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  6. Congenital uterine anomalies (951)
Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Congenital uterine anomalies (951)

Please report any inaccuracies or issues with this guideline using our online form

Congenital uterine anomalies (CUA) are malformations of the uterus which occur during development in-utero. These malformations are therefore present from birth and many women have no symptoms-some may experience heavy periods. The implications of CUA, depending on the type and severity, can range from an increased risk of 1st/2nd Trimester miscarriage(s), intra-uterine growth restriction (IUGR), fetal malpresentation, pre-eclampsia and pre-term birth (PTB). There can be an association with anomalies of the genital tract, bladder and kidneys. Consideration should therefore be given to ultrasound imaging of the renal tract if indicated.

Types

  • Bicornuate uterus (heart-shaped womb)
  • Unicornuate uterus
  • Didelphic (double womb)
  • Septate/sub-septate uterus
  • Arcuate womb

Women who have had resection of a uterine septum remain at risk of PTB

Implications

Women with bicornuate and unicornuate uteri have an increased risk of first trimester miscarriage (OR 3.4; 95% CI 1.18–9.76 and OR 2.15; 95% CI 1.03–4.47 respectively), preterm birth (OR 2.55; 95% CI 1.57–4.17 and OR 3.47; 95% CI 1.94–6.22 respectively) and fetal malpresentation (OR 5.38; 95% CI 3.15–9.19 and OR 2.74; 95% CI 1.3–5.77 respectively), while women with uterus didelphys appear to have an increased risk of preterm labour (OR 3.58; 95% CI 2.0–6.4) and fetal malpresentation (OR 3.7; 95% CI 2.04–6.7).

The presence of variations in uterine size and shape in expectant mothers is associated with a two to five-fold increase in the risk of spontaneous preterm birth compared to those with normal uterine anatomy.

Management

The UK Preterm Birth Clinical Network Guidance advises women with CUA are referred to consultant antenatal clinics to form a plan of care for the remainder of pregnancy. 

Within GG&C we suggest that women found to have a CUA on an EPAS or dating ultrasound should have a Critical Alert-Woman generated on Badger by the sonographer and an appointment arranged with the patient’s named consultant at 16 weeks gestation in order to discuss this further.

Critical Alert-Woman

To enter a Critical Alert-Woman please search under the ‘Enter new note tab’ (See Picture 1) Complete the boxes (See Picture 2) detailing the details of the alert e.g. Bicornate uterus at EPAS scan. 

Picture 1

Picture 2

Suggested management includes 3rd trimester growth scans to monitor for IUGR and to confirm fetal presentation by 36 weeks gestation. Women with CUA are advised with signs and symptoms of PTB to contact MAU 24/7 for further assessment. If PTB at <30 weeks gestation is confirmed the Preterm Birth should be followed remembering to include; corticosteroids, Magnesium Sulphate and anti-biotic cover.

Editorial Information

Last reviewed: 30/11/2021

Next review date: 30/11/2026

Author(s): Lynne Thomson.

Version: 1

Approved By: Gynaecology Clinical Governance Group

Document Id: 951

References

Reproductive Implications and Management of Congenital Uterine Anomalies MA Akhtar, SH Saravelos, TC Li, K Jayaprakasan, on behalf of the Royal College of Obstetricians and Gynaecologists

UK Preterm Clinical Network. Reducing preterm birth. Guidelines for commissioners and providers. 2019 [www.tommys.org/our-orga nisation/our-research/premature-birth-research/reducingpretermbirth-rates]

https://www.tommys.org/pregnancy-information/pregnancy-complications/uterine-abnormalityproblems-womb

Venetis CA, Papadopoulos SP, Campo R, Gordts S, Tarlatzis BC, Grimbizis GF. Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies. Reprod Biomed Online2014; 29(6): 665 – 8

Hua M, Odibo AO, Longman RE, Macones GA, Roehl KA, Cahill AG. Congenital uterine anomalies and adverse pregnancy outcomes. Am J Obstet Gynecol 2011; 205(6): 558 e1 –5