susan bewley

King's College London, Women's, Faculty Member

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Current position: Professor Emeritus (honorary) of Obstetrics & Women's Health, Department of Women & Children's Health, KCL 2018-date.

Qualifications: BA Oxford 1979, MB BS Middlesex Hospital1982, MRCOG 1987, MD London 1990, MA Medical Law & Ethics Kings College London 1991 (distinction), first female UK trainee Maternal Fetal Medicine 1991-4 UCH. Double accreditation O&G/ MFM 1994. Pt1 MFFLM 2018.

Senior clinical career: Consultant Obstetrician/ Maternal Fetal Medicine, Guy's & St Thomas' Hospitals.1994-2011. NHS consultant & clinical academic with wide-ranging research interests but focus on severe maternal morbidity. RAE-returned NHS clinician. Senior clinical opinion and trainer in busy inner-city teaching hospital (having done fetal medicine scans & procedures, diabetic, SLE/APS & HIV antenatal clinics, direct labour ward and on call etc.).

Managerial: Director of Obstetrics & Clinical Director 1994-2004. I set up & participated in evaluation of innovative services (eg external cephalic version, bereavement, perinatal mental health, routine enquiry and referral for domestic violence). The development of evidence-based guidelines, multidisciplinary team working, midwifery-led care, and an academic & reflective culture whilst merging two maternity units led onto St Thomas’ site and becoming the highest scoring London maternity unit (Healthcare Commission 2007). I then became Honorary Clinical Director Obstetrics NHS London, 2010-2013.

Academic career: Hon Senior Lecturer King's Health Partners 1994-2011. Honorary Professor of Complex Obstetrics, KCL 2011-2016. Professor of Women's Health, KCL 2016-18.

Clinical work 2014-2018. Sexual offenses examiner, Camberwell Haven Sexual Assault Referral Centre, London 2014-2018. Job-share locum consultant in charge of all London Havens 2016-2017.

Expert work at national level: NICE member Infertility GDG 2010-12, Chair of Intrapartum GDG 2011-13. Chair of NICE Standing Committee B & other updates until 2019. RCOG Council and committees: inc recruitment, structured training, standards board, set up & first chair Trainees committee 1993-5. Chair of RCOG Ethics Committee 2004-7. MDU Council & Cases Committee 2000-date, Member NSF Maternity Module Inequalities Subgroup 2002-2004, Invited expert Inquiries into NHS (Ayling/Neale) seminar 2003. Member Independent Review of West Hertfordshire maternity services 2003. Expert Advisor House of Commons Health Select Committee Reports on Maternity Services 2003, Research Advisor National Childbirth Trust. Member, All-Party Parliamentary Group on Maternity 2004-2016.

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Books by susan bewley

Violence Against Women

Training in Obstetrics and Gynaecology – a curriculum based guide.

Abuse in the doctor-patient relationship.

Ethics in Obstetrics and Gynaecology

Reproductive Ageing

Since 1973, the RCOG has regularly convened Study Groups to address important topics in our speci... more Since 1973, the RCOG has regularly convened Study Groups to address important topics in our specialty. Ageing and reproductive ageing affect us all as individuals and as society. Obstetricians and gynaecologists are witnesses to the impact of reproductive ageing and to some of the fears, misinformation and misapprehensions that the general public have.

One purpose of the Study Group was to raise awareness of the societal trends and implications. Practitioners, academics and informed lay contributors from around the world were brought together to look at the current situation and available evidence.

This volume gathers together a diverse but timely set of contributions in order to inform Members and Fellows of the RCOG, interested healthcare and research workers and the general public.

Table of contents:
SECTION 1 BACKGROUND TO AGEING AND DEMOGRAPHICS

1 Ageing: what is it and why?

2 Culture and reproductive ageing

3 Background to ageing

4 What has happened to reproduction in the 20th century?

5 Trends in fertility: what does the 20th century tell us about the 21st?

6 Demographics

SECTION 2 BASIC SCIENCE OF REPRODUCTIVE AGEING

7 Is ovarian ageing inexorable?

8 The science of ovarian ageing: how might knowledge be translated into practice?

9 Basic science: eggs and ovaries

10 Male reproductive ageing

11 The science of the ageing uterus and placenta

12 Basic science: sperm and placenta

SECTION 3 PREGNANCY: THE AGEING MOTHER AND MEDICAL NEEDS

13 The effect of age on obstetric (maternal and fetal) outcomes

14 The older mother and medical disorders of pregnancy

15 The ageing mother and medical needs

SECTION 4 THE OUTCOMES: CHILDREN AND MOTHERS

16 What is known about children born to older parents?

17 Consequences of changes in reproductive patterns on later health in women: a life course approach

18 The outcomes: children and mothers

SECTION 5 FUTURE FERTILITY INSURANCE: SCREENING, CRYOPRESERVATION OR EGG DONORS?

