Kitty Hardman

and 11 more

Objective To explore and characterise maternity healthcare professionals’ (MHCPs) experience and practice of informed decision-making (IDM), to inform policy, research and practice development. Design Qualitative focus group study. Setting Online with MHCPs from a single maternity unit in the Southwest of England. Population MHCPs who give information relating to clinical procedures and pregnancy care and are directly involved in decision-making conversations purposively sampled from a single National Health Service (NHS) Trust. Data collection: A semi-structured topic guide was used. Data Analysis: Reflexive thematic analysis . Results Twenty-four participants attended seven focus groups. Two themes were developed: contextualising decision-making and controversies in current decision-making. Contextual factors that influenced decision-making practices included lack of time, and challenges faced in intrapartum care. MHCPs reported variation in how they approach decision-making conversations and asked for more training on how to consistently achieve IDM. There were communication challenges with women/birthing people who do not speak English. Three controversies were explored in the controversies theme: the role of prior clinical experience, the validity of informed consent when women/birthing people were in pain and during emergencies, and instances where women/birthing people declined medical advice. Conclusions We found that MHCPs are committed to IDM but need better support to deliver it consistently. Structured processes including core information sets, communication skills training and the decision support aids may help to standardise the information and better support IDM.

Kathryn Hunt

and 7 more

Background: Micro- and nanoplastics are novel pollutants which have been detected in human tissues including placenta and fetal meconium. However, their association with adverse fertility or pregnancy outcomes in humans is not known. Objectives: To synthesise evidence for the presence of micro- and nanoplastics in human reproductive tissue and their associations with environmental exposures and reproductive outcomes. Search Strategy: Medline, Embase, Emcare, CINAHL, ClinicalTrials.gov and ICTRP were searched from inception to 03/02/2023. Selection Criteria: Studies of human participants, assessing presence of micro- and nanoplastics in reproductive tissues, environmental exposures to micro- and nanoplastics, and fertility or pregnancy-related outcomes. Data Collection and Analysis: Two independent reviewers selected studies and extracted data on study characteristics, microplastics detected, environmental exposures, reproductive outcomes, and risk of bias. Narrative synthesis was performed due to methodological heterogeneity. Main Results: Of 1094 citations, seven studies were included, covering 96 participants. Microplastics were detected in 68 out of 96 placentas examined across all studies, and in all 14 meconium samples. Two studies reported associations between lifestyle factors (daily water intake, use of scrub cleanser or toothpaste, bottled water and takeaway food) and placental microplastics. One study reported associations between meconium microplastics and microbiota diversity and composition. One reported placental microplastics levels correlated with reduced birth weights and 1-minute Apgar scores. All studies had a very high risk of bias. Conclusions: There is a need for high-quality observational studies to assess the effects of microplastics on human reproductive health. Funding: None received Keywords: microplastics, nanoplastics, pregnancy, fertility, environmental pollution

Danya Bakhbakhi

and 31 more

Background A core outcome set could address inconsistent outcome reporting and improve evidence for stillbirth care research, which has been identified as an important research priority. Objectives To identify outcomes and outcome measurement instruments reported by studies evaluating interventions after the diagnosis of a stillbirth. Search strategy Amed, BNI, CINAHL, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO, and WHO ICTRP from 1998 to August 2021. Selection criteria Randomised and non-randomised comparative or non-comparative studies reporting a stillbirth care intervention. Data collection and analysis Interventions, outcomes reported, definitions and outcome measurement tools were extracted. Main results 40 randomised and 200 non-randomised studies were included. 58 different interventions were reported, labour and birth care (52 studies), hospital bereavement care (28 studies), clinical investigations (116 studies), care in a multiple pregnancy (2 studies), psychosocial support (28 studies) and care in a subsequent pregnancy (14 studies). 391 unique outcomes were reported and organised into 14 outcome domains: labour and birth; postpartum; delivery of care; investigations; multiple pregnancy; mental health; emotional functioning; grief and bereavement; social functioning; relationship; whole person; subsequent pregnancy; subsequent children and siblings and economic. 242 outcome measurement instruments were used, with 0-22 tools per outcome. Conclusions Heterogeneity in outcome reporting, outcome definition and measurement tools in care after stillbirth exists. Considerable research gaps on specific intervention types in stillbirth care were identified. A core outcome set is needed to standardise outcome collection and reporting for stillbirth care research.