Can we justify the under-representation of pregnant women in clinical trials?

We will discuss “The pregnant women as a drug orphan: a global survey of registered clinical trials of pharmacological interventions in pregnancy.” by Scaffidi and co-workers from 29 June 2016 for 7 days.

*This paper is now free-to-view!

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 29 June (the discussion will open for 7 days between 29 June to 6 July 2016)

First hosted discussion session(s) on Twitter starts at: GMT+1 (British Summer Time) 8pm (using hashtag #BlueJC)

Host: @BlueJCHost

Platforms: Twitter, Facebook and LinkedIn 

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (click on the “supporting information” tab).

The discussion points are attached below (quoted from the published Journal Club guide)

Scenario

A young woman attends a multidisciplinary clinic for prenatal counseling. She has been on sodium valproate for her epilepsy since she was a teenager. She has no other medical concerns. She asks, “is my medication going to harm my baby?”  How would you counsel this woman?

Description of research

Participants Pregnant women
Intervention Participation in drug trials during pregnancy
Comparison Not applicable
Outcomes The numbers, location, funding sources, and areas of interest/development of pregnancy drug trials (PDTs)
Study design Comprehensive analysis of sixteen WHO-certified clinical trial registries
Authors’ conclusion Pregnant women are significantly under-represented in global clinical drug trials

Discussion Points

  • How do health professionals determine whether a drug is safe to use during pregnancy?
  • What are the barriers to the inclusion of women in pharmacological interventional trials during pregnancy?
  • What are the potential benefits of including women in pharmacological interventional trials during pregnancy?
  • In figure 1, which medical conditions had the highest number of pregnancy-related drug trials?
  • Which factors may have contributed to the emphases on the above conditions?
  • Which factors may have contributed to the geographic distribution of pregnancy-related drug trials (see the results section)?
  • Suggest one pregnancy-related drug trial that would be the most relevant, acceptable and safe.
  • What could be done to improve the current under-representation of pregnant women in clinical trials?

Suggested reading

  • Quinn SC, Butler J 3rd, Fryer CS, Garza MA, Kim KH, Ryan C, Thomas SB. Attributes of researchers and their strategies to recruit minority populations: results of a national survey. Contemp Clin Trials. 2012 Nov;33(6):1231-7.
  • Legro RS. Barriers to conducting clinical research in reproductive medicine: United States of America. Fertil Steril. 2011 Oct;96(4):817-9.
  • Milliez J. Just inclusion of women of reproductive age in research: FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Int J Gynaecol Obstet. 2009 Nov;107(2):168.

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

Is paternal depression a significant risk factor of preterm birth?

We will discuss “Prenatal parental depression and preterm birth: a national cohort study” by Liu and co-workers from 25 May 2016 for 7 days.

*This paper is now online and FREE-TO-VIEW

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 25 May (the discussion will open for 7 days between 25 May to 1 June 2016)

First hosted discussion session(s) starts at: GMT+1 (British Summer Time) 8pm 

Host: @BlueJCHost

Platforms: Twitter, Facebook and LinkedIn 

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published Journal Club guide)

Scenario

Mental health awareness in pregnancy was emphasised during an obstetrics continual professional development event. The speaker summarised adverse perinatal outcomes that has been linked with maternal depression. A midwife asked, “Does depression in dads have similar impact on these outcomes?”

Description of research

Participants Singleton births recorded in the Medical Birth Register of Sweden between 2007–2012
Intervention Parents with depression
Comparison Parents without depression
Outcomes Odds ratios (ORs) for very preterm and moderately preterm births
Study design A population-based cohort study
Authors’ conclusion New paternal and maternal prenatal depression are potential risk factors for preterm birth

Discussion Points

  • How common is paternal depression in the perinatal period? (See suggested reading)
  • What are the risk factors of parental depression identified in this study?
  • How was parental depression defined in this study? What are the pros and cons of using this definition?
  • What is Huber-White sandwich estimates of variance? Was its use appropriate?
  • What were the relationships between paternal depression, spontaneous preterm births and medically-indicated preterm births?
  • How was cohabitation of parents related to preterm birth rates?
  • What are the possible mechanisms behind the above associations?
  • How do the demographics of the study participants compare to parents you encounter in your usual practice? (See Table 1–2)
  • How may the results of this study influence your daily practice?

