BackgroundComplementary therapy and Alternative medicine (CAM) is used worldwide for many ailments and is a popular option amongst pregnant women for general wellbeing and managing symptoms. Many studies investigating the use of CAM in the antenatal and intrapartum period have been conducted however there is a lack of evidence regarding its effects on induction of labour and delivery. We established a post-dates clinic comprising of an antenatal check and CAM for low risk pregnant women to determine the impact of CAM on these outcomes.MethodsThis was a cohort study with convenience sampling. A total of 1044 women were included. 397 received a combination of three CAM techniques (acupressure, reflexology and aromatherapy) and 647 women received standard clinical practice. The primary outcome was rate of induction of labour and secondary outcomes such as rates for epidural, length of labour, oxytocin use for induction or augmentation of labour, mode of delivery, blood loss during delivery, postpartum haemorrhage, significant perineal trauma, shoulder dystocia and admission of the baby to a special care unit were analysed.FindingsCAM did not have an effect on rates of induction of labour in nulliparous or multiparous women attending the post-dates clinic. However, we noted that nulliparous women who received CAM had shorter labours (mean 8.4 vs 10 h, p = 0.0002), less oxytocin augmentation (23% vs 35%, p = 0.0002), lower epidural rates (41% vs 50.5%, p = 0.02) and reduced blood loss regardless of mode of delivery (mean reduction 82ml, p = 0.03; 95%CI = -159 to -5). There were no significant differences in secondary outcomes when CAM was used in multiparous women apart from a 5.3 times increased risk of significant perineal trauma (6% vs 2%, p = 0.004) and those who had their labours induced after CAM had a higher risk of requiring an emergency caesarean section (5% vs 1%, p = 0.012). There was no difference on shoulder dystocia and neonatal admissions rates with CAM.ConclusionThere is no reduction in induction of labour rates with the use of CAM. The other effects of CAM on labour and delivery outcomes are varied and potentially only beneficial in a selected group of women. Further research must be carried out before making any clear recommendations on its use.
Homebirth is recommended in the UK for women considered low-risk, but homebirth rates remain low. With the aim of enabling women to safely achieve the birth they want, and enabling midwives to support them in this, a community-based skills drills training session was organised by midwives at Hinchingbrooke Health Care NHS Trust, and attended by midwives, student midwives, maternity care assistants and paramedics. A questionnaire was given to participants to evaluate the training. A 100% response rate was achieved (n = 36). Results show a positive response from all parties in relation to the setting, which was deemed a more realistic environment for this workforce than that offered by hospital-based training. More funding and research to support this type of training may aid in raising homebirth rates, as well as developing midwives' and paramedics' confidence in dealing with emergencies in such settings.
This short discussion article examines induction of labour (IOL) and how complementary therapy clinics were established for post-dates pregnant women. The number of post-dates inductions performed 1 year after the clinics were established was 5% less than in the 1 year prior to their set up. The service has provided positive patient experience, and is being reviewed further. Consideration also has to be given to potential cost-savings when a reduction in medical inductions is recorded.
Background Asymptomatic carriage of COVID-19 in pregnant women has been reported and could lead to outbreaks in maternity units. We sought to ascertain the impact of rapid isothernal nucleic acid based testing for COVID-19 in an unselected cohort of pregnant women attending our maternity unit. We also assessed the correlation between community prevalence and asymptomatic carriage. Methods Data for the retrospective cohort study were collected from a large UK tertiary maternity unit over a 4-week period using computerised hospital records. Literature searches were performed across multiple repositories. COVID-19 prevalence was extracted from online repositories. Results Nasopharyngeal and oropharyngeal swabs were obtained from 457/465 (98%) women during the study period. The median turnaround time for results was 5.3 h (interquartile range (IQR) 2.6–8.9 h), with 92% of the results returned within 24 h. In our cohort, only one woman tested positive, giving a screen positive rate of 0.22% (1/457; 95% CI: 0.04–1.23%). One woman who tested negative developed a fever postnatally following discharge but was lost to follow-up. From our literature review, we did not find any correlation between asymptomatic carriage in pregnant women and the reported regional prevalence of COVID-19. Conclusions Testing using the SAMBA-II machine was acceptable to the vast majority of pregnant women requiring admission and had a low turnaround time. Asymptomatic carriage is low, but not correlated to community prevalence rates. Screening pregnant women on admission will remain an important component in order to minimise nosocomial infection.
OBJECTIVE: Asymptomatic carriage of COVID-19 in pregnant women has been reported and could lead to outbreaks in maternity units. We sought to ascertain the impact of rapid isothernal nucleic acid based testing for COVID-19 in an unselected cohort of pregnant women attending our maternity unit. We also assessed the correlation between community prevalence and asymptomatic carriage.DESIGN: Retrospective cohort analysis and literature reviewSETTING: Tertiary hospital in Cambridge, UKPOPULATION: Pregnant women (with gestation age between 12-42 weeks) admitted to a single maternity unit over a 4-week period (07/05/2020-06/06/2020) METHODS: Data were collected using computerised hospital records. Literature searches were performed across multiple repositories. COVID-19 prevalence was extracted from online repositories.RESULTS: NP and OP swabs were obtained from 457/465 women during the study period (98%). The median turnaround time for results was 5.3 hours (interquartile range (IQR) 2.6-8.9 hours). 92% of results were returned within 24 hours. In our cohort, only one woman tested positive, giving a screen positive rate of 0.22% (1/457; 95% confidence interval: 0.04-1.23%). One woman who tested negative developed a fever postnatally following discharge but was lost to follow-up. From our literature review, we did not find any correlation between asymptomatic carriage in pregnant women and the reported regional prevalence of COVID-19. CONCLUSIONS: Testing using the SAMBA-II machine was acceptable to the vast majority of pregnant women requiring admission and had a low turnaround time. Asymptomatic carriage is low, but not correlated to community prevalence rates. Screening pregnant women on admission will remain an important component in order to minimise nosocomial infection.
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