12 research outputs found
Iatrogenic and spontaneous preterm birth in England: a population-based cohort study
open access articleObjective: To describe the rates of and risk factors associated with iatrogenic and spontaneous preterm birth and the variation in rates between hospitals.
Design: Cohort study using electronic health records.
Setting: English National Health Service.
Population: Singleton births between 1st April 2015 and 31st March 2017.
Methods: Multivariable Poisson regression models were used to estimate adjusted risk ratios (adjRR) to measure association with maternal demographic and clinical risk factors.
Main outcome measures: Preterm births (<37 weeks gestation) were defined as iatrogenic or spontaneous according to mode of onset of labour.
Results: 6.1% of births were preterm and of these, 52.8% were iatrogenic. The proportion of preterm births that were iatrogenic increased after 32 weeks.
Both sub-groups are associated with previous preterm birth, extremes of maternal age, socio-economic deprivation and smoking. Iatrogenic preterm birth was associated with higher BMI (adjRR BMI >40 1.59 (1.50, 1.69)), and previous caesarean (adjRR 1.88 (1.83, 1.95)). Spontane-ous preterm birth was less common in women with a higher BMI (adjRR BMI>40 0.77 (0.70, 0.84)) and in women with a previous caesarean (adjRR 0.87 (0.83, 0.90)). More variation be-tween NHS hospital trusts was observed in rates of iatrogenic, compared to spontaneous, pre-term births.
Conclusions: Just over half of all preterm births resulted from iatrogenic intervention. Iatro-genic births have overlapping but different patterns of maternal demographic and clinical risk factors to spontaneous preterm births. Iatrogenic and spontaneous sub-groups should therefore be measured and monitored separately, as well as in aggregate, to facilitate different preven-tion strategies. This is feasible using routinely acquired hospital data
Blood stream infections in NHS Maternity and Perinatal Care for women and their babies: a feasibility report of linking maternity, neonatal and infection datasets in England. London: RCOG; 2023
HQIP commission the National Maternity and Perinatal Audit on behalf of NHS England and the Scottish and Welsh governments.The aim of this report was to link datasets that contain information about mothers, their babies, and infection data.
The NMPA has been unable to obtain linked datasets within the timeframe of the audit programme
contract, which ended on 31 December 2022. Therefore, this report focusses on how important it is to
join together the datasets that hold different information about infections during and after pregnancy in
women and birthing people and their babies. For example, data collected about pregnancy, labour and
birth, information about infections and data about admissions to hospital. Had the joined dataset been
available, this could have been used to look at aspects of maternity care and outcomes specifically for
women and birthing people who had a bloodstream infection during pregnancy or in the six weeks after
birth; and for babies who had a bloodstream or CSF infection in the first 3 days of life. Ongoing linkage of
these datasets could be used for longer term surveillance of infection and antimicrobial use in women and birthing people, and babie
Waterbirth: characteristics and outcomes in low risk women and babies: a retrospective population cohort study in England 2015/16.
Tina Harris is the Senior Clinical Lead (Midwifery) for the National Maternity and Perinatal Audit and is Senior Author on this paper.Background
Little is known about the incidence of delivery in water and concerns have been raised about the effects of waterbirth on women and their babies as it becomes more popular.
Aims and objectives of the study
To identify the proportion of low risk women who give birth in water.
To compare the characteristics and outcomes of low risk women and their babies who give birth in water with women who do not.
Methods
Ethical approval was not required as data from maternity information systems was linked to Hospital Episode Statistics for births in England from 1/4/15 -31/3/16. The cohort was restricted to singleton, term vaginal livebirths without instrument, in women with no risk factors requiring obstetric care, in trusts with complete data for birth in water.
Multivariate logistic regression models were used to examine maternal characteristics and outcomes (PPH ≥1500ml, OASI) and neonatal outcomes (Apgar <7 at 5 mins, NNU admission).