Suggested reading

  • Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis. JAMA. 2010 May 19;303(19):1961-9.
  • Scottish Intercollegiate Guidelines Network. Critical Appraisal: notes and checklists. Methodology checklist 3: Cohort study. http://www.sign.ac.uk/methodology/checklists.html (Last access 15 February 2016)

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

Why is it important to identify intimate partner violence during pregnancy?

We will discuss “Intimate partner violence during pregnancy and the risk for adverse infant outcomes: a systematic review and meta-analysis” by Donovan and co-workers from 30 March 2016 for 7 days.

*This paper is now online and will be FREE-TO-VIEW

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 30 March 2016 (the discussion will open for 7 days between 30 March to 6 April 2016)

First hosted discussion session(s) starts at: GMT+1 (British Summer Time) 8pm 

Host: @BlueJCHost

Platforms: Twitter, FacebookLinkedIn and Weibo

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published Journal Club guide)

Scenario

A nulliparous woman visits her midwife at 13+0 weeks with her partner. She is a healthy non-smoker. Her dating ultrasound scan was normal. She works as a shop assistant and lives with her partner. This is an unplanned but wanted pregnancy. She reports no concern. You notice small circular burn marks on her forearm, which the woman described as accidental burn by an iron. How would you counsel this woman?

Description of research

Participants Pregnant women
Intervention Women who experienced intimate partner violence (IPV) during pregnancy
Comparison Women who did not experience IPV during pregnancy
Outcomes
  • Preterm birth (PTB): infants born before 37 weeks gestation
  • Low birth weight (LBW): infants born <2500g
  • Small-for-gestational age (SGA): birth weight <10th percentile for a given gestational age
Study design Systematic review and meta-analysis of observational studies
Authors’ conclusion The risks of PTB and LBW were significantly increased in women who experienced IPV.

Discussion Points

  • In your practice, how prevalent is IPV during pregnancy?
  • Which additional factors would you consider when you counsel the woman in the scenario?
  • How was IPV identified in the included studies of this meta-analysis?
  • How was quality of the included studies assessed? (See Table 1 and S1)
  • What are the different factors leading to heterogeneity in a systematic review?
  • How did the authors assess heterogeneity in this systematic review?
  • How did the authors subsequently address the identified heterogeneity of the included studies?
  • Which interventions aimed at preventing IPV have been tested? Are they effective? (See suggested reading)
  • How would the results of this study influence your daily practice?

Suggested reading

  • The Centre for Evidence-based Medicine. Critical appraisal worksheet on systematic review. Available from: http://www.cebm.net/critical-appraisal/.
  • National Institute for Health and Care Excellence. Guideline PH50. Domestic violence and abuse: multi-agency working. February 2014. Available from: https://www.nice.org.uk/guidance/ph50.
  • The Cochrane Collaboration. Part 2 Section 9.5: Heterogeneity. Cochrane Handbook for Systematic Reviews of Interventions. 2011. Version 5.1.0. Available from http://handbook.cochrane.org/.
  • Van Parys A-S, Verhamme A, Temmerman M, Verstraelen H. Intimate Partner Violence and Pregnancy: A Systematic Review of Interventions. Vermund SH, ed. PLoS ONE. 2014;9(1):e85084.

 

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

How to improve obstetrics outcomes in overweight and obese pregnant women?

We will discuss “Self-weighing and simple dietary advice for overweight and obese pregnant women to reduce obstetric complications without impact on quality of life: a randomised controlled trial” by McCarthy and co-workers from 24 February 2016 for 7 days.

