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Welcome to August's news from APEC


Autumn is just around the corner and we are sure you are thinking about plans for the coming months. We certainly have plenty to feedback on, and new research findings are flying in almost more quickly than we can tell you about them! We are off to Hertfordshire for a study day in October and the GLOW conference in September, so we are very much looking forward to meeting many colleagues and supporters. I hope you find this month's information useful and as ever please get in touch if we can help with anything.
Thanks so much for all your support,
The APEC team
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APEC Study days 2020!
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More information

RESEARCH NEWS

Planned delivery reduces impact of potentially fatal pregnancy complication, trial finds.

 

In research published today in the Lancet, researchers from King’s College London have found that early, planned delivery for women with pre-term pre-eclampsia reduces complications and severe hypertension, as well as costs, compared to the current method of care.

The team from the Department of Women & Children’s Health at King’s carried out a trial comparing the current and new methods in women suffering from pre-eclampsia at 34-37 weeks of pregnancy, to see if they could reduce adverse outcomes for the mother such as hypertension, and without impacting substantially on the baby.

They found that planned delivery - starting delivery (either by induction of labour or by Caesarean section if it is needed) within 48 hours of the diagnosis of pre-term pre-eclampsia being made - reduced maternal complications including hypertension. They also found that the women in that group had more vaginal deliveries compared to those who experience the current method of care - specialist assessment of mother and unborn baby until 37 weeks, with delivery sooner if the clinical scenario changes and there is concern over severe pre-eclampsia and associated complications. Though planned delivery did lead to more neonatal unit admissions for prematurity, there were no other complications for the baby (such as more breathing problems) compared to the current method. Planned delivery also comes with lower costs compared to the current method of care in the UK.

Pre-eclampsia is a condition that affects around 1 in 20 pregnant women, usually during the second half of pregnancy affecting approximately 40,000 women annually in the UK. If untreated, it can progress to cause complications in the woman, including damage to vital organs, fits and can be fatal for the woman and baby. Globally, 100 women die as a result of the condition every day.

Current guidelines recommend prompt delivery after 37 weeks of pregnancy. However, for women with late preterm pre-eclampsia (defined as 34-37 weeks pregnant) the recommendations are less clear.
Lead author Professor Lucy Chappell from King’s College London said: “We wanted to find out what the best timing of delivery was for a woman with preterm pre-eclampsia. Clinical practice has already changed for women with term pre-eclampsia as a result of a previous trial showing that planned delivery was better. We felt that it was important to ask a similar question at 34-37 weeks of pregnancy to see whether it would help the woman and her baby to continue the pregnancy or get on with delivery.

“Our trial supports offering initiation of delivery in women with late preterm pre-eclampsia. Doctors and women will need to consider the trade-off between lower maternal complications and severe hypertension against more neonatal unit admissions, but the trial results tell us that these babies were not sicker from being born earlier. We suggest that these results should be discussed with women with late preterm pre-eclampsia to allow shared decision making on timing of delivery.”

Marcus Green, CEO for Action on Pre-eclampsia, said: ‘We welcome this research and results. Anything that empowers women and gives them more knowledge from which they can make choices about safer birth is great news.’

Read the full paper here. 
 

New study finds links between pre-eclampsia and end stage kidney disease

A new study published in PLOS Medicine last week [1], led by researchers at University College Cork (Ireland), involving colleagues from Karolinska Institute (Sweden) and the University of Liverpool (UK), has found that women with a history of pre-eclampsia have a five-fold increased risk of end stage kidney disease (ESKD) later in life compared to women who don’t develop pre-eclampsia during pregnancy.
 
The researchers analysed data from the Swedish Medical Birth Register on 1,366,441 healthy women with 2,665,320 singleton live births in Sweden between 1982 and 2012. The data revealed that women who had pre-eclampsia in at least one pregnancy were nearly five times more likely to have ESKD than women who had never had pre-eclampsia. The incidence rate of ESKD per 100,000 person-years was 1.85 among women with no history of pre-eclampsia and 12.35 among women with a history of pre-eclampsia. Moreover, the association was independent of other factors including maternal age and education, and diagnoses of renal disease or cardiovascular disease before pregnancy.
 