19 Screening for early ovarian ageing

20 Egg freezing: the reality and practicality

21 Assisted conception: uses and abuses

22 Future fertility insurance: screening, cryopreservation and egg donors

SECTION 6 SEX BEYOND, AND AFTER, FERTILITY

23 Contraception for older couples

24 Ageing, infertility and gynaecological conditions: how do they affect sexual function?

25 Sex beyond, and after, fertility

SECTION 7 REPRODUCTIVE AGEING AND THE RCOG: AN INTERNATIONAL COLLEGE

26 What should be the RCOG’s relationship with older women?

27 Reproductive ageing and the RCOG

SECTION 8 FERTILITY TREATMENT: SCIENCE AND REALITY – THE NHS AND THE MARKET

28 Evidence-based and cost-effective investigation and treatment of women aged over 35 or 40 years: moving beyond NICE

29 Bang for the buck: what purchasers and commissioners think and do?

30 Fertility treatment: science and reality – the NHS and the market

SECTION 9 THE FUTURE: DREAMS AND WAKING UP

31 In our wildest dreams: making gametes

32 The future: dreams

33 Managing expectations and achieving realism: the individual journey from hope to closure

34 Managing expectations and achieving realism: the realpolitik of reproductive ageing and its consequences

35 The future: waking up

SECTION 10 CONSENSUS VIEWS

36 Consensus views arising from the 56th Study Group: Reproductive Ageing in Older Mothers Index

Papers by susan bewley

Female genital mutilation

BMJ, 2010

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Care of Transgender Patients: A General Practice Quality Improvement Approach

SSRN Electronic Journal, 2021

Dependence and oestrogen replacement

The Lancet, 1992

1. Lancet. 1992 Mar 28;339(8796):814-5. Dependence and oestrogen replacement. Bewley S, Bewley T.... more

Prevalence of intimate partner violence among women seeking termination of pregnancy grouped by country's gross national income per capita (in intervals of Int$10,000)

<p>Weights are from random effects analysis. D+L, combined effects using the DerSimonian an... more

Might measuring cord pH in itself affect outcome?

BMJ, 2010

Malin and colleagues confirmed the expected association between low arterial cord pH and poor out... more Malin and colleagues confirmed the expected association between low arterial cord pH and poor outcome.1 However, caution should be applied before encouraging routine blood gas measurement—usually performed after premature cord clamping, <30 s after birth. There was no indication of cord clamping and neonatal resuscitation practices used in the studies which might plausibly adversely affect, or …

Reconstructive Surgery After Female Genital Mutilation

Obstetrical & Gynecological Survey, 2013

such as its use here in the bladder. What is the impact of injection on bladder neuron pathways a... more such as its use here in the bladder. What is the impact of injection on bladder neuron pathways and what types of reinnervation occur? Are there long-term effects into neurotransmitters in the bladder wall? Are there changes in sensory perception after injection? What is the effect of multiple injections? All of these are important issues to address with additional clinical and preclinical investigation now that this exciting new therapy is becoming a viable option in the control of this debilitating conditionVACW.

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Improbable, but plausible, research study: a randomised controlled trial of premature cord clamping vs. neonatal venesection to achieve routine prophylactic neonatal red cell reduction

Journal of the Royal Society of Medicine, 2018

Declaration of conflicting interests: AW registered intellectual property rights for a small neon... more Declaration of conflicting interests: AW registered intellectual property rights for a small neonatal resuscitation trolley (The BASICS trolley; Bedside Assessment, Stabilisation and Immediate Cardiorespiratory Support) via the University of Liverpool on behalf of a group of 8 clinicians (including SB) interested in avoiding premature cord clamping (Weeks et al. 2015). The rights were then transferred to LifeStart© in lieu of charitable donations. Such equipment may avoid premature cord clamping, even -or especially -in babies born in a compromised condition. If the proposed RCT does ever take there would still be no financial conflict of interest in the event that Day 1 venesection proved superior to premature cord clamping. SB chaired the 2014 NICE Intrapartum Care Guideline Update CG190. Copyright/licence for publication: The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, a worldwide licence to the Publishers and its licensees in perpetuity, in all forms, formats and media (whether known now or created in the future), to i) publish, reproduce, distribute, display and store the Contribution, ii) translate the Contribution into other languages, create adaptations, reprints, include within collections and create summaries, extracts and/or, abstracts of the Contribution, iii) create any other derivative work(s) based on the Contribution, iv) to exploit all subsidiary rights in the Contribution, v) the inclusion of electronic links from the Contribution to third party material where-ever it may be located; and, vi) licence any third party to do any or all of the above.

