Dysfunctional labour and postpartum haemorrhage

The GSFT research programme aims to improve clinical management of dysfunctional (and post-dates) labour, focusing on underlying causes of delayed or ineffective uterine contractions at term. An overarching hypothesis is that maternal obesity and maternal age impacts on the timing and initiation of labour and the ability of the uterus to contract effectively during labour and after birth to prevent postpartum haemorrhage (PPH).

Dr Susan Bewley recently convened an RCOG study group on Reproduction and Ageing. The PULSE study (Dr R Tribe and Prof. A Shennan - funded by GlaxoSmith Kline Giving committee) addressed the evidence base for induction and augmentation of labour protocols, leading to considerable debate amongst clinical practitioners. Dr Tribe’s group are undertaking laboratory based research to determine how maternal age and body mass index alters uterine and cervical function. 

The STOP study (Dr Susan Bewley, Mrs Annette Briley, Prof Jane Sandall and Dr Rachel Tribe) focuses on improving, monitoring and the treatment of PPH in the UK. This work is supported by the ‘Women’s Health Policy, Systems and Service strategy’ stream (Sandall), which is the largest clinical centre for the BUMPES study (funded by the HTA) a collaborative RCT coordinated from the Clinical Trials Unit in Oxford, investigating the role of maternal position in the second stage of labour in reducing intervention. 

Advances are being made with regard to obstetric tools; a device has been developed to ease delivery of the impacted fetal head at caesarean section (Briley, Tydeman, Bewley, Shennan funded by NHS Innovations) limiting trauma sustained to mothers and babies during these procedures. In conjunction with this a simulator has been developed (Briley, Tydeman, Shennan funded by GSTT Charity) to evaluate the device, but the potential to simulate other intrapartum complications using this device are also being explored.