A randomized trial comparing oral misoprostol alone with oral misoprostol followed by oxytocin in women induced for hypertension of pregnancy
Lead Research Organisation:
University of Liverpool
Department Name: Institute of Translational Medicine
Abstract
Every year around 30 000 women die from high blood pressure in pregnancy (pre-eclampsia). In South Asia alone it is responsible for 10 000 deaths annually. Many of these deaths are preventable with timely delivery of the baby, which is the only curative treatment. Vaginal delivery is safer than caesarean section (CS) but labour induction in preeclampsia presents additional challenges. It is more difficult as mothers are often preterm and in their first pregnancies, and more dangerous as babies can be growth restricted.
Induction of labour occurs in two stages; softening and opening of the neck of the womb (cervical ripening) followed by stimulation of contractions (augmentation). Our previous study established low dose oral misoprostol (LDOM) as the optimal method for cervical ripening in the low and middle-income country (LMIC) setting, and this is now strongly recommended by the World Health Organization. Standard practice in these settings is cervical ripening with LDOM followed by augmentation using intravenous oxytocin through a gravity drip infusion (M/Ox). However, gravity drip infusions have a high potential for human error and equipment faults, so constant monitoring and accurate titration of oxytocin are essential. Excessive contractions put mothers and babies at risk; whereas inadequate contractions lead to a failed induction. Both these mechanisms could explain the high CS rate (41%) seen in our previous labour induction study 'INFORM' in India. There is an urgent need to establish a safe and effective induction method that does not rely on oxytocin for augmentation.
Avoiding oxytocin and continuing LDOM into labour for augmentation, could have numerous clinical and logistic benefits:
- A cold-chain is not required for LDOM as it is heat stable (unlike oxytocin).
- The lack of an intravenous infusion means that women will be free to mobilise in labour.
- LDOM does not need to be actively monitored or titrated against contractions. It is therefore less work-intensive than an oxytocin infusion, giving health practitioners more time to care for other aspects of the women's labour.
- The simplicity of the protocol may allow task-shifting.
- In the absence of close monitoring, an unattended patient on oxytocin could receive hours of inappropriate stimulation. In contrast, LDOM does not need constant monitoring, the stimulation will cease unless there is drug administration every 2 hours.
- There will be significant health system savings by negating the need for IV infusion pumps and continuous presence of a health practitioner.
A misoprostol-only induction protocol has been successfully used in three randomized trials in South Africa. The trial participants that received a misoprostol-only (M/M) protocol required 40% less CSs compared with those using a standard (M/Ox) protocol (15 vs 26%). Despite promise, these rates cannot be directly compared as they occurred in different trials. Indeed, no published study has ever directly compared the two protocols.
We propose a randomized superiority trial in three large government hospitals in Nagpur, India. 1000 pregnant women with hypertensive disease will be randomly allocated to use the conventional (M/Ox) protocol or the misoprostol only (M/M) protocol. The primary objective is to investigate whether a misoprostol only labour induction (M/M) protocol, compared to the standard protocol (M/Ox), can reduce the rate of CS in women undergoing labour induction for pre-eclampsia in low-income settings. We also propose a qualitative study, a situational analysis and an economic evaluation to be conducted alongside the trial. The objectives of these studies are: to explore care providers' perspectives on the potential advantages, barriers and risks of each protocol; understand current knowledge, attitudes and practices concerning induction of labour; and compare the cost-effectiveness of the protocols.
Induction of labour occurs in two stages; softening and opening of the neck of the womb (cervical ripening) followed by stimulation of contractions (augmentation). Our previous study established low dose oral misoprostol (LDOM) as the optimal method for cervical ripening in the low and middle-income country (LMIC) setting, and this is now strongly recommended by the World Health Organization. Standard practice in these settings is cervical ripening with LDOM followed by augmentation using intravenous oxytocin through a gravity drip infusion (M/Ox). However, gravity drip infusions have a high potential for human error and equipment faults, so constant monitoring and accurate titration of oxytocin are essential. Excessive contractions put mothers and babies at risk; whereas inadequate contractions lead to a failed induction. Both these mechanisms could explain the high CS rate (41%) seen in our previous labour induction study 'INFORM' in India. There is an urgent need to establish a safe and effective induction method that does not rely on oxytocin for augmentation.
