GBS3

GBS3 is a study that is looking at whether offering pregnant women a routine test for group B Streptococcus (GBS) either during their pregnancy or during labour reduces the risk of GBS disease in the newborn baby, compared to the current strategy in place in the UK (offering antibiotics during labour to women who are considered at risk of their baby developing GBS disease).

Between May 2022 and December 2023, Maidstone and Tunbridge Wells NHS Trust took part in the GBS3 study and offered GBS testing during labour from 37 weeks pregnant using a bedside testOver 4,800 women receiving care at MTW participated in GBS3 during this time- thank you!

Outcome: The findings of this study are still being collated but will be available here once they are published.

• GBS3 Trial website
• Group B Strep Support
• Royal College of Obstetricians and Gynaecologists recommendations

Twitter: @GBS3Trial

CRAFT-OBS: a study of risk and management in women with a history of caesarean section in labour

CRAFT-OBS is an observational study that aims to explore the incidence of late miscarriage and preterm birth in women with a previous caesarean section in labour (4cm dilated or more).

Outcome: The findings of this study are currently being analysed.

Twitter: @CRAFTstudy2020

The Big Baby Clinical Trial

The purpose of the Big Baby trial is to find out if starting labour earlier than usual (inducing), at 38 weeks, makes it less likely that shoulder dystocia (when the head is born, but there is a delay in delivering the shoulders) will happen in women whose babies appear to be bigger than expected (over the 90th centile on the growth chart).

Outcome: The findings of this study are due to be published in summer 2024

Twitter: @BigBabyTrial

The POOL Study

The POOL study looked at the use of water for labour and birth to determine

• how many women are using birth pools
• how many women give birth in water
• the outcomes for mothers and their babies as a result of water birth

Twitter: @pool_study

RETHINK

This study followed participants through pregnancy, labour and birth, and into the postnatal period to see if we could identify those women who might benefit from additional support in early labour to reduce their chance of a difficult labour and unnecessary intervention.

The outcome of this study is pending.

ObsQoR

This National surveillance study, which ran for 3 consecutive days at MTW, recruited participants that had received anaesthetic care either during their labour, birth or immediate postnatal period. This study is looking at the quality of recovery in women following anaesthetic interventions to try and identify if a screening survey is able to highlight those who are likely to have problems, aiding us to improve aspects of their care.

Outcome summary:

To better understand outcomes in postpartum patients who receive peripartum anaesthetic interventions, we aimed to assess quality of recovery metrics following childbirth in a UK-based multicentre cohort study. This study was performed during a 2-week period in October 2021 to assess in- and outpatient post-delivery recovery at 1 and 30 days postpartum. The following outcomes were reported: obstetric quality of recovery 10-item measure (ObsQoR-10); EuroQoL (EQ-5D-5L) survey; global health visual analogue scale; postpartum pain scores at rest and movement; length of hospital stay; readmission rates; and self-reported complications. In total, 1638 patients were recruited and responses analysed from 1631 (99.6%) and 1282 patients (80%) at one and 30 days postpartum, respectively. Median (IQR [range]) length of stay postpartum was 39.3 (28.5–61.0 [17.7–513.4]), 40.3 (28.5–59.1 [17.8–220.9]), and 35.9 (27.1–54.1 [17.9–188.4]) h following caesarean, instrumental and vaginal deliveries, respectively. Median (IQR [range]) ObsQoR-10 score was 75 ([62–86] 4–100) on day 1, with the lowest ObsQoR-10 scores (worst recovery) reported by patients undergoing caesarean delivery. Of the 1282 patients, complications within the first 30 days postpartum were reported by 252 (19.7%) of all patients. Readmission to hospital within 30 days of discharge occurred in 69 patients (5.4%), with 49 (3%) for maternal reasons. These data can be used to inform patients regarding expected recovery trajectories; facilitate optimal discharge planning; and identify populations that may benefit most from targeted interventions to improve postpartum recovery experience.