Findings
Of 52,476 births, 7099 (13.5%) were recorded as having occurred in water. Water birth was more likely in older women (adjOR for age group 30-34 1.3, 95% CI (1.2,1.5), 35-39 1.3 (1.1,1.4)) and less likely in women of black (adjOR 0.42 (0.35, 0.94)) or Asian (0.26 (0.23, 0.31)) ethnicity, or of lower socioeconomic status (lowest quintile, adjOR 0.50 (0.45-0.55)).
There was no association between delivery in water and low Apgar score (adjOR 0.99 (0.70,1.39)) or OASI (adjOR 1.09 (0.94,1.28)). There was a small association with reduced admission to a NNU (adjOR 0.91 (0.84,0.99)) and PPH (adjOR 0.69 (0.53,0.89)); however, in a subset who gave birth in a midwife-led setting, this effect did not persist.
Conclusions and implications
There is no evidence of harm to the mother (PPH, OASI) or the baby (low Apgar, NNU admission) from waterbirth. Small differences in rates of admission to NNU and PPH may be explained by unmeasured confounding variables from events during labour. Why some groups of women are less likely to experience waterbirth may reflect women‘s choice, or inequitable access
Giving birth in water in England; a National retrospective cohort study of factors associated with its use in 50,482 women
Waterbirth: a national retrospective cohort study of factors associated with its use among women in England
open access articleBackground
Waterbirth is widely available in English maternity settings for women who are not at increased risk of complications during labour. Immersion in water during labour is associated with a number of maternal benefits. However for birth in water the situation is less clear, with conclusive evidence on safety lacking and little known about the characteristics of women who give birth in water.
This retrospective cohort study uses electronic data routinely collected in the course of maternity care in England in 2015–16 to describe the proportion of births recorded as having occurred in water, the characteristics of women who experienced waterbirth and the odds of key maternal and neonatal complications associated with giving birth in water.
Methods
Data were obtained from three population level electronic datasets linked together for the purposes of a national audit of maternity care. The study cohort included women who had no risk factors requiring them to give birth in an obstetric unit according to national guidelines. Multivariate logistic regression models were used to examine maternal (postpartum haemorrhage of 1500mls or more, obstetric anal sphincter injury (OASI)) and neonatal (Apgar score less than 7, neonatal unit admission) outcomes associated with waterbirth.
Results
46,088 low and intermediate risk singleton term spontaneous vaginal births in 35 NHS Trusts in England were included in the analysis cohort. Of these 6264 (13.6%) were recorded as having occurred in water. Waterbirth was more likely in older women up to the age of 40 (adjusted odds ratio (adjOR) for age group 35–39 1.27, 95% confidence interval (1.15,1.41)) and less common in women under 25 (adjOR 18–24 0.76 (0.70, 0.82)), those of higher parity (parity ≥3 adjOR 0.56 (0.47,0.66)) or who were obese (BMI 30–34.9 adjOR 0.77 (0.70,0.85)). Waterbirth was also less likely in black (adjOR 0.42 (0.36, 0.51)) and Asian (adjOR 0.26 (0.23,0.30)) women and in those from areas of increased socioeconomic deprivation (most affluent versus least affluent areas adjOR 0.47 (0.43, 0.52)).
There was no association between delivery in water and low Apgar score (adjOR 0.95 (0.66,1.36)) or incidence of OASI (adjOR 1.00 (0.86,1.16)). There was an association between waterbirth and reduced incidence of postpartum haemorrhage (adjOR 0.68 (0.51,0.90)) and neonatal unit admission (adjOR 0.65 (0.53,0.78)).
