Women & Children's Health Research Unit Past Projects

ENGAGE

Being overweight is a growing issue which can create problems in pregnancy for mother and baby. Weight-loss surgery is becoming more common, particularly for young women. 
Gastric banding is one type of weight-loss surgery in which a band with a fluid-filled balloon is placed around the stomach using keyhole surgery.  The band splits the stomach into two parts.  The space taken up by the inflated band slows food passing from the upper to the lower part; causing food to collect in the upper part, resulting in a feeling of fullness more quickly.  This reduces the amount of food that can be eaten and results in weight-loss.  Once the band is in place, the balloon can be adjusted to control the amount of food passing from the upper to the lower part and therefore the amount of food eaten.

More often now women who have a gastric band in place are becoming pregnant.  At the moment we have no information to guide doctors on how best to deal with the gastric band in pregnancy.  Keeping the band inflated may reduce the food women eat and the weight they gain in pregnancy. It may also make other problems such as high blood pressure and diabetes, (which occur more often when a person is overweight), less likely to happen.  However, keeping the band inflated may affect the growth of the baby, so it may be better to deflate the gastric band early in pregnancy.  More studies are needed to see how inflating or deflating the gastric band in pregnancy affects the mother and her baby.

Women who are overweight are more likely to suffer low mood and have a poor self- image before weight-loss surgery.  However, some studies show that women have lower risk of depression and a better image of themselves after weight-loss surgery.  What hasn’t been looked at is how pregnancy may affect the wellbeing and mood of women who have a gastric band.   We are also unsure what issues would be most important to women if they had to make a decision on whether they keep their band inflated or deflated in early pregnancy. We plan to ask women who are pregnant after gastric band surgery about their experiences of pregnancy and what issues (e.g. risk of problems for mother or baby) would affect their views on whether the band should be inflated or deflated in pregnancy.  We also plan to find out whether women would have liked to take part in a study comparing inflation with deflation of the band in pregnancy, and what could have made them taking part in such a study more likely. This will help us plan a large study to answer the main question: inflate or deflate the band in pregnancy?

The project was led by Amanda Jefferies. It was hosted by North Bristol NHS Trust and funded by the Southmead Hospital Charity’s Research Fund .

INSIGHT Study

The INvestigation into Stillbirth to Improve and Guide Healthcare staff Training (INSIGHT) Study aimed to recruit recently bereaved parents for a study to understand how they felt about the kind of care they received. In-depth interviews with parents consenting to be involved focused on what was done well and not so well, from 'breaking bad news' to issues regarding discussions about delivering the baby, post mortem consent and follow-up consultations several weeks' after their baby's death with their consultants.

Researchers also asked for the opinions of maternity doctors and midwives, to find which bereavement care practices are helpful and associated with better experiences for parents, and which ones are not, and how to improve care with training.

This project was led by Dimitrios Siassakos. The grant to support this project was through SANDs (Stillbirth And Neonatal Death Charity.

Study Results:

What were the main findings?
  • Care was often not as good as it should and could be. Communication with parents was not always as sensitive as they would have liked because staff did not have appropriate training.
  • Some women reported they did not ‘feel right’ before going to hospital. Once they arrived, there was no standard approach to how care was given. Sometimes there were long delays before the death of the baby was confirmed and action was taken.
  • After it had been confirmed that the baby had died, staff focussed on the mothers’ needs, but the parents’ priorities were still with their baby. There were several reasons why parents asked for a caesarean birth that staff had not considered.
  • Staff influenced parents’ decisions about post-mortem examinations. Parents found it helpful when staff explained the respectful nature and purpose of the examination.
  • After discharge from hospital, there was no consistent plan for how follow-up care would be given. Parents would have liked more information about their next hospital appointment.

What are the limitations of the work?

  • The parents interviewed depended on their memories of the details of the care, which happened some time ago. In staff group discussions, junior doctors may not have spoken openly because there were senior doctors present. Further research is necessary to understand and improve care globally.
  • What is the implication for parents?
  • Every bereaved parent is entitled to the best possible care after stillbirth, but some do not get good care. Parents and staff made suggestions that can help to develop processes for how care is given after stillbirth. These suggestions can also inform staff training, so that every single parent is treated respectfully and participates in decision making.

Further information can be found in the BJOG an International Journal of Obsetrics & gynaecology http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14765/abstract?elq_mid=23861&elq_cid=7413540

Hear Dimitrios Siassakos explaining the results of the study https://vimeo.com/241555476

IMOX

Around a quarter of all global pregnancy and child-birth related deaths are due to excessive bleeding after the birth of the baby and placenta, in the UK, this affects approximately 10% of new mothers. This can cause them to need additional treatments including a blood transfusion and extra medicines, as well as prolonging their hospital stay

The IMOX study  is taking place in 6 different maternity units across the country, to compare the effectiveness, side effects and cost of Syntocinon, Syntometrine and Carbetocin, for women having a vaginal birth. All of these medicines are already used for this purpose within maternity care.

It involves a one-off injection in the mother’s leg just after their baby is born and the umbilical cord has been clamped, and before the placenta being gently delivered by the midwife or doctor. Medicine is given to reduce the risk of experiencing heavy bleeding (haemorrhage), reduce the need for extra medicines to make their womb contract well, and reduce the need for a blood transfusion after the baby has been born. Having this injection also makes the “third stage of labour” shorter.

The IMOX study will find out which medicine is best at reducing blood loss and which allows women to feel as well as possible in the first hours after birth. The team will also be comparing the overall cost of these three medicines, to help the NHS spend its money most effectively.  Knowing all of this information will help midwives and doctors to provide the best possible care for mothers giving birth

STROBE

This project will implement and evaluate structured, locally-delivered operative vaginal birth (OVB) training in 4 large maternity units within the South West of England. The innovative package of structured training has been developed by a multi-disciplinary team of obstetricians and midwives, in collaboration with the Royal College of Obstetricians and Gynaecologists (RCOG).

Training will be delivered by groups of local senior obstetricians, supported by high-fidelity simulators. Outcomes for mothers and babies who have had an OVB will be collected following the delivery of training in each of the 4 maternity units.

OVB is a vitally important tool which can improve maternal and neonatal outcomes in situations of full cervical dilation and either fetal distress or prolonged labour. OVB, compared to the alternative management (Caesarean section), is associated with lower rates of major maternal haemorrhage, reduced analgesia requirements and shorter hospital stay. Babies delivered via OVB also have lower rates of admission to neonatal intensive care units.

We believe we will be able to demonstrate an improvement in successful OVB (and hence reduction in emergency Caesarean sections). This will be the first structured implementation and evaluation of a training intervention designed to improve the outcomes of OVB. Should this project demonstrate that locally-delivered training improves maternal and neonatal outcomes, the RCOG will include attendance at such a course in the curriculum for all trainee obstetricians within the UK. The direct benefits of this project could be to mothers and their children, as well as the NHS and wider society through reduction in costs associated with additional care.

The project is being led by our Clinical Research Fellow, Dr Stephen O’Brien. It is hosted by NBT and funded by the Health Foundation. The ultimate aim is to validate and standardise a national training programme for safer OVBs.