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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.
Impact: Health and welfare; healthcare guidelines on elective induction of labour. The research showed that elective induction at time points from 37 weeks' gestation progressively reduces perinatal mortality. UK guidelines now recommend routine induction at 39 weeks in mothers >40 years of age.
Significance: Implementation of the guidelines for mothers >40 years of age is estimated to prevent the stillbirth of 17 babies per year in the UK.
Beneficiaries: Pregnant women, policy makers and healthcare providers.
Attribution: The work was led by Jane Norman with Sarah Stock at UoE, in collaboration with NHS Information Scotland.
Reach: UK, Europe, North America. Applies to all pregnant women, especially those over 40 years of age.
Impact: Health and welfare; a UK clinical trial of uterine artery embolisation (UAE), with five-year follow-up, defined the risk- and cost-benefit of UAE versus surgery.
Significance: The trial informed guidelines/recommendations internationally and changed clinical practice. Women worldwide can now make an informed choice about their treatment; economic factors have been quantitated.
Beneficiaries: Uterine fibroid patients, the NHS, healthcare providers.
Attribution: G. Murray, UoE, developed and delivered innovative trial methodology; clinical aspects led by University of Glasgow.
Reach: UK guidelines; worldwide (Australia, USA, Europe) effect on clinical practice that will impact up to 25% of women.
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.
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.
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.
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.
The thesis of this case study is that a demonstration project, encompassing an organisational change, utilising the principles that underpinned a Department of Health (1993) policy for maternity care, has been influential in corroborating and establishing a philosophy for maternity services in industrialised countries within the 21st century.
The project provided an evidence-based approach to standards and quality of midwifery care. It demonstrates outcomes influencing national and international guidelines and policies for maternity practice. As a result, current midwifery guidelines for the UK and other countries, such as Australia, New Zealand, The Netherlands, Sweden and Canada, include elements of continuity of care/r (including one-to-one care and case loading) informed choice for women and evidence-based practice.
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.