Prevention of early-onset Group B Streptococcal disease - the Northern Ireland experience.

OBJECTIVES: To ascertain guideline adherence for prevention of Group B Streptococcal (GBS) neonatal infection and establish prevalence and outcomes in Northern Ireland (NI). DESIGN: Retrospective observational study. SETTING: Northern Ireland maternity units. POPULATION: Using NI Health Information Systems the following were identified: (1) a cohort of women with one or more risk factors for GBS disease in 2009-2010, (2) all culture-positive cases of GBS in babies aged 0-89 days (2008-2010), (3) stillbirths due to GBS (2009-2010). METHODS: Information was analysed for a 15% randomised sample of the available cases. Maternal and infant case notes were reviewed for confirmed cases of neonatal early onset GBS (EOGBS) during 2008-2010. MAIN OUTCOME MEASURES: Adherence to the 2003 RCOG guideline on prevention of GBS disease (2009-2010). Number of neonatal GBS infections: antenatal risk factors, management and neonatal outcomes (2008-2010). The number of stillbirths related to GBS (2009-2010). RESULTS: Five hundred and seventy-four women had one or more identifiable risk factors for GBS disease; intrapartum antibiotic prophylaxis (IAP) was administered in 42% of cases. Improved administration of IAP was noted in the presence of escalating risk factors. At best, guideline adherence was 50-70%. Forty-three neonates had proven early-onset Group B Streptococcal disease; 55.8% had maternal risk factors. Of the total identified cases, 25.5% received IAP. The total mortality rate was 11.46%. The incidence of EOGBS disease in NI was 0.57/1000 live births. CONCLUSIONS: Prevalence of EOGBS is higher in NI than the UK as a whole. Risk factors are present in 55.8% of mothers; IAP does not prevent all cases of EOGBS.

Raising awareness of pre-conception care in community pharmacies: a feasibility study.

BACKGROUND: There is growing evidence to support the introduction of pre-conception interventions to optimise the health of mothers and their future children. At present, there is poor awareness regarding the importance of pre-conception care (PCC) amongst healthcare professionals and couples planning a pregnancy. Community pharmacies are ideally placed to reach a range of prospective couples planning a pregnancy and could effectively provide information about PCC. METHODS: This study assessed feasibility of an intervention to raise awareness of PCC in community pharmacies in Northern Ireland over 3 months. INCLUSION CRITERIA: women of childbearing age (16-45 years) engaging with services at participating pharmacies. Study resources: campaign posters, information cards, crib sheets for pharmacy staff. A mixed methods approach was employed, including, brief information provision for women, record of staff interactions with customers, customer feedback cards and qualitative interviews with pharmacy staff. Descriptive statistics assessed distribution of study resources and staff interviews were analysed using a thematic analysis framework. RESULTS: There were eight participating pharmacies, three of which consented to post-study interviews. Three pharmacies chose not to deliver the planned intervention. Distribution of campaign cards (n = 456) varied (0-86%). Analysis of customer feedback cards (n = 9) demonstrated that the majority of respondents were happy to receive information on pre-conception health. Of the women who responded to this question (n = 8), all were 'extremely likely' or 'likely' to act on the information provided. Four main themes emerged from analysis of staff interviews: (1) training and experience in providing health advice, (2) intervention resources, (3) understanding the aims of the intervention, (4) perceived value of the intervention. Barriers to intervention delivery included non-engagement from pharmacies and need for additional training of staff. CONCLUSIONS: An intervention to raise awareness of PCC within a community pharmacy setting was feasible and acceptable to both women and staff in participating pharmacies. This study indicates that a number of factors must be considered to enhance implementation and effectiveness of PCC interventions in this setting. In particular, better understanding of non-engagement, provision of adequate training and support for staff, and exploring incentives for pharmacies to prioritise PCC.

Evaluation of the predictive value of placental vascularisation indices derived from 3-Dimensional power Doppler whole placental volume scanning for prediction of pre-eclampsia: A systematic review and meta-analysis.

Pre-eclampsia remains a leading cause of maternal and fetal morbidity and mortality. This systematic review aims to evaluate the ability of placental vascularisation indices (PVIs) derived from 3D power Doppler whole placental volume scanning to predict early, late and any-onset pre-eclampsia (PE). The following databases were searched: MEDLINE, EMBASE and Web of Science. Studies selected for inclusion measured PVIs: Vascularisation Index (%) (VI) and/or Flow Index (FI) and/or Vascularisation Flow Index (VFI) derived from 3D power Doppler whole placental volume scanning via Virtual Organ Computer-aided Analysis (VOCAL) technique prior to diagnosis of PE. A total of 667 records were screened with five eligible studies included. A narrative review of all studies was undertaken and three studies with sufficient data were included in a meta-analysis. This review, the first of its kind to evaluate the predictive value of PVIs for PE, reports significantly lower first trimester PVIs across a range of studies in women who develop PE. Mean differences in vascularisation indices in PE and non-PE pregnancies were: VI -2.93% (95% CI -5.84,-0.01), FR -2.83 (95% CI -3.97,-1.69) and VFI -0.93 (95% CI -1.6,-0.25), respectively. While only two studies reported sensitivity and specificity data, VI and VFI most accurately predicted early onset PE, and VFI predicted PE in high risk women. Further research is required to validate these findings in different study populations and to examine the performance of PVIs within combined screening models for PE.