Babies Lives Care Bundle Version 2 Element 5 (SBLCBv2)) has recommended a best practice pathway for women at risk of preterm birth (the Preterm Birth Pathway). This is to help meet the Department of Health’s aim to reduce preterm birth from 8% to 6% by 2025. Considering most hospitals do not currently have a preterm prevention clinic, implementing this pathway will require significant coordination. Methods and analysis The study will aim to investigate key features of contexts, mechanisms and outcomes, and their interactions in the implementation of the asymptomatic prediction and prevention components of the SBLCBv2 Preterm Birth Surveillance Pathway. This will be through a theory driven realist evaluation, utilising mixed methods (interviews with staff and women, observational analysis and analysing routinely collected hospital and admin data) in three case sites in England. The study has a Project Advisory Group composed of five women who have recently given birth. Ethics and dissemination The study has ethical approval (King’s College London REC approval number: MRSP-20/21-20955, and, IRAS:289144). A dissemination plan will be fully created with the Project Advisory Group, and we anticipate this will include presenting at conferences, publications, webinars, alongside dissemination to the wider population through parent and baby groups, the media and charities. Trial registration number ISRCTN57127874

FIGO good practice recommendations on progestogens for prevention of preterm delivery

Funding Information: Andrew Shennan reports payment/honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Manipal India; support for attending meetings and/or travel from Hologic; leadership or fiduciary roles in the HTA Commissioning Board UK and Action on Pre‐eclampsia charity. Natalie Suff reports no conflicts of interest. Jo Leigh Simpson reports royalties from Springer and Elsevier; consulting fees from the Illumina Clinical Expert Panel 2020; payment or honoraria for lectures, presentations, speakers bureaus, or educational events from the 1 and 2 International Congresses on the Future of Women's Health, and a speaker's bureau at ASRM 2019; participation on a data safety monitoring board or advisory board for the FDA DSMB; and leadership or fiduciary roles in IFFS and PGDIS. Bo Jacobbson reports research grants from Swedish Research Council, Norwegian Research Council, March of Dimes, Burroughs Wellcome Fund and the US National Institute of Health; clinical diagnostic trials on NIPT with Ariosa (completed), Natera (ongoing), Vanadis (completed) and Hologic (ongoing) with expendidures reimbused per patient; clinical probiotic studies with product provided by FukoPharma (ongoing, no funding) and BioGaia (ongoing; also provided a research grant for the specific study); collaboration in IMPACT study where Roche, Perkin Elmer and Thermo Fisher provided reagents to PLGF analyses; coordination of scientific conferences and meetings with commercial partners as such as NNFM 2015, ESPBC 2016 and a Nordic educational meeting about NIPT and preeclampsia screening. Bo Jacobbson is also Chair of the FIGO Working Group for Preterm Birth and the European Association of Perinatal Medicine's special interest group of preterm delivery; steering group member of Genomic Medicine Sweden; chairs the Genomic Medicine Sweden complex diseases group; and is Swedish representative in the Nordic Society of Precision Medicine. Ben W. Mol reports an investigator grant from NHMRC; consultancy for ObsEva; and research funding from Guerbet, Ferring, and Merck KGaA. William A. Grobman reports no conflicts of interest. st ndPeer reviewedPublisher PD