223 lines
6.8 KiB
YAML
223 lines
6.8 KiB
YAML
abstract: 'Background
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Midwifery continuity of care is the only health system intervention
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shown to reduce preterm birth (PTB) and improve perinatal survival, but
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no trial evidence exists for women with identified risk factors for PTB.
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We aimed to assess feasibility, fidelity, and clinical outcomes of a
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model of midwifery continuity of care linked with a specialist obstetric
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clinic for women considered at increased risk for PTB.
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Methods and findings
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We conducted a hybrid implementation-effectiveness, randomised,
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controlled, unblinded, parallel-group pilot trial at an inner-city
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maternity service in London (UK), in which pregnant women identified at
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increased risk of PTB were randomly assigned (1:1) to either midwifery
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continuity of antenatal, intrapartum, and postnatal care (Pilot study Of
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midwifery Practice in Preterm birth Including women''s Experiences
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{[}POPPIE] group) or standard care group (maternity care by different
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midwives working in designated clinical areas). Pregnant women attending
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for antenatal care at less than 24 weeks'' gestation were eligible if
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they fulfilled one or more of the following criteria: previous cervical
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surgery, cerclage, premature rupture of membranes, PTB, or late
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miscarriage; previous short cervix or short cervix this pregnancy; or
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uterine abnormality and/or current smoker of tobacco. Feasibility
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outcomes included eligibility, recruitment and attrition rates, and
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fidelity of the model. The primary outcome was a composite of
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appropriate and timely interventions for the prevention and/or
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management of preterm labour and birth. We analysed by intention to
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treat. Between 9 May 2017 and 30 September 2018, 334 women were
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recruited; 169 women were allocated to the POPPIE group and 165 to the
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standard group. Mean maternal age was 31 years; 32\% of the women were
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from Black, Asian, and ethnic minority groups; 70\% were in employment;
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and 46\% had a university degree. Nearly 70\% of women lived in areas of
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social deprivation. More than a quarter of women had at least one
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pre-existing medical condition and multiple risk factors for PTB. More
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than 75\% of antenatal and postnatal visits were provided by a
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named/partner midwife, and a midwife from the POPPIE team was present at
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80\% of births. The incidence of the primary composite outcome showed no
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statistically significant difference between groups (POPPIE group 83.3\%
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versus standard group 84.7\%; risk ratio 0.98 {[}95\% confidence
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interval (CI) 0.90 to 1.08]; p = 0.742). Infants in the POPPIE group
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were significantly more likely to have skin-to-skin contact after birth,
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to have it for a longer time, and to breastfeed immediately after birth
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and at hospital discharge. There were no differences in other secondary
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outcomes. The number of serious adverse events was similar in both
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groups and unrelated to the intervention (POPPIE group 6 versus standard
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group 5). Limitations of this study included the limited power and the
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nonmasking of group allocation; however, study assignment was masked to
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the statistician and researchers who analysed the data.
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Conclusions
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In this study, we found that it is feasible to set up and achieve
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fidelity of a model of midwifery continuity of care linked with
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specialist obstetric care for women at increased risk of PTB in an
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inner-city maternity service in London (UK), but there is no impact on
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most outcomes for this population group.
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Larger appropriately powered trials are needed, including in other
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settings, to evaluate the impact of relational continuity and
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hypothesised mechanisms of effect based on increased trust and
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engagement, improved care coordination, and earlier referral on
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disadvantaged communities, including women with complex social factors
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and social vulnerability.'
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affiliation: 'Turienzo, CF (Corresponding Author), Kings Coll London, Fac Life Sci
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\& Med, Dept Women \& Childrens Hlth, London, England.
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Fernandez Turienzo, Cristina; Silverio, Sergio A.; Singh, Claire; Seed, Paul T.;
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Tribe, Rachel M.; Shennan, Andrew H.; Sandall, Jane, Kings Coll London, Fac Life
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Sci \& Med, Dept Women \& Childrens Hlth, London, England.
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Bick, Debra, Univ Warwick, Warwick Med Sch, Warwick Clin Trials Unit, Coventry,
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W Midlands, England.
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Briley, Annette L., Flinders Univ S Australia, Caring Futures Inst, Adelaide, SA,
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Australia.
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Bollard, Mary, Lewisham \& Greenwich NHS Trust, Matern Serv, London, England.
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Coxon, Kirstie, Kingston Univ, Dept Midwifery, London, England.
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Coxon, Kirstie, St Georges Univ London, London, England.
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Cross, Pauline, London Borough Lewisham, Dept Publ Hlth, London, England.'
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article-number: e1003350
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author: Fernandez Turienzo, Cristina and Bick, Debra and Briley, Annette L. and Bollard,
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Mary and Coxon, Kirstie and Cross, Pauline and Silverio, Sergio A. and Singh, Claire
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and Seed, Paul T. and Tribe, Rachel M. and Shennan, Andrew H. and Sandall, Jane
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and Grp, POPPIE Pilot Collaborative
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author-email: cristina.fernandez\_turienzo@kcl.ac.uk
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author_list:
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- family: Fernandez Turienzo
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given: Cristina
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- family: Bick
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given: Debra
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- family: Briley
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given: Annette L.
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- family: Bollard
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given: Mary
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- family: Coxon
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given: Kirstie
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- family: Cross
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given: Pauline
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- family: Silverio
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given: Sergio A.
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- family: Singh
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given: Claire
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- family: Seed
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given: Paul T.
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- family: Tribe
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given: Rachel M.
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- family: Shennan
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given: Andrew H.
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- family: Sandall
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given: Jane
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- family: Grp
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given: POPPIE Pilot Collaborative
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da: '2023-09-28'
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doi: 10.1371/journal.pmed.1003350
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eissn: 1549-1676
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files: []
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issn: 1549-1277
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journal: PLOS MEDICINE
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language: English
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month: OCT
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number: '10'
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number-of-cited-references: '30'
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orcid-numbers: 'Fernandez Turienzo, Cristina/0000-0002-7393-6593
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Sandall, Jane/0000-0003-2000-743X
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Silverio, Sergio A./0000-0001-7177-3471
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Seed, Paul T/0000-0001-7904-7933
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Coxon, Kirstie/0000-0001-5480-597X
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Singh, Claire/0000-0003-1681-8467
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Tribe, Rachel/0000-0003-3675-9978
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Briley, Annette/0000-0002-4266-920X
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Bick, Debra/0000-0002-8557-7276
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Shennan, Andrew/0000-0001-5273-3132'
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papis_id: 37f9a638bdc7ab1b9ad05a027ab33473
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ref: Fernandezturienzo2020midwiferycontinuity
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researcherid-numbers: 'Fernandez Turienzo, Cristina/IUM-1522-2023
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Sandall, Jane/D-4146-2009
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Coxon, KIRSTIE/HGQ-1180-2022
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Silverio, Sergio A./Y-7118-2019
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Seed, Paul T/C-4435-2008
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Bick, Debra/P-9575-2018
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'
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times-cited: '22'
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title: 'Midwifery continuity of care versus standard maternity care for women at increased
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risk of preterm birth: A hybrid implementation-effectiveness, randomised controlled
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pilot trial in the UK'
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type: article
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unique-id: WOS:000578286200003
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usage-count-last-180-days: '0'
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usage-count-since-2013: '12'
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volume: '17'
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web-of-science-categories: Medicine, General \& Internal
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year: '2020'
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