DOI: 10.1111/1471-0528.13385 www.bjog.org
Oral Presentations Maternal Medicine (O1) O1.1 Evaluation of telehealth monitoring in pregnancy using a multimatrix, multipartner model – a Northeast and North Cumbria AHSN Innovation Funded Project
Hinshaw, K1,2; Nayar, R1; Emmerson, C1; Johnson, J1; Hewitt, L1; Wilkes, S2; Rees, J2; Walker, R3; Weaver, J3,4; Essen, U5; Mettayil, N5; Marriott, P6; Smart, J6; Allan, L6; Forbister, R6; Herdman, K1; Purvis, A1 1
Sunderland Royal Hospital, Sunderland, Tyne and Wear, United Kingdom; 2University of Sunderland, Sunderland, Tyne and Wear, United Kingdom; 3Queen Elizabeth Hospital, Gateshead, Tyne and Wear, United Kingdom; 4University of Newcastle upon Tyne, Newcastle, Tyne and Wear, United Kingdom; 5South Tyneside General Hospital, South Shields, Tyne and Wear, United Kingdom; 6Northern Senate, Newcastle upon Tyne, Tyne and Wear, United Kingdom Introduction We developed two innovative pathways with the
Northern Senate Telehealth Team, using simple secure teletext messaging via a central NHS server [‘Florence’]: 1 Mild pregnancy-induced hypertension (PIH) 2 Gestational diabetes mellitus (GDM). Aims (i) To embed patient-led home-monitoring in PIH/GDM
across three hospital Trusts (ii) To evaluate deliverability, satisfaction, safe outcome and health economics. Pilot work PIH: patients with PIH (20–38 weeks) used Microlife [Microlife AG, Widnau, Switzerland] blood pressure (BP) monitors, validated for pregnancy, and tested BP/urine three times weekly at home. Criteria for hospital review were agreed from NICE guidance and embedded within system algorithms. Results (n = 54) – ‘locus of control’ increased from 46% to 81% after using telehealth. 100% felt ‘system easy to use’ and 100% felt it ‘better than last pregnancy’ (compared to ‘standard BP monitoring’). GDM: patient texts blood glucose results by SMS. Diabetologist can adjust medication (including insulin) via return SMS. Systemgenerated motivational texts were sent separately. Previous systems required weekly hospital clinic visits. In the new system, telehealth was used for 12 weeks on average; clinic visits reduced by 30– 35%. The validated DTS questionnaire confirmed high scores for satisfaction, convenience, flexibility, and better understanding of GDM. Health economics Simple texting in pregnancy may result in NHS savings: reduced travel costs, carbon footprint etc. Estimated cost savings: £300/patient/pregnancy (PIH) and £1024/patient/year (GDM).
Summary The NE & N Cumbria AHSN has funded a 1 year
critical evaluation and the results will be available for presentation in April 2015. The project team were finalists in the National EHI Awards – Oct 2014.
O1.2 Rifampicin in the treatment of intrahepatic cholestasis of pregnancy
Geenes, V1; Chambers, J2; Khurana, R3; Wikstrom-Shemer, E4; Sia, W3; Mandair, D5; Elias, E5; Marschall, H-U4; Hague, W6; Williamson, C1 1 Women’s Health Academic Centre, King’s College London, London, United Kingdom; 2Women’s Health Research Centre, Imperial College London, London, United Kingdom; 3Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada; 4Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 5Liver Unit, University of Birmingham Trust Hospital, Birmingham, United Kingdom; 6Robinson Research Institute, University of Adelaide, Adelaida, SA, Australia
Introduction Intrahepatic cholestasis of pregnancy (ICP) is a
common pregnancy-specific liver disease associated with significant risk of adverse perinatal outcomes. The most common treatment for ICP is ursodeoxycholic acid (UDCA). However, UDCA treatment does not provide symptom relief or induce adequate biochemical improvement in all women with ICP. Dual therapy with UDCA and rifampicin has been used with success in other cholestatic liver diseases, and has been shown to be more effective at improving symptoms and biochemistry than UDCAmonotherapy. Methods We performed a questionnaire survey to establish the maternal and perinatal outcomes of 28 ICP-pregnancies treated with combined UDCA-rifampicin therapy. Results In all pregnancies there was a progressive rise in serum bile acids during UDCA-monotherapy [41 mmol/L (IQR 24– 99 mmol/L) to 181.5 mmol/L (IQR 85.5–282 mmol/L)]. In 14 pregnancies (54%) serum bile acids decreased following the introduction of rifampicin [181.5 mmol/L (IQR 85.5–mmol/L) to 102.8 mmol/L (IQR 40.5–149 mmol/L)], and in 10 pregnancies (38%) there was a 50% reduction in serum bile acids. Conclusion These data suggest that combined UDCA-rifampicin treatment may be an effective treatment in women with ICP who do not respond adequately to UDCA-monotherapy.
ª 2015 The Authors BJOG An International Journal of Obstetrics and Gynaecology ª 2015 RCOG
O1.3 Prediction of medically-indicated preterm delivery in women with chronic vascular disease
Myers, J1,2; Martin, J1; Shawkat, E2; Cockerill, R2; Chmiel, C2; Bernatavicius, G2; Horn, J1; Crocker, I1; Johnstone, E1,2 1 University of Manchester, Manchester, United Kingdom; 2Central Manchester NHS Foundation Trust, Manchester, United Kingdom
Introduction Women with chronic hypertension are at increased
risk of maternal and/or fetal complications. This study aimed to determine the utility of vascular compliance and biomarker measurements for the prediction of medically-indicated preterm delivery ( 1.5 L, arterial cord pH