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7. Association between perinatal mortality and morbidity and customised and non-customised birthweight centiles in Denmark, Finland, Norway, Wales, and England: comparative, population based, record linkage study

Author

Kilpi, Fanny, primary, Jones, Hayley E, additional, Magnus, Maria Christine, additional, Santorelli, Gillian, additional, Højsgaard Schmidt, Lise Kristine, additional, Urhoj, Stine Kjaer, additional, Nelson, Scott M, additional, Tuffnell, Derek, additional, French, Robert, additional, Magnus, Per Minor, additional, Nybo Andersen, Anne-Marie, additional, Martikainen, Pekka, additional, Tilling, Kate, additional, and Lawlor, Deborah A, additional

Published
2023
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16. Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study

Author

Fitzpatrick, Kathryn E., van den Akker, Thomas, Bloemenkamp, Kitty W. M., Deneux-Tharaux, Catherine, Kristufkova, Alexandra, Li, Zhuoyang, Schaap, Timme P., Sullivan, Elizabeth A., Tuffnell, Derek, and Knight, Marian

Subjects
EPUB (Standard), Mortality -- United Kingdom -- Netherlands -- France -- Australia -- Slovakia -- Surveys, Obstetrics -- Health aspects -- Surveys, Fibrin -- Health aspects -- Surveys, Strategic planning (Business) -- Health aspects -- Surveys, Embolism -- Risk factors -- Research -- Health aspects -- Surveys, Fibrinogen -- Health aspects -- Surveys, Medical research -- Health aspects -- Surveys, Tranexamic acid -- Research -- Health aspects -- Surveys, Maternal mortality, Hemostatic agents, Women, Amniotic fluid embolism, Cardiac arrest, Company business management, Biological sciences
Abstract

Background Amniotic fluid embolism (AFE) remains one of the principal reported causes of direct maternal mortality in high-income countries. However, obtaining robust information about the condition is challenging because of its rarity and its difficulty to diagnose. This study aimed to pool data from multiple countries in order to describe risk factors, management, and outcomes of AFE and to explore the impact on the findings of considering United Kingdom, international, and United States AFE case definitions. Methods and findings A population-based cohort and nested case-control study was conducted using the International Network of Obstetric Survey Systems (INOSS). Secondary data on women with AFE (n = 99-218, depending on case definition) collected prospectively in population-based studies conducted in Australia, France, the Netherlands, Slovakia, and the UK were pooled along with secondary data on a sample of control women (n = 4,938) collected in Australia and the UK. Risk factors for AFE were investigated by comparing the women with AFE in Australia and the UK with the control women identified in these countries using logistic regression. Factors associated with poor maternal outcomes (fatality and composite of fatality or permanent neurological injury) amongst women with AFE from each of the countries were investigated using logistic regression or Wilcoxon rank-sum test. The estimated incidence of AFE ranged from 0.8-1.8 per 100,000 maternities, and the proportion of women with AFE who died or had permanent neurological injury ranged from 30%-41%, depending on the case definition. However, applying different case definitions did not materially alter findings regarding risk factors for AFE and factors associated with poor maternal outcomes amongst women with AFE. Using the most liberal case definition (UK) and adjusting for the severity of presentation when appropriate, women who died were more likely than those who survived to present with cardiac arrest (89% versus 40%, adjusted odds ratio [aOR] 10.58, 95% confidence interval [CI] 3.93-28.48, p < 0.001) and less likely to have a source of concentrated fibrinogen (40% versus 56%, aOR 0.44, 95% CI 0.21-0.92, p = 0.029) or platelets given (24% versus 49%, aOR 0.23, 95% CI 0.10-0.52, p < 0.001). They also had a lower dose of tranexamic acid (median dose 0.7 g versus 2 g, p = 0.035) and were less likely to have had an obstetrician and/or anaesthetist present at the time of the AFE (61% versus 75%, aOR 0.38, 95% CI 0.16-0.90, p = 0.027). Limitations of the study include limited statistical power to examine factors associated with poor maternal outcome and the potential for residual confounding or confounding by indication. Conclusions The findings of our study suggest that when an AFE is suspected, initial supportive obstetric care is important, but having an obstetrician and/or anaesthetist present at the time of the AFE event and use of interventions to correct coagulopathy, including the administration of an adequate dose of tranexamic acid, may be important to improve maternal outcome. Future research should focus on early detection of the coagulation deficiencies seen in AFE alongside the role of tranexamic acid and other coagulopathy management strategies., Author(s): Kathryn E. Fitzpatrick 1,*, Thomas van den Akker 2, Kitty W. M. Bloemenkamp 3, Catherine Deneux-Tharaux 4, Alexandra Kristufkova 5, Zhuoyang Li 6, Timme P. Schaap 3, Elizabeth A. [...]

