Browsing by Author "Pasupathy, D."

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    National Maternity and Perinatal Audit: Organisational Report 2017
    (Royal College of Obstetricians and Gynaecologists, 2017) Blotkamp, A.; Cromwell, D.; Dumbrill, B.; Gurol-Urganci, I.; Hawdon, J.; Jardine, J.; Harris, Tina; Knight, H.; McDougal, L.; Moitt, N.; Pasupathy, D.; van der Meulen, J.
    Organisational report 2017 - A snapshot of NHS maternity and neonatal services in England, Scotland and Wales in January 2017
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    NHS Maternity Care for Women with a Body Mass Index of 30 kg/m2 or Above: Births between 1 April 2015 and 31 March 2017 in England, Wales and Scotland.
    (RCOG, 2021-05-13) Relph, S.; Coe, M.; Carroll, F.; Gurol-Urganci, I.; Webster, K.; Jardine, J.; Dunn, G.; Harvey, A.; Harris, Tina; Hawdon, J.; Khalil, A.; Pasupathy, D.; van der Meulen, J.
    Introduction This report focuses on the maternal and neonatal outcomes of pregnant women with body mass index (BMI) of 30 kg/m2 or above who gave birth between 1 April 2015 and 31 March 2017, compared with those of women with BMI in the range 18.5–24.9 kg/m2 . Methods This study uses existing NMPA linked datasets to explore the characteristics and outcomes of women and babies according to category of maternal BMI at booking with the maternity service provider. Women are grouped by BMI according to established World Health Organization (WHO) categories. The association between maternal BMI and each maternal or neonatal measure is represented using line graphs, stratified by maternal parity (nulliparous, multiparous with previous vaginal births only, multiparous with a previous caesarean birth). We also explored the feasibility of stratifying the outcomes according to the woman’s risk status at the time of labour and birth (as defined by the National Institute of Health and Care Excellence (NICE) Intrapartum Care for Healthy Women and Babies guideline). Finally, we described the type of maternity units in which the women gave birth, by maternal BMI. A lay advisory group was involved at all stages of this sprint audit, including discussing the choice of outcomes, interpreting the results, and reviewing the draft report and recommendations. Key findings For the period 1 April 2015 to 31 March 2017, we estimate that 21.8% of women giving birth had a BMI of 30 kg/m2 or above; however, 16.9% of women did not have a BMI (or height and weight) recorded. The likelihood of a woman experiencing an intrapartum intervention or adverse maternal outcome, or her baby experiencing very serious complications following birth, increases as BMI increases. We do not know whether this is because women with higher BMI are more likely to develop complications requiring intervention or because of differences in the clinicians’ threshold to intervene. However, those women with a BMI of 30 kg/m2 or above who have previously had at least one vaginal birth (and no caesarean births) are almost as likely to have another unassisted vaginal birth as multiparous women with a BMI in the range 18.5–24.9 kg/m2 who have also not previously had a caesarean birth. Babies born to women with a BMI of 30 kg/m2 or above are less likely to receive skin-to-skin contact within 1 hour of birth or breast milk for their first feed than babies born to women with a lower BMI. The proportion of women giving birth in a freestanding midwifery unit, or at home, decreases as BMI increases, although 1.7% of women with a BMI of 35.0–39.9 kg/m2 and 1.1% of women with a BMI of 40 kg/m2 or above did give birth in one of these settings. The lay advisory group requested that we also measure access to birth in water, monitoring of fetal growth by ultrasound, access to perinatal mental health services and prevention of venous thromboembolism in women with a BMI of 30 kg/m2 or above. We currently do not have sufficient information in the NMPA dataset to assess these. Presentation of maternal or neonatal outcomes by maternal BMI, parity and risk status (as assessed at admission for birth) is both feasible and likely to be useful to support informed decision making. It is limited by uncertainty with less common outcomes (particularly those indicating poor condition of the baby at birth), more so when these are estimated in smaller groups of women. Recommendations R1 Audit local rates of missing data on BMI (or height and weight) before the end of the 2021/22 reporting year, and commence local initiatives to improve electronic recording of this where it is low. (Audience: Maternity service providers) R2 Commence by the end of June 2023 the production of, or include in updates to existing documents, detailed guidance on the antenatal and intrapartum care offered to women who are suspected to have a large-for-gestational-age baby, including whether the guidance should differ for women with a BMI of 30 kg/m2 or above. (Audience: National organisations responsible for publishing guidance on maternity care) R3 Support research and investigation into why women with a BMI of 30 kg/m2 or above have a higher risk of stillbirth, in order to inform clinical