Jane Sandall

• PhD Sociology
• Professor at King's College London

Background We aimed to describe the prevalence of exposure to traumatic events and post-traumatic stress disorder (PTSD) in pregnant women attending antenatal care (ANC) in rural Ethiopia. We hypothesised that antenatal PTSD symptoms would be associated with previous obstetric complications and intimate partner violence (IPV) and impact negatively...

Background Person-centred maternal care is associated with positive experiences in high-income countries. Little is known about the transferability of this concept to non-Western, low-income settings. We aimed to explore women’s experiences of care and investigate satisfaction with antenatal care (ANC) in relation to person-centred care and unmet p...

Pre-eclampsia is a leading cause of maternal and neonatal mortality; 30,000 pre-eclampsia-related maternal deaths occur annually, with 70% in Sub-Saharan Africa (SSA) and 16% in South Asia. We have shown that early, accurate detection of hypertension combined with planned early delivery in women with late preterm pre-eclampsia significantly reduces...

Background The COVID-19 pandemic accelerated the adoption of remote care, or telemedicine, in many clinical areas including maternity care. One component of remote care, the use of self-monitoring of blood pressure in pregnancy, could form a key component in post-pandemic care pathways. The BUMP trials evaluated a self-monitoring of blood pressure...

Objective In screening for small‐for‐gestational age ( SGA ) using third‐trimester antenatal ultrasound, there are concerns about the low detection rates and potential for harm caused by both false‐negative and false‐positive screening results. Using a selective third‐trimester ultrasound screening program, this study aimed to investigate the incid...

Background Preterm birth is a major cause of infant mortality and morbidity and accounts for 7–8% of births in the UK. It is more common in women from socially deprived areas and from minority ethnic groups, but the reasons for this disparity are poorly understood. To inform interventions to improve child survival and their quality of life, this st...

Objective To identify whether maternal and pregnancy characteristics associated with stillbirth differ between preterm and term stillbirth. Design Secondary cohort analysis of the DESiGN RCT. Setting Thirteen UK maternity units. Population Singleton pregnant women and their babies. Methods Multiple logistic regression was used to assess whether...

Introduction Selective fetal growth restriction (sFGR) in monochorionic twin pregnancy, defined as an estimated fetal weight (EFW) of one twin <10th centile and EFW discordance ≥25%, is associated with stillbirth and neurodisability for both twins. The condition poses unique management difficulties: on the one hand, continuation of the pregnancy ca...

Background Women who suffer an early pregnancy loss require specific clinical care, aftercare, and ongoing support. In the UK, the clinical management of early pregnancy complications, including loss is provided mainly through specialist Early Pregnancy Assessment Units. The COVID-19 pandemic fundamentally changed the way in which maternity and gyn...

Background There is a policy drive in NHS maternity services to improve open disclosure with harmed families and limited information on how better practice can be achieved. Objectives To identify critical factors for improving open disclosure from the perspectives of families, doctors, midwives and services and to produce actionable evidence for s...

Introduction Hypertension in pregnancy is one of the leading causes of maternal mortality worldwide¹ and although mortality is declining in the UK,² women can still experience substantial morbidity from complications such as eclampsia.³ Additionally, perinatal mortality remains high, with the UK population-attributable risk of stillbirth from chron...

Introduction Many women with chronic hypertension are conflicted about antihypertensive medication during pregnancy and some are non-adherent to prescribed medication.¹ We intended to codesign, implement and evaluate a novel shared decision-making (SDM) intervention for use with pregnant women with chronic hypertension that consisted of both a pati...

Background The perinatal period is known as time of transition and anticipation. For women with social risk factors, child protection services may become involved during the perinatal period and this might complicate their interactions with healthcare providers. Aim To systematically review and synthesise the existing qualitative evidence of healt...

Objective To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies. Design Cross‐sectional survey. Setting International. Population Clinicians involved in the management of MCDA twin pregnancies with sFGR. Methods A structured, self‐administered survey. Ma...

Background Evidence suggests that obstetric violence has been prevalent globally and is finally getting some attention through research. This human rights violation takes several forms and is best understood through the narratives of embodied experiences of disrespect and abuse from women and other people who give birth, which is of utmost importan...

( Lancet . 2023;402:386–396) Pre-eclampsia is a relatively common condition and poses a disproportionately high risk to women in low-income and middle-income countries where it is a leading cause of maternal morbidity and mortality, estimated to have caused more than 42,000 deaths. The only known treatment is delivery, but there are also risks asso...