Avoiding oxytocin and continuing LDOM into labour for augmentation, could have numerous clinical and logistic benefits:
- A cold-chain is not required for LDOM as it is heat stable (unlike oxytocin).
- The lack of an intravenous infusion means that women will be free to mobilise in labour.
- LDOM does not need to be actively monitored or titrated against contractions. It is therefore less work-intensive than an oxytocin infusion, giving health practitioners more time to care for other aspects of the women's labour.
- The simplicity of the protocol may allow task-shifting.
- In the absence of close monitoring, an unattended patient on oxytocin could receive hours of inappropriate stimulation. In contrast, LDOM does not need constant monitoring, the stimulation will cease unless there is drug administration every 2 hours.
- There will be significant health system savings by negating the need for IV infusion pumps and continuous presence of a health practitioner.
A misoprostol-only induction protocol has been successfully used in three randomized trials in South Africa. The trial participants that received a misoprostol-only (M/M) protocol required 40% less CSs compared with those using a standard (M/Ox) protocol (15 vs 26%). Despite promise, these rates cannot be directly compared as they occurred in different trials. Indeed, no published study has ever directly compared the two protocols.
We propose a randomized superiority trial in three large government hospitals in Nagpur, India. 1000 pregnant women with hypertensive disease will be randomly allocated to use the conventional (M/Ox) protocol or the misoprostol only (M/M) protocol. The primary objective is to investigate whether a misoprostol only labour induction (M/M) protocol, compared to the standard protocol (M/Ox), can reduce the rate of CS in women undergoing labour induction for pre-eclampsia in low-income settings. We also propose a qualitative study, a situational analysis and an economic evaluation to be conducted alongside the trial. The objectives of these studies are: to explore care providers' perspectives on the potential advantages, barriers and risks of each protocol; understand current knowledge, attitudes and practices concerning induction of labour; and compare the cost-effectiveness of the protocols.
Technical Summary
Every year approximately 30 000 women die from hypertensive disease in pregnancy. Magnesium sulphate and anti-hypertensives reduce morbidity, but delivery is the only cure.
Low dose oral misoprostol, a prostaglandin E1 analogue, is the optimal method for labour induction in low resource settings. Usually, once active labour has commenced, the misoprostol is replaced with an intravenous oxytocin infusion (M/Ox). Some studies have shown that you can continue oral misoprostol into active labour (M/M protocol). In the Cochrane review on labour induction, those on the M/M protocol had 42% less CSs than those on the M/Ox protocol (15% vs 26%). This protocol may also be simpler, safer and more acceptable to women. However, these two protocol have never been directly compared.
We propose a pragmatic, open-label, randomised trial to compare an M/M labour induction protocol with the standard M/Ox protocol. We will recruit 1000 women with hypertensive disease of pregnancy over 24 months in 3 Indian government hospitals. After informed consent, the treatment will be allocated using sequentially numbered, sealed envelopes. The M/M group will be induced using oral misoprostol tablets (25 mcg) every 2 hours for a maximum of 12 doses, with artificial rupture of membranes (ARM) once in active labour. In the M/Ox arm, the misoprostol will be replaced with an intravenous oxytocin infusion following ARM if a good contraction pattern hasn't established.
The primary outcome will be caesarean section. Secondary outcomes will assess the efficacy of the induction process, maternal and fetal/neonatal complications and the relative cost-effectiveness. The Mother-Generated Index will be used to assess satisfaction alongside individual in-depth interviews with staff and patients. A situational analysis will explore health providers' knowledge, attitudes and practices regarding the use of uterotonics in labour in two districts adjacent to Nagpur.
