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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...
NIHR Signal Outpatient video consultations are feasible but challenging for the NHS
Video consultations may be a useful substitute for face-to-face consultations for some hospital outpatient appointments. This NIHR funded study provided insights into the conditions which made them better. When these practical and clinical conditions are met, video consultations can be safe and effective and are liked by staff and patients. But there are challenges in embedding new technology in routine practice, and these challenges may have been under-estimated. This high-quality implementati...
NIHR Signal Balance of long-term benefits and risks of caesarean delivery explained
Caesarean delivery has immediate known benefits and risks for those women who need help in childbirth. This review measures the long-term outcomes for the mothers’ health, the links to a higher risk of childhood illness and the chance of problems with future pregnancies. The large review of 80 studies from high-income countries used data from nearly 30 million women and compared caesarean section with vaginal delivery. Caesarean delivery was associated with a lower risk of urinary inconti...
NIHR Signal Cell salvage during caesarean section doesn’t reduce blood transfusions
In a large UK trial, cell salvage for women at risk of blood loss during caesarean did not reduce the need for donor blood transfusion, though few needed transfusion (2.5% compared with 3.5% among controls). More babies are being born by caesarean section and if blood loss is excessive, transfusions may be required, probably by about one in 20 women. Collecting the mother’s own lost blood during the procedure, filtering and returning it to her (cell salvage) is a potential alternative tha...
NIHR Signal Domperidone increases breast milk production in mothers of premature babies
The drug domperidone increases the amount of breast milk women produce. This review looked at its use for up to two weeks in women with premature babies being fed with expressed milk. Women had a moderate increase in breast milk of about 88ml a day, a clinically important increase for these small babies. Domperidone is an anti-sickness medication. It has not been widely used to increase breast milk because of unknown effectiveness and concerns that it can cause an irregular heart rhythm with lo...
NIHR Signal Imaging is the only way to diagnose blood clots in pregnancy
No blood test can accurately tell if a pregnant or recently pregnant woman has a blood clot. All pregnant women with a suspected clot should continue to have imaging investigations as per current UK guidelines. This NIHR-funded study recruited 328 pregnant or postpartum women with a suspected blood clot in the lung (pulmonary embolism) or leg (deep vein thrombosis). They had a blood test to measure the levels of 13 biomarkers, such as the D-dimer, to see if they could rule a blood clot in or ou...
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