Background In the UK, 7.6% of babies are born preterm, which the Department of Health aims to decrease to 6% by 2025. To advance this, NHS England released Saving Babies Lives Care Bundle Version 2 Element 5, recommending the Preterm Birth Pathway for women at risk of preterm birth. The success of this new pathway depends on its implementation. The...

Background Pre-eclampsia (PE) is a leading causes of maternal and neonatal mortality; 30,000 PE-related maternal deaths occur annually, with 70% in Sub-Saharan Africa (SSA) and 16% in South Asia. We have shown that early, accurate detection of hypertension combined with planned early delivery in women with suspected pre-eclampsia between 34 and 37...

Background Midwives are primary providers of care for childbearing women globally and there is a need to establish whether there are differences in effectiveness between midwife continuity of care models and other models of care. This is an update of a review published in 2016. Objectives To compare the effects of midwife continuity of care models...

Objective Providing comprehensible information is essential to the process of valid informed consent. Recruitment materials designed by sponsoring institutions in English-speaking, high-income countries are commonly translated for use in global health studies in other countries; however, key concepts are often missed, misunderstood or ‘lost in tran...

Background Suicide is a leading cause of maternal death during pregnancy and the year after birth (the perinatal period). While maternal suicide is a relatively rare event with a prevalence of 3.84 per 100,000 live births in the UK [1], the impact of maternal suicide is profound and long-lasting. Many more women will attempt suicide during the peri...

Background Sierra Leone has a very high maternal mortality rate, and this burden falls heavily on adolescents, a particularly vulnerable group; this is usually driven by poverty, lack of education and employment opportunities. In 2017, a local grassroots organisation, Lifeline Nehemiah Projects, developed a community-based mentoring intervention ‘2...

Introduction: The COVID-19 pandemic posed a significant lifecourse rupture, not least to those who had specific physical vulnerabilities to the virus, but also to those who were suffering with mental ill health. Women and birthing people who were pregnant, experienced a perinatal bereavement, or were in the first post-partum year (i.e., perinatal)...

Background Person-centred maternal care is associated with positive experiences in high-income countries. Little is known about the transferability of this concept to non-Western, low-income settings. We aimed to explore women’s experiences of care and investigate satisfaction with antenatal care (ANC) in relation to person-centred care and unmet p...

(Abstracted from Lancet 2023; 402:386–396) Preeclampsia is a disorder of pregnancy that proposes a disproportionately high risk to women in low- and middle-income countries (LMICs); it is one of the leading causes of maternal morbidity and mortality worldwide and is estimated to have an annual death toll of greater than 40,000. The only treatment w...

Objective: Refine the programme theory for OptiBreech Care Design: Concurrent mixed methods implementation process evaluation Setting: 6 NHS hospitals in England participating in the OptiBreech 1 Feasibility Study Sample: 15 women planning a vaginal breech birth at term and 6 breech lead midwives Methods: Outcomes were recorded on case report forms...

Background Seroprevalence studies are an alternative approach to estimating the extent of transmission of SARS-CoV-2 and the evolution of the pandemic in different geographical settings. We aimed to determine the SARS-CoV-2 seroprevalence from March 2020 to March 2022 in a rural and urban setting in Kilifi County, Kenya. Methods We obtained repres...

Aim There is currently limited evidence on the costs associated with late preterm pre-eclampsia beyond antenatal care and post-natal discharge from hospital. The aim of this analysis is to evaluate the 24-month cost-utility of planned delivery for women with late preterm pre-eclampsia at 34 ⁺⁰ and 36 ⁺⁶ weeks’ gestation compared to expectant manage...

Objective To assess the diagnostic performance of angiogenic biomarkers in determining need for delivery in seven days in women with late preterm preeclampsia. Study design In a prospective observational cohort study in 36 maternity units across England and Wales, we studied the diagnostic accuracy of placental growth factor (PlGF) and sFlt-1 in d...

Objective We evaluated the best time to initiate delivery in late preterm pre-eclampsia in order to optimise long-term infant and maternal outcomes. Design Parallel-group, non-masked, randomised controlled trial. Setting 46 UK maternity units. Population Women with pre-eclampsia between 34 ⁺⁰ and 36 ⁺⁶ weeks’ gestation, without severe disease, w...