Low dose oral misoprostol, a prostaglandin E1 analogue, is the optimal method for labour induction in low resource settings. Usually, once active labour has commenced, the misoprostol is replaced with an intravenous oxytocin infusion (M/Ox). Some studies have shown that you can continue oral misoprostol into active labour (M/M protocol). In the Cochrane review on labour induction, those on the M/M protocol had 42% less CSs than those on the M/Ox protocol (15% vs 26%). This protocol may also be simpler, safer and more acceptable to women. However, these two protocol have never been directly compared.
We propose a pragmatic, open-label, randomised trial to compare an M/M labour induction protocol with the standard M/Ox protocol. We will recruit 1000 women with hypertensive disease of pregnancy over 24 months in 3 Indian government hospitals. After informed consent, the treatment will be allocated using sequentially numbered, sealed envelopes. The M/M group will be induced using oral misoprostol tablets (25 mcg) every 2 hours for a maximum of 12 doses, with artificial rupture of membranes (ARM) once in active labour. In the M/Ox arm, the misoprostol will be replaced with an intravenous oxytocin infusion following ARM if a good contraction pattern hasn't established.
The primary outcome will be caesarean section. Secondary outcomes will assess the efficacy of the induction process, maternal and fetal/neonatal complications and the relative cost-effectiveness. The Mother-Generated Index will be used to assess satisfaction alongside individual in-depth interviews with staff and patients. A situational analysis will explore health providers' knowledge, attitudes and practices regarding the use of uterotonics in labour in two districts adjacent to Nagpur.
Planned Impact
Who might benefit from this research?
This research to establish the optimal induction labour method in LMIC is critical to preventing morbidity and mortality from pre-eclampsia. Approximately 30,000 women die every year from preeclampsia, and many more suffer complications or stillbirth. Virtually all these deaths take place in LMICs, and could be prevented with prompt delivery, the only cure for the disease. This depends on having a safe, effective induction protocol that is acceptable to women, cost-effective and widely available.
Research has previously focussed on the higher cost prostaglandins. However it is clear that the global burden of pre-eclampsia cannot be reduced unless low-cost solutions are developed to assist those who cannot afford expensive medications. Misoprostol is an effective low cost solution to this problem, but has not been available in a suitable form. Recently, however, a low cost, high quality oral misoprostol 25mcg tablet has been produced (Cipla, Mumbai) for labour induction, making effective induction methods available to vast numbers of poorer Indian women. If we can demonstrate the effectiveness of an 'all oral misoprostol' induction regimen, it will allow labour induction to be conducted at a lower level of health facilities. In this way it could reach the very poorest in society, those most vulnerable to the complications of pre-eclampsia.
The large numbers in the study and the use of intravenous infusion pumps for the oxytocin in the M/Ox arm will make the results generalisable beyond LMICs. If effective, it will also benefit women in richer settings who, understandably, would prefer a method of induction in which vaginal drug administration, intravenous cannulation and restrictive infusion sets are avoided. The results will also be of great interest to those who fund health services, as an effective, low cost induction method would be welcomed worldwide.
How might they benefit from this research?
This research has the potential to save the lives of many mothers and babies around the world. Moreover, with the centrality of women to family life throughout the world, the impact of a maternal life saved spreads far beyond that woman to her children, family and community. Developing strategies to prevent maternal death is therefore highly cost effective as a public health intervention.
Caesarean section in LMIC settings carries high risks of morbidity and mortality, especially so in pre-eclampsia when mothers can already be critically unwell. Any intervention that reduces caesarean section will benefit mothers by averting complications such as sepsis, haemorrhage, anaesthetic complications, and risks in future pregnancies.
Intrapartum oxytocin infusions are recognised to be associated with poor fetal outcomes [18]. This is related to the need for constant titration against effect, as well as the potential for overdose unless carefully monitored. Low dose oral misoprostol (LDOM) has the potential to be far safer for these vulnerable, often growth restricted fetuses, thus reducing rates of both stillbirth and cerebral palsy that can result from intrapartum hypoxia.