Dr Ali Khashan, lead author of the study noted that the paper “shows that pre-eclampsia is a sex-specific, independent risk factor for the subsequent development of ESKD. However, the overall ESKD risk remains small and women with a history of pre-eclampsia should not be overly concerned.”
 
Professor Kenny, one of the study co-authors said “This work shows a significant link between pre-eclampsia and end stage kidney disease. Given the burden of disease end stage kidney disease has in our increasingly aging population, this is an important public health issue and further research is need to clarify the role for using pregnancy outcome in screening tests for later health outcomes.”
 
Research reference
  1. Khashan AS, Evans M, Kublickas M, McCarthy FP, Kenny LC, Stenvinkel P, et al. (2019) Preeclampsia and risk of end stage kidney disease: A Swedish nationwide cohort study. PLoS Med 16(7): e1002875. https://doi.org/10.1371/journal.pmed.1002875

New study on ethnicity and chronic hypertension in pregnancy

 
In the largest study of its kind in the UK, doctors from King’s College London have found that ethnicity has a major impact on the risk of complications for pregnant women with pre-existing high blood pressure (chronic hypertension). Chronic hypertension effects about three per cent of pregnancies worldwide and is becoming more common with rising maternal age and levels of obesity. It is associated with several severe complications including pre-eclampsia, stillbirth, fetal growth restriction and preterm birth. The team analysed 4,481 pregnancies from three NHS maternity units over 14 years. After adjusting for a range of other demographic factors (deprivation index, maternal age, parity, BMI, smoking history and year of delivery) the team calculated how often complications associated with chronic hypertension in pregnancy occurred. Their results, published in the journal Ultrasound in Obstetrics and Gynaecology, showed that each complication was more common for Black women than White women. The risk of stillbirth was five times greater (3.1% versus 0.6%), preterm birth nearly double (21% versus 11%) and fetal growth restriction more than double (16% versus 7.4%).
 
Dr Louise Webster, Clinical Lecturer in the Department of Women & Children’s Health, said of the study:
“We cannot yet explain these results. Previous studies have found the same to be true in the USA but researchers suggested that this was due to inequalities in access to healthcare. This now seems unlikely to be the sole cause as our analysis took account of deprivation and, although barriers to healthcare are more complex than just its cost, we would have expected the affect to be reduced in the UK where the NHS provides free healthcare. Further research is needed to establish what other factors could be involved and whether tailoring blood pressure medication to ethnicity could improve outcomes for pregnant women and their babies.”
Read the full article here

EDUCATION NEWS

 

The Miscarriage Association launches new e-learning
resource for medical professionals



 

The Miscarriage Association has developed a new e-learning resource to support medical professionals in providing the best care they can to women experiencing pregnancy loss.
 
The resource is based on the real experiences of health professionals and those who have experienced miscarriage, ectopic or molar pregnancy, and includes films and interactive activities.
 
The resource takes around two hours to complete, and is an excellent tool for continuing professional development and learning towards revalidation.
 
Ruth Bender Atik, National Director at the Miscarriage Association, said: “Pregnancy loss can be a deeply distressing experience and the support health professionals give can make all the difference to helping women through this difficult time.
 
“We know it isn’t always easy for those working in clinical environments to find the time to reflect on the care they provide. This is why we wanted to create a resource that they can dip in and out of and access easily from their phone, iPad or computer, so the training is available to them anytime.”
 
The five units focus on different aspects of care, such as having difficult conversations, considering language, and taking care of your own wellbeing while providing care.
 
Cerian Gingell has experienced two miscarriages and is passionate about improving the care that is provided to those who experience pregnancy loss.
 