*This paper is now FREE-TO-VIEW

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 24 February 2016 (the discussion will open for 7 days between 27 January to 3 February 2016)

First hosted discussion session(s) starts at: GMT 8pm (UK time) *** NOTE: new start time for #BlueJC in 2016

Host: @BlueJCHost

Platforms: Twitter, FacebookLinkedIn and Weibo

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published Journal Club guide)

Scenario

A nulliparous woman visits her obstetrician at 13+0 weeks. Her body mass index (BMI) is 35 kg/m2, but she has no other medical history. Her dating ultrasound scan was normal. Her obstetrician explained the risks of obesity on her pregnancy. She asks, “what can I do to minimise these risks?”.

Description of research

Participants Overweight or obese pregnant women at <20 weeks with a singleton pregnancy, without pre-existing diabetes
Intervention Simple dietary advice, written personalised weight gain targets, encouragement of regular self-weighing and discussions of weight gain with the obstetric care provider
Comparison Written personalised weight gain targets only
Outcomes Composite primary outcome including any of: gestational diabetes; pregnancy-induced hypertension and pre-eclampsia; mode of birth other than spontaneous vertex; post-partum haemorrhage; 3rd or 4th degree perineal tear; admission to adult intensive care/ high-dependence units, maternal death
Study design Randomised controlled trial (Trial registration number: NCT01001689)
Authors’ conclusion Randomised controlled trial (RCT; Trial registration number: ACTRN12611000881932)


Discussion Points

  • What are the risks of obesity in pregnancy for mothers and babies?
  • How would you manage the woman in the scenario, compared to women with normal weight?
  • What are the strengths and weaknesses of this RCT?
  • How do the demographics of the study participants compare to women in your practice (see Table 1)?
  • Analysis of covariance (ANCOVA) was used to analyse the difference in gestational weight gain. What is ANCOVA and was its use appropriate?
  • Are the outcomes of women who were overweight different from those who were obese (see supplementary figure S2 and S4)?
  • How did the authors assess the impact of missing data (18%) in this study (see supplementary figure S3)?
  • How does this RCT enhance your practice, in view of the existing evidence (see suggested reading)?

Suggested reading

  • Critical Appraisal Skill Programme (CASP). CASP checklist for Randomised Controlled Trials (http://www.casp-uk.net/).
  • Thangaratinam S, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ. 2012 May 16;344:e2088.
  • Brownfoot FC, Davey MA, Kornman L. Routine weighing to reduce excessive antenatal weight gain: A randomised controlled trial. BJOG. 2016.
  • Sagedal LR, Øverby NC, Bere E, Torstveit MK, Lohne-Seiler H, Småstuen M, Hillesund ER, Henriksen T, Vistad I. Lifestyle intervention to limit gestational weight gain: the Norwegian Fit for Delivery randomised controlled trial. BJOG. 2016.

 

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

How to avoid excessive weight gain during pregnancy?

We will discuss “Lifestyle intervention to limit gestational weight gain: the Norwegian Fit for Delivery randomised controlled trial” by Sagedal and co-workers from 27 January 2016 for 7 days.

*This paper is now FREE-TO-VIEW

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 27 January 2016 (the discussion will open for 7 days between 27 January to 3 February 2016)

First hosted discussion session(s) starts at: GMT 8pm (UK time) *** NOTE: new start time for #BlueJC in 2016

Host: @BlueJCHost

Platforms: Twitter, FacebookLinkedIn and Weibo

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published manuscript)

Scenario

A nulliparous woman visits with her midwife at 13 week of her pregnancy. Her body mass index is 23 kg/m2 and she is healthy. Her dating ultrasound scan was normal. She is concerned about weight gain during pregnancy because her sister became overweight during pregnancy and struggled to lose weight after birth. She asks, “what can I do to avoid gaining too much weight during my pregnancy?”.

Description of research

Participants Healthy, non-diabetic, nulliparous women, ≥18 years, body mass index ≥19 kg/m2, with a singleton pregnancy of ≤20 gestational-weeks.
Intervention Dietary counselling twice by telephone and access to twice-weekly exercise groups
Comparison Standard prenatal care
Outcomes Primary outcomes: maternal gestational weight gain (GWG), weight of the newborn, maternal fasting serum glucose level, incidence of operative delivery, maternal body composition

Secondary outcomes: proportion of newborns with weight ≥90th percentile, the proportion of women with elevated 2-hour glucose tolerance tests, measurement of hormones related to glucose metabolism, the incidence of delivery complications and postpartum weight retention

Study design Randomised controlled trial (Trial registration number: NCT01001689)
Authors’ conclusion Despite a modest but significant decrease in GWG, lifestyle intervention had no measurable effect on obstetrical or neonatal outcomes.


