Recent publications
Planned delivery or expectant management for late preterm pre-eclampsia in low-income and middle-income countries (CRADLE-4): a multicentre, open-label, randomised controlled trial
A Beardmore-Gray, N Vousden, P Seed, B Vwalika, S Chinkoyo, V Sichone, A Kawimbe, U Charantimath, G Katageri, M Bellad, L Lokare, K Donimath, S Bidri, S Goudar, J Sandall, L Chappell, A Shennan, on behalf of the CRADLE-4 Study Group. Published 29 June 2023. Objective: Planned delivery or expectant management for late preterm pre-eclampsia in low-income and middle-income countries (CRADLE-4): a multicentre, open-label, randomised controlled trial..
Innovations to reduce maternal mortality and improve health and wellbeing of adolescent girls and their babies in Sierra Leone
C Fernandez Turienzo, L November, M Kamara, P Kamara, V Goodhart, A Ridout, B Sam, S Thomas, P Williams, J Sandall, A Shennan on behalf of CRIBS Collaborative Group. Published 25 November 2022. Objective: The 2YoungLives community engagement mentoring scheme aims to develop simple, scalable innovations to reduce maternal mortality and build research capacity and expertise in Sierra Leone.
Accurate surveillance of maternal deaths is an international priority
AH Shennan, M Green, AE Ridout. Published 16 November 2022. Objective: Variations in maternal mortality remain one of the starkest health injustices in the world
The neutrophil-to-lymphocyte ratio: A low-cost antenatal indicator of placental chorioamnionitis in women who deliver preterm without clinical signs and symptoms of infection
AE Ridout, V Horsley, PT Seed, N Simpson, R Tribe, AH Shennan. Published 1 November 2022. Objective: To explore the relationship between the neutrophil-to-lymphocyte ratio and histological chorioamnionitis in women who delivered preterm with no clinical signs or symptoms of infection.
Placental growth factor testing for suspected pre-eclampsia: a cost-effectiveness analysis
KE Duhig, PT Seed, JE Myers, R Bahl, G Bambridge, S Barnfield, J Ficquet, JC Girling, A Khalil,, AH Shennan, LC Chappell, RM Hunter. Accepted 10 June 2019. Published Online 17 July 2019. Objective: To calculate the cost-effectiveness of implementing PlGF testing alongside a clinical management algorithm in maternity services in the UK, compared with current standard care.
Development and evaluation of a novel Vital Signs Alert device for use in pregnancy in low-resource settings
Hannah L Nathan, Nicola Vousden, Elodie Lawley, Annemarie de Greeff, Natasha L Hezelgrave, Nicola Sloan, Nina Tanna, Shivaprasad S Goudar, Muchabayiwa F Gidiri, Jane Sandall, Lucy C Chappell, Andrew H Shennan Received 9 August 2017. Revised 15 August 2018. Accepted 17 August 2018 Objective: Haemorrhage, hypertension, sepsis and abortion complications (often from haemorrhage or sepsis) contribute to 60% of all maternal deaths. Each is associated with vital signs (blood pressure (BP) and pulse) abnormalities, and the majority of deaths are preventable through simple and timely intervention. This paper presents the development and evaluation of the CRADLE Vital Signs Alert (VSA), an accurate, low-cost and easy-to-use device measuring BP and pulse with an integrated traffic light early warning system. The VSA was designed to be used by all cadres of healthcare providers for pregnant women in low-resource settings with the aim to prevent avoidable maternal mortality and morbidity.
Can a Low-Resource-Use Blood Pressure Device Impact on Global Maternal Mortality?
Elinor Chloe Baker, Andrew van der Westhuizen, Kate E. Duhig & Andrew Shennan Published online: 22 Oct 2010 Objective and methods: To describe how existing antenatal care systems provide a useful and relevant model through which to evaluate the potential for this initiative to be applied in low-resource settings and to offer opportunities for much needed further research.
The BMJ Awards 2020 Entry Form
Pregnant women can develop pre-eclampsia, a common and potentially serious complication. For the last 100 years, we have relied on measuring blood pressure and dipping their urine for protein. But the clinical presentation is varied, with complications occurring before diagnosis is confirmed. Conversely hypertension or proteinuria can occur without progression to pre-eclampsia.
Diagnostic Accuracy of Placental Growth Factor in Women With Suspected Preeclampsia. A Prospective Multicenter Study
Lucy C. Chappell, PhD; Suzy Duckworth, MBBS; Paul T. Seed, CStat; Melanie Griffin, MBChB; Jenny Myers, PhD; Lucy Mackillop, MA; Nigel Simpson, MBBS; Jason Waugh, MBBS; Dilly Anumba, MD; Louise C. Kenny, PhD; Christopher W.G. Redman, MBChir; Andrew H. Shennan, MD Received April 15, 2013; accepted September 3, 2013. Methods and Results: In a prospective multicenter study, we studied the diagnostic accuracy of low plasma PlGF concentration (<5th centile for gestation, Alere Triage assay) in women presenting with suspected preeclampsia between 20 and 35 weeks’ gestation (and up to 41 weeks’ gestation as a secondary analysis).
