Partner Experiences of “Near-Miss” Events in Pregnancy and Childbirth in the UK : A Qualitative Study

Funding: This article presents independent research funded by the National Institute for Health Research (NIHR) under the “Beyond maternal death: Improving the quality of maternity care through national studies of ‘near-miss’ maternal morbidity” programme (Programme Grant RP-PG-0608-10038). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Acknowledgments The authors are grateful to all the women and men who contributed to the study, and the reviewers’ comments on the previous version of this article.Peer reviewedPublisher PD

Maternal critical care: what can we learn from patient experience? A qualitative study.

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Single photons on demand from 3D photonic band-gap structures

We describe a practical implementation of a (semi-deterministic) photon gun based on stimulated Raman adiabatic passage pumping and the strong enhancement of the photonic density of states in a photonic band-gap material. We show that this device allows {\em deterministic} and {\em unidirectional} production of single photons with a high repetition rate of the order of 100kHz. We also discuss specific 3D photonic microstructure architectures in which our model can be realized and the feasibility of implementing such a device using ${Er}^{3+}$ ions that produce single photons at the telecommunication wavelength of $1.55 \mu$m.Comment: 4 pages, 4 EPS figure

Systematic exploration of local reviews of the care of maternal deaths in the UK and Ireland between 2012 and 2014:a case note review study

ObjectivesLocal reviews of the care of women who die in pregnancy and post-birth should be undertaken. We investigated the quantity and quality of hospital reviews.DesignAnonymised case notes review.ParticipantsAll 233 women in the UK and Ireland who died during or up to 6 weeks after pregnancy from any cause related to or aggravated by pregnancy or its management in 2012–2014.Main outcome measuresThe number of local reviews undertaken. Quality was assessed by the composition of the review panel, whether root causes were systematically assessed and actions detailed.ResultsThe care of 177/233 (76%) women who died was reviewed locally. The care of women who died in early pregnancy and after 28 days post-birth was less likely to be reviewed as was the care of women who died outside maternity services and who died from mental health-related causes. 140 local reviews were available for assessment. Multidisciplinary review was undertaken for 65% (91/140). External involvement in review occurred in 12% (17/140) and of the family in 14% (19/140). The root causes of deaths were systematically assessed according to national guidance in 13% (18/140). In 88% (123/140) actions were recommended to improve future care, with a timeline and person responsible identified in 55% (77/140). Audit to monitor implementation of changes was recommended in 14% (19/140).ConclusionsThis systematic assessment of local reviews of care demonstrated that not all hospitals undertake a review of care of women who die during or after pregnancy and in the majority quality is lacking. The care of these women should be reviewed using a standardised robust process including root cause analysis to maximise learning and undertaken by an appropriate multidisciplinary team who are given training, support and adequate time

What can make things better for parents when babies need abdominal surgery in their first year of life? : A qualitative interview study in the UK

This study was funded through a National Institute for Health Research (NIHR) Professorship award to Marian Knight (NIHR-RP-011-032). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and by the National Institute for Health Research Biomedical Research Centre, Oxford, grant BRC-1215-20008 to the Oxford University Hospitals NHS Foundation Trust and the University of Oxford.Peer reviewedPublisher PD

Systematic exploration of local reviews of the care of maternal deaths in the UK and Ireland between 2012 and 2014: A case note review study

Objectives Local reviews of the care of women who die in pregnancy and post-birth should be undertaken. We investigated the quantity and quality of hospital reviews. DesignAnonymised case notes review. Participants All 233 women in the UK and Ireland who died during or up to 6 weeks after pregnancy from any cause related to or aggravated by pregnancy or its management in 2012-2014. Main outcome measures The number of local reviews undertaken. Quality was assessed by the composition of the review panel, whether root causes were systematically assessed and actions detailed. Results The care of 177/233 (76%) women who died was reviewed locally. The care of women who died in early pregnancy and after 28 days post-birth was less likely to be reviewed as was the care of women who died outside maternity services and who died from mental health-related causes. 140 local reviews were available for assessment. Multidisciplinary review was undertaken for 65% (91/140). External involvement in review occurred in 12% (17/140) and of the family in 14% (19/140). The root causes of deaths were systematically assessed according to national guidance in 13% (18/140). In 88% (123/140) actions were recommended to improve future care, with a timeline and person responsible identified in 55% (77/140). Audit to monitor implementation of changes was recommended in 14% (19/140). Conclusions This systematic assessment of local reviews of care demonstrated that not all hospitals undertake a review of care of women who die during or after pregnancy and in the majority quality is lacking. The care of these women should be reviewed using a standardised robust process including root cause analysis to maximise learning and undertaken by an appropriate multidisciplinary team who are given training, support and adequate time

The change in haemoglobin concentration between the first and third trimesters of pregnancy: a population study

© 2019 The Authors. Published by BMC. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1186/s12884-019-2495-0Background: The physiological fall in haemoglobin concentration from the 1st to the 3rd trimester of pregnancy is often quoted as 5 g/L. However, other studies have suggested varying levels of fall between 8 and 13 g/L. We evaluated the change in haemoglobin concentration between the 1st and 3rd trimesters of pregnancy in a multi-ethnic population of pregnant women. Methods: A retrospective cohort analysis of 7054 women with singleton pregnancies, giving birth during 2013-15 in a single urban maternity unit in England. We calculated the changes in haemoglobin concentration from 1st to 3rd trimester using the first trimester haemoglobin as the reference point. The population was stratified into sub-groups to explore any differences that existed within the population. Results: In general the fall in haemoglobin concentration was in the order of 14 g/L or 11% of the first trimester value. This fall was consistent for the majority of sub-groups of the population. The fall was lower (7.7%) in the most deprived section of the population, IMD1, but it increased to 11.7% when we restricted that sub-group to pregnant women without health problems during the index pregnancy. Conversely, there was an increase in haemoglobin of 10.2% in women whose first trimester haemoglobin concentration was in the lowest 5% of the total study population. The population fall in haemoglobin was 10.2 g/L (7.8%), after excluding cases above the 95th and below the 5th centiles, and women with a medical and/or obstetric disorder during the pregnancy. Conclusion: The fall in haemoglobin during pregnancy is in the order of 14 g/L or 11% of the first trimester level. This is 2 to 3 times higher than suggested by some guidelines and higher than previously published work. The results challenge the current accepted thresholds for practice, and have broader implications for diagnosis and managment of antenatal anaemia. Tweetable abstract: Fall in haemoglobin across pregnancy is around 14 g/L (11%) and significantly higher than previously stated in the pregnant population. This poses questions over currently accepted thresholds for anaemia in pregnancy.Marian Knight is funded by a National Institute for Health Research (NIHR) Research Professorship. The funding sources had no role in the study, and the researchers were independent from the funders. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Published versio