### What you need to know Miscarriage and ectopic pregnancy have an adverse effect on the quality... more ### What you need to know Miscarriage and ectopic pregnancy have an adverse effect on the quality of life of many women, with early pregnancy loss accounting for over 50 000 hospital admissions in the UK annually.1 Ectopic pregnancy (where the pregnancy implants outside the endometrial cavity, most commonly within the fallopian tube) occurs in approximately 11 per 1000 pregnancies.2 Unfortunately, women still die during early pregnancy, with four maternal deaths reported in the UK between 2013 and 2015.3 However, the case fatality rate has decreased over recent years,2 suggesting that earlier diagnosis and treatment has made an impact. Accurate diagnosis and effective management of early pregnancy loss is therefore vital to avoid women dying unnecessarily, and to reduce the incidence of associated physical and psychological morbidity. This article summarises the updated recommendations from the National Institute for Health and Care Excellence (NICE) on the diagnosis and management of tubal ectopic pregnancy and miscarriage in early pregnancy (up to 13 completed weeks of pregnancy).4 In addition to these updated recommendations, the guideline also contains recommendations on providing …
Collaborative working to generate guidelines is a recommendation from the document Making a Diffe... more Collaborative working to generate guidelines is a recommendation from the document Making a Difference (DoH, 1999). A protocol development group was set up to address problems in the existing care pathway, which had been identified by the Oxfordshire Symphysis Pubis Dysfunction (SPD) support group. The aims of the protocol development group were to make sure that all women who experience SPD have appropriate and timely diagnosis and treatment. The objectives were to develop a protocol which bridges professional roles and service/agency boundaries, and to raise awareness of the issue and protocol with professionals and women who use the service. The SPD protocol development group consisted of all those who might be affected by a clinical guideline, as advised by the National Institute of Clinical Excellence (NICE, 2000) and included the users of the service (DoH, 2000). A strategy of change in practice was designed. The experience of a collaborative project resulted in positive benef...
Pelvic girdle pain related to pregnancy (PGP) is increasingly well recognised by midwives and wom... more Pelvic girdle pain related to pregnancy (PGP) is increasingly well recognised by midwives and women. There is a growing awareness that PGP results from a mechanical dysfunction of the pelvic joints, causing pain and disability, and that it is treatable. Recent literature has examined the prevalence and duration of PGP; the use of caesarean section, treatment with manual therapy and exercise during and after pregnancy (now gaining more and more acceptance as the most effective way to manage and resolve PGP); and evidence to support continued breastfeeding. There are new studies about the long-term prevalence and consequences of lack of treatment, both physical and psychological, and the financial impact on society. By treating PGP with manual therapy during pregnancy, as symptoms arise, the associated morbidity can be avoided or minimised. This article reviews the recent literature on PGP and reflects on the response to the Pelvic Partnership's 2015 ‘Stickmum’ campaign.
Pelvic girdle pain (PGP) continues to cause morbidity for a significant number of pregnant women ... more Pelvic girdle pain (PGP) continues to cause morbidity for a significant number of pregnant women (around one in five). Although research into the causes of PGP has not identified significant or preventable causes, the understanding of contributing factors has evolved significantly in recent years. It was previously thought that PGP was a hormonal problem caused by relaxin production and subsequent ‘loosening’ or laxity of pelvic joints; current evidence suggests that it is an asymmetry of mobility of the pelvic joints, in particular the sacroiliac joints. Treatment has evolved to provision of manual, hands-on therapy treatment, restoring symmetry of pelvic joint movement and function, rather than rest, crutches and support belts; hence the woman's overall biomechanical function and her mobility and independence are restored. This article seeks to raise awareness of this change of focus regarding treatment and promote its adoption across the UK, in line with national guidelines, with the goal of reducing t...