Evaluation of a novel vital sign device to reduce maternal mortality and morbidity in low-resource settings: a mixed method feasibility study for the CRADLE-3 trial
Nicola Vousden , Elodie Lawley, Hannah L. Nathan, Paul T. Seed, Adrian Brown, Tafadzwa Muchengwa, Umesh Charantimath, Mrutyunjaya Bellad, Muchabayiwa Francis Gidiri, Shivaprasad Goudar, Lucy C. Chappell, Jane Sandall, Andrew H. Shennan and on behalf of the CRADLE Trial Collaborative Group Received: 4 January 2018 Accepted: 9 April 2018. Published online: 27 April 2018 Background: The CRADLE-3 trial is a stepped-wedge randomised controlled trial aiming to reduce maternal mortality and morbidity by implementing a novel vital sign device (CRADLE Vital Sign Alert) and training package into routine maternity care in 10 low-income sites. The MRC Guidance on complex interventions proposes that interventions and implementation strategies be shaped by early phase piloting and development work. We present the findings of a three-month mixed-methodology feasibility study for this trial, describe how this was informed by the MRC guidance and the study design was refined.
Effect of a novel vital sign device on maternal mortality and morbidity in low-resource settings: a pragmatic, stepped-wedge, cluster-randomised controlled trial
Nicola Vousden, Elodie Lawley, Hannah L Nathan, Paul T Seed, Muchabayiwa Francis Gidiri, Shivaprasad Goudar, Jane Sandall, Lucy C Chappell, Andrew H Shennan, on behalf of the CRADLE Trial Collaborative Group Lancet Glob Health 2019; 7: e347–56 Background: In 2015, an estimated 303 000 women died in pregnancy and childbirth. Obstetric haemorrhage, sepsis, and hypertensive disorders of pregnancy account for more than 50% of maternal deaths worldwide. There are effective treatments for these pregnancy complications, but they require early detection by measurement of vital signs and timely administration to save lives. The primary aim of this trial was to determine whether implementation of the CRADLE Vital Sign Alert and an education package into community and facility maternity care in lowresource settings could reduce a composite of all-cause maternal mortality or major morbidity (eclampsia and hysterectomy).
Evaluation of a novel device for the management of high blood pressure and shock in pregnancy in low-resource settings: study protocol for a steppedwedge cluster-randomised controlled trial (CRADLE-3 trial)
Hannah L. Nathan, Kate Duhig, Nicola Vousden, Elodie Lawley, Paul T. Seed, Jane Sandall, Mrutyunjaya B. Bellad, Adrian C. Brown, Lucy C. Chappell, Shivaprasad S. Goudar, Muchabayiwa F. Gidiri, Andrew H. Shennan and the CRADLE-3 Trial Collaboration Group Nathan et al. Trials (2018) 19:206 Background: Obstetric haemorrhage, sepsis and pregnancy hypertension account for more than 50% of maternal deaths worldwide. Early detection and effective management of these conditions relies on vital signs. The Microlife® CRADLE Vital Sign Alert (VSA) is an easy-to-use, accurate device that measures blood pressure and pulse. It incorporates a traffic-light early warning system that alerts all levels of healthcare provider to the need for escalation of care in women with obstetric haemorrhage, sepsis or pregnancy hypertension, thereby aiding early recognition of haemodynamic instability and preventing maternal mortality and morbidity. The aim of the trial was to determine whether implementation of the CRADLE intervention (the Microlife® CRADLE VSA device and CRADLE training package) into routine maternity care in place of existing equipment will reduce a composite outcome of maternal mortality and morbidity in low- and middle-income country populations.
Development of an accurate oscillometric blood pressure device for low resource settings
Annemarie de Greeff, Hannah Nathan, Nina Stafford, Bing Liu and Andrew H. Shennan Received 10 April 2008 Revised 23 June 2008, Accepted 24 June 2008 Background: To assess and develop an accurate blood pressure measurement device for use in low resource settings and by untrained staff, according to the World Health Organisation guidelines.
Incidence of eclampsia and related complications across 10 low- and middleresource geographical regions: Secondary analysis of a cluster randomised controlled trial
Nicola Vousden, Elodie Lawley, Paul T. Seed, Muchabayiwa Francis Gidiri, Shivaprasad Goudar, Jane Sandall, Lucy C. Chappell, Andrew H. Shennan, on behalf of the CRADLE Trial Collaborative Group Received: November 13, 2018, Accepted: March 5, 2019, Published: March 29, 2019 Background: In 2015, approximately 42,000 women died as a result of hypertensive disorders of pregnancy worldwide; over 99% of these deaths occurred in low- and middle-income countries. The aim of this paper is to describe the incidence and characteristics of eclampsia and related complications from hypertensive disorders of pregnancy across 10 low- and middleincome geographical regions in 8 countries, in relation to magnesium sulfate availability.
