Lesley Briscoe

Postnatal screening for thrombophilia in women with severe pregnancy complications.

Objective To examine the prevalence of maternal thrombophilia in women with severe preeclampsia/eclampsia, placental abruption, fetal growth restriction, and unexplained stillbirth. Methods We studied 102 women who had pregnancy complications and 44 healthy women with uncomplicated pregnancies. All women were tested 10 weeks postpartum for mutations of factor V Leiden, methylenetetrahydrofolate reductase (MTHFR) C677T, and G20210A prothrombin gene; deficiencies of protein C, protein S, and antithrombin III; and the presence of lupus anticoagulant and anticardiolipin antibodies. We aimed to recruit 100 cases and 300 controls to detect a 10% difference in thrombophilia between the groups. However, we were able to recruit only 44 controls. Results Abnormal thrombophilia screen was found in 54 women with pregnancy complications (53%) and in 17 women (39%) with normal pregnancies (odds ratio [OR] 1.8; 95% confidence interval [CI] 0.87, 3.67). Mutations encoding for factor V Leiden, G20210A prothrombin gene, and MTHFR C677T (homozygous) were identified in 18% of women with complications compared with 16% of controls (OR 1.1; 95% CI 0.44, 2.94). Activated protein C resistance, not due to factor V Leiden mutation, was the most common thrombophilic defect, found in 26% of women with pregnancy complications compared with 18% of controls Conclusion In our cohort of women with pregnancy complications, maternal thrombophilia was less common than previously thought, and multiple thrombophilias were not a major additional risk factor

Can transcutaneous bilirubinometry reduce the need for blood tests in jaundiced full term babies

Background: Previous studies have suggested that transcutaneous bilirubinometry (TcB) may provide a useful method for screening for significant jaundice, thereby reducing unnecessary blood tests. These studies have not allowed an estimation of the magnitude of such a benefit. Objectives: To evaluate the accuracy of TcB as a method of determining the need for serum bilirubin (SBR) measurements in full term babies and to quantify the magnitude of any benefit. Subjects: Babies born at more than 34 weeks gestation who had not previously been exposed to phototherapy and were requiring blood sampling in the first week of life. Method: TcB measurements were made at the same time as blood sampling. SBR was measured in all blood samples. For jaundiced babies, the ability of TcB to detect significant jaundice (SBR > 249 μmol/l) was evaluated. Results: There was a correlation between SBR and TcB measurements (n = 303, r = 0.76, p < 0.0001), but the 95% prediction interval for SBR from TcB was wide (± 88.3 μmol/l). For the 285 jaundiced babies, the area under the receiver operator characteristic curve was 0.89. A TcB value of 18 detected significant jaundice with a sensitivity of 100% and a specificity (95% confidence interval) of 45% (39% to 51%). If blood samples had only been taken from babies with a TcB value greater than 18, the number of samples taken would have been reduced by 34%. Conclusions: SBR cannot be measured accurately by TcB. However, TcB measurements can be used to determine the need for blood sampling in jaundiced babies and will reduce the number of blood samples taken. Recent improvements in TcB may improve the performance of this method.

Becoming culturally sensitive: A painful process?

OBJECTIVE to discuss how midwifery students develop cultural sensitivity. DESIGN students carried out international observational elective placements and 13 matched self-assessments from before and after a Global Midwifery Module were compared. The module is based around a model of immersion and permitted measured responses and qualitative evaluation to be explored. SETTINGS observational placements occurred in the UK, America, Canada, and Gutamala. PARTICIPANTS seventeen year 3 midwifery students. FINDINGS raised awareness about international midwifery was identified; the module contributed to enhancement of practice, confidence about caring for those from a different culture varied, the process of critical reflection was uncomfortable for some. KEY CONCLUSIONS critical reflection facilitated in a safe place may support individuals to transform their way of thinking. IMPLICATIONS FOR PRACTICE responsibility for developing cultural sensitivity should lie with the individual. However, leaders need to facilitate space for critical reflection. Critical self-assessment and reflection about cultural sensitivity should be part of a life long learning approach.