Review of Late Preterm birth at Mowbray Maternity Hospital

Introduction: Preterm births are common in all obstetric hospitals and present multiple challenges to both the obstetrician and the paediatrician. Preterm delivery is an important cause of perinatal morbidity and mortality, and places significant psychosocial stress on all involved. Late Preterm Birth (LPTB) is an important topic with many consequences for mother, child and society. It would be of interest to quantify the problem of late preterm birth at Mowbray Maternity Hospital (MMH); quantifying the deliveries into spontaneous versus medically indicated, and to explore the reasons and outcomes for each category. Aims and Objectives: To review the causes, indications for, and outcomes (maternal and neonatal) of all late preterm births delivered at Mowbray Maternity Hospital. Methods: This was a retrospective descriptive study, conducted at Mowbray Maternity Hospital, between January 1 st 2016 and March 31 st 2016. The study population, consisting of 231 patients, includes all deliveries at MMH during the above time period, which fit the inclusion criteria of a gestational age (GA) of between 34⁺⁰ and 36⁺⁶ weeks. All data pertaining to the patient’s previous history, risk factors and current pregnancy were captured and analyzed using Stata. This study was approved by the UCT Ethics Committee (HREC) and institutional approval was obtained from Mowbray Maternity Hospital. All information was treated with confidentially and in accordance with the Helsinki Declaration. Results: During the study period, 1st January 2016 and 31st March 2016, there were a total of 2342 deliveries. Of these deliveries 36 (1.5%) were found to have a GA < 28 weeks (these included those that were categorised as miscarriages); 24 (1%) were between 28 – 31⁺⁶ weeks; 56 (2.4%) were between 32 – 33⁺⁶ weeks and 1833 (78.2%) had a GA above 37 weeks. 162 (6.9%) folders were missing and therefore GA was not calculated, leaving 231 (9.9%) deliveries of late preterm infants. Of the 231 patients included, 64 (27.7%) were noted to have a poor obstetric history, 38 (16.5%) had a history of a previous preterm delivery. Gestational age was calculated by Early Ultrasound Scan (EUS) in 44.2% of cases; Late Ultrasound Scan (LUS) in 36.4 % of cases; Last Normal Menstrual Period (LNMP) in 14.3% of cases and booking palpation in 5.12% of cases. At least one maternal characteristic associated with preterm labour was seen in 131 (56.7%) of the included patients. There were 20 (8.7%) sets of twins. Of the 231 patients, 129 (55.8%) presented in spontaneous labour and 102 were delivered late preterm for medical reasons; this included 70 (30.3% of 231) who had labour induced and 32 (13.9% of 231) who were delivered via caesarean section despite not being in labour for reasons that prevented an Induction of Labour (IOL)/vaginal birth. There were 251 babies delivered in the late preterm category, and of these, 250 (99.6%) were born alive, with 1 Early Neonatal Death (ENND) and 1 macerated stillborn. Of the 251 newborns, 63 (25.1%) were admitted to at least one of the neonatal wards during their hospital stay. Of these, 64.1% spent time in the High Care Unit (HCU), 28.1% spent time in the Neonatal Intensive Care Unit (NICU) and 68.8% spent time in Kangaroo Mother Care (KMC) unit (majority of these newborns had been in either HCU or NICU prior to KMC). Of the 63 neonates admitted to a neonatal ward; there were 37 (36.3%) from the 102 mothers delivered for medical reasons and 26 (20.2%) from the 129 mothers who had presented in spontaneous labour. The overall correlation between gestational age calculated by EUS/LUS/LMNP and Ballard score was calculated as 37%. The average length of stay in the hospital for the newborns, whether admitted or with mom, was 4.96 days. Discussion and Conclusion: Late Preterm Birth accounts for 9.9% of all births and 66.6% of all preterm births at Mowbray Maternity Hospital. This is a substantial proportion of MMH deliveries, putting pressure on already strained resources. This pressure is confounded by the fact that 25.1% of these neonates are admitted to a neonatal ward. 44.2% of these births are medically initiated and this should give cause for thought as to whether our protocols that govern certain medical conditions in pregnancy could possibly be altered to prolong pregnancies and reduce the incidence of Late Preterm Birth