Exploring the effect of implementation and context on a stepped-wedge randomised controlled trial of a vital sign triage device in routine maternity care in low-resource settings
Nicola Vousden, Elodie Lawley, Paul T. Seed, Muchabayiwa Francis Gidiri, Umesh Charantimath, Grace Makonyola, Adrian Brown, Lomi Yadeta, Rebecca Best, Sebastian Chinkoyo, Bellington Vwalika, Annettee Nakimuli, James Ditai, Grace Greene, Lucy C. Chappell, Jane Sandall, Andrew H. Shennan and on behalf of the CRADLE Trial Collaborative Group Vousden et al. Implementation Science (2019) 14:38 Background: Interventions aimed at reducing maternal mortality are increasingly complex. Understanding how complex interventions are delivered, to whom, and how they work is key in ensuring their rapid scale-up. We delivered a vital signs triage intervention into routine maternity care in eight low- and middle-income countries with the aim of reducing a composite outcome of morbidity and mortality. This was a pragmatic, hybrid effectiveness-implementation stepped-wedge randomised controlled trial. In this study, we present the results of the mixed-methods process evaluation. The aim was to describe implementation and local context and integrate results to determine whether differences in the effect of the intervention across sites could be explained.
Incidence and characteristics of pregnancyrelated death across ten low- and middle-income geographical regions: secondary analysis of a cluster randomised controlled trial
N Vousden, E Holmes, PT Seed, MF Gidiri, S Goudar, J Sandall, S Chinkoyo, LY Kumsa, A Brown, U Charantimath, M Bellad, A Nakimuli, B Vwalika, LC Chappell, AH Shennan, on behalf of the CRADLE Trial Collaborative Group Accepted 22 April 2020. Published Online 2 June 2020 Background: The aim of this article is to describe the incidence and characteristics of pregnancy-related death in low- and middleresource settings, in relation to the availability of key obstetric resources.
The IC2030 Report. Reimagining global health. 30 high-impact innovations to save lives
Steve Davis (President and CEO, PATH), Tore Godal (Special Advisor on Global Health, Ministry of Foreign Affairs, Norway), Christopher Elias (President, Global Development Program, Bill & Melinda Gates Foundation), Ariel Pablos-Méndez (Assistant Administrator for Global Health, US Agency for International Development) July 2015 Background: We stand on the cusp of an unprecedented opportunity—the chance to transform health through the power of innovation, ensuring a brighter future for people in every corner of the globe. Advances in science, technology, and health care delivery are already opening the doors of possibility in ways that were previously unimaginable. The United Nations (UN) Millennium Development Goals catalyzed a new global focus on ending preventable maternal and child deaths, goals that have driven unparalleled progress since 2000. Reimagining Global Health, the inaugural report of the Innovation Countdown 2030 initiative, highlights 30 lifesaving innovations with great promise to accelerate that progress over the next 15 years to reach the proposed health targets of the UN Sustainable Development Goals (SDGs).
Placental growth factor testing to assess women with suspected pre-eclampsia: a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial
Kate E Duhig, Jenny Myers, Paul T Seed, Jenie Sparkes, Jessica Lowe, Rachael M Hunter, Andrew H Shennan, Lucy C Chappell, on behalf of the PARROT trial group Lancet 2019; 393: 1807–18. Published Online April 1, 2019 Background: Previous prospective cohort studies have shown that angiogenic factors have a high diagnostic accuracy in women with suspected pre-eclampsia, but we remain uncertain of the effectiveness of these tests in a real-world setting. We therefore aimed to determine whether knowledge of the circulating concentration of placental growth factor (PlGF), an angiogenic factor, integrated with a clinical management algorithm, decreased the time for clinicians to make a diagnosis in women with suspected pre-eclampsia, and whether this approach reduced subsequent maternal or perinatal adverse outcomes.
Accuracy validation of the Microlife 3AS1-2 blood pressure device in a pregnant population with low blood pressure
Hannah L. Nathan, Annemarie de Greeff, Natasha L. Hezelgrave, Lucy C. Chappell and Andrew H. Shennan Received 19 August 2014 Revised 15 April 2015 Accepted 18 April 2015 Background: To assess the accuracy of the Microlife 3AS1-2 blood pressure (BP) device in pregnant women with low BP to investigate suitability for hypotensive detection in lowincome and middle-income countries.
Development of an accurate oscillometric blood pressure device for low resource settings
Annemarie de Greeff, Hannah Nathan, Nina Stafford, Bing Liu and Andrew H. Shennan Received 10 April 2008, Revised 23 June 2008, Accepted 24 June 2008 Background: To assess and develop an accurate blood pressure measurement device for use in low resource settings and by untrained staff, according to the World Health Organisation guidelines.
An accurate semiautomated oscillometric blood pressure device for use in pregnancy (including pre-eclampsia) in a low-income and middle-income country population: the Microlife 3AS1-2
Hannah L. Nathan, Annemarie de Greeff, Natasha L. Hezelgrave, Lucy C. Chappell and Andrew H. Shennan Received 27 March 2014, Revised 13 August 2014, Accepted 19 August 2014 Background: To assess the accuracy of the Microlife 3AS1-2 blood pressure device in pregnancy and pre-eclampsia in a low-resource setting.
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