Protocol for the development of a core outcome set for stillbirth care research (iCHOOSE Study)

INTRODUCTION

Stillbirth is associated with significant physical, psychosocial and economic consequences for parents, families, wider society and the healthcare system. There is emerging momentum to design and evaluate interventions for care after stillbirth and in subsequent pregnancies. However, there is insufficient evidence to inform clinical practice compounded by inconsistent outcome reporting in research studies. To address this paucity of evidence, we plan to develop a core outcome set for stillbirth care research, through an international consensus process with key stakeholders including parents, healthcare professionals and researchers.

METHODS AND ANALYSIS

The development of this core outcome set will be divided into five distinct phases: (1) Identifying potential outcomes from a mixed-methods systematic review and analysis of interviews with parents who have experienced stillbirth; (2) Creating a comprehensive outcome long-list and piloting of a Delphi questionnaire using think-aloud interviews; (3) Choosing the most important outcomes by conducting an international two-round Delphi survey including high-income, middle-income and low-income countries; (4) Deciding the core outcome set by consensus meetings with key stakeholders and (5) Dissemination and promotion of the core outcome set. A parent and public involvement panel and international steering committee has been convened to coproduce every stage of the development of this core outcome set.

ETHICS AND DISSEMINATION

Ethical approval for the qualitative interviews has been approved by Berkshire Ethics Committee REC Reference 12/SC/0495. Ethical approval for the think-aloud interviews, Delphi survey and consensus meetings has been awarded from the University of Bristol Faculty of Health Sciences Research Ethics Committee (Reference number: 116535). The dissemination strategy is being developed with the parent and public involvement panel and steering committee. Results will be published in peer-reviewed specialty journals, shared at national and international conferences and promoted through parent organisations and charities.

PROSPERO REGISTRATION NUMBER

CRD42018087748.

Parents' experiences of care offered after stillbirth: An international online survey of high and middle-income countries

BACKGROUND

Stillbirth, the death of a baby before birth, is associated with significant psychological and social consequences that can be mitigated by respectful and supportive bereavement care. The absence of high-level evidence to support the broad scope of perinatal bereavement practices means that offering a range of options identified as valued by parents has become an important indicator of care quality. This study aimed to describe bereavement care practices offered to parents across different high-income and middle-income countries.

METHODS

An online survey of parents of stillborn babies was conducted between December 2014 and February 2015. Frequencies of nine practices were compared between high-income and middle-income countries. Differences in proportions of reported practices and their associated odds ratios were calculated to compare high-income and middle-income countries.

RESULTS

Over three thousand parents (3041) with a self-reported stillbirth in the preceding five years from 40 countries responded. Fifteen countries had atleast 40 responses. Significant differences in the prevalence of offering nine bereavement care practices were reported by women in high-income countries (HICs) compared with women in middle-income countries (MICs). All nine practices were reported to occur significantly more frequently by women in HICs, including opportunity to see and hold their baby (OR = 4.8, 95% CI 4.0-5.9). The widespread occurrence of all nine practices was reported only for The Netherlands.

CONCLUSIONS

Bereavement care after stillbirth varies between countries. Future research should look at why these differences occur, their impact on parents, and whether differences should be addressed, particularly how to support effective communication, decision-making, and follow-up care.

Evaluation of Movements Matter: A social media and hospital-based campaign aimed at raising awareness of decreased fetal movements

BACKGROUND

The Movements Matter campaign aimed to raise awareness of decreased fetal movements (DFM) among pregnant women and inform clinicians of best practice management.

AIM

To conduct a process evaluation of campaign implementation, and an impact evaluation of the campaign's effects on knowledge and experiences of pregnant women, and attitudes and practices of clinicians in relation to DFM.

METHODS

This study used a cross-sectional before-after design. Pregnant women and clinicians were sampled at five hospitals. Women were surveyed about their knowledge of DFM, and actions to take if they noticed DFM. Clinicians were asked about their current practices and attitudes about informing women about DFM. Logistic regression was used to calculate campaign effects on outcome measures.

RESULTS

The Movements Matter campaign reached 653 262 people on social media, as well as being covered on news media and popular women's websites. The evaluation surveyed 1142 pregnant women pre-campaign and 473 post-campaign, and 372 clinicians pre-campaign and 149 post-campaign. Following the campaign, women were more likely to be aware that babies should move the same amount in late pregnancy (adjusted odds ratio (aOR) 1.81, 95% CI 1.43-2.27), and were more likely to contact their health service immediately if their baby was moving less (aOR 1.52, 95% CI 1.22-1.91). Clinicians were 2.84 times more likely to recommend women should come in for assessment if they experience DFM (95% CI 1.35-5.97).

CONCLUSIONS

This evaluation has shown that a campaign using social media and in-hospital education materials led to some increases in knowledge about fetal movements among pregnant women.

[Evaluation of 5-year surgical treatment outcome in patients with vulvar tumors]

A retrospective study of all patients with carcinoma of the vulva treated by surgery and/or radiation therapy, between 1980 and 1985, is reported. Sixty eight patients were analyzed for survival, recurrence patterns, complications and clinical features. The stages of disease were as follows: Stage I or II 49 pts, Stage III 13 pts and Stage IV 6 pts. The 5-year survival rate was 45.2%. Recurrences were diagnoses in 25% of the patients. With the less aggressive surgical approach used, combined with radiation therapy to eradicate subclinical disease, the morbidity rate was acceptable and the survival rate comparable to the reported after more aggressive surgery.

[Invasive cervical carcinoma coexistent with pregnancy]

Results are presented of treatment of 28 cases of invasive cervical carcinoma coexistent with pregnancy. The degree of progression, according to FIGO, was as follows: grade I degree--9 cases, grade II degrees--7 cases, grade III degrees--11 cases. The treatment included, depending on the degree of progression, operation and radiotherapy, both brachytherapy and teletherapy. Eight patients (28.6%) survived 5 years. The best results of the treatment were obtained in patients with low progression grade in early pregnancy. No patient with carcinoma diagnosed in puerperium survived 5 years.

[Results of a 2-year study of multiple drug induction chemotherapy in patients with advanced ovarian carcinoma FIGO grade III]

The results of induction chemotherapy were analysed in cases of advanced ovarian carcinoma grade III (FIGO) during second-look operation. In 108 cases after the first operation with varying degree of radical removal of the tumour chemotherapy was given by the PAC schedule (cisplatin, adriablastin, cyclophosphamide) achieving in 90 cases 9 treatment courses. The results were evaluated using WHO clinical criteria. The best therapeutic results were noted in patients after radical operations or with aggressive cytoreduction of tumour mass. The clinical assessment of chemotherapy was corrected during the second-look operation which led to reduction of the percent of cured cases.