Discussion Points

  • Which additional factors you may consider when you counsel this woman?
  • Which interventions have been used to maintain maternal weight during pregnancy? Are they effective? (See suggested reading)
  • Critically appraise this randomised controlled trial (RCT) using the Critical Appraisal Skill Programme (CASP; http://www.casp-uk.net/) checklist.
  • Based on your assessment, what are the strengths and weaknesses of this RCT?
  • Which parameter was used in the power calculation of this RCT? How does it impact on the design of this study?
  • How do the demographics of the study participants compare to women you encounter in your usual practice?
  • In this study how do the measured outcomes differ between women who had normal BMI (<25 kg/m2), women who were overweight (20-25 kg/m2) and obese (>25 kg/m2)
  • How would you advice the woman in the scenario?

Suggested reading

  • Sagedal LR, Øverby NC, Lohne-Seiler H, Bere E, Torstveit MK, Henriksen T, Vistad I. Study protocol: fit for delivery – can a lifestyle intervention in pregnancy result in measurable health benefits for mothers and newborns? A randomized controlled trial. BMC Public Health. 2013 Feb 13;13:132.
  • Thangaratinam S, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ. 2012 May 16;344:e2088.

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

#BlueJC in 2015- ended on a high at #RCOGNTC

At the RCOG National Trainees’ Conference (#RCOGNTC) in December 2015, #BlueJC team had the opportunity to speak to doctors about engagement using social media. 

Social media- What’s in it for me?

Dr. Ann-Marie Cunningham, Primary Care Clinical Director at Aneurin Bevan University Health Board, has succinctly summarised the potential of social media for doctors using her wonderful infographic and slideshare slides.

someblog 

Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

 

Who should get HPV vaccines in low-resource settings?

We will discuss “The value of male HPV vaccination in preventing cervical cancer and genital warts in a low resource setting” by Sharma and co-workers from 25 November 2015 for 7 days.

*This paper will be made FREE-TO-VIEW on 16 November 2015.

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 25 November 2015 (the discussion will open for 7 days between 25 November to 2 December 2015)

First hosted discussion session(s) starts at: GMT 7pm (UK time)

Host: @BlueJCHost

Platforms: TwitterLinkedIn and Weibo

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published manuscript)

Scenario

At a conference on cervical cancer prevention, a speaker presented data on the cost-effectiveness of HPV vaccination for girls in Thailand (BJOG. 2012;119(2):166-76). An audience asked, “Would vaccinating both boys and girls be better than vaccinating girls only?”.

Description of research

Participants Male and female population (≥ 9 years old) in South Vietnam
Intervention HPV vaccination for both male and female
Comparison HPV vaccination for female only
Outcomes Economical costs, estimates of cervical cancer and genital warts incidence, mortality and quality-adjusted life years (QALYS)
Study design Economic evaluation using mathematical models


Discussion Points

  • What are the incidence of cervical cancer, uptake rate of cervical screening and coverage of HPV vaccine in your country?
  • What is GAVI Alliance? How does it achieve its goals?
  • What are the advantages and disadvantages of using a mathematical model to address this research question? Are there alternatives?
  • What is the purpose of sensitivity analysis in economical evaluations?
  • What is your interpretation of the results presented? Where may the results be generalisable?
  • What are the factors influencing how policy makers utilise findings of economical evaluations?
  • How can researchers maximise the potential of their research being utilised for health policy decision-making?
  • Should we give HPV vaccines to all boys in LMICs?