Oral dosing and the freedom to mobilize in labour are additional benefits to women themselves. A LDOM protocol may be less work-intensive, giving health practitioners more time to care for other aspects of the women's condition. The implementation of a misoprostol-only protocol has logistical advantages: no cold chain is required, and there are greater opportunities for task-shifting within facilities. This could increase access to this key intervention. Health systems could make significant savings by negating the need for intravenous infusion pumps, the continual presence of a highly trained health practitioner and reduced resources required for caesarean sections. If so, then it will also release resources for other health care interventions and other parts of the health system.
This research to establish the optimal induction labour method in LMIC is critical to preventing morbidity and mortality from pre-eclampsia. Approximately 30,000 women die every year from preeclampsia, and many more suffer complications or stillbirth. Virtually all these deaths take place in LMICs, and could be prevented with prompt delivery, the only cure for the disease. This depends on having a safe, effective induction protocol that is acceptable to women, cost-effective and widely available.
Research has previously focussed on the higher cost prostaglandins. However it is clear that the global burden of pre-eclampsia cannot be reduced unless low-cost solutions are developed to assist those who cannot afford expensive medications. Misoprostol is an effective low cost solution to this problem, but has not been available in a suitable form. Recently, however, a low cost, high quality oral misoprostol 25mcg tablet has been produced (Cipla, Mumbai) for labour induction, making effective induction methods available to vast numbers of poorer Indian women. If we can demonstrate the effectiveness of an 'all oral misoprostol' induction regimen, it will allow labour induction to be conducted at a lower level of health facilities. In this way it could reach the very poorest in society, those most vulnerable to the complications of pre-eclampsia.
The large numbers in the study and the use of intravenous infusion pumps for the oxytocin in the M/Ox arm will make the results generalisable beyond LMICs. If effective, it will also benefit women in richer settings who, understandably, would prefer a method of induction in which vaginal drug administration, intravenous cannulation and restrictive infusion sets are avoided. The results will also be of great interest to those who fund health services, as an effective, low cost induction method would be welcomed worldwide.
How might they benefit from this research?
This research has the potential to save the lives of many mothers and babies around the world. Moreover, with the centrality of women to family life throughout the world, the impact of a maternal life saved spreads far beyond that woman to her children, family and community. Developing strategies to prevent maternal death is therefore highly cost effective as a public health intervention.
Caesarean section in LMIC settings carries high risks of morbidity and mortality, especially so in pre-eclampsia when mothers can already be critically unwell. Any intervention that reduces caesarean section will benefit mothers by averting complications such as sepsis, haemorrhage, anaesthetic complications, and risks in future pregnancies.
Intrapartum oxytocin infusions are recognised to be associated with poor fetal outcomes [18]. This is related to the need for constant titration against effect, as well as the potential for overdose unless carefully monitored. Low dose oral misoprostol (LDOM) has the potential to be far safer for these vulnerable, often growth restricted fetuses, thus reducing rates of both stillbirth and cerebral palsy that can result from intrapartum hypoxia.
Oral dosing and the freedom to mobilize in labour are additional benefits to women themselves. A LDOM protocol may be less work-intensive, giving health practitioners more time to care for other aspects of the women's condition. The implementation of a misoprostol-only protocol has logistical advantages: no cold chain is required, and there are greater opportunities for task-shifting within facilities. This could increase access to this key intervention. Health systems could make significant savings by negating the need for intravenous infusion pumps, the continual presence of a highly trained health practitioner and reduced resources required for caesarean sections. If so, then it will also release resources for other health care interventions and other parts of the health system.