OptiBreech collaborative care is a multi-disciplinary care pathway for breech presentation at term, with continuity from a breech specialist midwife, including where chosen, for vaginal breech birth (VBB). Pilot randomised trial using unblinded 1:1 parallel group allocation to OptiBreech versus standard care, within a cohort. Participants were wome...

Background Sierra Leone has a very high maternal mortality rate, and this burden falls heavily on adolescents, a particularly vulnerable group; this is usually driven by poverty, lack of education and employment opportunities. In 2017, a local grassroots organisation, Lifeline Nehemiah Projects, developed a community-based mentoring intervention ‘2...

OptiBreech collaborative care is a multi-disciplinary care pathway for breech presentation at term, with continuity from a breech specialist midwife, including where chosen, for vaginal breech birth (VBB). Pilot randomised trial using unblinded 1:1 parallel group allocation to OptiBreech versus standard care, within a cohort. Participants were wome...

Background The CRADLE Vital Signs Alert intervention (an accurate easy-to-use device that measures blood pressure and pulse with inbuilt traffic-light early warning system, and focused training package) was associated with reduced rates of eclampsia and maternal death when trialled in urban areas in Sierra Leone. Subsequently, implementation was su...

Background Disadvantaged populations (such as women from minority ethnic groups and those with social complexity) are at an increased risk of poor outcomes and experiences. Inequalities in health outcomes include preterm birth, maternal and perinatal morbidity and mortality, and poor-quality care. The impact of interventions is unclear for this pop...

Background The CRADLE Vital Signs Alert intervention (an accurate easy-to-use device that measures blood pressure and pulse with inbuilt traffic-light early warning system, and focused training package) was associated with reduced rates of eclampsia and maternal death when trialled in urban areas in Sierra Leone. Subsequently, implementation was su...

Background: Pre-eclampsia is a leading cause of maternal and perinatal mortality. Evidence regarding interventions in a low-income or middle-income setting is scarce. We aimed to evaluate whether planned delivery between 34+ 0 and 36+ 6 weeks' gestation can reduce maternal mortality and morbidity without increasing perinatal complications in India...

Background: Ageing populations globally have contributed to increasing numbers of people living with frailty, which has significant implications for use of health and care services and costs. The British Geriatrics Society defines frailty as "a distinctive health state related to the ageing process in which multiple body systems gradually lose the...

Background Pregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom...

Background OptiBreech Care is a care pathway for breech presentation at term, including where chosen, physiological breech birth attended by professionals with advanced training and/or proficiency. We aimed to assess the feasibility of implementing OptiBreech team care prior to proceeding with a planned pilot randomised controlled trial. Methods O...

Objective To explore hospital-level care for pre-eclampsia in Ethiopia, considering the perspectives of those affected and healthcare providers, in order to understand barriers and facilitators to early detection, care escalation and appropriate management. Setting A primary and a general hospital in southern Ethiopia. Participants Women with liv...

Objective To determine whether the Growth Assessment Protocol (GAP) affects the antenatal detection of large for gestational age (LGA) or maternal and perinatal outcomes amongst LGA babies. Design Secondary analysis of a pragmatic open randomised cluster control trial comparing the GAP with standard care. Setting Eleven UK maternity units. Popul...

Background Open Disclosure (OD) is open and timely communication about harmful events arising from health care with those affected. It is an entitlement of service-users and an aspect of their recovery, as well as an important dimension of service safety improvement. Recently, OD in maternity care in the English National Health Service has become a...

Objectives To evaluate how women access and engage with different models of maternity care, whether specialist models improve access and engagement for women with social risk factors, and if so, how? Design Realist evaluation. Setting Two UK maternity service providers. Participants Women accessing maternity services in 2019 (n=1020). Methods P...

Problem Maternity care underwent substantial reconfiguration in the United Kingdom during the COVID-19 pandemic. Background COVID-19 posed an unprecedented public health crisis, risking population health and causing a significant health system shock. Aim To explore the psycho-social experiences of women who received maternity care and gave birth...

Problem: There is a paucity of research on experiences and views of women at higher risk of preterm birth of midwifery continuity of care. Background: Midwifery continuity of care (MCoC) has been associated with improved maternal outcomes and with lower levels of preterm births and stillbirths. The majority of MCoC studies have focused on women...

Background National guidance (Saving Babies Lives Care Bundle Version 2 (SBLCBv2) Element 5) was published in 2019, with the aim to standardise preterm care in England. We plan to identify how many preterm birth surveillance clinics there are in England, and to define current national management in caring for women who are both asymptomatic and hig...