Suggested reading

  • Critical Appraisal Skills Programme checklist for economical evaluation. http://bit.ly/1EX0KXE
  • Cohen DJ, Reynolds MR. Interpreting the results of cost-effectiveness studies. J Am Coll Cardiol. 2008 Dec 16;52(25):2119-26.
  • Linhares IM, Witkin SS. HPV vaccination: unanswered questions remain. BJOG. 2015 Jan;122(1):118.
  • Gold M. Pathways to the use of health services research in policy. Health Serv Res. 2009 Aug;44(4):1111-36.
  • Haynes AS, Gillespie JA, Derrick GE, Hall WD, Redman S, Chapman S, Sturk H. Galvanizers, guides, champions, and shields: the many ways that policymakers use public health researchers. Milbank Q. 2011 Dec;89(4):564-98.

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

Are invasive therapies for primary post-partum haemorrhage effective?

We will discuss “Invasive therapies for primary postpartum haemorrhage: a population-based study in France.” by Kayem and co-workers from 28 October 2015 for 7 days.

*This paper will be made FREE-TO-VIEW on 19 October 2015.

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 28 October (the discussion will open for 7 days between 28 October to 4 November 2015)

First hosted discussion session(s) starts at: GMT 7pm (UK time- please note the clock changes on 24 October)

Host: @BlueJCHost

Platforms: TwitterLinkedIn and Weibo

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published manuscript)

Scenario

During a multidisciplinary training day on the management of post-partum haemorrhage (PPH), a number of invasive therapies were described. One of the delegates asked, “how often are these invasive therapies used? Are they effective?”.

Description of research

Participants Women who have participated in the PITHAGORE6 trial (106 maternity units in 6 French regions) and developed primary PPH between December 2004 and November 2006
Intervention Invasive therapies for PPH, including uterine suture, pelvic vessel ligation, arterial embolisation and hysterectomy.
Comparison National databases in the UK and Netherlands
Outcomes Maternal mortality, hysterectomy rate, incidence of conservative invasive therapies and their failure rates
Study design Observational study (retrospective analysis of a large clinical trial cohort)

Discussion Points

  • In your local practice, how often are invasive therapies used to manage PPH? Moreover, what is the most frequently used invasive therapies for PPH?
  • What are the advantages and disadvantages of a retrospective analysis of large clinical trial datasets compared to a prospective population-based surveillance programme?
  • How may a prospective population-based surveillance programme further improve the quality of the data collected in this study?
  • How do maternal mortality and morbidity rates from PPH in France compared to those in the UK and Netherlands (see Table 4)?
  • Which factors may have caused the observed differences in maternal mortality and morbidities?
  • Did the results of the current study support the authors’ conclusions?
  • How would the results of this study influence your daily practice?

Suggested reading

  • Deneux-Tharaux C, Dupont C, Colin C, Rabilloud M, Touzet S, Lansac J, Harvey T, Tessier V, Chauleur C, Pennehouat G, Morin X, Bouvier-Colle M, Rudigoz R. Multifaceted intervention to decrease the rate of severe postpartum haemorrhage: the PITHAGORE6 cluster-randomised controlled trial. BJOG 2010;117:1278–1287.
  • Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, Gonzalez-Medina D, Barber R, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014 Sep 13;384(9947):980-1004.
  • Doumouchtsis SK, Nikolopoulos K, Talaulikar V, Krishna A, Arulkumaran S. Menstrual and fertility outcomes following the surgical management of postpartum haemorrhage: a systematic review. BJOG. 2014 Mar;121(4):382-8.

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

Who develops abnormally invasive placenta during pregnancy?

We will discuss “Abnormally invasive placenta – Prevalence, risk factors and antenatal suspicion: Results from a large population-based pregnancy cohort study in the Nordic Countries” by Thurn and co-workers from 30 September 2015 for 7 days.

*This paper will be made FREE-TO-VIEW on 21 September 2015.

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 30 September 2015 (the discussion will open for 7 days between 30 September to 7 October 2015)

First hosted discussion session(s) starts at: BST 7pm (UK time)

Host: @BlueJCHost

Platforms: Twitter and LinkedIn

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published manuscript)

 

Scenario

A 32-year-old woman presents with small amount of vaginal bleeding at 26 weeks of her pregnancy. She has no other symptoms and is stable. She had two previous caesarean sections; for breech presentation in her first pregnancy and a subsequent elective caesarean section. Ultrasound assessment confirms the fetus is viable with normal growth. However, placenta is anterior and low-lying (placenta praevia). How would you manage this woman?

