Maternity services in the UK during the coronavirus disease 2019 pandemic: a national survey of modifications to standard care.

OBJECTIVE: To explore the modifications to maternity services across the UK, in response to the coronavirus disease 2019 (COVID-19) pandemic, in the context of the pandemic guidance issued by the Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives (RCM) and NHS England. DESIGN: National survey. SETTING: UK maternity services during the COVID-19 pandemic. POPULATION OR SAMPLE: Healthcare professionals working within maternity services. METHODS: A national electronic survey was developed to investigate local modifications to general and specialist maternity care during the COVID-19 pandemic, in the context of the contemporaneous national pandemic guidance. After a pilot phase, the survey was distributed through professional networks by the RCOG and co-authors. The survey results were presented descriptively in tabular and graphic formats, with proportions compared using chi-square tests. MAIN OUTCOME MEASURES: Service modifications made during the pandemic. RESULTS: A total of 81 respondent sites, 42% of the 194 obstetric units in the UK, were included. They reported substantial and heterogeneous maternity service modifications. Seventy percent of units reported a reduction in antenatal appointments and 56% reported a reduction in postnatal appointments; 89% reported using remote consultation methods. A change to screening pathways for gestational diabetes mellitus was reported by 70%, and 59% had temporarily removed the offer of births at home or in a midwife-led unit. A reduction in emergency antenatal presentations was experienced by 86% of units. CONCLUSIONS: This national survey documents the extensive impact of the COVID-19 pandemic on maternity services in the UK. More research is needed to understand the impact on maternity outcomes and experience. TWEETABLE ABSTRACT: A national survey showed that UK maternity services were modified extensively and heterogeneously in response to COVID-19.

Healthcare evaluation of the use of atosiban and fibronectin for the management of pre-term labour.

Our objective was to assess the effectiveness, safety and efficiency of a protocol combining fetal fibronectin diagnostic testing and atosiban tocolysis for the management of pre-term labour, using a combination of narrative review and economic modelling. We compared the proposed protocol to alternatives using nifedipine with or without fetal fibronectin. We have found that the proposed protocol may be safer and more acceptable by women than the alternatives, and its use can result in significant cost-savings.

The managed care of early pregnancy problems.

There is an increasing trend towards non-invasive diagnosis and conservative treatment for early pregnancy problems. Although there are enormous potential benefits for women being treated thus, the ideal treatment methods and diagnostic algorithms have yet to be elucidated. Further large-scale studies are required.