Published
2019
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22. The Influence of Meteorological Factors and Atmospheric Pollutants on the Risk of Preterm Birth

Author

Giorgis-Allemand, Lise, Pedersen, Marie, Bernard, Claire, Aguilera, Inmaculada, Beelen, Rob M. J., Chatzi, Leda, Cirach, Marta, Danileviciute, Asta, Dedele, Audrius, van Eijsden, Manon, Estarlich, Marisa, Fernández-Somoano, Ana, Fernández, Mariana F., Forastiere, Francesco, Gehring, Ulrike, Grazuleviciene, Regina, Gruzieva, Olena, Heude, Barbara, Hoek, Gerard, de Hoogh, Kees, van den Hooven, Edith H., Håberg, Siri E., Iñiguez, Carmen, Jaddoe, Vincent W. V., Korek, Michal, Lertxundi, Aitana, Lepeule, Johanna, Nafstad, Per, Nystad, Wenche, Patelarou, Evridiki, Porta, Daniela, Postma, Dirkje, Raaschou-Nielsen, Ole, Rudnai, Peter, Siroux, Valérie, Sunyer, Jordi, Stephanou, Euripides, Sørensen, Mette, Eriksen, Kirsten Thorup, Tuffnell, Derek, Varró, Mihály J., Vrijkotte, Tanja G. M., Wijga, Alet, Wright, John, Nieuwenhuijsen, Mark J., Pershagen, Göran, Brunekreef, Bert, Kogevinas, Manolis, and Slama, Rémy

Published
2017
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26. Ondansetron and metoclopramide as second-line antiemetics in women with nausea and vomiting in pregnancy: the EMPOWER pilot factorial RCT

Author

Robson, Stephen, primary, McParlin, Catherine, additional, Mossop, Helen, additional, Lie, Mabel, additional, Fernandez-Garcia, Cristina, additional, Howel, Denise, additional, Graham, Ruth, additional, Ternent, Laura, additional, Steel, Alison, additional, Goudie, Nicola, additional, Nadeem, Afnan, additional, Phillipson, Julia, additional, Shehmar, Manjeet, additional, Simpson, Nigel, additional, Tuffnell, Derek, additional, Campbell, Ian, additional, Williams, Rew, additional, O’Hara, Margaret E, additional, McColl, Elaine, additional, and Nelson-Piercy, Catherine, additional

Published
2021
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27. Authors' reply re: Intrapartum‐related perinatal deaths in births planned in midwifery‐led settings in Great Britain: findings and recommendations from the ESMiE confidential enquiry

Author

Rowe, Rachel, primary, Draper, Elizabeth S, additional, Kenyon, Sara, additional, Bevan, Charlotte, additional, Dickens, Joanne, additional, Forrester, Mandy, additional, Scanlan, Rachel, additional, Tuffnell, Derek, additional, and Kurinczuk, Jennifer J, additional

Published
2021
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32. A National Cohort Study and Confidential Enquiry to Investigate Ethnic Disparities in Maternal Mortality

Author

Knight, Marian, primary, Bunch, Kathryn, additional, Vousden, Nicola, additional, Banerjee, Anita, additional, Cox, Philippa, additional, Cross-Sudworth, Fiona, additional, Dhanjal, Mandish K., additional, Douglas, Jenny, additional, Girling, Joanna, additional, Kenyon, Sara, additional, Kotnis, Rohit, additional, Patel, Roshni, additional, Shakespeare, Judy, additional, Tuffnell, Derek, additional, Wilkinson, Meg, additional, and Kurinczuk, Jenny J., additional

Published
2021
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33. Pravastatin for early-onset pre-eclampsia:a randomised, blinded, placebo-controlled trial