care which aims to reduce this risk. (Audience: National Institute for Health Research, Health and Care Research Wales and NHS Research Scotland in consultation with the Royal College of Obstetricians and Gynaecologists and policy makers, service planners/commissioners, service managers and healthcare professionals working for maternity services) R4 Ensure that women with a BMI of 30 kg/m2 or above are given preconception and antenatal information tailored to their individual circumstances (including their BMI and whether this is their first birth or they have previously had a caesarean birth). To support women in their decision making, this should include information from this report on their risk of the following: ● birth interventions ● major postpartum blood loss ● postnatal readmission to hospital ● very serious complications for their baby following birth. (Audience: Healthcare professionals working in maternity services, general practitioners) R5 Identify common causes for readmission to the maternity unit following birth specifically for women with a BMI of 40 kg/m2 or above, and commence local quality improvement initiatives to reduce the risk of readmission. (Audience: Maternity service providers) R6 Support all women and babies to experience skin-to-skin contact with one another within 1 hour of birth should they choose to and regardless of the woman’s BMI, unless it is unsafe to do so because either the woman or baby requires immediate medical attention. (Audience: Healthcare professionals working in maternity services) R7 Offer all women breastfeeding information and support during pregnancy and again shortly after the birth. Women with a BMI of 30 kg/m2 or above may require support to be tailored to their specific needs and to be provided by a healthcare professional who is trained to adapt breastfeeding techniques for women with a higher BMI. (Audience: Healthcare professionals working in maternity services) R8 Incorporate information on antenatal assessment of fetal growth status (suspected SGA or LGA) and on venous thromboembolism risk scores and prophylaxis in future trust/board and national maternity dataset specifications. (Audience: Maternity service providers, the Data and Intelligence Division of Public Health Scotland, the National Welsh Informatics Service) R9 Assess the quality of data on labour or birth in water, and where completeness is low, commence initiatives to improve it. (Audience: Maternity service providers)
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    Obstetric and neonatal outcomes in pregnant women with and without a history of specialist mental healthcare: a national population-based cohort study using linked routinely collected data in England.
    (Lancet, 2023-08-14) Langham, J.; Gurol-Urganci, I.; Muller, P.; Webster, K.; Tassie, E.; Heslin, M.; Byford, S.; Khalil, A.; Harris, T.; Sharp, H.; Pasupathy, D.; van der Meulen, J.; Howard, L.; O'Mahen, H.
    Background: Pregnant women with pre-existing mental illness have increased risks of adverse obstetric and neonatal outcomes. We estimated these difference in risks according to the highest level of pre-pregnancy specialist mental healthcare, defined as psychiatric hospital admission, crisis resolution team (CRT) contact, or specialist community care only, and the timing of the most recent care episode within 7 years before pregnancy. Methods: Hospital and birth registration records of women with singleton births between 2014 and 2018 in England were linked to records of babies and records from specialist mental health services, provided by the English National Health Service, a publicly funded healthcare system. Composite indicators captured neonatal adverse outcomes and maternal morbidity. We calculated odds ratios (ORs), adjusted for maternal characteristics. Outcomes: Of 2,081,043 included women (mean age 30.0 years; range 18 to 55 years; 77.7% White, 11.1% South Asian, 4.7% Black and 6.2% other ethnic background), 151,770 (7·3%) had at least one pre-pregnancy specialist mental healthcare contact. 7,247 (0·3%) had been admitted, 29,770 (1·4%) had CRT contact, and 114,753 (5·5%) had community care only. With a pre-pregnancy mental healthcare contact, risk of stillbirth or neonatal death within seven days was not significantly increased (0·45% to 0·49%; OR 1·11, 95%CI 0·99–1·24). Risk of preterm birth (<37 weeks) increased (6·5% to 9·8%; OR 1·53, 1·35–1·73) as did risk of small for gestational age (birthweight <10th percentile) (6·2% to 7·5%; OR 1·34, 1·30–1·37), and neonatal adverse outcomes (6·4% to 8·4%; OR 1·37, 1·21–1·55). With a pre-pregnancy mental healthcare contact, maternal morbidity increased slightly from 0·9% to 1·0% (OR 1·18, 1·12–1·25). Overall, risks were highest for women who had a psychiatric hospital admission any time or a mental healthcare contact in the year before pregnancy. Interpretation: Information about level and timing of pre-pregnancy specialist mental healthcare contacts can support identifying pregnant women at increased risk of adverse obstetric and neonatal outcomes, most likely to benefit from integrated perinatal mental health and obstetric care.
