Tagged / obstetrics

BMC blog on latest HSS paper

Dr. Rachel Arnold’s recent paper in BMC Pregnancy & Childbirth was highlighted in a blog promoted by the publisher.  The paper ‘Villains or victims? An ethnography of Afghan maternity staff and the challenge of high quality respectful care‘ reports on the everyday lives of maternal healthcare providers working in a tertiary maternity hospital in Kabul, Afghanistan (1). BMC Pregnancy & Childbirth is an Open Access journal so the paper is available free of charge to anybody in Afghanistan (and elsewhere) with an internet connection.  The aim was to understand the staff’s notions of care, their varying levels of commitment to providing care for women in childbirth, and the obstacles and dilemmas that affected standards, and thereby gain insight into their contributions to respectful maternity care, whether as ‘villains’ or as ‘victims.’

Dr. Arnold is Postdoctoral Midwifery Researcher in the Centre for Midwifery, Maternal & Perinatal Health (CMMPH).  This is the third paper from Rachel’s excellent PhD project, the previous two papers appeared in BJOG and Social Science & Medicine (2-3).

Click here for BMC Blog post:

Villains or victims? The role of maternity staff in decreasing or enhancing respectful care

Reference:

  1. Arnold, R., van Teijlingen, E., Ryan, K., Holloway, I. (2019) Villains or victims? An ethnography of Afghan maternity staff and the challenge of high quality respectful care, BMC Pregnancy & Childbirth 19 :307 https://rdcu.be/bPqlj
  2. Arnold R., van Teijlingen E, Ryan K., Holloway I. (2015) Understanding Afghan health care providers: Qualitative study of culture of care in Kabul maternity hospital, BJOG 122: 260-267.
  3. Arnold, R., van Teijlingen, E., Ryan, K., Holloway, I. (2018) Parallel worlds: an ethnography of care in an Afghan maternity hospital, Social Science & Medicine 126:33-40.

 

New collaborative paper BU-NHS colleagues

The month saw the publication of the latest collaborative paper between FHSS academics, BU Visiting Faculty and NHS clinicians.  Our paper ‘Design errors in vital sign charts used in consultant-led maternity units in the United Kingdom’ [1] is available for a free download from Elsevier until August 28, 2019. Till then no sign up, registration or fees are required, click here.

The authors, as part of the Modified Obstetric Warning Score (MObs) Research Group, lead by BU Visiting Faculty Richard Isaac, argue that obstetric observation charts in the UK contain poor design features. These charts have common errors such as an inappropriate use of colour, poor alignment and axes labelling.  Consequently, these design errors render charts difficult to use and could compromise patient safety. The article calls for an evidence-based, standardised obstetric observation chart, which should integrate ‘human factors’ and user experience.

This research team, earlier published ‘Vital signs and other observations used to detect deterioration in pregnant women: Analysis of vital sign charts in consultant-led maternity units’. [2]

References:

  1. Isaacs, R., Smith, G., Gale-Andrews, L., Wee, M., van Teijlingen, E., Bick, D.E., Hundley, V. on behalf of the Modified Obstetric Warning Score (MObs) Research Group. (2019) Design errors in vital sign charts used in consultant-led maternity units in the United Kingdom, International Journal of Obstetric Anesthesia 39:60-67.
  2. Smith, G., Isaacs, R., Gale-Andrews, L., Wee, M., van Teijlingen, E., Bick, D., Hundley, V. (2017) Vital signs and other observations used to detect deterioration in pregnant women: Analysis of vital sign charts in consultant-led maternity units. International Journal of Obstetric Anesthesia 30: 44-51.

 

First publication of 2019

Having had the pleasure of announcing the last BU publication yesterday, today we received an email that our paper ‘Design errors in vital sign charts used in consultant-led maternity units in the United Kingdom’ has been accepted by the International Journal of Obstetric Anesthesia.  This paper is led by FHSS Visiting Faculty Gary Smith and Richard Isaac and has as co-authors Vanora Hundley, Lisa Gale-Andrews and Edwin van Teijlingen as well as two further BU Visiting Professors: Mike Wee and Debra Bick.

New publication: vital signs obstetric charts

Congratulations on the Faculty of Health & Social Sciences team which had its paper ‘Vital signs and other observations used to detect deterioration in pregnant women: an analysis of vital sign charts in consultant-led UK maternity units’ accepted by the International Journal of Obstetric Anesthesia (published by Elsevier). 
The paper compares: (i) vital sign values used to define physiological normality; (ii) symptoms and signs used to escalate care; (iii) 24 type of chart used; and (iv) presence of explicit instructions for escalating care. The authors conclude that the wide range of ‘normal’ vital sign values in different systems used in the UK and the Channel Islands suggests a lack of equity in the processes for detecting deterioration and escalating care in hospitalised pregnant and postnatal women. Agreement regarding ‘normal’ vital sign ranges is urgently required and would assist the development of a standardised obstetric early warning system and chart. The lead author of this new paper is FHSS Visiting Professor Gary Smith, his co-authors include FHSS staff Vanora Hundley, Lisa Gale_Andrews and Edwin van Teijlingen as well as three BU Visiting Faculty: Debra Bick (King’s College London), Mike Wee (Poole Hospital NHS Foundation Trust) and Richard Isaacs (University Hospital Southampton).