Publications
Bracken H
(2021)
Oral Misoprostol alone versus oral misoprostol followed by oxytocin for labour induction in women with hypertension in pregnancy (MOLI): protocol for a randomised controlled trial
in BMC Pregnancy and Childbirth
Kemper JI
(2021)
Foley catheter vs oral misoprostol for induction of labor: individual participant data meta-analysis.
in Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
Kerr RS
(2021)
Low-dose oral misoprostol for induction of labour.
in The Cochrane database of systematic reviews
Kumar N
(2021)
Misoprostol for labour induction.
in Best practice & research. Clinical obstetrics & gynaecology
Leigh S
(2018)
Foley catheter vs. oral misoprostol to induce labour among hypertensive women in India: a cost-consequence analysis alongside a clinical trial.
in BJOG : an international journal of obstetrics and gynaecology
Lightly K
(2020)
Authors' reply re: Induction of labour should be offered to all women at term: FOR: Induction of labour should be offered at term.
in BJOG : an international journal of obstetrics and gynaecology
Lightly K
(2020)
Authors' reply re: Induction of labour should be offered to all women at term.
in BJOG : an international journal of obstetrics and gynaecology
Lightly K
(2021)
Authors' reply re: Induction of labour should be offered to all women at term. FOR: Induction of labour should be offered at term.
in BJOG : an international journal of obstetrics and gynaecology
Lightly K
(2019)
Induction of labour should be offered to all women at term FOR: Induction of labour should be offered at term
in BJOG: An International Journal of Obstetrics & Gynaecology
Symon A
(2023)
Introducing the participant-generated experience and satisfaction (PaGES) index: a novel, longitudinal mixed-methods evaluation tool.
in BMC medical research methodology
Sørbye IK
(2020)
Induction of labor and nulliparity: A nationwide clinical practice pilot evaluation.
in Acta obstetricia et gynecologica Scandinavica
Weeks AD
(2022)
Induction of labour: first, do no harm.
in Lancet (London, England)
Weeks AD
(2018)
Foley catheterisation versus oral misoprostol to induce labour - Author's reply.
in Lancet (London, England)
Description | PROBIT-F Trial Steering Committee (Prostaglandin insert (Propess) versus trans-cervical balloon catheter for out-patient labour induction: A randomised controlled trial of feasibility) |
Geographic Reach | National |
Policy Influence Type | Participation in a guidance/advisory committee |
Title | The Induction with Foley OR Misoprostol (INFORM) Study, 2013-2015 |
Description | This is the published dataset from the INFORM study. |
Type Of Material | Database/Collection of data |
Year Produced | 2021 |
Provided To Others? | Yes |
Impact | None as yet. |
URL | https://reshare.ukdataservice.ac.uk/854663/ |
Description | WHO Collaborating Centre for Research and Research Synthesis in Reproductive Health |
Organisation | World Health Organization (WHO) |
Department | Department of Reproductive Health and Research |
Country | Global |
Sector | Academic/University |
PI Contribution | The Terms of Reference are: 1. Collaborate in research synthesis to support the translation of evidence-based research findings into WHO policy and services in the area of maternal and newborn health |
Collaborator Contribution | To advise on research proposals and protocols, contribute to Trial Steering Groups |
Impact | The WHO officers contribute to all the research proposals within the Sanyu Research Unit by commenting on the protocols. In addition, Julie Storr was a co-investigator on the BabyGel Study and Metin Gulmezoglu chaired the Steering Committee for INFORM study. |
Start Year | 2012 |
Description | All India Congress of Obstetrics and Gynaecology 2023 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | One hour dissemination session within the conference to present the results of the MOLI study. |
Year(s) Of Engagement Activity | 2023 |
Description | Annual meeting of European WHO Collaborating Centres in Edinburgh |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Annual meeting of European WHO Collaborating Centres at which we each present our ongoing work. |
Year(s) Of Engagement Activity | 2018 |
Description | BMFMS 2022 Conference, Birmingham |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Two day national conference, I gave a keynote lecture on wellbeing of the workforce and I supported my PhD student as she presented the MOLI study. |
Year(s) Of Engagement Activity | 2022 |
Description | BMFMS Edinburgh - session on global maternal health |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Professor Andrew Weeks gave a lecture on causes of maternal deaths in LMIC. |
Year(s) Of Engagement Activity | 2019 |