Quality of recovery following childbirth: a prospective, multicentre cohort study – O’Carroll – 2023 – Anaesthesia – Wiley Online Library

Further outcomes:

Disparities relating to postpartum recovery outcomes in different socio-economic and racial ethnic groups are underexplored. We conducted a planned analysis of a large prospective caesarean delivery cohort to explore the relationship between ethnicity, socio-economic status and postpartum recovery. Eligible patients were enrolled and baseline demographic, obstetric and medical history data were collected 18 h and 30 h following delivery. Patients completed postpartum quality of life and recovery measures in person on day 1 (EuroQoL EQ-5D-5L, including global health visual analogue scale; Obstetric Quality of Recovery-10 item score; and pain scores) and by telephone between day 28 and day 32 postpartum (EQ-5D-5L and pain scores). Socio-economic group was determined according to the Index of Multiple Deprivation quintile

of each patient’s usual place of residence. Data from 1000 patients who underwent caesarean delivery were included. There were more patients of Asian, Black and mixed ethnicity in the more deprived quintiles. Patients of White ethnicities had shorter postpartum duration of hospital stay compared with patients of Asian and Black ethnicities (35 (28–56 [18–513]) h vs. 44 (31–71 [19–465]) h vs. 49 (33–75 [23–189]) h, respectively. In adjusted models at day 30, patients of Asian ethnicity had a significantly greater risk of moderate to severe pain (numerical rating scale ≥ 4) at rest and on movement (odds ratio (95%CI) 2.42 (1.24–4.74) and 2.32 (1.40–3.87)), respectively). There were no differences in readmission rates or incidence of complications between groups. Patients from White ethnic backgrounds experience shorter postpartum duration of stay compared with patients from Asian and Black ethnic groups. Ethnic background impacts pain scores and recovery at day 1 postpartum and following hospital discharge, even after adjusting for

socio-economic group. Further work is required to understand the underlying factors driving differences in pain and recovery and to develop strategies to reduce disparities in obstetric patients.

Twitter: @ObsQor

PANCOVID

This study collected information about COVID-19 and SARS-CoV-2 in pregnancy and babies from around the world into a register which will be used to share information with healthcare professionals around the world, allowing them to improve the care they give. The study wanted to find out more about the effect of COVID-19 on early pregnancy, the growth of babies, early delivery and possible infection of babies.

More information can be found at https://pan-covid.org

Twitter: @PANCOVIDreg

Acupuncture for treatment of slow labour

The purpose of this study was to explore if acupuncture could be used to treat an established labour that had slowed down, instead of using a hormone drip.

The findings of this study are currently being analysed.

GBS2

This study aimed to see if a rapid test system is better in identifying women who need antibiotics because they are colonised with Group B streptococcus (GBS) compared with the current system  based on risk factors alone.

We are currently awaiting the findings of this study to be published.

Further information can be found here.

Intradermal sterile water injections for relief of low back pain in labour: is a two-injection technique as effective as a four-injection technique? A pilot study.

The aim of this study was to find out if a two-sterile water injection (SWI) technique was as effective at relieving lower back pain in labour compared with a four-SWI technique (standard practice).

Findings

The findings of this study suggest that a two-SWI technique may reduce lower back pain as adequately as the current four-SWI technique. The two-SWI technique, if given in the upper part of the lower back, may also reduce the pain of injection administration. However, as this study was small, a larger study is advised to confirm the findings.

Kangaroo care in preterm or low birth weight babies in a postnatal ward

The aim of this study was to explore if Kangaroo care (skin-to-skin contact with the mother) affected the length of stay and feeding outcome compared with standard care (baby next to the mother in a cot) for preterm and low birthweight babies, and babies of diabetic mothers.

Findings

The outcome of this study suggests that the use of Kangaroo care reduces the length of hospital stay by one day, and significantly increases the rate of exclusive breastfeeding at the time of discharge from hospital. There was no significant difference in the rate of exclusive breastfeeding at 6 weeks post birth or admissions to the neonatal unit. Overall, parents rated Kangaroo care highly.

Please see the published article for further information

Skin-to-skin contact after elective caesarean section: investigating the effect of breastfeeding rates

The purpose of this study was to determine whether Kangaroo care (skin-to-skin contact with the mother) in the operating theatre following a planned caesarean section affected breastfeeding outcomes.

Findings

There was no significant difference between the rate of breastfeeding at 48 hours, 10 days and 6 weeks post birth. However there was a significant correlation between the duration of skin-to-skin contact and the breastfeeding rate at 48 hours and 6 weeks; the greater the duration of skin-to-skin contact, the greater the rate of breastfeeding.

Acupressure for inducing labour for nulliparous women with post-dates pregnancy

This study compared the use of acupressure against a sham treatment for the induction of labour in first time mothers who were 41 weeks gestation or greater.

Findings

The findings of this study suggest that acupressure is not beneficial to induce labour; there was no significant difference in the time of labour onset between those receiving acupressure and those receiving the sham treatment. Those receiving acupressure were more likely to require induction of labour or augmentation of labour using the hormone drip. There was no difference in the mode of delivery or the condition of the baby at birth.