Foley catheter for induction of labour: a UK observational study

We conducted a prospective observational study of all inductions using Foley's catheter at our center between 2016 and 2018. Outcome data collected included induction to delivery time, mode of delivery, complication rates, patient and staff satisfaction. Ninety-nine women were included in our study. Median induction to delivery time was 28.3 h (IQR 19.7-34 h), 20 (20.2%) women required Caesarean section. No relevant complications were recorded. Patients and staff were satisfied with the technique overall.These results show transcervical Foley's catheter is a safe and effective method of induction of labour in the UK setting. It was shown to be feasible in the outpatient and previous Caesarean section groups.Impact statementWhat is already known on the subject? Foley catheter as an induction agent has already been shown to be as clinically effective as slow release prostaglandins with lower costs.What do the results of this study add? No study has been published on its use for routine inductions in the UK. Our results show that Foley's catheter is a safe, effective method for inducing labour in the UK.What are the implications of these findings for clinical practice and/or further research? This suggests this technique should be implemented more widely in the UK.

A prospective cohort study evaluating the cost-effectiveness of carbetocin for prevention of postpartum haemorrhage in caesarean sections

Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Prophylaxis with oxytocic medication is recommended by the WHO to prevent its occurrence. Carbetocin is a newer oxytocic, with potential to lower PPH rates, reduce the total use of oxytocic drugs and lead to financial savings. Meta-analyses have confirmed a reduction in the use of additional oxytocic medication with the use of carbetocin compared to oxytocin. However, there are few studies evaluating the costs of carbetocin prophylaxis. We carried out a prospective cohort study evaluating the financial impact of carbetocin, following its introduction at our centre for caesarean section. We collected data for 400 patients in total, making this, to our knowledge, the largest study conducted on this topic. We found a significant reduction in PPH rates and the use of additional oxytocics with projected overall financial savings of £68.93 per patient with the use of carbetocin. Impact statement It is well established that carbetocin reduces the use of secondary oxytocics compared to oxytocin alone in the active management of the third stage of labour. Evidence for reduction of post-partum haemorrhage and its cost effectiveness are more equivocal. Our study demonstrates that carbetocin also reduces post-partum haemorrhage, use of blood and blood products and midwifery recovery time in the setting of caesarean section. We have also demonstrated that despite the increased index cost of carbetocin it delivers an overall substantial cost benefit. The implications of these findings are of reduced morbidity, faster recovery and cost savings in these times of austerity in the UK. It allows more efficient labour distribution of midwives, particularly in the setting of staff shortages across the NHS. A randomised control trial in this area needs to be conducted to determine the cost benefit of carbetocin and with this and post-partum haemorrhage rates as the primary outcome measures.

Breast cancer in pregnancy

Breast cancer in pregnancy is rare with an incidence of 1:3,000 to 1:10,000 and is the second most common after cervical cancer. The outlook for such patients is less favourable than that of non- pregnant women probably because the stage of the disease is more advanced when it is discovered and also due to delay in therapy. The need for prompt treatment presents a clinical dilemma of considerable magnitude as there is always a conflict between optimal maternal therapy and the resultant risks imposed on fetal well-being. In the absence of a standardised protocol for management, this review focuses on the issues of diagnosis and treatment of breast cancer in pregnancy. Relevant current literature using Medline search strategy was examined.

Awareness of correct use of a seatbelt among pregnant women and health professionals: A multicentric survey

A questionnaire survey was conducted to determine if pregnant women and healthcare professionals were aware of the correct use of a seatbelt and if advice was given. A total of 154 pregnant women and 56 health professionals were included in the study. A total of 115 (74.6 %) pregnant women wore seatbelts as drivers; 51 (33.1%) women were concerned about wearing the seatbelt in pregnancy; eight (14.2 %) received advice from health professionals. Incorrect positioning of a seatbelt was indicated by 67 (43.5 %) pregnant women and nine (16 %) health professionals. The majority of the doctors and community midwives advised women on seatbelt use only if asked. This study shows that almost half of pregnant women are ignorant of the correct use of a seatbelt, which puts them at risk for injuries. Well-informed prenatal care providers should substantially influence the practice among pregnant women through education.

Epirubicin for breast cancer during pregnancy: a case report

BACKGROUND

The rarity of breast cancer in pregnancy and conflict between the optimal maternal therapy and fetal risks make its management challenging. Chemotherapy is the standard treatment for advanced cases. Epirubicin as a combination agent has been reported for breast and other cancers in pregnancy but not as a single agent. We report a case of advanced breast cancer treated with epirubicin neoadjuvant chemotherapy in pregnancy.

CASE

A 30-year-old primigravida with multifocal, grade 3 invasive ductal carcinoma, stage T2 N1M0, received 4 cycles of primary epirubicin chemotherapy in pregnancy from 23 weeks' gestation. The chemotherapy was well tolerated by the mother and fetus, and a good response was achieved prior to postnatal combination chemotherapy and definitive surgery.

CONCLUSION

Epirubicin chemotherapy appears safe and effective in pregnancy.