Author

Ahmed, Asif, Williams, David, Cheed, Versha, Middleton, Lee J, Ahmad, Shakil, Wang, Keqing, Vince, Alex T, Hewett, Peter, Spencer, Kevin, Khan, Khalid S, Daniels, Jane P, Barber, Katherine, Kilby, Mark, Knox, Ellen, Sellman, Tara, Trinham, Paula, Tuffnell, Derek, Jones, Vicky, Syson, Jennifer, Shah, Neil, Deeks, Laurie, Carter, Wendy, Dorman, Ed, Thomas, Susannah, Harrington, Deborah, Higgins, Nicola, Wilmott‐powell, Mirriam, Simpson, Nigel, Dolby, Vivian, Bricker, Leanne, Walkinshaw, Steve, Houghton, Gillian, Longworth, Heather, Williamson, Catherine, Dhanjal, Mandish, Noori, Muna, Machirori, Mavis, Howard, Richard, Murray, Rebecca, Weist, Sarah, Denison, Fiona, Crawford, Isobel, Robson, Stephen, Allan, Carly, Myers, Jenny, Bernatavicius, Giovanna, Moorhead, Lynsey, Chappell, Lucy, Nelson‐piercy, Catherine, Daley, Rebecca, Rosas, Miguel, Greer, Ian, Vitek, Libor, Shennan, Andy, Marlow, Neil, Marie Barnard, Ann, Thornton, Jim, Rennie, Janet, Peacock, Janet, Gao Smith, Fang, Hyde, Carolyn, Cudmore, Melissa, Furmston, Alex, Fulcher, Leanne, Homer, Leanne, Howman, Andrew, Hilken, Nicholas, and Brown, Stephen

Subjects
embryonic structures
Abstract

Objective: Women with pre-eclampsia have elevated circulating levels of soluble fms-like tyrosine kinase-1 (sFlt-1). Statins can reduce sFlt-1 from cultured cells and improve pregnancy outcome in animals with a pre-eclampsia-like syndrome. We investigated the effect of pravastatin on plasma sFlt-1 levels during pre-eclampsia. Design: Blinded (clinician and participant), proof of principle, placebo-controlled trial. Setting: Fifteen UK maternity units. Population: We used a minimisation algorithm to assign 62 women with early-onset pre-eclampsia (24 +0–31 +6 weeks of gestation) to receive pravastatin 40 mg daily (n = 30) or matched placebo (n = 32), from randomisation to childbirth. Primary outcome: Difference in mean plasma sFlt-1 levels over the first 3 days following randomisation. Results: The difference in the mean maternal plasma sFlt-1 levels over the first 3 days after randomisation between the pravastatin (n = 27) and placebo (n = 29) groups was 292 pg/ml (95% CI −1175 to 592; P = 0.5), and over days 1–14 was 48 pg/ml (95% CI −1009 to 913; P = 0.9). Women who received pravastatin had a similar length of pregnancy following randomisation compared with those who received placebo (hazard ratio 0.84; 95% CI 0.50–1.40; P = 0.6). The median time from randomisation to childbirth was 9 days [interquartile range (IQR) 5–14 days] for the pravastatin group and 7 days (IQR 4–11 days) for the placebo group. There were three perinatal deaths in the placebo-treated group and no deaths or serious adverse events attributable to pravastatin. Conclusions: We found no evidence that pravastatin lowered maternal plasma sFlt-1 levels once early-onset pre-eclampsia had developed. Pravastatin appears to have no adverse perinatal effects. Tweetable abstract: Pravastatin does not improve maternal plasma sFlt-1 or placental growth factor levels following a diagnosis of early preterm pre-eclampsia #clinicaltrial finds.

Published
2020

34. Additional file 2 of An evaluation of the influence of the publication of the UK National Institute for health and Care Excellence’s guidance on hypertension in pregnancy: a retrospective analysis of clinical practice

Author

Farrar, Diane, Tuffnell, Derek, and Sheldon, Trevor

Abstract

Additional file 2 : Table S1. Prevention of pre-eclampsia and management of pre-existing hypertension by hospital (A-E). Values are n (%) of the included/eligible hospital population. Table S2. Antenatal surveillance by hospital (A-E). Values are n (%) of the included/eligible hospital population. Table S3. Diagnosis and treatment. Values are n (%) of the included/eligible hospital population. Table S4. Postnatal management of women diagnosed with a HDP. Values are n (%) of the included/eligible hospital population.