BUCRU – Seminar presenting Breaking News!

 

BREAKING  NEWS…

We would like to invite you to an afternoon seminar by one of our Visiting Faculty, Professor Mike Wee, presenting some exciting new research findings to come out of a recently completed Research for Patient Benefit funded study comparing two methods of pain relief during labour (abstract and biography below).  This paper was just voted best paper of the conference at the Obstetric Anaesthetists Association Annual Conference in Liverpool and was featured recently in the Bournemouth Echo http://www.bournemouthecho.co.uk/news/9770928.Pain_relief_in_labour__study_at_Poole_hospital_makes_important_discovery/

The seminar is scheduled for Thursday 19th July 2-3pm in BG10 Bournemouth House (after the HSC end of term lunch and next door for your convenience).

We hope you can make it and look forward to seeing you then.

BUCRU

Website: http://microsites.bournemouth.ac.uk/bucru/

Administrator: +44 (0)1202 961939 / wardl@bournemouth.ac.uk

Title: The IDvIP Trial: A two-centre double blind randomised controlled trial comparing i.m. diamorphine and i.m. pethidine for labour analgesia

Research team and affiliations: MYK Wee, JP Tuckey,* P Thomas,† S Burnard,* D Jackson.

Poole Hospital NHS Foundation Trust, Poole, UK, *Royal United Hospital, Bath, UK, Bournemouth University Clinical Research Unit, Bournemouth, UK.

Abstract:

Background: Intramuscular pethidine, the commonest parenteral opioid analgesic used in obstetrics and more recently diamorphine usage has increased in the UK.  The maternal, fetal and neonatal side effects are well known for pethidine but there are no sufficiently powered large RCTs comparing pethidine with diamorphine. The aim of this trial is to address this.

Methods: After ethical approval, informed consent was obtained from 484 women randomised to receive either 7.5mg diamorphine i.m. or 150mg pethidine i.m. for labour analgesia. The sample size calculation derived from a small RCT giving 90% power (at the 5% significance level) is based upon the maternal primary outcome measure of pain relief at 60mins and the neonatal primary outcome measures of Apgar Score of <7 at 1min and neonatal resuscitation. Secondary outcome measures include verbal pain intensity at 60mins and over 3hrs post-analgesia, pain relief over first 3hrs, maternal oxygen saturation, sedation, nausea and vomiting and maternal satisfaction with analgesia. Fetal and neonatal secondary outcomes include CTG trace, meconium staining, UApH, UVpH, time of delivery to first breath, Apgar Score at 5mins, naloxone use, neonatal oxygen saturations, sedation and feeding behaviour for the first 2hrs after delivery.

Results: Reported using CONSORT guidelines. At 60mins post-administration and over a 3hr period, diamorphine is better at reducing pain scores than pethidine (p<0.001). There were no statistical differences between the two groups regarding Apgar Scores of <7 at 1min and the need for neonatal resuscitation.  The time between first dose administered and delivery is on average 82mins longer with the diamorphine group compared to pethidine (p<0.001). The vast majority of women experienced moderate to severe pain at all times. Women receiving diamorphine were more satisfied with their analgesia. There were no statistically significant differences in maternal sedation, nausea and vomiting or oxygen saturations over the 3hr period. There were no statistically significant differences in the fetal and neonatal outcomes including feeding behaviour between the two groups within 2hrs of birth but neonates in the pethidine group were more likely to be moderately or severely sedated at delivery.

Discussion: Intramuscular 7.5mg diamorphine gives significantly better analgesia than 150mg pethidine but prolongs delivery by approx. 82mins.  Women given diamorphine are more likely to be satisfied with their analgesia.  The mechanism for the prolongation of delivery time in the diamorphine group should be investigated further.

Acknowledgement: This research was funded by the NIHR Research for Patient Benefit Programme (PB-PG-0407-13170).

References

1. Tuckey JP, Prout RE, Wee MYK. Prescribing intramuscular opioids for labour analgesia in consultant-led maternity units: a survey of UK practice. International Journal of Obstetric Anesthesia 2008, 17(1):3-8.

2. Fairlie FM, Marshall L, Walker JJ et al. Intramuscular opioids for maternal pain relief for labour: a randomised controlled trial comparing pethidine with diamorphine. British  Journal of Obstetrics and Gynaecology 1999; 106(11): 1181 -1187.

Biography of speaker:

Michael Wee is a consultant anaesthetist from Poole Hospital and Royal Bournemouth Hospitals.  He has a special interest in obstetric anaesthesia and is the lead obstetric anaesthetist at Poole Hospital.  He is chair of the Research and Innovations Group at Poole Hospital and is a Board member of the Western Comprehensive Local Research Network.  He was awarded a visiting professorship at Bournemouth University in 2009.  He is a referee for several medical journals.  His research interests include patient information, safety in anaesthesia, maternal analgesia and simulation in epidural anaesthesia.  He is a co-supervisor of a PhD student at BU and chief investigator of the MObs study investigating early warning scores in obstetrics.