Short statured primigravidae: Options for the obstetric management from a survey of UK obstetricians (2021)

Type of publication:
Journal article

Author(s):
*Rachaneni S.; Gurol-Urganci I.; Basu M.; Thakar R.; Sultan A.; Freeman R.

Citation:
European Journal of Obstetrics Gynecology and Reproductive Biology; Jan 2021; vol. 256 ; p. 379-384

Abstract:
Objective: To assess the current antenatal and intrapartum management options for primigravid women of short stature with a clinically large fetus by a survey of UK Obstetricians. Study design: An online survey comprised of 15 questions including the options on timing and mode of delivery, counselling about the risk of long-term pelvic floor morbidity following spontaneous vaginal and instrumental deliveries, choice of instruments and the role of episiotomy. The survey was sent to the participants as a part of Royal College of Obstetricians and Gynaecologists (RCOG) Newsletter between September 2017 to October 2018. The scenario described was of a primigravid short stature woman (i.e. height of 160 cm or less) who presents with a clinically large fetus at 38 weeks gestation. Result(s): 424 Obstetricians participated in the survey. The participation ratio cannot be identified as the survey was emailed as a part of the RCOG Newsletter. Sixty five percent respondents stated that they would scan for estimated fetal weight, 48 % would offer induction of labour at 40 weeks and 14 % would offer an elective/planned caesarean section (CS) at 39-40 weeks. Fifty nine percent would discuss all these risks: obstructed labour, shoulder dystocia, instrumental delivery and obstetric anal sphincter injury (OASI). 73 % would not discuss the long-term risks of urinary and/or faecal incontinence and pelvic organ prolapse. In the presence of failure to progress in the second stage of labour, 69 % would attempt a rotational instrumental delivery and 5% would offer a caesarean section. Manual rotation and ‘straight’ forceps application were the most frequent type of rotational delivery, followed by Ventouse and Kiellands forceps. Thirty four percent stated that they do not routinely perform an episiotomy in this scenario. Seventy three percent stated that their choice of instrument was not based on the long-term risk of urinary and faecal incontinence. Conclusion(s): The results suggest that 40 % of the respondents would not discuss all of the complications after vaginal delivery in women of short stature. The most common delivery option would be vaginal delivery.

Suicidal ideation during pregnancy in British Pakistani women (2016)

Type of publication:
Conference abstract

Author(s):
*Sharif A., Gire N., Tomenson B., Chaudhry N., Husain M.

Citation:
European Psychiatry, March 2016, vol./is. 33/(S272-S273)

Abstract:
Introduction Suicide is a major public health problem and one of the common causes of maternal mortality. Rates of suicide and self-harm are higher in British South Asian women compared to the majority white population. Suicidal Ideation (SI) is a significant risk factor associated with self-harm and suicide. Objective To explore the prevalence and risk factors of SI in British Pakistani women. Aim To identify risk factors associated with SI, in order to inform future preventive strategies. Method This is a secondary analysis of a larger study which looked at depression during pregnancy and infant outcomes. Par ticipants who consented (women aged 18 or over, in their third pregnancy trimester) were initially assessed for maternal depression using the Edinburgh Post-Natal Depression Scale (EPDS), with one of the questions on the EPDS being on SI. Participants who met the study criteria, were further assessed regarding sociodemographic factors, perceived social support, social adversity and isolation. Results The rate of SI in this group of women was 8.1%, with baseline interview results suggesting that women with SI being significantly more likely to be aged 20 or less, have experience of severe life events and being less likely to have social support. Conclusion This area of research is key to understanding SI in British Pakistani women, to better develop culturally sensitive interventions for use within this group.

The first case of thrombolysis for stroke in pregnancy in the UK (2014)

Type of publication:
Conference abstract

Author(s):
*Ritchie J., *Lokman M., *Panikkar J.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, November 2014, vol./is. 121/(7), 1470-0328 (November 2014)

Abstract:
Case: A healthy 28-year-old Caucasian woman presented to the Royal Shrewsbury Hospital (RSH) in her second pregnancy at 39 weeks of gestation with a sudden onset of dense left hemiparesis. This woman had no preceding risk factors. An urgent CT scan showed no acute changes suggesting a diagnosis of ischaemic stroke. Through discussion between the stroke specialist and consultant obstetrician, it was decided for thrombolysis which was performed in the emergency department prior to transfer to a larger hospital with stroke facilities. We wished to discover how many other women had undergone thrombolysis for stoke in pregnancy and the associated risks. We conducted a literature review concentrating on stroke and pregnancy including known risk factors and thrombolyis in pregnancy. We have found no other documented case of thromboylsis being used for stroke in pregnancy in the UK. Additionally there are many case reports not from the UK that demonstrate good maternal and fetal outcomes after thromobolysis. Conclusion: Our case appears to be the first reported case of thrombolysis for stroke in pregnancy in the UK. All post investigations have so far come back as normal, which is unusual as most other cases have had known risk factors for stroke. Our patient has recovered well post thrombolysis, which demonstrates the importance of dealing with stroke in pregnancy efficiently to allow thrombolysis to be achieved quickly. Although the risks and benefits need to be weighed up on an individual basis, our case and the relevant literature show that thrombolyiss can be safely used in pregnancy with good maternal and fetal outcomes.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201411006-00021&LSLINK=80&D=ovft