Traditionally, pelvic girdle pain (PGP) was viewed as a hormonal problem, untreatable during preg... more Traditionally, pelvic girdle pain (PGP) was viewed as a hormonal problem, untreatable during pregnancy and exacerbated by the weight of the baby. Customary advice was for rest, support belts and to await recovery following the baby's birth. However, the outcome of this management resulted in many women experiencing short or long-term physical disability, as well as the psychological impact of pain and immobility. Recent research links an asymmetry of the pelvic joints to the incidence and severity of PGP and shows the cause is biomechanical and not due to pregnancy hormones. Evidence supports manual therapy as the effective way to resolve PGP quickly during pregnancy through a realignment and restoration of symmetry of movement in the pelvic joints, thereby avoiding the adverse long-term consequences of the condition.
BACKGROUND The gold standard for assessment and diagnosis of significant proteinuria in pregnancy... more BACKGROUND The gold standard for assessment and diagnosis of significant proteinuria in pregnancy has been by 24-hour urine collection and analysis. Determining fast, accurate methods to identify clinically significant proteinuria would aid diagnosis of pre-eclampsia. The objective of this study was to determine the accuracy of spot protein-creatinine ratio (PCR) and albumin-creatinine ratio (ACR) measurements compared with 24-hour urine collection for the identification of clinically significant proteinuria in women with hypertensive disorders of pregnancy. METHODS Search strategies were developed for electronic databases from inception to 1st October 2020. Data were assessed for methodological quality using the QUADAS-II checklist for risk of bias and quality of the evidence using GRADE. Meta-analysis was performed where there were at least four studies presenting data for the same comparison (test and threshold). This is an update of the review for NICE guideline NG133 (published...
Initiatives to optimise preconception health are emerging following growing recognition that this... more Initiatives to optimise preconception health are emerging following growing recognition that this may improve the health and well-being of women and men of reproductive age and optimise health in their children. To inform and evaluate such initiatives, guidance is required on indicators that describe and monitor population-level preconception health. We searched relevant databases and websites (March 2021) to identify national and international preconception guidelines, recommendations and policy reports. These were reviewed to identify preconception indicators. Indicators were aligned with a measure describing the prevalence of the indicator as recorded in national population-based data sources in England. From 22 documents reviewed, we identified 66 indicators across 12 domains. Domains included wider (social/economic) determinants of health; health care; reproductive health and family planning; health behaviours; environmental exposures; cervical screening; immunisation and infec...
### What you need to know Miscarriage and ectopic pregnancy have an adverse effect on the quality... more ### What you need to know Miscarriage and ectopic pregnancy have an adverse effect on the quality of life of many women, with early pregnancy loss accounting for over 50 000 hospital admissions in the UK annually.1 Ectopic pregnancy (where the pregnancy implants outside the endometrial cavity, most commonly within the fallopian tube) occurs in approximately 11 per 1000 pregnancies.2 Unfortunately, women still die during early pregnancy, with four maternal deaths reported in the UK between 2013 and 2015.3 However, the case fatality rate has decreased over recent years,2 suggesting that earlier diagnosis and treatment has made an impact. Accurate diagnosis and effective management of early pregnancy loss is therefore vital to avoid women dying unnecessarily, and to reduce the incidence of associated physical and psychological morbidity. This article summarises the updated recommendations from the National Institute for Health and Care Excellence (NICE) on the diagnosis and management of tubal ectopic pregnancy and miscarriage in early pregnancy (up to 13 completed weeks of pregnancy).4 In addition to these updated recommendations, the guideline also contains recommendations on providing …
Collaborative working to generate guidelines is a recommendation from the document Making a Diffe... more Collaborative working to generate guidelines is a recommendation from the document Making a Difference (DoH, 1999). A protocol development group was set up to address problems in the existing care pathway, which had been identified by the Oxfordshire Symphysis Pubis Dysfunction (SPD) support group. The aims of the protocol development group were to make sure that all women who experience SPD have appropriate and timely diagnosis and treatment. The objectives were to develop a protocol which bridges professional roles and service/agency boundaries, and to raise awareness of the issue and protocol with professionals and women who use the service. The SPD protocol development group consisted of all those who might be affected by a clinical guideline, as advised by the National Institute of Clinical Excellence (NICE, 2000) and included the users of the service (DoH, 2000). A strategy of change in practice was designed. The experience of a collaborative project resulted in positive benef...
