Atosiban in the management of preterm labour

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Maternal and Perinatal Outcomes in women with Hepatitis B Carrier State

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Is frozen embryo transfer better for mothers and babies? Can cumulative meta-analysis provide a definitive answer?

A.M. and S.B. are co-applicants on the HTA/ NIHR grant, UK (ISCTRN-61225414) for E-Freeze Trial which is a randomised controlled trial comparing elective freezing of embryos with current policy of fresh embryo transfer. Otherwise the authors have no conflict of interest.Peer reviewedPostprin

Changing risk factors for placental abruption : a case crossover study using routinely collected data from Finland, Malta and Aberdeen

ACKNOWLEDGEMENTS With thanks to the women from Malta, Finland and Aberdeen whose data is included and to all who contributed to the datasets used. Data Availability: The dataset was created from three population based international datasets and permissions obtained from governing committees for the 3 databases. Therefore permission for public access to data will need to be given by all three committees. The Finnish register data have been given for this specific study, and the data cannot be shared without authorization from the register keepers. More information on the authorization application to researchers who meet the criteria for access to confidential data can be found at https://thl.fi/fi/web/thlfi-en/statistics/information-for-researchers/authorisation-application (THL). Similarly data from Aberdeen can be accessed by applying to the AMND steering committee found at https://www.abdn.ac.uk/iahs/research/obsgynae/amnd/access.php. The authors did not have special access privileges in accessing the data. Funding: Funding was received from NHS Grampian Endowment Fund (Grant number RG14524-10) to cover data access and storage costs and for article processing charges for open access publication for this research project. The funders played no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Complementary and Alternative Medicines Use during Pregnancy : A Systematic Review of Pregnant Women and Healthcare Professional Views and Experiences

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Herbal Medicinal Product Use During Pregnancy and the Postnatal Period: : A Systematic Review

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'Asking the right question'. A comparison of two approaches to gathering data on 'herbals' use in survey based studies

BACKGROUND:Over the last decade academic interest in the prevalence and nature of herbal medicines use by pregnant women has increased significantly. Such data are usually collected by means of an administered questionnaire survey, however a key methodological limitation using this approach is the need to clearly define the scope of 'herbals' to be investigated. The majority of published studies in this area neither define 'herbals' nor provide a detailed checklist naming specific 'herbals' and CAM modalities, which limits inter-study comparison, generalisability and the potential for meta-analyses. The aim of this study was to compare the self-reported use of herbs, herbal medicines and herbal products using two different approaches implemented in succession. METHODS:Cross-sectional questionnaire surveys of women attending for their mid-trimester scan or attending the postnatal unit following live birth at the Royal Aberdeen Maternity Hospital, North-East Scotland. The questionnaire utilised two approaches to collect data on 'herbals' use, a single closed yes/no answer to the question "have you used herbs, herbal medicines and herbal products in the last three months"; and a request to tick which of a list of 40 'herbals' they had used in the same time period. RESULTS:A total of 889 responses were obtained of which 4.3% (38) answered 'yes' to herbal use via the closed question. However, using the checklist 39% (350) of respondents reported the use of one or more specific 'herbals' (p<0.0001). The 312 respondents who reported 'no' to 'herbals' use via the closed question but "yes" via the checklist consumed a total of 20 different 'herbals' (median 1, interquartile range 1-2, range 1-6). CONCLUSIONS:This study demonstrates that the use of a single closed question asking about the use of 'herbals', as frequently reported in published studies, may not yield valid data resulting in a gross underestimation of actual use

Risk assessment and decision making about in-labour transfer from rural maternity care: a social judgment and signal detection analysis

Background: The importance of respecting women's wishes to give birth close to their local community is supported by policy in many developed countries. However, persistent concerns about the quality and safety of maternity care in rural communities have been expressed. Safe childbirth in rural communities depends on good risk assessment and decision making as to whether and when the transfer of a woman in labour to an obstetric led unit is required. This is a difficult decision. Wide variation in transfer rates between rural maternity units have been reported suggesting different decision making criteria may be involved; furthermore, rural midwives and family doctors report feeling isolated in making these decisions and that staff in urban centres do not understand the difficulties they face. In order to develop more evidence based decision making strategies greater understanding of the way in which maternity care providers currently make decisions is required. This study aimed to examine how midwives working in urban and rural settings and obstetricians make intrapartum transfer decisions, and describe sources of variation in decision making. Methods: The study was conducted in three stages. 1. 20 midwives and four obstetricians described factors influencing transfer decisions. 2. Vignettes depicting an intrapartum scenario were developed based on stage one data. 3. Vignettes were presented to 122 midwives and 12 obstetricians who were asked to assess the level of risk in each case and decide whether to transfer or not. Social judgment analysis was used to identify the factors and factor weights used in assessment. Signal detection analysis was used to identify participants' ability to distinguish high and low risk cases and personal decision thresholds. Results: When reviewing the same case information in vignettes midwives in different settings and obstetricians made very similar risk assessments. Despite this, a wide range of transfer decisions were still made, suggesting that the main source of variation in decision making and transfer rates is not in the assessment but the personal decision thresholds of clinicians. Conclusions: Currently health care practice focuses on supporting or improving decision making through skills training and clinical guidelines. However, these methods alone are unlikely to be effective in improving consistency of decision making

Pregnancy, prescription medicines and the potential risk of herb-drug interactions:a cross-sectional survey

Funding All funding was from institutional resource. JSM, AS are employed by the University of Aberdeen. DS is employed by the Robert Gordon University. BP and CR are employed by NHS Scotland. ARP and MAH are employed by the Hamad Medical Corporation. Qatar. NI is a postgraduate student at the University of Aberdeen.Peer reviewedPublisher PD

New perspectives in labour induction at term - with particular reference to the role of the PGE1 analogue misoprostol

The main research question for this thesis was to see if misoprostol is effective in labour induction at term while maintaining safety for both mother and baby, and to determine its most appropriate dosage and route of administration for any future clinical use. The other objectives of the thesis were: 1.  to review the understanding of the physiology of the onset of labour and the development of the currently used pharmacological agents for artificial initiation of labour with a viable fetus; 2.  to review the evidence on the trends of labour induction and the clinical efficacy and safety of the currently used induction regimens with a view to suggesting improvements; 3.  to evaluate the use of oral misoprostol for the specific indication of active management of pre-labour rupture of membranes at term; 4.  to investigate the use of mifepristone in outpatient cervical ripening and labour induction at term, with the addition of misoprostol regimens if mifepristone alone is unsuccessful in ripening the cervix. The management of pre-labour rupture of membranes is still a matter of debate.  Oral inducing agents may have an advantage in the induction of labour after PROM by reducing the need for internal examinations and therefore of sepsis, both neonatal and maternal.  The trial comparing conservative management with active management with oral misoprostol n the management of PROM is presented. Mifepristone has not been extensively investigated for labour induction at term.  The results of a pilot study evaluating the clinical regimen of mifepristone and misoprostol is presented.  There is an observational comparison group of women managed with the routine protocol of vaginal PGE2 for labour induction.EThOS - Electronic Theses Online ServiceGBUnited Kingdo