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Impact: Health and welfare; public policy; the work led to UK and international guidelines advising against progesterone use to prevent preterm birth in twin pregnancy.
Significance: Thousands of women now avoid this unpleasant procedure annually, with a saving to the NHS of £25M.
Beneficiaries: Pregnant women, policy-makers, the NHS and healthcare-providers.
Attribution: The work was initiated by a five-centre UK collaborative group including UoE. Data analysis, interpretation and translation into practice were led by Jane Norman, UoE.
Reach: The data are cited in guidelines and have changed clinical practice on three continents: Europe (NICE), North America and Australasia. Applies to 11,000 women annually in UK alone.
This University of Liverpool (UoL) research programme has provided the first international guidance on pregnancy dosage regimes for the drug misoprostol. Although commonly used, its use in pregnancy is off-label. This has led to a wide variety of different dosage regimens. Professors Weeks, Alfirevic and Neilson (all UoL) have been at the forefront of research into its correct use since 1998. In 2007 they initiated a WHO expert conference to conduct dosage reviews, thus establishing an international consensus. These regimens were adopted by the International Federation of Gynecology and Obstetrics (FIGO) in 2009, and updated in 2012. Examples of resulting guidelines with social marketing are provided.
Our theoretical and empirical work in the area of normal childbirth and associated cultural and contextual issues has been cited in two NICE guidelines, in professional body standards, and national consumer group websites (AIMS, NCT, BirthChoiceUK). One study provided the catalyst for the UK's Normal Birth Campaign (http://www.rcmnormalbirth.org.uk/ and international successors, and influenced the definition of normal birth in UK National Statistics. The programme has generated: significant media coverage; an EU funded network including 26 countries that is influencing the international normal birth debate; recognition as international change agents in this area (http://econpapers.repec.org/paper/emnwpaper/023.htm, leading to the award of an OBE.
Instrumental births can cause problems and are needed more often with epidurals. The Comparative Obstetric Mobile Epidural Trial (COMET) was the definitive trial that led to the NICE Intrapartum Care guideline recommendation to discontinue traditional epidurals using high concentration local anaesthetic solutions in favour of low dose epidural techniques which allow women to be mobile during labour. It is estimated that these changes have resulted in about 10,000 fewer instrumental deliveries annually in the UK. Correspondingly, numbers of women experiencing effects of instrumental births such as faecal incontinence will have been substantially reduced. This research has also influenced clinical guidelines and led to changes in practice on the type of epidurals used during labour elsewhere, including Australia and Canada.
Researchers at the University of Oxford instituted a rapid study of pregnant women hospitalised across the UK with 2009/H1N1 infection, which demonstrated that early antiviral treatment improved maternal outcomes of infection and led to actions by the Department of Health to ensure rapid availability of antivirals specifically for pregnant women. The poor maternal and perinatal outcomes identified by this study also led to an on-going policy change, so that all pregnant women in the UK are now recommended to receive annual immunisation against seasonal influenza.
International obstetric practice has been changed by two large randomised controlled trials led from the University of Oxford's National Perinatal Epidemiology Unit, which demonstrated the efficacy of magnesium sulphate for both treatment and prevention of eclampsia during pregnancy, a condition characterised by fits in association with hypertension, and an important cause of maternal morbidity and mortality. Until the 1990s there was widespread geographical variation in the management of the condition, with magnesium sulphate used almost exclusively in North America. Following the publication of the results of these two trials magnesium sulphate is now in routine use globally, widely recommended in guidelines, and has been placed on the WHO Model List of Essential Medicines.
Smith identified four novel findings around the relationship between caesarean section and perinatal death (i.e. stillbirth or neonatal death). 1. Vaginal birth after previous caesarean had a low absolute risk of death, but the risk was lower still with planned caesarean delivery. 2. The second twin had a higher risk of death at term. 3 Caesarean section was associated with an increased future risk of stillbirth. 4. Use of prostaglandins to induce labour in women with a previous caesarean increased the risk of death. The studies subsequently led to changes in national and international clinical guidelines, which remain current.
Impact: Health and wellbeing; commerce; studies and clinical trials of the effects of progesterone receptor modulators (PRMs) underpinned their application for the benefit of women of childbearing age.
Significance: UoE studies underpinned the application of PRMs as emergency contraception including over-the-counter availability and the treatment of heavy menstrual bleeding (HMB); changed clinical guidelines; influenced Pharma R&D.
Beneficiaries: Women of reproductive age; the NHS and healthcare delivery organisations; pharmaceutical companies.
Attribution: Studies were conducted by Critchley, Baird and colleagues (UoE).
Reach: Worldwide; annually 4M women seek emergency contraception in the USA, and in the UK 1M women seek help for HMB. Drugs targeting the PR are licenced in 67 countries. Multiple global Pharma are active in the field of PRM biology.
UCL researchers and overseas partners have developed a successful community intervention to improve maternal and newborn health, which is now saving lives in India's poorest communities and is being taken up in other low- and middle-income countries. The intervention involves village women's groups working together to identify, prioritise and address common problems during and after pregnancy using local resources. The process was tested successfully in Nepal, led to a 45% reduction in newborn mortality in an award-winning trial in rural India, demonstrated an impact on maternal mortality in a meta-analysis of seven trials across four countries, and has already been scaled up to a population of over 1.5 million in rural India's poorest communities.
Research started by Professor Joni Lovenduski in 1992 and developed with Dr Rosie Campbell since 2003, influenced both policies about party political representation of women and the understandings of women's role in politics of party officials and activists. Showing that political recruitment, representation and participation are highly gendered — masculine — processes, Lovenduski and Campbell have successfully challenged the attitudes and contributed to changing processes that determine political equality between women and men. Both are routinely consulted about policy on political representation by political parties, UK government and parliament, the EU, and national and international organisations.