Background The development and evaluation of specific maternity care packages designed to address preterm birth remains a public health priority. We aim to evaluate the implementation, context, and potential mechanisms of action, of a new care pathway that combined midwifery continuity of care with a specialist obstetric clinic for women at risk of...

Background: The CRADLE (Community blood pressure monitoring in Rural Africa: Detection of underLying pre-Eclampsia) Vital Signs Alert device-designed specifically to improve maternity care in low resource settings-had varying impact when trialled in different countries. To better understand the contextual factors that may contribute to this variat...

Pre-eclampsia, a complex and multi-system disorder specific to pregnancy, is a leading cause of preventable maternal and perinatal deaths in low-resource settings. Early detection and appropriate intervention with management of hypertension, prevention of eclampsia and timely delivery are effective at reducing mortality and morbidity. Outcomes can...

Objectives: This project builds on previous influential series on stillbirth [1] and miscarriage [2]; an evaluation of Early Pregnancy Assessment Unit configurations and care [3-5]; and more specifically a global survey conducted on pregnancy and parenthood, during the pandemic [6]. The PUDDLES Study explores fetal and neonatal loss during the SARS...

Objectives: This project builds on previous influential series on stillbirth [1] and miscarriage [2]; an evaluation of Early Pregnancy Assessment Unit configurations and care [3-5]; and more specifically a global survey conducted on pregnancy and parenthood, during the pandemic [6]. The PUDDLES Study explores fetal and neonatal loss during the SARS...

(Abstracted from JAMA 2022;327:1656–1665 It is estimated that approximately 10% of pregnancies worldwide in 2019 were affected by elevated blood pressure (BP). The United Kingdom has previously reported inadequate monitoring of elevated BP as a significant contributing factor to maternal death.

Background Women with low socioeconomic status and social risk factors are at a disproportionate risk of poor birth outcomes and experiences of maternity care. Specialist models of maternity care that offer continuity are known to improve outcomes but underlying mechanisms are not well understood. Aim To evaluate two UK specialist models of care t...

Background In women with late preterm pre-eclampsia (i.e. at 34 ⁺⁰ to 36 ⁺⁶ weeks’ gestation), the optimal delivery time is unclear because limitation of maternal–fetal disease progression needs to be balanced against infant complications. The aim of this trial was to determine whether or not planned earlier initiation of delivery reduces maternal...

Background Attendance of skilled and experienced professionals at breech births has been associated with a reduction in adverse perinatal outcomes. We aimed to determine whether United Kingdom National Health Service (NHS) sites could reliably provide attendants with OptiBreech training and/or advanced proficiency (intervention feasibility) and con...

Background OptiBreech Care is a care pathway for breech presentation at term, including where chosen, physiological breech birth attended by professionals with advanced training and/or proficiency. We aimed to assess the feasibility of implementing OptiBreech team care to test it in trial-within-a-cohort study. Methods Our design was a mixed metho...

Background/Objectives Obesity in pregnancy has been associated with increased childhood cardiometabolic risk and reduced life expectancy. The UK UPBEAT multicentre randomised control trial was a lifestyle intervention of diet and physical activity in pregnant women with obesity. We hypothesised that the 3-year-old children of women with obesity wou...

Objective: To identify the clinical characteristics and patterns of ultrasound use amongst pregnancies with antenatally unidentified SGA, compared to those in which it is identified, to understand how to better design interventions that improve antenatal SGA identification. Methods: A prospective cohort study of singleton, non-anomalous, small f...

Background: Safety measurement tools have traditionally examined safety climate and culture from the perspective of healthcare professionals. A small number of studies have used tools to measure patients' perceptions of safety. Aim: To develop and check the validity of a questionnaire, the King's Patient Safety Measure (KPSM), that assesses how...

Qualitative researchers often engage in work addressing challenging, difficult, or sensitive topics and are consequently exposed to the participants' narratives which may be emotionally charged, distressing, or compromising. These narratives occasionally rest heavy on a researcher's conscience or may linger in the mind. Much literature has assessed...

Background Health visitors play an important role in supporting new parents in their transition to parenthood. A programme known as the Promotional Guide system is used by many health visitors in England with mothers and fathers to support this transition, but there is little known about health visitors’ views of the Promotional Guides, how they ar...

