Objective: Preventing recurrent miscarriage is a top research priority, for which luteal phase progesterone is a potential treatment.  A systematic review was conducted to investigate the available evidence on luteal phase progesterone supplementation to reduce miscarriage, increase live birth rate and improve pregnancy outcomes in women and birthing people with a history of unexplained recurrent miscarriage. Evidence review: Pubmed, Cochrane Library, Ovid MEDLINE, Ovid EMBASE, CINAHL and ClinicalTrials.gov were systematically searched in 05/2025 to identify English-language, peer-reviewed, randomised-controlled trials and observational studies involving human participants published from the year 2000 onwards. This study adhered to PRISMA guidelines. Participants had a history of unexplained recurrent miscarriage who were prescribed luteal phase progesterone or placebo/usual care. Primary outcomes were miscarriage and live birth. Additional outcomes were informed by the miscarriage prevention core outcome set. Two independent reviewers conducted screening and study selection. Our protocol was pre-registered (PROSPERO CRD:420250653486).   Results: A systematic search yielded 6722 studies. None of the 47 articles that underwent full text review met eligibility criteria. Three observational studies were identified however, due to differences in population characteristics or study design, none were eligible for inclusion. This highlights a significant gap in evidence.  Conclusion: No evidence was identified linking luteal phase progesterone treatment to a reduction in miscarriage or increase in live births in women and birthing people with a history of unexplained recurrent miscarriage. A feasibility trial investigating treatment acceptability and adherence is proposed. This will subsequently support a definitive trial assessing clinical effectiveness, providing high quality evidence on luteal progesterone supplementation in recurrent miscarriage care. 

Objectives: To understand differences between birth expectations and experiences, and to explore possible reasons for mismatches. Design: Online survey Setting: UK Population: Postnatal primiparous (PP) and multiparous (MP) women within 5 years of a birth Methods: Survey advertised on social media, Participants completed questions relating to birth expectations, experience and preparedness. Data were analysed descriptively and presented overall and by parity. Results: Of the 819 women, 40% expected birth to be straightforward [PP 29% vs MP 51%], 20% anticipated difficulty [PP 22% vs MP 19%], and 40% [PP 51% vs MP 30%] were unsure. Among the 737/819 whose birth was not exactly as expected, 44% [PP 30% vs MP 47%] found it better than expected, while 56% [PP 66% vs MP 38%] found it more difficult. Unplanned births were higher in those with difficult experiences, particularly for primiparous women [PP 58% vs MP 23%]. Women cited quicker births, fewer complications, and better coping as reasons for positive experiences, while complications, pain, and slower labour contributed to difficulties. Overall, 77% (633/819) [PP 64% vs MP 80%] of women felt very or somewhat prepared for birth. Among them, 76% (484/633) [PP 88% vs MP 69%] had attended antenatal education. However similarly, 75% (130/174) [PP 80% vs MP 66%] of those who felt less prepared had also attended antenatal education. Conclusions: Most women have an element of expectation-experience mismatch. Over half in the found birth more difficult than expected, this suggests current approaches to birth preparation may be inadequate. Further research into reducing the expectations-experience gap is needed.

Objective: To design and validate an instrument to measure birth expectations (EXPECTBirth). Design: Mixed methods instrument development study Setting: Online maternity services users and in-person at a maternity unit Population: Pregnant women Methods: 1) systematic review of birth expectations to identify instrument content, 2) think aloud interviews to iteratively develop instrument, 3) online survey for exploratory analysis and item reduction, 4) Rasch analysis to select best functioning items and 5) responsiveness to change test was assessed using data from an antenatal education intervention development study 6) test-retest reliability using responses from 3, 7) external validity compared to existing gold standard. Main outcome measures: EXPECTBirth tool for assessment of expectations of birth which can be positive, negative or neutral. Results: An initial 45 item questionnaire was developed based on the systematic review and modified in 14 think aloud interviews. 255 women completed the online questionnaire (elements 3,6,7) and 110 participated in the antenatal education intervention (elements 4&5). The applied statistical procedures led to a 12-item tool for measuring birth expectations that presents satisfactory overall responsiveness to change (Cohen’s average effect size 0.35, showing moderate responsiveness), test-retest reliability (Spearman Co-efficient 0.83 p<0.001) and performs well against the existing gold standard Slade-Pais tool, all subscales being at least moderately correlated (rho 0.25 and 0.71). Conclusions: The EXPECTBirth tool can be used to assess expectations of birth quickly and in a neutral manner. It can be used to investigate whether antenatal interventions alter expectations of birth, or whether expectations vary within and between groups.

