Niamh Keating

The Valsalva manoeuvre (VM) is a normal physiological event that occurs during the second active phase of labour. In women with medical conditions that may be exacerbated by the Valsalva, caesarean birth may be recommended. This carries with it its own potential for maternal morbidity, and thus it is important that women are appropriately counselled about the mode of delivery most suited to their individual situation. It is possible to avoid VM with spontaneous pushing rather than reverting to caesarean birth. Neuraxial analgesia and instrumental delivery may also be used to avoid prolonged VM. We outline the effect of VM on the various organ systems in pregnancy and summarise the available evidence on its implication.

Ustekinumab (USK) was used in the treatment of two pregnant patients with Crohn's disease. It was given in the third trimester and restarted postnatally for both women. One woman remained on USK and in remission throughout pregnancy. The second woman, took a treatment break, flared, and then had remission induced with reintroduction of USK. Both women delivered healthy term infants. The interval from last dose to birth was 11 and 8 weeks respectively. Interestingly, USK levels in cord blood was observed in higher concentrations than in the maternal serum taken in third trimester. While no adverse effect in infants has been observed, clinicians should remain aware of fetal transfer when using USK in pregnancy. An evaluation of risk and benefit may favour continuing USK in pregnancy in patients with refractory disease.

Background The COVID-19 pandemic has changed how maternity care services are provided worldwide. To contain the virus, many providers reduced the number of face-to-face visits for women. In addition, partner attendance was prohibited in many circumstances to protect staff, and other service users, from potential infection. Aims To explore women’s experience of pregnancy and birth in the Republic of Ireland during the COVID-19 pandemic. Methods A qualitative study with 14 women was conducted using a grounded theory approach. Data were collected between April and July 2020, and in-depth interviews were conducted either in pregnancy or in the first 12 weeks after the birth. Results Six categories emerged: loss of normality, navigating “new” maternity care systems, partners as bystanders, balancing information, uncertainty, and unexpected benefits of pregnancy during the pandemic. While benefits were reported (working from home and additional time spent with partners during the “fourth trimester”), in general, the themes were of increased anxiety and uncertainty. Conclusion The pandemic caused additional anxiety for pregnant women. This was exacerbated by uncertainty about the effects of COVID-19 on pregnancy and unclear messaging about restrictions. More interactive and personalized communication is required to support women to cope with uncertainty during a pandemic. The birth partner plays an important role as an advocate for women and excluding them from pregnancy care caused additional anxiety for pregnant women. Containment strategies for a pandemic should be developed with this in mind, to view the family as a unit rather than the woman in isolation.