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    Rapid Response: Re:Risk of complicated birth at term in nulliparous and multiparous women using routinely collected data in England: cohort study. Rapid Response
    (BMJ Publishing Group, 2020-10-23) Pasupathy, D.; Jardine, J.; Harris, Tina; Hawdon, J.; Blotkamp, A.; Knight, H.; Gurol-Urganci, I.; Walker, K.; van der Meulen, J.
    De Jonge et al express concerns about the use of the term 'trial of labour' and our interpretation of the results.
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    Risk of postpartum haemorrhage is associated with ethnicity: A cohort study of 981 801 births in England
    (British Journal of Obstetrics and Gynaecology, 2021-12-09) Jardine, J.; Gurol-Urganci, I.; Harris, Tina; Hawdon, J.; Pasupathy, D.; van der Meulen, J.; Walker, K.; the NMPA Project Team
    Women with an ethnic minority background giving birth in England have an increased risk of postpartum haemorrhage, even when characteristics of the mother, the baby and the care received are taken into account.
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    Waterbirth: a national retrospective cohort study of factors associated with its use among women in England
    (BMC Pregnancy and Childbirth, 2021-03-26) Aughey, H.; Jardine, J.; Moitt, N.; Fearon, Kriss; Jawdon, J.; Pasupathy, D.; Urganci, I.; NMPA Project Team; Harris, Tina
    Background Waterbirth is widely available in English maternity settings for women who are not at increased risk of complications during labour. Immersion in water during labour is associated with a number of maternal benefits. However for birth in water the situation is less clear, with conclusive evidence on safety lacking and little known about the characteristics of women who give birth in water. This retrospective cohort study uses electronic data routinely collected in the course of maternity care in England in 2015–16 to describe the proportion of births recorded as having occurred in water, the characteristics of women who experienced waterbirth and the odds of key maternal and neonatal complications associated with giving birth in water. Methods Data were obtained from three population level electronic datasets linked together for the purposes of a national audit of maternity care. The study cohort included women who had no risk factors requiring them to give birth in an obstetric unit according to national guidelines. Multivariate logistic regression models were used to examine maternal (postpartum haemorrhage of 1500mls or more, obstetric anal sphincter injury (OASI)) and neonatal (Apgar score less than 7, neonatal unit admission) outcomes associated with waterbirth. Results 46,088 low and intermediate risk singleton term spontaneous vaginal births in 35 NHS Trusts in England were included in the analysis cohort. Of these 6264 (13.6%) were recorded as having occurred in water. Waterbirth was more likely in older women up to the age of 40 (adjusted odds ratio (adjOR) for age group 35–39 1.27, 95% confidence interval (1.15,1.41)) and less common in women under 25 (adjOR 18–24 0.76 (0.70, 0.82)), those of higher parity (parity ≥3 adjOR 0.56 (0.47,0.66)) or who were obese (BMI 30–34.9 adjOR 0.77 (0.70,0.85)). Waterbirth was also less likely in black (adjOR 0.42 (0.36, 0.51)) and Asian (adjOR 0.26 (0.23,0.30)) women and in those from areas of increased socioeconomic deprivation (most affluent versus least affluent areas adjOR 0.47 (0.43, 0.52)). There was no association between delivery in water and low Apgar score (adjOR 0.95 (0.66,1.36)) or incidence of OASI (adjOR 1.00 (0.86,1.16)). There was an association between waterbirth and reduced incidence of postpartum haemorrhage (adjOR 0.68 (0.51,0.90)) and neonatal unit admission (adjOR 0.65 (0.53,0.78)). Conclusions In this large observational cohort study, there was no association between waterbirth and specific adverse outcomes for either the mother or the baby. There was evidence that white women from higher socioeconomic backgrounds were more likely to be recorded as giving birth in water. Maternity services should focus on ensuring equitable access to waterbirth.