Pelvic girdle pain related to pregnancy (PGP) is increasingly well recognised by midwives and wom... more Pelvic girdle pain related to pregnancy (PGP) is increasingly well recognised by midwives and women. There is a growing awareness that PGP results from a mechanical dysfunction of the pelvic joints, causing pain and disability, and that it is treatable. Recent literature has examined the prevalence and duration of PGP; the use of caesarean section, treatment with manual therapy and exercise during and after pregnancy (now gaining more and more acceptance as the most effective way to manage and resolve PGP); and evidence to support continued breastfeeding. There are new studies about the long-term prevalence and consequences of lack of treatment, both physical and psychological, and the financial impact on society. By treating PGP with manual therapy during pregnancy, as symptoms arise, the associated morbidity can be avoided or minimised. This article reviews the recent literature on PGP and reflects on the response to the Pelvic Partnership's 2015 ‘Stickmum’ campaign.
Pelvic girdle pain (PGP) continues to cause morbidity for a significant number of pregnant women ... more Pelvic girdle pain (PGP) continues to cause morbidity for a significant number of pregnant women (around one in five). Although research into the causes of PGP has not identified significant or preventable causes, the understanding of contributing factors has evolved significantly in recent years. It was previously thought that PGP was a hormonal problem caused by relaxin production and subsequent ‘loosening’ or laxity of pelvic joints; current evidence suggests that it is an asymmetry of mobility of the pelvic joints, in particular the sacroiliac joints. Treatment has evolved to provision of manual, hands-on therapy treatment, restoring symmetry of pelvic joint movement and function, rather than rest, crutches and support belts; hence the woman's overall biomechanical function and her mobility and independence are restored. This article seeks to raise awareness of this change of focus regarding treatment and promote its adoption across the UK, in line with national guidelines, with the goal of reducing t...
Traditionally, pelvic girdle pain (PGP) was viewed as a hormonal problem, untreatable during preg... more Traditionally, pelvic girdle pain (PGP) was viewed as a hormonal problem, untreatable during pregnancy and exacerbated by the weight of the baby. Customary advice was for rest, support belts and to await recovery following the baby's birth. However, the outcome of this management resulted in many women experiencing short or long-term physical disability, as well as the psychological impact of pain and immobility. Recent research links an asymmetry of the pelvic joints to the incidence and severity of PGP and shows the cause is biomechanical and not due to pregnancy hormones. Evidence supports manual therapy as the effective way to resolve PGP quickly during pregnancy through a realignment and restoration of symmetry of movement in the pelvic joints, thereby avoiding the adverse long-term consequences of the condition.
BACKGROUND The gold standard for assessment and diagnosis of significant proteinuria in pregnancy... more BACKGROUND The gold standard for assessment and diagnosis of significant proteinuria in pregnancy has been by 24-hour urine collection and analysis. Determining fast, accurate methods to identify clinically significant proteinuria would aid diagnosis of pre-eclampsia. The objective of this study was to determine the accuracy of spot protein-creatinine ratio (PCR) and albumin-creatinine ratio (ACR) measurements compared with 24-hour urine collection for the identification of clinically significant proteinuria in women with hypertensive disorders of pregnancy. METHODS Search strategies were developed for electronic databases from inception to 1st October 2020. Data were assessed for methodological quality using the QUADAS-II checklist for risk of bias and quality of the evidence using GRADE. Meta-analysis was performed where there were at least four studies presenting data for the same comparison (test and threshold). This is an update of the review for NICE guideline NG133 (published...
Initiatives to optimise preconception health are emerging following growing recognition that this... more Initiatives to optimise preconception health are emerging following growing recognition that this may improve the health and well-being of women and men of reproductive age and optimise health in their children. To inform and evaluate such initiatives, guidance is required on indicators that describe and monitor population-level preconception health. We searched relevant databases and websites (March 2021) to identify national and international preconception guidelines, recommendations and policy reports. These were reviewed to identify preconception indicators. Indicators were aligned with a measure describing the prevalence of the indicator as recorded in national population-based data sources in England. From 22 documents reviewed, we identified 66 indicators across 12 domains. Domains included wider (social/economic) determinants of health; health care; reproductive health and family planning; health behaviours; environmental exposures; cervical screening; immunisation and infec...
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Papers by Sarah Fishburn