Objective Spontaneous vaginal births are often the presumed choice and represent 45% of UK births. However, information is inconsistently given about benefits and risks. This impacts decision-making and experience. A Core Information Set (CIS) is an agreed set of information points discussed prior to a decision. We aimed to develop a CIS for vaginal birth. Design Information points were identified from a literature search, patient information leaflets, interviews, and a survey. These informed a two-round Delphi survey, where stakeholders voted on the importance of items for inclusion. Items supported by >80% of participants were discussed by 28 parents and professionals at consensus meetings. The final CIS was populated with an engagement group ensuring accessibility. Setting The study took place in the UK, with participants recruited online. Population Pregnant and postnatal women, birth partners, healthcare professionals, medico-legal professionals and people working for interested/relevant organisations. Main outcome A CIS for vaginal birth. Results 77 information items were identified. In round 1 (631 participants) of the Delphi Survey, 84.5% were from the patient group and 15.5% from the professional group; in round 2 (228 participants), 74.3% were from the patient group and 25.7% from the professional group. 28 items met the criteria for consensus discussion. The final CIS includes 19 information points addressing: labour process, pain relief, labour complications, procedures or interventions during labour, experiences after birth, outcomes for the baby and environment during labour. Conclusions This CIS can be used to facilitate discussions and support informed decision-making about vaginal birth.

Objective To develop a core outcome set for stillbirth care. Design Consensus development study. Setting International. Population 542 participants from 29 countries, including 381 parents or family members who have experienced stillbirth, 192 care professionals and researchers (31 of which identified as both parent and professional). Methods Modified Delphi method and Modified Nominal Group Technique. Results A long list of 108 potential outcomes was developed by combining outcomes reported in 240 stillbirth care studies with those derived from interviews of 40 parents and family members with lived experience of stillbirth. Following a two-round Delphi process with consensus meetings, stakeholders agreed upon 8 core outcomes to measure in all stillbirth care studies; an additional 11 outcomes for specific interventions or care were also decided. Core outcomes for all stillbirth care studies were life-threatening complications and maternal death, parents’ experience of respectful and supportive care, grief, mental health and emotional wellbeing, isolation, stigma, impact on work, impact on relationship with immediate family. Outcomes for studies assessing interventions to understand the cause of stillbirth (investigations): cause of death identified and parents’ understanding of cause of death. Outcomes in studies assessing subsequent pregnancy after stillbirth: antenatal complications for mother, antenatal complications for baby, survival of baby, neonatal outcomes and attachment to baby. Outcomes for when a stillbirth occurs in a multiple pregnancy: Survival of other baby/ies, preterm birth, pregnancy complications for baby/ies and neonatal outcomes. Conclusion This core outcome set for stillbirth care should now be used in future trials and systematic reviews to ensure that outcomes considered important by a range of stakeholders are addressed, and to minimise outcome reporting bias.

Objective: International consensus about best diagnostic and care practices for gestational diabetes mellitus (GDM) is limited. We explored variations in GDM practices in relation to national guidelines in the UK, Ireland and Australia. Design: Cross-sectional online survey Setting: UK, Irish and Australian maternity services. Sample: Healthcare professionals providing pregnancy diabetes care. Methods: Questions addressed guidelines used, diagnostic practices and post-diagnosis management. Data were descriptively analysed. Results: Sixty-three maternity units participated (35 England and Wales, 12 Ireland, 16 Australia). 94% of units in England and Wales and Australia used their national guidelines to select women for GDM testing, a wider variety of guidelines were used in Ireland. Over 80% of units across countries undertake risk-factor based GDM testing in early pregnancy. At 24-28 weeks’ gestation, 94% of Australian units used universal screening. Risk factors varied between units and countries at both timepoints, including those outside of guidelines. Diagnostic tests for GDM varied between units and countries, and according to gestation and previous GDM. Insulin was the most common first-line treatment in Australia, whereas in Ireland and England and Wales it was Metformin. Induction and caesarean birth were offered at differing gestations according to unit and country, and according to management strategy. Conclusions: GDM-related practices vary within and between Australia, Ireland and England and Wales. National guidelines are inconsistently applied, which could increase inequalities and impact perinatal outcomes. Further research should address standardised, evidence-informed care and guideline implementation barriers.

Objective To identify outcomes that are important to families, to inform the development of a core outcome set for stillbirth care research. Design Qualitative interview study. Setting A national study in the United Kingdom. Population A diverse sample of parents with a personal history of stillbirth were interviewed. Methods Data collection, coding and analysis were influenced by a modified Grounded Theory approach. Parents’ lived experiences of stillbirth were translated into outcomes for the purpose of developing a core outcome set. Results Forty parents and family members were interviewed. Analysis identified 343 potential care outcomes, 298 (87%) of which have not been previously reported by stillbirth care studies. Outcomes were organised into four major care outcome themes: 1) Clinical 2) Mental health and wellbeing 3) Social and family 4) Future pregnancy and children. Short- and long-term outcomes related to the labour, birth, investigations to understand why a baby had died, stillbirth in a multiple pregnancy, postpartum, psychological and subsequent pregnancy care were reported. Outcomes infrequently measured in previous stillbirth care research yet discussed by most participants were social isolation, impact on occupation and need for mental health support. Parents spoke of the importance of counselling to help them understand their grief, however, the provision of this service was reported to be varied throughout the UK. Conclusion A comprehensive outcome inventory has now been constructed, from which the final core outcome set will be determined. Future care should be developed and evaluated using outcomes that directly relate to the lived experiences of parents and families exposed to stillbirth.