Adoption and Foster Care by Gay and Lesbian Parents in the United States

Discussion and debate about adoption and foster care by gay, lesbian, and bisexual (GLB) parents occurs frequently among child welfare policymakers, social service agencies, and social workers. They all need better information about GLB adoptive and foster parents and their children as they make individual and policy-level decisions about placement of children with GLB parents. This report provides new information on GLB adoption and foster care from the U.S. Census 2000, the National Survey of Family Growth (2002), and the Adoption and Foster Care Analysis and Reporting System (2004)

Designing a Tool and Cooperative Learning: A MACOS Inspired Activity

This simulation activity presents how elements of Man: A Course of Study (MACOS) can be implemented into the social studies classroom. Inspired by the Tool-Making Activity found in MACOS, this modified simulation activity prompts students to design an instrument to peel an orange as they discuss life and daily tasks related to the Great Plains settlement

Towards a new social justice agenda: understanding political responses to crises

This In Focus Policy Briefing was written by Naomi Hossain of the institute of development Studies with inputs and advice from Kate Bishop, Robert Chambers, Kate Carroll, Rosalind Eyben, Richard Jolly, Claire Melamed and Rachel Sabates-Wheeler. The series editor is Carol Smithyes.Food riots across the developing world in 2008 sent powerful messages about the limits to people’s tolerance of acute economic insecurity. Yet political responses of this kind are mainly treated as the inevitable social convulsions after economic shocks – as natural, almost physiological responses to hunger. This briefing proposes that these political responses to crises can provide insights into popular perspectives on the global political issues of the day: global economic uncertainty, the moral limits to market freedom, and responsibilities of governments to protect against risk. Understanding such perspectives could inform emerging debates within development and help shape a new social justice agenda

The right to fail? Problematizing failure discourse in international conservation

A growing body of critical research interrogates the tendency within international conservation circles to present interventions as successful, even when evidence points to substantial negative impacts. The flip side of this ‘selling’ success is a growing emphasis on the importance of embracing and even celebrating failure. Yet this important trend in international conservation policymaking has yet to be examined in depth. We address this research gap by first tracing the origins of the embracing failure narrative, linking it to the historical handling of failure in conservation and in fields such as business management and international development. We then explore the implications of this framing of failure for international conservation policy and practice by examining relevant policy literature and illustrative case studies in Tanzania and Peru. Based on this analysis, we demonstrate how a ‘right to fail’ can justify both continuing and discontinuing conservation interventions in highly problematic ways. We show how the framing of failure as a positive outcome for global learning can reduce accountability for significant and long-lasting negative consequences of failed interventions. Furthermore, the emphasis on approaches to learning that employ narrow technical frames can depoliticize issues and limit possibilities to fundamentally question and transform dominant conservation models with histories of persistent failure. Consequently, we argue that by affording interventions the ‘right to fail’, conservation actors with a stake in dominant models have taken control of failure discourse in ways that reinforce instead of undermine their ability to ‘sell’ success amidst negative (or limited) local outcomes. While it is of course important to acknowledge failure in order not to repeat it, we caution against embracing failure in ways that may further exacerbate conservation injustices and hinder transformative societal change. We advocate instead for an explicitly political approach to addressing failure in conservation

The impact of across-slope forest strips on hillslope subsurface hydrological dynamics