Description | Beyond the Research talk - Institute of Medical Sciences, Nagpur, India |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Talking about dissemination of research results in Institute of Medical Sciences in Nagpur, India at MOLI study launch. |
Year(s) Of Engagement Activity | 2019 |
Description | Conducting research in low income settings talk |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Undergraduate students |
Results and Impact | Conducting research in low income settings talk for The British Undergraduate Society of Obstetrics and Gynaecology. |
Year(s) Of Engagement Activity | 2021 |
Description | European Congress on Intrapartum Care (ECIC) 2021 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Talk on the examining pathways in the induction of labour. |
Year(s) Of Engagement Activity | 2021 |
Description | GLOW 2020 Conference organisation |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Prof Andrew Weeks chaired the GLOW 2020 organising committee and also took part at the conference as a moderator and presenter (decolonising global health, running an online conference). |
Year(s) Of Engagement Activity | 2020 |
Description | GLOW Conference 2022, Birmingham. |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | I attended the GLOW 2022 conference, which I had helped arrange. I gave a presentation on instrumental birth in low and middle income countries. One of my PhD students gave a presentation on the fetal monitoring study (part of MOLI study). |
Year(s) Of Engagement Activity | 2022 |
Description | GLOW conference debate chair |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | I am on the steering committee for the GLOW Society (Global Women's Health) that has a conference every 1-2 years. In this year conference in Cambridge I chaired a round-table discussion with female African scientists about the role of women in science. |
Year(s) Of Engagement Activity | 2018 |
Description | Global Health CSG |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | I sit on the RCOG Global Maternal Health Clinical Study Group. This meets 3 times per year to co-ordinate global maternal health activity. |
Year(s) Of Engagement Activity | 2018 |
Description | Guideline Development Group meeting to update recommendations related to induction of labour (timing, setting, and the use of mechanical methods). |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | GDG meeting to update recommendations related to Induction of labour (timing, setting, and the use of mechanical methods). |
Year(s) Of Engagement Activity | 2021 |
Description | India Birth Network Annual Meeting |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Hybrid conference of the India Birth Network, which I helped organise. |
Year(s) Of Engagement Activity | 2022 |
Description | India Birth Network event |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Talk on misoprostol. |
Year(s) Of Engagement Activity | 2021 |
Description | India Birth Network two-day workshop |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Two-day workshop on developing research links with India. |
Year(s) Of Engagement Activity | 2022 |
Description | Induction of Labour Community of Practice, University of Birmingham |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Myself and a colleague set up the community of practice to improve the care of women undergoing IOL throughout UK. I helped set up the meeting and ran one of discussion groups. |
Year(s) Of Engagement Activity | 2023 |
Description | Induction of labour: weighing up the harms and benefits, Oslo, Norway |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Professor Andrew Weeks gave a keynote lecture on 'Induction of labour: weighing up the harms and benefits' at an IOL meeting in Oslo, Norway. |
Year(s) Of Engagement Activity | 2020 |
Description | Interview for Project Saturn |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Industry/Business |
Results and Impact | Development of cohort study with industrial partners. |
Year(s) Of Engagement Activity | 2022 |
Description | Lecture for German Society for Perinatal Medicine |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Lecture on outpatient induction "Outpatient cervical ripening for all?" |
Year(s) Of Engagement Activity | 2021 |
Description | Lecture on Global Women's Health for medical students |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Undergraduate students |
Results and Impact | Lecture for Year 3 medical students on global women's health. |
Year(s) Of Engagement Activity | 2020 |
Description | Lecture on Normal Labour |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Undergraduate students |
Results and Impact | A lecture to the undergraduate SNOGS (Students in Neonatology, Obstetrics and Gynaecology Society) conference. |
