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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...
NIHR Signal MRI scan does not help to find the cause of pelvic pain in women
MRI scans are not sufficiently accurate to find the cause of chronic pelvic pain in women and should not replace laparoscopy (keyhole surgery), which can be used for diagnosis and often treatment. MRI only correctly ruled out a gynaecological condition in half of women judged to have no obvious cause and missed half of women who did have a treatable gynaecological condition. Pinpointing the origin of chronic pelvic pain is often difficult due to the number of possible causes. If initial tests a...
NIHR Signal No benefit from monitoring antiepileptic drug levels in pregnancy
Regular monitoring of antiepileptic drug levels in pregnant women with epilepsy does not improve seizure control compared with clinical features-based monitoring. This NIHR-funded study was conducted across 50 UK hospitals and is the largest randomised trial in pregnant women with epilepsy. Just over 260 pregnant women with unstable antiepileptic drug levels were assigned to ongoing monthly blood checks or clinical features monitoring. There were no differences in seizures or other pregnancy ou...
NIHR Signal Better pain relief for women in labour
Women in labour, who had the short acting strong painkiller remifentanil, rather than pethidine, had less need for further pain relief. Only 19% of women given remifentanil received a subsequent epidural compared with 41% given pethidine. Remifentanil was given intravenously, using a patient-controlled delivery device, and pethidine given by intramuscular injection. This NIHR-funded study is the first large trial to compare intravenous remifentanil (administered via a patient-controlled deliver...
NIHR Signal Women rate quality and safety of birth experience as important
Most healthy women would like a natural birth if possible, but acknowledge the unpredictability and risks of childbirth. They also appreciate the supportive care environment where healthcare providers are competent, kind and respectful to them, their partners and their baby. In a large review of studies with over 1,800 women’s views on what matters in childbirth, having a healthy baby was important. Avoiding unnecessary medical intervention and retaining a sense of control over their birt...
NIHR Signal Inducing labour at or after 41 weeks reduces risks to infants
Inducing labour after the due date slightly lowers the risk of stillbirth or infant death soon after birth compared with watchful waiting. But the overall risk is very low. Induced deliveries may reduce admissions to the neonatal intensive care unit. Pregnant women having induced labour are less likely to have a caesarean section than those who wait for labour to begin naturally. They may have a slightly higher chance of needing an assisted vaginal birth (for example, using forceps or vacuum ex...
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