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

Why is it important to identify intimate partner violence during pregnancy? Explore its impact and discuss potential strategy to minimise it at #BlueJC in March 2016. Continue reading

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.

Is home birth safe?

We will discuss “Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases” by de Jong and co-workers from 29 July 2015 for 7 days.

*This paper will be made FREE-TO-VIEW on 15 June 2015.

There are two linked commentaries with this #BlueJC paper:

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

Start date: 29 July 2015 (the discussion will open for 7 days between 29 July 2015 to 5 August)

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

Host: @jimgthornton (Prof. Thornton, University of Nottingham) and @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 (data S1).

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

Scenario

A 28-year-old nulliparous woman comes to see her midwife at 36 week of her pregnancy. She has an uncomplicated pregnancy to date and no other medical history. She asks, “can I have a home birth?”

Description of research

Participants

Low-risk women in midwife-led care

Intervention

Planned home birth

Comparison

Planned hospital birth

Outcomes

Intrapartum and neonatal death, Apgar scores, and admission to a neonatal intensive care unit (NICU) within 28 days of birth

Study design

A nationwide cohort study, using national registration data

Discussion Points

  • In your practice, how common is home birth?
  • Which additional factors health professionals need to consider when counseling the woman in the scenario?
  • According to this study, what are the risks of home birth in nulliparous women? Compare these risks in multiparous woman.
  • How do the results of this study different from the Birthplace Study?
  • What are the strengths and weaknesses of this cohort study?
  • How do the results of this study cognate with the recommendations on the place of birth by the National Institute for Health and Care Excellence (NICE CG190)?
  • Are the results of this study generalisable in different healthcare settings?
  • Are randomised controlled trials appropriate to determine safety of home birth?
  • How would the results of this study influence your daily practice?

Suggested reading

  • Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, McCourt C, et al. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011;343:d7400.
  • Chervenak FA, McCullough LB, Arabin B, Brent RL, Levene MI, Grünebaum A. Planned homebirth: not a Dutch treat for export. BJOG. 2015 Apr;122(5):730.
  • Knight M. How should we interpret the new Dutch evidence on home birth? BJOG. 2015 Apr;122(5):729.
  • The National Institute for Health and Care Excellence. Intrapartum Care (CG190). Available from: nice.org.uk/Guidance/CG190/Evidence
  • Olsen O, Clausen JA. Planned hospital birth versus planned home birth. Cochrane Database Syst Rev. 2012 Sep 12;9:CD000352.

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.