Thread by @OBsleepmerchant

@ProfAsmaKhalil follows @FarberMichaela in @Eltonchris’ information dense opening session of #OAA3dc2022. “What’s new in OB? (for #OBAnes)” Relevance? Ockenden report & recent Kirkup report make harrowing reading - best we keep a finger on the pulse

#COVID19 infection and vaccination’s effects on the Obstetric population. Stillbirth rates had been heading in right direction prepandemic. #COVID19 infection associated with increased risk of SB (doubles aOR). #CovidVaccine associated with 15% decrease in SB #OAA3dc2022

Stillbirth: 2x increase Black population (50% in Asian). 2x increase in most deprived areas. @NICEComms considered induction at 39weeks (draft) in these populations - since removed. IOL decreases perinatal death & stillbirth ~70%
#OAA3dc2022

IOL at 39 weeks vs expectant management (@NEJM): perinatal death/ severe complication trend favours IOL, decreased risk cesarean. Meta-analysis (@AJOG_thegray): IOL decreases respiratory morbidity 30%, meconium aspiration 50%, perinatal death 73%. But uproar in press. #OAA3dc2022

Uproar in press —> change in @NICEComms to closer monitoring & additional support. Adverse perinatal outcomes in low risk pregnancies according to ethnicity, deprivation & parity. Retrospective analysis compared IOL at 39 weeks vs expectant management - large numbers. #OAA3dc2022

Composite outcome: stillbirth, neonatal death, neonatal morbidity. 625 IOL to avoid 1 adverse outcome. 291 IOL to avoid 1 adverse outcome in most deprived. No evidence risk varied according to ethnicity.
#OAA3dc2022

@nmpa_audit large scale audit of @NHSuk maternity services. Several valuable strengths. Innovations: rapid quarterly reporting; responding to national priorities; making maternity information accessible. National priorities: Covid-19, @OckReview, inequalities. #OAA3dc2022

Rapid quarterly reporting: timely information on pregnancy outcomes and maternity care. Lots of data. Can search by trust. #OAA3dc2022

Allowed analysis of effects of Covid-19 on pregnancies and neonates. Covid-19 increased adverse outcomes (stillbirth and preterm birth most). Neonatal adverse events increased by Covid-19, although not in term neonates. What of the effects of vaccination? #OAA3dc2022

OB interventions & pregnancy outcomes during Covid-19 (@PLOSMedicine) - broken down different periods of pandemic. Stillbirth unchanged. Decreased preterm, SGA births. Increased OB intervention. Linked to behaviour, environment, maternity practice, staffing levels. #OAA3dc2022

Use of IOL, emergency cesarean & perinatal outcomes, national hospital-level study (@BJOGTweets): IOL reflects proactive care, emergency section reflects acute response. Considerable inter-hospital variation in practice. #OAA3dc2022

Hospitals with higher IOL had better perinatal outcomes - for each 5% increase in IOL decreased stillbirth 9%,mechanical ventilation 14%. No significant association between emergency cesarean and perinatal outcomes. Study in @TheLancet follows… #OAA3dc2022

@TheLancet: Retrospective >1M singleton births included - most deprived had more stillbirths, preterm birth, FGR. Ethnic inequalities visible (not statistically significant?) - Asian & Black affected. #OAA3dc2022

Is it inequality or other risk factors affecting adverse outcomes? Trends are present for socioeconomic deprivation and ethnic minorities. Group specific: 75% of FGR in most deprived Asian women would not have occurred if risk same as white. #OAA3dc2022

@nmpa_audit 3rd pillar: real time comparison via family gateway. Ethnic and socioeconomic inequalities in accessible format. Preterm birth incidence in increases with # of fetuses & varies with chorionicity & amnionicity. @mbrrace identified area for improvement. #oaa3dc2022

@mbrrace: 73.6% pregnancies with suboptimal care were extreme preterm gestations —> recommendation. What of 2nd trimester cervical dilation >1cm? Singletons and twins similar. Cerlage in twins improves gestational age at delivery and perinatal mortality. #OAA3dc2022

History indicated cerckage not recommended in unselected twin pregnancy, before 24 weeks medical management in asymptomatic twin pregnancy. And so concludes @ProfAsmaKhalil’s stroll through “what’s new in OB” #OAA3dc2022

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