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Objectives: To determine the diagnostic accuracy of ultrasound at 11-14 weeks gestational age in the detection of fetal cardiac abnormalities, and to evaluate factors that impact detection rates.Methods: A systematic review of studies evaluating the diagnostic accuracy of ultrasound in the detection of fetal cardiac anomalies at 11-14 weeks gestational age was undertaken by two independent reviewers. Prospective and retrospective studies evaluating pregnancies at all levels of prior risk and in any healthcare setting were eligible for inclusion. The reference standard used was the detection of a major cardiac abnormality on postnatal or post-mortem examination. Data were extracted from included studies to populate 2 x 2 tables. Meta-analysis was performed using a random-effects model in order to determine the overall performance of first trimester ultrasound in the detection of major cardiac abnormalities overall and in addition, for individual types of cardiac abnormalities. Data were analysed separately for high-risk populations vs. non-high risk populations. Pre-planned secondary analyses were conducted in order to assess factors which may impact screening performance including: the imaging protocol used for cardiac assessment (including use of Colour Doppler), mode of ultrasound, publication year of study, and the index of sonographer suspicion at the time of scan. A risk of bias and quality assessment was undertaken for all included studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).Results: An electronic search of four databases (Medline, Embase, Web of Science Core Collection and Cochrane Library) was conducted from January 1998 until July 2020 and identified 4108 citations. This led to 223 full text reviews from which a total of 63 studies were selected for inclusion. Data from a total of 328,214 screened fetuses were included. In non-high risk populations (45 studies, 306,872 fetuses), 1,445 major cardiac anomalies were identified (prevalence 0.41 (95% C.I. 0.39 -0.43)). Of these, 767 were correctly detected by first trimester examination of the heart and 678 were not detected. Pooled sensitivity was 55.80% (95% CI 45.87-65.50%,), specificity 99.98% (95% CI 99.97 -99.99%) and positive predictive value 94.85% (95% CI 91.63-97.32%). The cases diagnosed in the first trimester represent Accepted ArticleThis article is protected by copyright. All rights reserved.63.67% (95% CI 54.35 -72.49%) of all antenatally diagnosed major cardiac abnormalities. In high risk populations (18 studies, 21,342 fetuses) 480 major cardiac anomalies were identified (prevalence 1.36 (95% C.I. 1.20 -1.52)). Of these, 338 were correctly detected in the first trimester, and 142 were not detected. The sensitivity was 67.74% (95% CI 55.25 -79.06%), specificity 99.75% (95% CI 99.47 -99.92%) and positive predictive value 94.22% (95% CI 90.22 -97.22%). The cases diagnosed in the first trimester represent 79.86% (95% CI 69.89 -88.25%) of all antenatally diagnosed major cardiac abnormalities in high risk populati...

Asking diff erent questions: research priorities to improve the quality of care for every woman, every child Unacceptably high rates of adverse outcomes persist for childbearing women and infants, including maternal and newborn mortality, stillbirth, and short-term and long-term morbidity. 1 In light of the challenges to achieve the UN Sustainable Development Goals, it is timely to reconsider priorities for research in maternal and newborn health. Are we asking the right questions? 2 Recent evidence indicates the importance of seeking knowledge beyond the treatment of complications, to inform better ways of providing sustainable, high quality care, including preventing problems before they occur. 3 The 2014 publication of The Lancet's Series on Midwifery presented a unique opportunity to generate future areas of inquiry by drawing on the most extensive examination to date of evidence on the care that all women and newborn infants need across the continuum from pre-pregnancy, birth, post partum, and the early weeks of life. [4][5][6] The Series summarised the evidence base for quality maternal and newborn care in a new framework that focuses on the needs of women, infants, and families and diff erentiates between what care is provided, how it is provided, and Research prioritiesResearch priority score

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The aim of this study was to improve emergency theatre efficiency via the introduction of a theatre booking form and morning briefing meeting. Process mapping was used to engage staff and consider if the emergency theatre may benefit from the application of a structured process of communication. A theatre booking form and morning briefing meeting were implemented to promote change. Efficiency was measured by theatre utilisation and characterised into neutral time, efficient time and inefficient time. The results demonstrated a 12.9% increase in efficient time, 3.3% fall in inefficient time and 9.6% fall in neutral time post-implementation, during the high volume work period of 08:00 to 17:59 on weekdays. No improvement in efficiency was demonstrated outside these hours or on weekends during lower volume workloads. Utilisation of a theatre booking form and morning briefing meeting improved emergency theatre efficiency during high volume work periods by the application of a structured process of communication.