Conclusions
In this large observational cohort study, there was no association between waterbirth and specific adverse outcomes for either the mother or the baby. There was evidence that white women from higher socioeconomic backgrounds were more likely to be recorded as giving birth in water. Maternity services should focus on ensuring equitable access to waterbirth
Technical Report: Feasibility of evaluating perinatal mental health services using linked national maternity and mental health data sets, based on births between 1 April 2014 and 31 March 2017 in Scotland
Introduction
In this short report, we describe the feasibility of using linked national data sets to evaluate perinatal
mental health services. Perinatal mental health conditions are common. About 10% of pregnant
women and 13% of women who have just given birth experience a mental health problem. Some
perinatal mental health problems can, if not adequately treated, have significant and long-lasting
effects on a woman and her baby.
For this report, we only used Scottish data sources. The data sets include episodes of admission to
secondary care, including hospital admission for perinatal mental health conditions. The results based
on Scottish data are expected to inform future analyses of similar data from England and Wales.
Specific data sets on mental health services in Wales were not yet available at the time of this study.
The report consists of three parts. First, we describe the data sets that were used and how they were
linked. Second, we present a grouping of mental health diagnoses that are similar with respect to
their prognosis and treatment (to maximise the clinical relevance) while limiting the number of
diagnosis groups (to maximise statistical power). Third, we use the results of this preparatory work to
demonstrate the clinical relevance of the linked data sets by describing a number of clinical
outcomes according to the timing of the perinatal mental health admissions.
Methods
We used linked national maternity and mental health data for Scotland on all births that took place
between 1 April 2014 and 31 March 2017, and inpatient admissions for mental health conditions
between 1 April 2000 and 31 March 2018.
Births records were identified in the National Records of Scotland (NRS). These records were used as
a ‘spine’ against which records from all other Scottish Morbidity Record (SMR) data sets were linked:
general/acute inpatient records (SMR-01), maternity inpatient records (SMR-02), mental health
inpatient records (SMR-04) and the Scottish Birth Record (SBR).
Women who had a mental health admission were identified in SMR-04 data as well as in SMR-01
data if their admission record contained a diagnosis code from Chapter V (‘Mental and behaviour
disorders’) of the International Classification of Disease, 10th Revision (ICD-10).
Findings
Both mental health inpatient data (SMR-04) and general/acute inpatient data (SMR-01) need to be
used to identify women who had a hospital admission for mental health indications. We identified
3457 births in women who had a mental health admission. About two-thirds of the mental health
admissions were identified in SMR-04 and about one-third in SMR-01.
163109 births were identified. 3043 (2.1%) of these births were in women with a prepregnancy
history of a mental health admission. 176 (5.8%) of the women with prepregnancy mental health
admission were also admitted during the perinatal period (during pregnancy or in the first year after
giving birth). In comparison, only 414 (0.3%) of the 160066 births of women without a prepregnancy
mental health admission had a perinatal mental health admission. Therefore, in the majority of cases
Evaluating perinatal mental health services using linked national maternity and mental health data sets
– 414 of the 590 perinatal mental health admissions (70.2%) – the perinatal mental health admission
was a women’s first mental health admission.
Diagnostic codes were grouped into eight diagnosis groups aiming to maximise the clinical relevance
and statistical power. Based on this grouping, we found that major depressive disorders were the
most frequently observed diagnoses (22.9%) among the 590 women with a perinatal mental health
admission, followed by admissions for anxiety and post-traumatic stress disorders (19.3%). However,
if we only considered the 176 women who had a perinatal mental health admission after a
prepregnancy mental health admission, the most frequently observed diagnoses were related to
psychoactive substance use (25.0%).
Following this preparatory work, we demonstrated the clinical relevance of these data. Babies born
to women with a prepregnancy history of perinatal health admission were found to be more likely to
be preterm (12.0% born before 37 weeks), to have low birthweight (4.3% with birthweight below
2500 g in term babies) or to need some medical help (2.6% with an Apgar score less than 7 at
5 minutes after birth) than babies born to women without such a history (7.1%, 2.0%, and 1.7%,
respectively). Outcomes in babies of women who had a perinatal mental health admission (590) were
similar to those of women with a prepregnancy history of mental health admission (3043).