Cerian, said: “Miscarriage is a devastating loss, often without explanation. Nothing can take the pain away, but a kind word, the correct information on what to expect next, the truth about what’s happening – these things can all help make a horrible experience slightly less horrible.
 
“To me, good care is saying ‘I’m sorry your baby’s gone, it wasn’t your fault’. It’s letting me cry, answering my questions with honesty and sensitivity, reassuring me that because it’s happened once it doesn’t mean it’ll happen again. It’s about respect, sympathy and honesty.
 
“I think this resource is so important and will help create more consistent care across the country. Every single person that goes through pregnancy loss deserves to be treated with dignity and compassion.  Whether they’re speaking to their GP or being treated in hospital, every contact can have a huge impact on the way that person copes with their loss.”
 
The resource was peer reviewed and produced with the help of Janet Birrell, Gynaecology Matron at Western Sussex Hospitals NHS Foundation Trust, Dr Nicola Davies, GP at The Pinn Medical Centre, Annmaria Ellard, Miscarriage Specialist Nurse at Liverpool Women’s NHS Foundation Trust, Amanda Mansfield, Consultant Midwife at  London Ambulance Service NHS Trust, and the Association of Early Pregnancy Units.
 
Dr. Sarah Bailey, Lead Nurse Recurrent Miscarriage Care and Clinical Research Specialist at University Hospitals Southampton, said: “The Miscarriage Association’s e-learning resource is extremely useful, informative and easily accessible.
 
“I would thoroughly recommend this excellent training package to any care professional who is involved in caring for women with miscarriage.”
 
You can access the e-learning resource at: Bit.ly/2Gtniu9 or call the Miscarriage Association on 01924 200795 to find out more
 

 For more details and interview opportunities please contact Ruth Bender Atik, National Director at the Miscarriage Association ruth@miscarriageassociation.org.uk / 01924 200795/ 07527 070046
 
Access The Miscarriage Association's E-Learning

New study days for 2020 announced

Our study days are widely recognised as being excellent, with expert speakers who are leaders in the field of pre-eclampsia and associated conditions. 92% of midwives and healthcare professionals feel more confident dealing with pre-eclampsia after attending.
We are working hard to reach places in the UK where we have not visited for some time, and are delighted to be coming on a Scottish Tour in March, where we will visit Dumfries, Edinburgh and Inverness. Please do keep an eye on the newsletter for booking information and confirmed dates.
 
“Thank you so much for your help and support with the study days. It has made a huge difference to our unit. I have seen such a change in the management of pre-eclampsia since I have been back at work. The study days seem to have had a very positive impact on our practice which is fantastic!
 
Julie Smith, DAU lead midwife (recently returned to work following maternity leave)
Become a Volunteer speaker
Dates and Venues for the next few months
Hold a study day at your hospital or university

Supporting parents and families

Bliss launch new resources for parents of babies on NICU.

Bliss have launched a new podcast resource in response to a recent survey of more than 1200 parents, 90% told us that they felt like parents after getting involved in their baby’s care on the unit.  They told us they really want to reach as many parents as possible with this new vital information.
Listen to podcast, NICU, SCBU and you  

FUNDRAISING NEWS



Fitness Challenge people at Striving to have a new September challenge about to launch and APEC is their chosen charity! Founder Jo chose APEC in memory of Charlotte Brian, her niece, who was born sleeping due to complications from pre-eclampsia. Jo and her family are long term supporters of APEC and we are incredibly grateful to her and Charlotte's parents Kirsty and Terry who have supported us now for many years.  For every entry to the September challenge, £2 will go straight to APEC and towards the fantastic work we are doing.
 
Fancy joining in with the challenge? Click below to get involved!
 
https://www.strivingto.co.uk/collections/challenges

London Marathon 2020

We have already filled two thirds of our 2020 London Marathon places.To grab yours, please get your application in to us as soon as possible to be in with the chance to join our wonderful team.
Register for your place
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