Abnormal uterine activity in pregnancy causes a range of important clinical disorders, including preterm birth, dysfunctional labour and post-partum haemorrhage. Uterine contractile patterns are controlled by the generation of complex electrical signals at the myometrial smooth muscle plasma membrane. To identify novel targets to treat conditions associated with uterine dysfunction, we undertook a genome-wide screen of potassium channels that are enriched in myometrial smooth muscle. Computational modelling identified Kir7.1 as potentially important in regulating uterine excitability during pregnancy. We demonstrate Kir7.1 current hyper-polarizes uterine myocytes and promotes quiescence during gestation. Labour is associated with a decline, but not loss, of Kir7.1 expression. Knockdown of Kir7.1 by lentiviral expression of miRNA was sufficient to increase uterine contractile force and duration significantly. Conversely, overexpression of Kir7.1 inhibited uterine contractility. Finally, we demonstrate that the Kir7.1 inhibitor VU590 as well as novel derivative compounds induces profound, long-lasting contractions in mouse and human myometrium; the activity of these inhibitors exceeds that of other uterotonic drugs. We conclude Kir7.1 regulates the transition from quiescence to contractions in the pregnant uterus and may be a target for therapies to control uterine contractility.

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This concept analysis provides a unique examination of compassionate midwifery and starting point for reflection on practice, education and further analysis. Empirical studies will provide the potential to take the process further by studying the experience of compassionate midwifery from different perspectives. A theory of compassionate midwifery will develop as new findings emerge.

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Objective: To determine whether timing of deinfibulation influences obstetric outcomes for women with type 3 female genital mutilation (FGM). Design: A retrospective observational study comprising 94 women with type 3 FGM who gave birth from 2008–2012. Method: Outcomes described in maternity notes of women with deinfibulation performed prior to labour (n=62) compared with ‘not deinfibulated before labour’ (n=32). Secondary analysis was then performed excluding women who had caesarean sections. Findings: Women who were ‘not deinfibulated before labour’ had a significantly greater risk of episiotomy (RR 1.67, P<0.05) and prolonged hospital stay of >2 days (RR 1.33, P<0.05). They also had non-significant increased risk of a postpartum haemorrhage (RR 1.15, P=0.58); prolonged second stage (RR 1.77, P=0.16); and required vaginal packing in theatre (RR 2.6, P =0.17). Apgar scores were no different, and both groups had higher than the national average rates for emergency caesarean section and instrumental birth. Conclusion: Type 3 FGM is associated with morbidity in childbirth. When deinfibulation is deferred until labour the risk of morbidity increases.

Background: traditional health workforce roles are changing, with existing roles being extended and advanced, while new roles are being created, often undertaking duties previously completed by doctors, sometimes referred to as non-medical practitioners (NMPs). Aim: to investigate which NMP roles exist within the UK, mapping distribution, and explore factors influencing their development and recruitment. Methods: two descriptive, exploratory, online self-completed semi-structured questionnaires were used. One was sent to all NHS acute healthcare providers (n=156) and private/independent healthcare providers in England (n=90). A separate questionnaire collected data, using convenience and snowballing approaches, from NMPs across the UK. Quantitative data were analysed using descriptive and frequency statistics. Qualitative data derived from open questions and comments were analysed using content and thematic analysis. Results: healthcare organisations in England returned 23/246 useable questionnaires; 115 NMPs returned responses, 19 did not meet the criteria, leaving 96 useable responses. Conclusion: seven NMP roles were identified, throughout the UK, with regional variation. Several factors influence the development and recruitment of NMP roles in England such as service delivery and national policies. Inconsistencies were noted in Agenda for Change pay banding. Many practitioners undertook NMP roles to progress their career clinically.

We will use a mixed-methods approach, a cohort study, a qualitative element and analysis of in-app data. Participants will be first-time pregnant women, aged 16 years and over, between 12 and 16 weeks of gestation and recruited from five English study sites.Evaluation planWe will compare maternal self-efficacy and mental health at three months post-delivery in mothers who have downloaded the Baby Buddy app compared with those that have not downloaded the app, controlling for confounding factors. Women will be recruited antenatally between 12 and 16 weeks of gestation. Further follow-ups will take place at 35 weeks of gestation and three months post-birth. Data from the cohort study will be supplemented by in-app data that will include, for example, patterns of usage. Qualitative data will assess the impact of the app on the lives of pregnant women and health professionals using both focus groups and interviews.EthicsApproval from the West Midlands-South Birmingham Research Ethics Committee (NRES) (16/WM/0029) and the University of the West of England, Bristol, Research Ethics Committee (HAS.16.08.001).DisseminationFindings of the study will be published in peer reviewed and professional journals, presented locally, nationally and at international conferences. Participants will receive a summary of the findings and the results will be published on Best Beginnings' website.