Projects

Below are listed projects that UKARCOG members have worked on.

ABFAB – Accuracy of fetal Blood sampling For detecting Acidaemia at Birth.

Status: case identification and data collection in progress.

Our present understanding of the value of fetal blood sampling (FBS) in labour relies on the assumption that FBS accurately represents fetal central organ acid-base status and that it can predict adverse outcome. However, the procedure requires much skill and training, and can be accompanied by (thankfully rare) complications. The failure to obtain an FBS may also contribute to the rising Caesarean delivery rates.

This observation study aims to collect consecutive fetuses’ FBS results and assess the correlation with the corresponding cord gas results in the neonate. We will collect data from across the United Kingdom and pool them together to improve the reliability and generalisability of our findings.

Implementation of RCOG and NICE guidelines in obstetrics and gynaecology.

Status: planning.

RCOG and NICE assess the evidence behind management strategies and interventions in obstetrics and gynaecology. These are used to produce national guidelines, which hospitals across the UK are recommended to follow, with adaptation for local circumstances as necessary. However the extent to which they are adopted by hospitals is unknown.

This study will involve interviewing key personnel in centres across the UK to obtain a cross-sectional survey of the extent to which a sample of guidelines produced by RCOG and NICE are adopted at each centre. It is anticipated that UK-ARCOG will collaborate with the aforementioned organisations in addition to the National Guideline Alliance.

ReDEFINe – Rotational DElivery at Full dILatatioN. A national prospective audit.

Status: writing manuscript.

ReDEFINe aims to evaluate current national trends in the operative obstetric management of fetal malposition in the second stage of labour, which complicates around 15-20% of all deliveries. Importantly, fetal malposition is associated with an increase in adverse outcomes for both mother and baby. This includes increased risk of caesarean sections, perineal injury, admission to the neonatal unit and babies with low apgar scores. Current management options include, manual rotation, instrumental delivery (with or without manual rotation) or caesarean section. Which methods are currently being utilised or preferred, and what outcomes these options have on both the mother and the baby, remain poorly defined. We anticipate that the findings from this timely project will be valuable from an obstetric training perspective, as well as providing essential information to guide future obstetric practise and UK guideline development for the benefit of our patients.

Management of obstetric postpartum haemorrhage (MOPA): a UK national audit of practice

Status: published

Description:

Postpartum haemorrhage (PPH) continues to be one of the major causes of maternal mortality and morbidity. To assess the current practice in the UK, we conducted a national prospective multicentre prospective audit over one calendar month (September-October 2014) against national guidelines. We collected data on patients’ demographics, the incidence of PPH, prophylaxis and management measures, estimated blood loss, the onset of labour and mode of delivery. Data was collected by 197 specialty trainees from 98 maternity units in the UK. We captured 3635 cases of primary postpartum haemorrhage. The majority of cases were mild to moderate PPH (92%). Prophylactic agents were given in 97% of cases most commonly using Syntometrine. The most frequently utilised additional uterotonic agent was Syntocinon IV (32%). There was poor senior involvement in the management of PPH from both consultant obstetricians and anaesthetist. Our audit demonstrates evidence of wide variations in practice for preventing and managing primary postpartum haemorrhage across maternity units in the UK compared to national guidelines. Interventions are needed to improve the quality of maternity care in this field.