Sensitive Midwifery - Issue 44 - October 2019

Obstetric cholestasis – who is at risk? While obstetric cholestasis is associated with adverse perinatal outcomes, there has previously been little evidence regarding which women were more at risk and why. Now, a recent systematic review and meta- analysis has found that: ‘The risk of stillbirth is increased in women with intrahepatic cholestasis of pregnancy and singleton pregnancies when serum bile acids concentrations are of 100 µmol/L or more’. Because most women with obstetric cholestasis have bile acids below this concentration, their risk of stillbirth is probably similar to that of pregnant women in the general population. Repeat bile acid testing must be done until delivery. These results mean that more informed choices can be made when considering interventions like induction. Ovadia, C, et al, ‘Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses’, Lancet , 2019, 393: 899–909. Available: https://www.thelancet.com/journals/lancet/ article/PIIS0140-6736(18)31877-4/fulltext Fertility app proven to be useful A study was done to assess six-cycle perfect and typical use e ffi cacy of Dynamic Optimal Timing (Dot), an algorithm-based fertility app that identifies the fertile window of the menstrual cycle using a woman's period start date. The app also provides guidance on when to avoid unprotected sex to prevent pregnancy. Current six-cycle results suggest that Dot’s guidance, when used correctly, provides women with useful information for preventing pregnancy. Hennings, VH, et al, ‘Estimating six-cycle e ffi cacy of the Dot app for pregnancy prevention’, Contraception , 2019, 99(1), 52–55 Mourning miscarriage with a Buddhist ritual The loss of a loved one in Western cultures is often followed by a funeral or some sort of ritual to mark the family’s grief. Miscarriage, however, is often private. Parents who are coming to terms with pregnancy loss may find comfort in the Buddhist ritual of mizuko kuyo . Following a moving ceremony, parents can visit Jizo figurines (which represent babies never born), leaving gifts and honouring their lost child. Zevelo ff , J, ‘Japan has a beautiful tradition for grieving lost pregnancies, and it helped me come to terms with my own miscarriage’, 15 October 2018. Available: https://www.insider.com/japan-buddhist-tradition-jizo- grieving-miscarriage-lost-pregnancy-2018-10 No clear risk factor for two-thirds of preterm births Predicting the worldwide 11% preterm birth rate risk is complicated by inconsistencies in measurement of gestational age, preterm definitions, and data collection and reporting, despite the known associations between preterm birth and a wide range of socio-demographic, medical, obstetric, fetal and environmental factors. E ff orts to standardise definitions and compare preterm birth rates internationally have yielded important insights into the prevention and epidemiology of preterm birth. This will hopefully soon improve risk assessment and lessen neonatal and child mortality and morbidity, particularly in resource-poor settings, and the deleterious e ff ects of preterm birth on health and welfare in adult life. Vogel, JP, et al, ‘The global epidemiology of preterm birth’, Best Practice & Research Clinical Obstetrics & Gynaecology , 2018, 52, 13–22 Pregnancy 16 eSensitive Midwifery Magazine Issue 44