Objectives: To estimate the incidence of breast cancer diagnosed during pregnancy in the UK, to describe its management and short-term outcomes for mothers and babies. Design: A population-based descriptive study using the UK Obstetric Surveillance System (UKOSS). Setting: All UK consultant-led maternity units. Participants: All cases of breast cancer diagnosed first during pregnancy, between 1st October 2015 and 30th September 2017, with 84 confirmed cases analysed. Women with breast cancer diagnosed before pregnancy or with a recurrence were excluded. Method: Prospective case identification through monthly UKOSS mailings. Main outcome measures: Incidence of breast cancer arising for the first time in pregnancy, maternal mortality, severe maternal morbidity, perinatal mortality and severe neonatal morbidity. Results: The incidence found was 5.4/100,000 maternities (95% CI 4.37, 6.70). Nine women (11%) had an IVF pregnancy. During pregnancy, 30 women (36%) underwent surgery and 37 women (44%) received chemotherapy. Three women had major maternal morbidity during pregnancy. Two women died and there were two perinatal deaths. Conclusions: The incidence of breast cancer arising in pregnancy in the UK is similar to that reported in other countries. The higher proportion of IVF pregnancies among these women diagnosed with breast cancer during pregnancy needs further investigation. With caveats, the management followed that outside pregnancy, but there was considerable variation in practice. Although the short-term outcome was in general good for mothers and babies, a larger prospective study is required. It is often possible to avoid exposing the baby to iatrogenic prematurity.
Objective: To describe the processes used to establish and standardise a UK-India collaborative platform for maternal and perinatal health research (MaatHRI). Design: Hospital-based research platform. Setting: India Population: Pregnant women Methods: MaatHRI is adapted from the UK Obstetric Surveillance System (UKOSS) and built on a pilot model (IndOSS-Assam), which has been extensively standardised using the following methods: (i) establishing a network of hospitals; (ii) setting up a secure system for data collection, storage and transfer; (iii) developing a standardised laboratory infrastructure; and (iv) developing and implementing regulatory systems. Results: MaatHRI was established in September 2018. Fourteen hospitals participate across four states in India – Assam, Meghalaya, Uttar Pradesh and Maharashtra. The Indian research team includes 20 nurses, a project manager, 16 obstetricians, two pathologists, a public health specialist, a general physician and a paediatrician. The UK partners include clinicians and epidemiologists from the University of Oxford. MaatHRI has advanced standardisation of data and laboratory parameters, monitoring data and participant safety, and secure transfer of data. An integral component of MaatHRI is bi-directional capacity building. It is overseen by a steering committee and a data safety and monitoring board which ensure equitable partnerships between the collaborating institutions. Conclusion: MaatHRI is the first prototype of UKOSS and other similar platforms in a low and middle income country (LMIC). The model used to develop the platform can be replicated in other LMICs. Funding: Medical Research Council Career Development Award to Manisha Nair (Ref:MR/P022030/1).
Objective: report maternal, fetal and neonatal complications associated with single intrauterine fetal death (sIUFD) in monochorionic twin pregnancies Design: prospective observational study Setting: UK Population: 81 monochorionic twin pregnancies with sIUFD after 14 weeks gestation, irrespective of cause Methods: UKOSS reporters submitted data collection forms using data from hospital records. Main outcome measures: aetiology of sIUFD; surviving co-twin outcomes: perinatal mortality, central nervous system (CNS) imaging, gestation and mode of delivery, neonatal outcomes; post-mortem findings; maternal outcomes. Results: The commonest aetiology was twin-twin transfusion syndrome (38/81, 47%), “spontaneous” sIUFD (22/81, 27%) was second commonest. Death of the co-twin was common (10/70, 14%). Preterm birth (<37 weeks gestation) was the commonest adverse outcome (77%): half were spontaneous and half iatrogenic. Only 46/75 (61%) cases had antenatal CNS imaging, of which 33 cases had known results of which 7/33 (21%) had radiological findings suggestive of neurological damage. Postnatal CNS imaging revealed an additional 7 babies with CNS abnormalities, all born at <36 weeks, including all 4 babies exhibiting abnormal CNS signs. Major maternal morbidity was relatively common, with 6% requiring ITU admission, all related to infection. Conclusions: Monochorionic twin pregnancies with single IUD are complex and require specialist care. Further research is required regarding optimal gestation at delivery of the surviving co-twin, preterm birth prevention, and classifying the cause of death in twin pregnancies. Awareness of the importance of CNS imaging, and follow-up, needs improvement.