OAA Large Project Grants

Barts and The London School of Medicine and Dentistry, Queen Mary University of London

Title
EPIFEVER-2: personalised genomic medicine to guide labour analgesia

Amount
£59,782

Scientific Abstract
Epidural-related maternal fever (ERMF) occurs in 15-20% of labouring women. Intra-partum fever is associated with more frequent obstetric interventions and antibiotic administration, plus lower rates of spontaneous vaginal delivery. Bupivacaine impairs release of the anti-pyrogenic cytokine interleukin-1 receptor antagonist [ from circulating leucocytes, by reducing caspase-1 activity. Lower IL-1Ra levels increase the risk of fever.

Common polymorphisms in the IL-1Ra gene may account for the remarkably similar incidence of ERMF internationally. Two common variants in the IL-1Ra gene are the strongest genetic determinants of plasma IL-1Ra concentration. Having fewer alleles for the IL-1Ra gene is associated with lower circulating IL-1Ra, which may predispose women in labour developing epidural-related maternal fever.

We will determine whether IL-1Ra polymorphisms are associated with ERMF and alter the IL-1Ra secretion response to local anaesthetics used in labour epidurals. If a lower number of alleles for the IL-1Ra gene predispose ~20% of women in labour to epidural-related maternal fever and more complicated labour, remifentanil analgesia may be the optimal analgesic choice to reduce obstetric interventions (including instrumental delivery) and unnecessary antibiotic administration in this subgroup. These data will help obstetricians, midwives and anaesthetists personalise labour management using genomics to enhance women's experience of labour.

University College London

Title
National Obstetric Anaesthesia Health Audit Research and patient-Centred outcomes project 1 (NOAH's ARC 1): Neuraxial Anaesthesia for Obstetric Surgery

Amount
£54,011

Scientific Abstract
There is limited high-quality information available about the quality of neuraxial anaesthesia during obstetric surgery, how intraoperative pain should be managed and what the outcomes are for mothers who experience this adverse event.

National Obstetric Anaesthesia Health Audit Research and patient-Centred outcomes project 1 (NOAH's ARC1) will be a prospective multi-centre cohort study of patients and anaesthetic departments in UK NHS hospitals comprising four main parts:

STUDY 1: An organisational survey of NHS hospitals undertaking obstetric surgery to determine institutional policy and protocols on the quality of neuraxial anaesthesia and follow-up.

STUDY 2: A non-consenting audit of patients undergoing obstetric surgery to evaluate incidence and processes of care related to intraoperative pain.

STUDY 3: A consenting cohort study of women who have had an operative obstetric procedure under neuraxial anaesthesia to evaluate short-term (inpatient) and medium term (6-week) clinical outcomes.

This research will enable us to develop strategies which can be implemented nationally and internationally to help reduce or better manage this important problem and will provide better information to future patients and healthcare professionals.