Admission to an inpatient psychiatric mother-and-baby unit (MBU) was most frequent in women
who had a mental health admission in the first 12 weeks after giving birth (79.5%) and considerably
lower in women who had a mental health admission during pregnancy (23.7%) or between 13 and
52 weeks after giving birth (38.1%).
Conclusions
This study demonstrates the feasibility as well as the clinical relevance of using linked national
maternity and mental health data sets from Scotland to assess the care that women with perinatal
mental health problems receive. Despite only identifying women with severe perinatal mental health
conditions, linkage of data sets of secondary care admission will offer an important opportunity to
monitor the impact of national initiatives to improve perinatal mental health services in all four nations of the UK
Risk of postpartum haemorrhage is associated with ethnicity: A cohort study of 981 801 births in England
The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Women with an ethnic minority background giving birth in England have an increased risk of postpartum haemorrhage, even when characteristics of the mother, the baby and the care received are taken into account
Risk of postpartum haemorrhage is associated with ethnicity: A cohort study of 981Â 801 births in England.
OBJECTIVE: To determine the association between ethnic group and risk of postpartum haemorrhage in women giving birth. DESIGN: Cohort study. SETTING: Maternity units in England. SAMPLE: A total of 981 801 records of births between 1 April 2015 and 31 March 2017 in a national clinical database. METHODS: Multivariable logistic regression analyses with multiple imputation to account for missing data and robust standard errors to account for clustering within hospitals. MAIN OUTCOME MEASURE: Postpartum haemorrhage of ≥1500 ml (PPH). RESULTS: A total of 28 268 (2.9%) births were complicated by PPH. Risks were higher in women from black (3.9%) and other (3.5%) ethnic backgrounds. Following adjustment for maternal and fetal characteristics, and care at birth, there was evidence of an increased risk of PPH in women from all ethnic minority groups, with the largest increase seen in black women (adjusted OR 1.54, 95% CI 1.45-1.63). The increase in risk was robust to sensitivity analyses, which included changing the outcome to PPH of ≥3000 ml. CONCLUSIONS: In England, women from ethnic minority backgrounds have an increased risk of PPH, when maternal, fetal and birth characteristics are taken into account. Factors contributing to this increased risk need further investigation. Perinatal care for women from ethnic minority backgrounds should focus on preventative measures to optimise maternal outcomes. TWEETABLE ABSTRACT: Women with an ethnic minority background giving birth in England have an increased risk of postpartum haemorrhage, even when characteristics of the mother, the baby and the care received are taken into account
Associations between ethnicity and admission to intensive care among women giving birth: a cohort study
The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Abstract
Objective: To determine the association between ethnic group and likelihood of admission to intensive care in pregnancy and the postnatal period.
Design: Cohort study.
Setting: Maternity and intensive care units in England and Wales.
Population or Sample: 631 851 women who had a record of a registerable birth between 1st April 2015 and 31st March 2016 in a database used for national audit.
Methods: Logistic regression analyses of linked maternity and intensive care records, with multiple imputation to account for missing data.
Main Outcome Measures: Admission to intensive care in pregnancy or postnatal period to six weeks after birth.
Results: 2.24 per 1000 maternities were associated with intensive care admission. Black women were more than twice as likely as women from other ethnic groups to be admitted (OR 2.21 (1.82, 2.68). This association was only partially explained by demographic, lifestyle, pregnancy and birth factors (adjOR 1.69 (95% CI 1.37, 2.09)). A higher proportion of intensive care admissions in Black women were for obstetric haemorrhage than in women from other ethnic groups.
Conclusions: Black women have an increased risk of intensive care admission which cannot be explained by demographic, health, lifestyle, pregnancy and birth factors. Clinical and policy intervention should focus on the early identification and management of severe illness, particularly obstetric haemorrhage, in Black women, in order to reduce inequalities in intensive care admission.
Funding: This study was funded by a programme grant from the Healthcare Quality Improvement Partnership