ABSTRACT
Background: Magnetic Resonance Imaging (MRI) may be useful as an alternative to perinatal post-mortem autopsy. Our service has high rates of perinatal loss, and low rates of post-mortem autopsy. We have offered post-mortem MRI for the last 5 years, however how MRI is currently being used, have not been reviewed. Aim(s): To describe: (i) the number of perinatal post-mortem MRIs performed, (ii) the reasons for offering MRI, (iii) whether the MRI was contributory to diagnosing cause of perinatal loss or adding extra information. Method(s): Cases were identified crosschecking perinatal loss and radiology data from 2010 to 2021. Anonymised summaries of clinical notes and investigation results of all cases were reviewed by two multidisciplinary groups, each of whom had MRI reports for half of the cases. Congruency of final classification of cause of death was compared and groups reported for each case whether MRI provided new information. Result(s): Between 2018 and 2021 there were 426 perinatal losses, of which 17 were investigated with MRI. In all cases MRI was offered after parents declined autopsy and was performed in addition to other investigations (maternal blood tests, placental karyotype, and histology). MRI changed the final PDC code in 1 case, provided additional findings in 2 cases, confirmed antenatally diagnosed anomalies in 4 cases and was non-contributory to diagnosing cause of death in 11/17 cases. Conclusion(s): In our service, post-mortem MRI has been used infrequently as part of the investigations into perinatal loss. When used, it has been most useful in confirming presence of structural anomalies diagnosed antenatally. Conclusion(s): High COVID-19 community prevalence was associated with increased MROP numbers at our clinical site, but inferences are limited by a lack of standardisation of operative reporting.
ABSTRACT
Background: Diabetes in pregnancy (DIP) affects 6% of pregnancies annually in Aotearoa New Zealand, and 12% of pregnancies in our service at The Whatu Ora Counties Manukau, a multi-ethnic, socioeconomically diverse region. At the onset of the 2020 COVID-19 pandemic, telephone clinics (teleclinics) replaced face-to-face visits for those with DIP. However, there is limited information on the views of patients affected by DIP in Aotearoa about their maternity care, and their care since the COVID-19 pandemic. Aim(s): To explore the views of patients within Counties Manukau about their maternity care for DiP, including their perceptions of teleclinics. Method(s): Semi-structured interviews with women via telephone. Interviewers were matched by ethnicity with participants. Responses were analysed using a qualitative Framework Analysis. Result(s): We interviewed 20 women: New Zealand Maori ( n = 5), Pacific ( n = 4), Asian ( n = 5), and other ethnicity (European/New Zealand European) ( n = 4). Three key themes were identified, (1) 'shock, shame and adjustment', (2) 'learning to manage DIP' and (3) 'preparation for birth.' Participants primarily reported positive care experiences and appreciated both face-to-face and teleclinics. Women of Maori and Pacific ethnicity reported that the visible presence of healthcare professionals of a similar ethnicity within the DIP service would enhance their comfort and facilitate cultural understanding. Conclusion(s): This study adds important insights into the pregnancy care experience of a multi-ethnic and socioeconomically diverse group of women with DIP. Continuing teleclinics may be useful outside of a pandemic setting. More work is required to improve support and communication around diagnosis and management, particularly for gestational diabetes.