Year(s) Of Engagement Activity | 2018 |
Description | MOLI Study restart training |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Professional Practitioners |
Results and Impact | Presentation delivered for the research team at the MOLI Study restart training. |
Year(s) Of Engagement Activity | 2020 |
Description | NIHR GCRF Stillbirth Advisory Board |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | I am a member of the advisory group for the University of Manchester Stillbirth project (funded by NIHR Grand Challenges Research Fund). The project seeks to explore the causes of stillbirth in African countries. |
Year(s) Of Engagement Activity | 2018 |
Description | NVOG Gynaecongres, Amsterdam: 'Working in the global health arena: challenges and opportunities' |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Professor Andrew Weeks gave a keynote lecture 'Working in the global health arena: challenges and opportunities' at the NVOG Gynaecongres in Amsterdam, Netherlands, to launch their global health programme. |
Year(s) Of Engagement Activity | 2019 |
Description | Oral prostaglandins from bench to bedside: 40 years of non-commercial development |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Postgraduate students |
Results and Impact | 45-minute lecture to postgraduate students on "Oral prostaglandins from bench to bedside: 40 years of non-commercial development". |
Year(s) Of Engagement Activity | 2022 |
Description | Outreach - teaching of midwifery students at LJMU |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Undergraduate students |
Results and Impact | Lecture on global health for LJMU midwifery students. |
Year(s) Of Engagement Activity | 2020 |
Description | Presentation on Medicalisation of Childbirth |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Presentation on Medicalisation of Childbirth at ATSM Advanced Labour Ward Practice Course 13 - 15 January 2021 |
Year(s) Of Engagement Activity | 2021 |
Description | Public engagement on social media in relation to 'Authors' reply re: Induction of labour should be offered to all women at term.' article |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | Discussion about induction of labour to prevent stillbirth and also about routine IOL. |
Year(s) Of Engagement Activity | 2019 |
Description | RCOG Congress 2022, London. |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | I attended the RCOG Congress to support my PhD student presenting the qualitative work from the MOLI study. |
Year(s) Of Engagement Activity | 2022 |
Description | RCP ICH Group 'The appropriate technology to achieve UHC' |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Professor Andrew Weeks gave a lecture on the use of appropriate technology to achieve universal health care to the Royal College of Physicians, International Child Health Group. |
Year(s) Of Engagement Activity | 2019 |
Description | Talk at the British Intrapartum Care Society - Virtual Conference 2020 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Talk on medicalisation of childbirth at the British Intrapartum Care Society - Virtual Conference 2020, 23 November 2020. |
Year(s) Of Engagement Activity | 2020 |
Description | Talk at the RCOG Annual Professional Development conference. |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Lecture given at the RCOG APD conference on overcoming the challenges of intrapartum research. |
Year(s) Of Engagement Activity | 2020 |
Description | Talk at the WMCH Science Club Meeting |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Professional Practitioners |
Results and Impact | Talk on "Optimising protocols for induction of labour" at the WMCH Science Club Meeting. |
Year(s) Of Engagement Activity | 2020 |
Description | Teaching LSTM Diploma in sexual and reproductive health (DSRH) students |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Postgraduate students |
Results and Impact | Discussion with LSTM DSRH students. |
Year(s) Of Engagement Activity | 2020 |
Description | The INFORM Study results |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | I gave an invited lecture at the ISSHP (International Society for the study of hypertension in pregnancy) in Amsterdam entitled: Trials in low-resourced setting. The INFORM study (oral misoprostol versus balloon induction in women with PIH or Preeclampsia). |
Year(s) Of Engagement Activity | 2018 |
Description | Women's Voices in African Low Income Settings |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | This was a working group set up to take forward the concept of PPI (Patient and public involvement) in research in low income settings. Interested parties came from Leicester, London, Liverpool and Uganda to develop a funding application. |
Year(s) Of Engagement Activity | 2018 |