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NIHR Signal Decision aids including leaflets and computer programs help patients make treatment choices
Decision aids help patients choose between treatment options in obstetrics and gynaecology, and reduce uncertainty. A systematic review of trials of decision aids used for choices of contraception, caesarean section and menopause treatment found that patients who used them felt more confident in their ability to make the decision that was right for them, and less uncertain about this decision. This was compared with usual care or an information aid. Decision aids set out information about medi...
NIHR Signal Universal ultrasound in late pregnancy did not reduce serious harms to babies
Offering all women third trimester ultrasounds did not reduce the rate of serious illness or death in babies in the first week of life. Monitoring fetal growth is part of routine antenatal care, using regular tape measurements from the pubic bone to the top of the uterus. To date, it has been unclear whether also monitoring babies’ growth using ultrasound late in pregnancy can reduce the risks for babies. The large Dutch IRIS trial investigated whether a policy of offering third trimeste...
NIHR Signal Antenatal MRI can aid ultrasound when fetal brain abnormality is suspected
In utero magnetic resonance imaging (iuMRI) can provide a more accurate diagnosis when used after ultrasound in pregnancy. Adding iuMRI when a brain abnormality is suspected but unclear from ultrasound could help clinicians provide better prognostic advice and support to parents during pregnancy. This NIHR-funded cohort study compared ultrasound and iuMRI in 570 women at more than 18 weeks' pregnancy carrying a fetus with a suspected brain abnormality. It found that iuMRI was more accurate ...
NIHR Signal Planned earlier delivery for late pre-eclampsia may be better for mothers
If pregnant women develop late pre-eclampsia, after 34 but before 37 weeks of gestation, then planning to deliver their babies within 48 hours of the diagnosis reduces the risk of problems to the mother. This is compared with waiting until 37 weeks or delivering earlier if other problems arise (“expectant management”). However, this benefit needs to be offset against an increased likelihood of the baby being admitted to the neonatal unit. This trial found that in women with late pre...
NIHR Signal Enhanced communication and staff training could improve the experience of maternity services for asylum-seeking women
Pregnant asylum seekers experience significant barriers to accessing maternity services in the UK. A review found that these barriers often relate to language differences and practical challenges associated with their status. Provision of interpreter services and training for health care professionals could improve maternity support for these women. Pregnant women seeking asylum have often experienced significant trauma. Many arrive in the country having received no maternity care and experienc...
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...
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