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Lesbian and bisexual women's likelihood of becoming pregnant: a systematic review and meta‐analysis

BJOG: An International Journal of Obstetrics & Gynaecology, 2016

Background Few data exist regarding pregnancy in lesbian and bisexual (LB) women. Objectives To d... more Background Few data exist regarding pregnancy in lesbian and bisexual (LB) women. Objectives To determine the likelihood of LB women becoming pregnant, naturally or assisted, in comparison with heterosexual women Search strategy Systematic review of papers published 1 January 2000 to 23 June 2015. Selection criteria Studies contained details of pregnancy rates among LB women compared with heterosexual women. No restriction on study design. Data collection and analysis Inclusion decisions, data extraction and quality assessment were conducted in duplicate. Meta-analyses were carried out, with subgroups as appropriate. Main results Of 6859 papers identified, 104 full-text articles were requested, 30 papers (28 studies) were included. The odds ratio (OR) of ever being pregnant was 0.19 (95% CI 0.18-0.21) in lesbian women and 1.22 (95% CI 1.15-1.29) in bisexual women compared with heterosexual women. In the general population, the odds ratio for pregnancy was nine-fold lower among lesbian women and over twofold lower among bisexual women (0.12 [95% CI 0.12-0.13] and 0.50 [95% CI 0.45-0.55], respectively). Odds ratios for pregnancy were higher for both LB adolescents (1.37 [95% CI 1.18-1.59] and 1.98 [95% CI 1.85, 2.13], respectively). There were inconsistent results regarding abortion rates. Lower rates of previous pregnancies were found in lesbian women undergoing artificial insemination (OR 0.17 [95% CI 0.11-0.26]) but there were higher assisted reproduction success rates compared with heterosexual women (OR 1.56 [95% CI 1.24-1.96]). Conclusions Heterosexuality must not be assumed in adolescents, as LB adolescents are at greater risk of unwanted pregnancies and terminations. Clinicians should provide appropriate information to all women, without assumptions about LB patients' desire for, or rejection of, fertility and childbearing.

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Mandatory submission of patient identifiable information to third parties: FGM now, what next?

BMJ, 2015

professor of complex obstetrics 1 , Brenda Kelly consultant obstetrician and clinical lead for th... more professor of complex obstetrics 1 , Brenda Kelly consultant obstetrician and clinical lead for the Oxford Rose Clinic 2 , Katrina Darke general practitioner and clinical lead for the Bristol Community Rose Clinic 3 , Katrina Erskine consultant obstetrician and gynaecologist and associate medical director 4 , Clare Gerada general practitioner 5 , Patricia Lohr medical director 6 , Paquita de Zulueta honorary senior clinical lecturer 7

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Intrapartum care of healthy women and their babies: summary of updated NICE guidance

BMJ (Clinical research ed.), Jan 3, 2014

#### The bottom line The care that a woman receives during labour has the potential to affect the... more #### The bottom line The care that a woman receives during labour has the potential to affect the woman herself, both physically and emotionally, and the health of her baby in the short and longer term. Good communication, support, and compassion from staff, as well as having her wishes respected, can help her feel in control of what is happening and help make birth a positive experience for the woman and her birth companion(s). About 700 000 women give birth in England and Wales each year. Most are healthy, have a straightforward pregnancy, go into labour spontaneously, and give birth to a single baby after 37 weeks of pregnancy. Uncertainty around consistent practice and the availability of new evidence necessitated an update of 2007 guidance from the National Institute for Health and Care Excellence (NICE) on intrapartum care.1 This article summarises the most recent recommendations from NICE on the care of healthy women who go into labour at term (37-41 weeks’ gestation) (Clinical Guideline CG190).2 NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Choosing the planned place of birth

Recommending treatments that don't work patronises women

The Obstetrician & Gynaecologist, 2013

We support the caveat on individual risk factors and on lowering the threshold for investigation ... more We support the caveat on individual risk factors and on lowering the threshold for investigation based on a case by case assessment. This rational conclusion resonates with our regional cancer network guideline 6 that states: 'Asymptomatic thickening of the endometrium/polyps does not routinely justify further investigation. In the absence of evidence to support further testing in asymptomatic postmenopausal women, decisions for further investigation should be made on an individual basis.' This would be more rational than the blanket 'reassure and discharge' policy suggested by the letter above. We all should note that any recommendation may have to be modified with the publication of the final UKCTOCS data in 2015.