Published
2020
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40. Intravenous co-amoxiclav to prevent infection after operative vaginal delivery: the ANODE RCT

Author

Knight, Marian, primary, Chiocchia, Virginia, additional, Partlett, Christopher, additional, Rivero-Arias, Oliver, additional, Hua, Xinyang, additional, Bowler, Ursula, additional, Gray, James, additional, Gray, Shan, additional, Hinshaw, Kim, additional, Khunda, Aethele, additional, Moore, Philip, additional, Mottram, Linda, additional, Owino, Nelly, additional, Pasupathy, Dharmintra, additional, Sanders, Julia, additional, Sultan, Abdul H, additional, Thakar, Ranee, additional, Tuffnell, Derek, additional, Linsell, Louise, additional, and Juszczak, Edmund, additional

Published
2019
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41. Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial

Author

Chappell, Lucy C, primary, Brocklehurst, Peter, additional, Green, Marcus E, additional, Hunter, Rachael, additional, Hardy, Pollyanna, additional, Juszczak, Edmund, additional, Linsell, Louise, additional, Chiocchia, Virginia, additional, Greenland, Melanie, additional, Placzek, Anna, additional, Townend, John, additional, Marlow, Neil, additional, Sandall, Jane, additional, Shennan, Andrew, additional, Agarwal, Umber, additional, Ahmed, Irshad, additional, Ajay, Bini, additional, Alfirevic, Zarko, additional, Arya, Rita, additional, Bambridge, Gabrielle, additional, Bamfo, Jacqueline, additional, Basak, Sambita, additional, Bowler, Ursula, additional, Cameron, Helen, additional, Churchill, David, additional, Cresswell, Janet, additional, Crosfill, Fiona, additional, Denbow, Mark, additional, Dey, Madhuchanda, additional, Everden, Caroline, additional, Ficquet, Jo, additional, Gajewska-Knapik, Katarzyna, additional, Ganapathy, Ramesh, additional, Garrett, Angela, additional, Girling, Joanna, additional, Gornall, Adam, additional, Harding, Kate, additional, Hendy, Eleanor, additional, Howard, Richard, additional, James, Mark, additional, Johnson, Antoinette, additional, Kemp, Michelle, additional, Khalil, Asma, additional, Khan, Rehan, additional, Khan, Rahila, additional, Knox, Ellen, additional, Margarit, Lavinia, additional, Marsden, Philippa, additional, McIntyre, Karen, additional, Myers, Jenny, additional, Nugent, Justine, additional, Rao, Sanjay, additional, Robinson, Zoey, additional, Robson, Stephen, additional, Rushby, Pauline, additional, Scholz, Laura, additional, Shahin, Mohamed, additional, Sharma, Bhavna, additional, Simpson, Nigel, additional, Singh, Natasha, additional, Sparkes, Jenie, additional, Stone, Sophia, additional, Subair, Seni, additional, Tan, Bee, additional, Thakur, Vidya, additional, Thamban, Sujatha, additional, Thornton, Jim, additional, Tohill, Sue, additional, Tsoi, Elly, additional, Tuffnell, Derek, additional, Waterstone, Mark, additional, Waugh, Jason, additional, Wiesender, Cornelia, additional, and Wu, Pensee, additional

Published
2019
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50. The oxytocin antagonist atosiban versus the β-agonist terbutaline in the treatment of preterm labor: A randomized, double-blind, controlled study

Author

Fisk, Nicholas M., Calder, Andrew A., Cameron, Alan D., Elder, Murdoch G., Fusi, Luca, Greer, Ian A., Lamont, Ronnie F., Mason, Gerald C., Elizabeth Owen, Miss, Steer, Philip J., Tuffnell, Derek J., Walker, James, Maršál, Karel, Ekman-Ordeberg, Gunvor, Gudmundsson, Saemundur, Ingemarsson, Ingemar, Lyrenäs, Sven, Mattsson, Lars-Åke, Molin, Anders, Thomassen, Peter, Wennergren, Margareta, Weber, Tom, Andersen, Lars F., Lyndrup, Jens, Presl, Jirí, Bouda, Jaromír, Cech, Evzen, Koliba, Peter, Kucera, Pavel, Kudela, Milan, Pilka, Ladislav, Unzeitig, Vít, and Zivný, Jaroslav

Published
2001

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