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Uptake of Results in Obstetric Trials in NHS

Leads: Dr Beck Taylor, Prof Sara Kenyon (Maternity), Dr Katharine Reeves, Dr Laura Kudrna, Dr Kelly-Ann Schmidtke (Meths)

The team are working in partnership with public contributors linked to ARC WM's Maternity theme.

Dates: Paused due to COVID-19

Background:

The ARC WM Maternity team were approached by the West Midlands Academic Health Sciences Network, and researchers who led two important recent maternity care trials, due to concerns that there had been poor translation into clinical practice and opportunities to improve outcomes for women had been missed.

The first trial is the RESPITE trial which explored the use of remifentanil intravenous patient-controlled analgesia (PCA) as an alternative to intramuscular pethidine for pain relief during labour. It found that, compared to pethidine, use of remifentanil had half the proportion of women subsequently requiring an epidural (41% and 19% respectively, risk ratio 0.48, 95% CI 0.34-0.66, P<0.0001) resulting in fewer instrumental deliveries and more spontaneous vaginal deliveries (although the trial was not powered for differences in mode of birth). Despite these compelling findings, ARC collaborators report through informal networks that that remifentanil is not currently used routinely in this way in many units, but no empirical evidence is available to confirm this, and the reasons for low uptake are not well-understood.

Many women receive epidural pain relief in labour, and this is associated with an increase in instrumental birth. The second trial is the BUMPES trial which explored whether being upright in the second stage of labour in nulliparous women with a low dose epidural increased the chance of spontaneous vaginal birth compared with lying down. The trial found that this was not the case: 41% (632/1537) of women lying down had a spontaneous vaginal delivery (SVD) compared to 35% (548/1556) who were positioned upright. Once again, despite these compelling findings, our ARC collaborators have informally reported that a belief persists that upright position in second stage of labour results in more SVDs in spite of the findings of the BUMPES trial. However, it is not known how widely this belief is held, or whether BUMPES findings have been widely adopted by maternity units across the UK.

Policy and Practice Partners:

West Midlands Academic Health Sciences Network (WM-AHSN), researchers involved in the original research.

Co-Funding Partners:

WM-AHSN.

Aims and Objectives:

To explore clinician’s perspectives regarding implementation of RESPITE and BUMPES trial findings in delivery suites across the UK to understand current practice and to inform future research.

Methods:

Interviews with key informants in maternity services.

Main Results:

Not yet underway.

Conclusions:

Not yet underway.

Implications for Implementation:

We are researching barriers and facilitators in order to potentially design and implement an intervention to improve uptake.