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NIHR Signal Antibiotics reduce complications after assisted vaginal delivery
Preventative antibiotics halve the risk of infection for women who have assisted vaginal delivery using forceps or suction-cup devices. About 10% of women receiving antibiotics develop an infection within six weeks of delivery compared with 20% of women who receive a placebo. Antibiotics are not routinely recommended for women undergoing assisted delivery as there hasn’t been enough evidence that they reduce maternal infection rates. This large NIHR-funded trial, including almost 3,500 wo...
NIHR Signal Transvaginal ultrasound and MRI achieve similar accuracy for diagnosing lower bowel endometriosis
Transvaginal ultrasound and magnetic resonance imaging (MRI) scans are both accurate ways to diagnose the most severe form of deep endometriosis affecting the bowel. By using both transvaginal ultrasound and MRI, the chance of non-invasively and accurately diagnosing endometriosis of the lower bowel rises to nearly 100%. This review and meta-analysis looked at eight studies where both transvaginal ultrasound and MRI had been used to diagnose endometriosis in a total of 1,132 women. In each indi...
NIHR Signal Routine use of progesterone does not prevent miscarriage
Progesterone did not affect the chance of live birth among women presenting with vaginal bleeding in the first 12 weeks of pregnancy. Live birth rates were 72% with placebo and 75% with progesterone, which is not a clinically or statistically important difference. Progesterone has been prescribed for threatened miscarriage in some centres since the 1950s, but there has been poor evidence for its use. NICE recently highlighted this as a priority area for research asking for large, robust trials ...
NIHR Signal Placental growth factor testing can speed up diagnosis of pre-eclampsia
Measuring the level of placental growth factor (PlGF) in women with suspected pre-eclampsia helps to reduce the time to diagnose pre-eclampsia from 4 days to 2 days. PlGF testing is also associated with fewer adverse outcomes for mothers. In this NIHR-funded trial, the test results were used alongside the NICE clinical management algorithm to help clinicians make a diagnosis. Pre-eclampsia can lead to serious complications for mothers and babies. Women with suspected pre-eclampsia require furt...
NIHR Signal New insights into how ethnicity and culture affect maternal mental health
Ethnicity and culture can affect how and when women seek help for mental health problems before or after having a baby. Many women avoid seeking help because they feel services are not sensitive to their beliefs. Services should ensure all women, regardless of background, can access the support they need during and after pregnancy. This mixed methods systematic review of UK evidence found that many women are not aware of the help available to them, and those that are aware often view it negativ...
NIHR Signal Updated evidence on progesterone to prevent preterm birth in at-risk pregnancies
Progesterone administered via the vagina may reduce the risk of preterm birth in women who are at risk of giving birth early when compared to a placebo, treatment as usual or no intervention. Other treatments, such as oral or injected progesterone, cervical stitch, and pessary, appear not to show the same level of effectiveness. A recent trial suggested that vaginal progesterone provided little or no benefit in preventing preterm birth. Those results have been pooled with 39 other trials in thi...
NIHR Signal Delaying pushing in labour has no benefit for women with an epidural and/or spinal for pain relief
For women having their first baby with an epidural and/or spinal anaesthetic for pain-relief, the timing of pushing after full dilatation of the cervix does not affect the numbers that achieve normal vaginal delivery. The best management for the second stage of labour is still debated. In the UK epidurals are by far the most widely used regional anaesthetic technique for pain relief in labour. In this large trial, women either pushed immediately or delayed pushing by waiting for 60 minutes. Wo...
NIHR Signal A care package to increase awareness of fetal movements does not reduce risk of stillbirth
A care package to increase awareness of fetal movements, and allow identification and delivery of high-risk babies, did not reduce the risk of stillbirth. The incidence of stillbirth varies across high-income countries suggesting that many could be preventable. The AFFIRM trial is the largest to date to assess whether interventions that increase awareness of fetal movements can reduce risk of stillbirth. The trial involved 33 hospitals in the UK and Ireland who implemented the care package at ...
NIHR Signal Diet and exercise can reduce the risk of developing diabetes during pregnancy
Diet and exercise are effective ways of preventing the development of diabetes during pregnancy, known as gestational diabetes. Gestational diabetes is becoming more common and is associated with poorer outcomes for mother and baby. Diet, physical activity and weight are modifiable risk factors, but trials published to date have shown inconsistent results. This systematic review pooled 47 trials and found that any form of lifestyle intervention reduced the risk of gestational diabetes by 23%, ...
NIHR Signal Intravenous oxytocin reduces severe bleeding after vaginal delivery
Routine oxytocin injected directly into the bloodstream, rather than into the muscle, after birth results in fewer people suffering severe bleeding (postpartum haemorrhage). The overall rate of postpartum haemorrhage (PPH) or side effects was similar between the groups, but the intravenous group had fewer severe haemorrhages, needed fewer blood transfusions and fewer admissions to high dependency care. Intramuscular route oxytocin is currently recommended in the UK, partly due to concerns about...
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