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Forewarned is forearmed in massive obstetric haemorrhage

Cases with Expert Commentary, 2015

Shock index: an effective predictor of outcome in postpartum haemorrhage?

BJOG: An International Journal of Obstetrics & Gynaecology, 2014

Objectives To compare the predictive value of the shock index (SI) with conventional vital signs ... more Objectives To compare the predictive value of the shock index (SI) with conventional vital signs in postpartum haemorrhage (PPH), and to establish 'alert' thresholds for use in low-resource settings. Design Retrospective cohort study. Setting UK tertiary centre. Population Women with PPH ≥1500 ml (n = 233). Methods Systolic blood pressure (BP), diastolic BP, mean arterial pressure, pulse pressure, heart rate (HR) and SI (HR/systolic BP) were measured within the first hour following PPH. Values measured at the time of highest SI were selected for analysis. The area under the receiver operating characteristic curve (AUROC) for each parameter, used to predict admission to an intensive care unit and other adverse outcomes, was calculated. Sensitivity, specificity and negative/positive predictive values determined thresholds of the best predictor. Main outcome measures Intensive care unit (ICU) admission, blood transfusion ≥4 iu, haemoglobin level <7 g/dl, and invasive surgical procedures. Results Shock index has the highest AUROC to predict ICU admissions (0.75 for SI [95% CI 0.63-0.87] compared with 0.64 [95% CI 0.44-0.83] for systolic BP). SI compared favourably for other outcomes: SI ≥0.9 had 100% sensitivity (95% CI 73.5-100) and 43.4% specificity (95% CI 36.8-50.3), and SI ≥1.7 had 25.0% sensitivity (95% CI 5.5-57.2) and 97.7% specificity (CI 94.8-99.3), for predicting ICU admission. Conclusions Shock index compared favourably with conventional vital signs in predicting ICU admission and other outcomes in PPH, even after adjusting for confounding; SI <0.9 provides reassurance, whereas SI ≥1.7 indicates a need for urgent attention. In low-resource settings this simple parameter could improve outcomes. It was not possible to adjust for resuscitative measures administered following vital sign measurement that may have influenced the outcome.

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Domestic violence in a UK abortion clinic: anonymous cross-sectional prevalence survey

Journal of Family Planning and Reproductive Health Care, 2014

Objective To measure the prevalence of domestic violence (DV) experienced by women seeking termin... more Objective To measure the prevalence of domestic violence (DV) experienced by women seeking termination of pregnancy (TOP) in a UK abortion clinic. Methods A cross-sectional anonymous questionnaire survey of all women aged over 16 years accessing a TOP clinic in inner London between 20 May 2012 and 2 July 2012. The main outcome measures were: distribution of questionnaires, response rate, lifetime prevalence of abuse, past-year prevalence of physical and sexual abuse, prevalence of physical abuse during current pregnancy, relationship of lifetime abuse to number of terminations, and receptivity to DV services. Results Questionnaires were distributed to 46% (383/828) of women accessing the clinic. Response rate was 50% (190/383). Lifetime prevalence of abuse was 16%. Past-year prevalence of physical abuse was 11% and sexual abuse was 4%. Prevalence of physical abuse during the current pregnancy was 4%. Prevalence of lifetime abuse was lower in women having a first termination (12%) versus one (20%) or two or more previous terminations (24%), although this was not statistically significant (p=0.192). The majority (75%) of participants expressing an opinion on the possibility of having a support service for DV in the abortion clinic setting were positive, unrelated to their personal experience, but some concerns were raised about implementation. Conclusions In order to provide effective support for women, services require a needs assessment of their local population. Asking women presenting for abortion about DV, even anonymously, is challenging but feasible. Future work should be directed to women's unmet safety needs.

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Tragic outcome of post-menopausal pregnancy: An obstetric commentary

Reproductive BioMedicine Online, 2013

The recent Italian court report regarding the removal and adoption of a 1-year-old child conceive... more The recent Italian court report regarding the removal and adoption of a 1-year-old child conceived with assisted reproduction treatment from parents deemed to be 'too old' at ages 57 and 70 brings to the fore the complex medical and ethical issues that surround assisted reproduction. This obstetric commentary examines the biology of reproductive ageing, current childbearing trends and the outcomes of post-reproductive age pregnancies, particularly focusing on maternal mortality as 'the tip of the iceberg' of IVF harms. The case highlights the need for global standards to ensure medical accountability. RBMOnline

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