Description of research

Participants Women giving birth in the Nordic Countries between 2009-2012
Intervention Women with abnormally invasive placenta (AIP), with or without antenatal suspicion of AIP
Comparison The respective background population of each country (women without AIP)
Outcomes Prevalence, risk factors, antenatal suspicion, birth complications and risk estimations using aggregated national data.
Study design Population-based Cohort Study, the Nordic Obstetric Surveillance Study (NOSS)

Discussion Points

  • How do you define and diagnose abnormally invasive placenta (AIP)?
  • How common is AIP in your practice?
  • What is the Nordic Obstetric Surveillance Study (NOSS)?
  • What are the benefits of prospective registration of rare complications of pregnancy (compared to existing retrospective registration systems based on ICD-10 codes)?
  • What are the strengths and pitfalls of amalgamating data from multiple countries?
  • What are the major risk factors of AIP identified in this study? How much more likely are women with these risk factors to have AIP?
  • Is antenatal suspicion of AIP associated with improved maternal and neonatal outcomes?
  • Can you briefly summarise the results of this study in one sentence?
  • How would the results of this study influence your daily practice?
  • How can we develop an internationally agreed definition of AIP?

Suggested reading

  • Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG. 2014 Jan;121(1):62-70; discussion 70-1.
  • Calì G, Giambanco L, Puccio G, Forlani F. Morbidly adherent placenta: evaluation of ultrasound diagnostic criteria and differentiation of placenta accreta from percreta. Ultrasound Obstet Gynecol. 2013 Apr;41(4):406-12.
  • Rustamov O, Alfirevic Z, Arora R, Siddiqui I, Mitchell AL. Imaging techniques for antenatal detection of morbidly adherent placenta (Protocol). Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD008985.

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

Can we reliably identify large babies before birth?

We will discuss “Antenatal magnetic resonance imaging versus ultrasound for predicting neonatal macrosomia: a systematic review and meta-analysis.” by Malin and co-workers from 26 August 2015 for 7 days.

*This paper is an open-access article and is now on early view!

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 26 August 2015 (the discussion will open for 7 days between 26 August to 2 September 2015)

First hosted discussion session(s) starts at: BST 7pm (UK time)

Host: @BlueJCHost

Platforms: Twitter and LinkedIn

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published manuscript)

 

 

Scenario

A midwife referred an African-Caribbean woman at 33 weeks of her first pregnancy because of ‘large for dates’ on abdominal palpation (symphysis fundal height= 37cm).

Her oral glucose tolerance test at 28 weeks was normal. She is overweight (body mass index= 27 kg/m2), but has no other risk factors. She has no family history of obstetrics complication. How would you counsel this woman?

 

Description of research

Participants Women with a singleton pregnancy
Intervention 2D or 3D ultrasound scan or MRI performed in the third trimester to detect fetal macrosomia.
Comparison Another index test (if used)
Outcomes Birthweight >4000 g, >4500 g, >90th or >95th centile
Study design Systematic review and meta-analysis


Discussion Points

  • How common is macrosomia in your practice?
  • How do you currently counsel women similar to the one in the scenario?
  • How did the authors assess the quality of individual studies? (also see suggested reading
  • What were the problems identified by their quality assessment of individual studies?
  • Critically appraise this meta-analysis using the PRISMA checklist (http://bit.ly/1CIZNHw).
  • Can you briefly summarise the results of this study as a one-sentence take-home message
  • Would the results of this study influence your management of the woman in the scenario
  • How would the results of this study influence your daily practice?

Suggested reading

  • Coomarasamy A, Connock M, Thornton J, Khan KS. Accuracy of ultrasound biometry in the prediction of macrosomia: a systematic quantitative review. BJOG. 2005 Nov;112(11):1461-6.
  • Schünemann HJ, et al; GRADE Working Group. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ. 2008 May 17;336(7653):1106-10.

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.