Forest cover has a significant effect on hillslope hydrological processes through its influence on the water balance and flow paths. However, knowledge of how spatial patterns of forest plots control hillslope hydrological dynamics is still poor. The aim of this study was to examine the impact of an across-slope forest strip on sub-surface soil moisture and groundwater dynamics, to give insights into how the structure and orientation of forest cover influences hillslope hydrology. Soil moisture and groundwater dynamics were compared on two transects spanning the same elevation on a 9° hillslope in a temperate UK upland catchment. One transect was located on improved grassland; the other was also on improved grassland but included a 14 m wide strip of 27-year-old mixed forest. Sub-surface moisture dynamics were investigated upslope, underneath and downslope of the forest over 2 years at seasonal and rainfall event timescales. Continuous data from point-based soil moisture sensors and piezometers installed at 0.15, 0.6 and 2.5 m depth were combined with seasonal (~bi-monthly) time-lapse electrical resistivity tomography (ERT) surveys. Significant differences were identified in sub-surface moisture dynamics underneath the forest strip over seasonal timescales: drying of the forest soils was greater, and extended deeper and for longer into the autumn compared to the adjacent grassland soils. Water table levels were also persistently lower in the forest and the forest soils responded less frequently to rainfall events. Downslope of the forest, soil moisture dynamics were similar to those in other grassland areas and no significant differences were observed beyond 15 m downslope, suggesting minimal impact of the forest at shallow depths downslope. Groundwater levels were lower downslope of the forest compared to other grassland areas, but during the wettest conditions there was evidence of upslope-downslope water table connectivity beneath the forest. The results indicate that forest strips in this environment provide only limited additional sub-surface storage of rainfall inputs in flood events after dry conditions in this temperate catchment setting

Antenatal peer support workers and initiation of breast feeding: cluster randomised controlled trial

Objective To assess the effectiveness of an antenatal service using community based breastfeeding peer support workers on initiation of breast feeding

Effects of a demand-led evidence briefing service on the uptake and use of research evidence by commissioners of health services:A controlled before-and-after study

Background: The Health and Social Care Act 2012 has mandated research use as a core consideration of health service commissioning arrangements. We evaluated whether or not access to a demand-led evidence briefing service improved use of research evidence by commissioners compared with less intensive and less targeted alternatives. Design: Controlled before-and-after study. Setting: Clinical Commissioning Groups (CCGs) in the north of England. Main outcome measures: Change at 12 months from baseline of a CCG’s ability to acquire, assess, adapt and apply research evidence to support decision-making. Secondary outcomes measured individual clinical leads’ and managers’ intentions to use research evidence in decision-making. Methods: Nine CCGs received one of three interventions: (1) access to an evidence briefing service; (2) contact plus an unsolicited push of non-tailored evidence; or (3) an unsolicited push of non-tailored evidence. Data for the primary outcome measure were collected at baseline and 12 months post intervention, using a survey instrument devised to assess an organisation’s ability to acquire, assess, adapt and apply research evidence to support decision-making. In addition, documentary and observational evidence of the use of the outputs of the service was sought and interviews with CCG participants were undertaken. Results: Most of the requests were conceptual; they were not directly linked to discrete decisions or actions but intended to provide knowledge about possible options for future actions. Symbolic use to justify existing decisions and actions were less frequent and included a decision to close a walk-in centre and to lend weight to a major initiative to promote self-care already under way. The opportunity to impact directly on decision-making processes was limited to work to establish disinvestment policies. In terms of impact overall, the evidence briefing service was not associated with increases in CCGs’ capacity to acquire, assess, adapt and apply research evidence to support decision-making, individual intentions to use research findings or perceptions of CCGs’ relationships with researchers. Regardless of the intervention received, at baseline participating CCGs indicated that it felt it was inconsistent in its research-seeking behaviours and its capacity to acquire research remained so at follow-up. The informal nature of decision-making processes meant that there was little or no traceability of the use of evidence. Limitations: Low baseline and follow-up response rates (of 68% and 44%, respectively) and missing data limit the reliability of these findings. Conclusions: Access to a demand-led evidence briefing service did not improve the uptake and use of research evidence by NHS commissioners compared with less intensive and less targeted alternatives. Commissioners appear to be well intentioned but ad hoc users of research. Future work: Further research is required on the effects of interventions and strategies to build individual and organisational capacity to use research. Resource-intensive approaches to providing evidence may best be employed to support instrumental decision-making. Comparative evaluation of the impact of less intensive but targeted strategies on the uptake and use of research by commissioners is warranted. Funding: National Institute for Health Research Health Services and Delivery Research programme