Introduction Globally, the COVID-19 pandemic has significantly disrupted the provision of healthcare and efficiency of healthcare systems and is likely to have profound implications for pregnant and postpartum women and their families including those who experience the tragedy of stillbirth or neonatal death. This study aims to understand the psych...

Background Reducing the rate of stillbirth is an international priority. At least half of babies stillborn in high-income countries are small for gestational-age (SGA). The Growth Assessment Protocol (GAP), a complex antenatal intervention that aims to increase the rate of antenatal detection of SGA, was evaluated in the DESiGN type 2 hybrid effect...

Background Many women with chronic hypertension are conflicted about antihypertensive medication during pregnancy and some are non-adherent to prescribed medication. Objectives Codesign, implement and evaluate a novel shared decision-making (SDM) intervention for use with pregnant women with chronic hypertension. Setting and participants: Pregnant...

Background Disparities in stillbirth and preterm birth persist even after correction for ethnicity and social deprivation, demonstrating that there is wide geographical variation in the quality of care. To address this inequity, Tommy’s National Centre for Maternity Improvement developed the Tommy’s Clinical Decision Tool, which aims to support the...

Introduction The SARS‐CoV‐2 pandemic has devastated populations, posing unprecedented challenges for healthcare services, staff and service‐users. In the UK, rapid reconfiguration of maternity healthcare service provision changed the landscape of antenatal, intrapartum and postnatal care. This study aimed to explore the experiences of maternity ser...

Digital health occupies an increasingly important role within the context of managing risk and safety in pregnancy. Women routinely use websites, mobile phone apps and social media platforms to learn about ‘normal’ pregnancy related changes and potential signs of a complication. This paper shifts attention from women's digital experiences to explor...

Qualitative researchers are often engaged in work addressing challenging, difficult, or sensitive topics. Consequently, qualitative researchers can be frequently exposed to the narratives of participants’ experiences which may, at times, be emotionally charged, distressing, compromising, or filled with information or details which rest heavy on a r...

Objectives: To determine whether the Growth Assessment Protocol (GAP), as implemented in the DESIGN trial, is cost-effective in terms of antenatal detection of small for gestational age (SGA) neonates, when compared to standard care. Methods: Design: An incremental cost-effectiveness analysis undertaken from a UK National Health Service hospital...

Introduction: In Brazil, interventions during labor and childbirth are harmful and, for the most part, unnecessary. In addition, there is a high prevalence of abuse and disrespect for women and babies during this period. Objective: To describe the prevalence of maternal and neonatal harm and harm-free care in a Brazilian maternity setting. Methods:...

Background Antenatal detection and management of small for gestational age (SGA) is a strategy to reduce stillbirth. Large observational studies provide conflicting results on the effect of the Growth Assessment Protocol (GAP) in relation to detection of SGA and reduction of stillbirth; to the best of our knowledge, there are no reported randomised...

Objective: We examined the perceptions and experiences of decision making about service reconfiguration by maternity care staff who provided maternity care services during the pandemic in one NHS Trust in South London. Design: We employed a qualitative research design to allow expression of experiential data about how maternity healthcare profess...

Background The SARS-CoV-2 pandemic has brought racial and ethnic inequity into sharp focus, as Black, Asian, and Minority Ethnic people were reported to have greater clinical vulnerability. During the pandemic, priority was given to ongoing, reconfigured maternity and children's healthcare. This study aimed to understand the intersection between ra...

The Final Report of the Ockenden Review examined the care of 1486 families who experienced adverse outcomes in one hospital Trust in England, the majority of whom received care between 2000 and 2020 ( Ockenden 2022 ). It describes the damaging outcomes and experiences caused by poor care for women and babies in pregnancy, labour and birth. Multiple...

Importance: Inadequate management of elevated blood pressure is a significant contributing factor to maternal deaths. The role of blood pressure self-monitoring in pregnancy in improving clinical outcomes for the pregnant individual and infant is unclear. Objective: To evaluate the effect of blood pressure self-monitoring, compared with usual ca...

Importance: Inadequate management of elevated BP is a significant contributing factor to maternal deaths. Self-monitoring of blood pressure (BP) in the general population has been shown to improve the diagnosis and management of hypertension, however little is known about its use in pregnancy. Objective: To determine whether self-monitoring of BP...

Background Evidence on obstetric violence is reported globally. In India, research shows that almost every woman goes through some level of disrespect and abuse during childbirth, more so in states such as Bihar where over 70% of women give birth in hospitals. Objective 1) To understand how women experience and attach meaning to respect, disrespec...