Objective To explore and characterise maternity healthcare professionals’ (MHCPs) experience and practice of informed decision-making (IDM), to inform policy, research and practice development. Design Qualitative focus group study. Setting Online with MHCPs from a single maternity unit in the Southwest of England. Population MHCPs who give information relating to clinical procedures and pregnancy care and are directly involved in decision-making conversations purposively sampled from a single National Health Service (NHS) Trust. Data collection: A semi-structured topic guide was used. Data Analysis: Reflexive thematic analysis . Results Twenty-four participants attended seven focus groups. Two themes were developed: contextualising decision-making and controversies in current decision-making. Contextual factors that influenced decision-making practices included lack of time, and challenges faced in intrapartum care. MHCPs reported variation in how they approach decision-making conversations and asked for more training on how to consistently achieve IDM. There were communication challenges with women/birthing people who do not speak English. Three controversies were explored in the controversies theme: the role of prior clinical experience, the validity of informed consent when women/birthing people were in pain and during emergencies, and instances where women/birthing people declined medical advice. Conclusions We found that MHCPs are committed to IDM but need better support to deliver it consistently. Structured processes including core information sets, communication skills training and the decision support aids may help to standardise the information and better support IDM.

Background: Micro- and nanoplastics are novel pollutants which have been detected in human tissues including placenta and fetal meconium. However, their association with adverse fertility or pregnancy outcomes in humans is not known. Objectives: To synthesise evidence for the presence of micro- and nanoplastics in human reproductive tissue and their associations with environmental exposures and reproductive outcomes. Search Strategy: Medline, Embase, Emcare, CINAHL, ClinicalTrials.gov and ICTRP were searched from inception to 03/02/2023. Selection Criteria: Studies of human participants, assessing presence of micro- and nanoplastics in reproductive tissues, environmental exposures to micro- and nanoplastics, and fertility or pregnancy-related outcomes. Data Collection and Analysis: Two independent reviewers selected studies and extracted data on study characteristics, microplastics detected, environmental exposures, reproductive outcomes, and risk of bias. Narrative synthesis was performed due to methodological heterogeneity. Main Results: Of 1094 citations, seven studies were included, covering 96 participants. Microplastics were detected in 68 out of 96 placentas examined across all studies, and in all 14 meconium samples. Two studies reported associations between lifestyle factors (daily water intake, use of scrub cleanser or toothpaste, bottled water and takeaway food) and placental microplastics. One study reported associations between meconium microplastics and microbiota diversity and composition. One reported placental microplastics levels correlated with reduced birth weights and 1-minute Apgar scores. All studies had a very high risk of bias. Conclusions: There is a need for high-quality observational studies to assess the effects of microplastics on human reproductive health. Funding: None received Keywords: microplastics, nanoplastics, pregnancy, fertility, environmental pollution

Background A core outcome set could address inconsistent outcome reporting and improve evidence for stillbirth care research, which has been identified as an important research priority. Objectives To identify outcomes and outcome measurement instruments reported by studies evaluating interventions after the diagnosis of a stillbirth. Search strategy Amed, BNI, CINAHL, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO, and WHO ICTRP from 1998 to August 2021. Selection criteria Randomised and non-randomised comparative or non-comparative studies reporting a stillbirth care intervention. Data collection and analysis Interventions, outcomes reported, definitions and outcome measurement tools were extracted. Main results 40 randomised and 200 non-randomised studies were included. 58 different interventions were reported, labour and birth care (52 studies), hospital bereavement care (28 studies), clinical investigations (116 studies), care in a multiple pregnancy (2 studies), psychosocial support (28 studies) and care in a subsequent pregnancy (14 studies). 391 unique outcomes were reported and organised into 14 outcome domains: labour and birth; postpartum; delivery of care; investigations; multiple pregnancy; mental health; emotional functioning; grief and bereavement; social functioning; relationship; whole person; subsequent pregnancy; subsequent children and siblings and economic. 242 outcome measurement instruments were used, with 0-22 tools per outcome. Conclusions Heterogeneity in outcome reporting, outcome definition and measurement tools in care after stillbirth exists. Considerable research gaps on specific intervention types in stillbirth care were identified. A core outcome set is needed to standardise outcome collection and reporting for stillbirth care research.