Women & Children's Health Research Unit Current Projects

The Unit is currently running 29 studies. Over the last 2 years we have recruited over 2,000 patients to participate in our research.

Core Outcome Set for Stillbirth

Exploring parental involvement in deciding which core outcomes matter to parents in stillbirth studies

Care for parents following a stillbirth is not always as good as it should be. Until recently, research on how to improve care for bereaved parents had been neglected. This was identified as a significant problem worldwide in a series of papers in one of the most influential medical journals (The Lancet).

Currently studies evaluating potential care and pathways after a stillbirth measure many different outcomes. Therefore, when the studies have finished, their results cannot be directly compared or combined.  We intend to develop a Core Outcome Set (COS) for care and treatments following a stillbirth to address this issue.  A COS is a list of minimum outcomes that should be reported in every study of a health or medical condition.  If all studies use the same outcomes they could be directly compared and combined. This will help patients, clinicians, and guideline developers make the best use of available research in the future, making research and the use of research funding more efficient. 

In order to develop and decide on a COS, interviews, surveys, and meetings are performed to draw together the opinions of researchers, healthcare professionals, and patients on what outcomes are most important.  This has never been done in conjunction with bereaved parents affected by stillbirth.  Therefore, prior to actually developing the COS we will find out from parents with a lived experience of stillbirth how best to develop a COS for the stillbirth research.  We will carry out a small group interview to gain parental opinions.

By involving women and their partners from the beginning of this whole programme of research we hope to actively engage them in the research process to develop a COS that is relevant to patients, but also ensures rapid progress in the field of stillbirth research.

The project is being led by our Research Fellow, Danya Bakhbakhi. It is hosted by North Bristol NHS Trust and funded by Southmead Hospital Charity’s Research Fund . Collaborative initiatives include: COMET (Core Outcome Measures in Effectiveness Trials) and CROWN (CoRe Outcomes in Women’s and Newborn health), and iCHOOSE (International Collaboration for Harmonising Outcomes for Stillbirth). Danya has also just secured a prestigious National Institute for Health Research (NIHR) Doctoral Research Fellowship to expand this initial project and fully develop the COS for stillbirth research. This is an exciting leap forward for this field and a great accolade for the Research Unit here at NBT and our partners at the University of Bristol.

The team with the help of the Southmead Hospital Charity have developed a compassionate & sensitive short animation which explains the ichoose project. A groundbreaking project that will help ensure that in future parents of still born babies receive the best care possible. https://vimeo.com/274073491

 

Impacted Fetal Head

Development of simulation training for difficult delivery of an impacted fetal head at caesarean section

Over one quarter of women in the UK undergo a Caesarean birth. This sometimes occurs when women are fully (10cm) dilated, also known as the second stage of labour. Data from studies outside the UK suggest that this occurs in almost 2% of all births. In these circumstances, it can be difficult for doctors to deliver the baby, as the head can be very low and fixed in the mother’s pelvis. Doctors can use different approaches to help dislodge the baby’s head. One method involves an assistant inserting a hand into the woman’s vagina and pushing the baby’s head out of the pelvis. Another method involves delivering the baby feet first, followed by the baby’s head (reverse breech delivery). Rarely, obstetricians may deliver the baby’s shoulders first.

These technically difficult births are associated with significant risks to mother and baby. Complications for mothers include unintentional damage to the womb or urinary system, excessive bleeding and longer stays in hospital. Babies are at increased risk of injury including head and face trauma, low oxygen levels, infection, admission to the neonatal intensive care unit, and even death.

There is no established consensus regarding which method is safest and most effective in these situations. Furthermore, obstetricians are not always familiar with the differing techniques. Lack of knowledge and training can lead to delays in the birth and increased risk of complications. These situations occur relatively infrequently, making it difficult for obstetricians to learn the skills from experience alone.

Ultimately, this project aims to develop a training program, where maternity staff can learn in simulation and apply these skills in clinical practice. We anticipate that the introduction of this training will lead to greater confidence in maternity staff and improvements in outcomes for mothers and babies.

This project is led by our Research Fellow, Katie Cornthwaite. It is hosted by North Bristol NHS Trust and funded by Southmead Hospital Charity’s Research Fund.

International Bereavement Consensus

 

In the UK, more than 5,000 babies a year die before or shortly after birth. However, stillbirth rates elsewhere are, devastatingly, even higher. 98% of stillbirths worldwide in occur in low and middle income countries (LMICs). Despite this, there is limited evidence on what care should be provided in these settings.

To begin to address this healthcare challenge, we are carrying out two key projects. Firstly, a review of all the scientific literature (a systematic review) will be carried out, to understand the experiences parents and healthcare professionals have of care after stillbirth in LMICs.  This systematic review aims to assess the available evidence and identify themes which are important to both parents and healthcare workers, to be used to inform training, guidelines and provision of care.

Secondly, want to achieve a global consensus on bereavement care after stillbirth. We will identify principles for care after stillbirth that are applicable in all settings, whilst taking into account the diversity of different global cultures.

Our ultimate aim is to standardise the quality of bereavement care given after the loss of a baby, whilst adopting a pragmatic approach to suit all settings globally.
This work is led by our Academic Clinical Fellow and Obstetrics and Gynaecology trainee, Clare Shakespeare, in collaboration with the International Stillbirth Alliance. Clare is funded by the National Institute for Health Research and her main interest is in global women's health. She has been involved in several projects in Malawi and Zimbabwe and is a member of the Royal College of Obstetricians and Gynaecologists Trainee's Global Health Committee.

The team  with the help of the Southmead Hospital Charity have developed a compassionate & sensitive short animation which explains the ichoose project. A groundbreaking project that will help ensure that in future parents of still born babies receive the best care possible. https://vimeo.com/274073491