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Objective: To describe the incidence of mechanical prosthetic heart valves (MPHV) in pregnancy in the UK; rates of maternal and fetal complications in this group of women, and whether these vary with the anticoagulation used during pregnancy.Design: Prospective descriptive population-based study.Setting: All consultant-led maternity units in the UK.Population: All women with an MPHV who were pregnant between 1 February 2013 and 31 January 2015.Methods: Collection and analysis of anonymous data relating to pregnancy management and outcome, using the UKOSS notification and data collection system.Main Outcome Measures: Maternal death, serious maternal morbidity, poor fetal outcome.Results: Data were obtained for 58 women giving an estimated incidence of 3.7 (95% CI 2.7-4.7) per 100 000 maternities. There were five maternal deaths (9%); a further 24 (41%) suffered serious maternal morbidity. There was a poor fetal outcome from 26 (47%) pregnancies. Only 16 (28%) women had a good maternal and good fetal outcome. Low-molecular-weight heparin (LMWH) was used throughout pregnancy by 71% of women. Of these, 83% required rapid dose escalation in the first trimester. Monitoring regimens lacked consistency.Conclusions: This study has estimated the incidence of MPHV in pregnant women in the UK. It includes the largest cohort managed with LMWH throughout pregnancy reported to date. It demonstrates a high rate of maternal death, and serious maternal and fetal morbidity. Women with MPHVs, and their clinicians need to appreciate the significant maternal and fetal risks involved in pregnancy. Care should be concentrated in specialist centres.Tweetable Abstract: High rates of poor maternal and fetal outcomes in pregnant women with mechanical prosthetic heart valves. [ABSTRACT FROM AUTHOR]

The authors discuss aspects of the randomised controlled study concerning the conditions of maternal and child health following assisted vaginal delivery. They are critical on the outcomes on the use of forceps and ventouse for the mother and baby. Also investigated is the randomised trial of obstetric practice and different methods of instrumental delivery.

OBJECTIVE: To assess short- and long-term outcomes of pregnant women with very early rupture of membranes randomized to serial amnioinfusion or expectant management, and to collect data to inform a larger, more definitive clinical trial. METHODS: This was a prospective non-blinded randomized controlled trial with randomization stratified for pregnancies in which the membranes ruptured between 16 + 0 and 19 + 6 weeks' gestation and 20 + 0 and 23 + 6 weeks' gestation to minimize the risk of random imbalance in gestational age distribution between randomized groups. Intention-to-treat analysis was used. The study was conducted in four UK hospital-based fetal medicine units (Liverpool Women's NHS Trust, St Mary's Hospital Manchester, Birmingham Women's NHS Foundation Trust and Wirral University Hospitals Trust). The participants were women with confirmed preterm prelabor rupture of membranes at 16 + 0 to 24 + 0 weeks' gestation. Women with multiple pregnancy, fetal abnormality or obstetric indication for immediate delivery were excluded. Participants were randomly allocated to either serial weekly transabdominal amnioinfusions if the deepest pool of amniotic fluid was < 2 cm or expectant management until 37 weeks' gestation. Short-term maternal, pregnancy and neonatal and long-term outcomes for the child were studied. Long-term respiratory morbidity was assessed using validated respiratory questionnaires at 6, 12 and 18 months of age and infant lung function test at around 12 months of age. Neurodevelopment was assessed using the Bayley Scales of Infant Development, second edition (BSID-II) at corrected age of 2 years. RESULTS: Fifty-eight women were randomized to the study. Two babies were excluded from the analysis because of termination of pregnancy for lethal anomaly, leaving 56 participants (28 assigned to serial amnioinfusion and 28 to expectant management) recruited between 2002 and 2009. There was no significant difference in perinatal mortality (19/28 vs 19/28; relative risk (RR) 1.0 (95% CI, 0.70-1.43)) and maternal or neonatal morbidity. The overall chance of surviving without long-term respiratory or neurodevelopmental disability was 4/56 (7.1%); 4/28 (14.3%) in the amnioinfusion group and 0/28 in the expectant group (RR 9.0 (95% CI, 0.51-159.70)). CONCLUSIONS: This pilot study found no major differences in maternal, perinatal or pregnancy outcomes. The study was not designed to show a difference between the groups and the number of survivors was too small to draw any conclusions about long-term outcomes. It does, however, signal that a larger definitive study to evaluate amnioinfusion for improvement in healthy survival is needed. The pilot suggests that, with appropriate funding, such a study is feasible. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective To assess short- and long-term outcomes of pregnant women with very early rupture of membranes randomized to serial amnioinfusion or expectant management, and to collect data to inform a larger, more definitive clinical trial. Methods This was a prospective non-blinded randomized controlled trial with randomization stratified for pregnancies in which the membranes ruptured between 16 + 0 and 19 + 6 weeks' gestation and 20 + 0 and 23 + 6 weeks' gestation to minimize the risk of random imbalance in gestational age distribution between randomized groups. Intention-to-treat analysis was used. The study was conducted in four UK hospital-based fetal medicine units (Liverpool Women's NHS Trust, St Mary's Hospital Manchester, Birmingham Women's NHS Foundation Trust and Wirral University Hospitals Trust). The participants were women with confirmed preterm prelabor rupture of membranes at 16 + 0 to 24 + 0 weeks' gestation. Women with multiple pregnancy, fetal abnormality or obstetric indication for immediate delivery were excluded. Participants were randomly allocated to either serial weekly transabdominal amnioinfusions if the deepest pool of amniotic fluid was < 2 cm or expectant management until 37 weeks' gestation. Short-term maternal, pregnancy and neonatal and long-term outcomes for the child were studied. Long-term respiratory morbidity was assessed using validated respiratory questionnaires at 6, 12 and 18 months of age and infant lung function test at around 12 months of age. Neurodevelopment was assessed using the Bayley Scales of Infant Development, second edition (BSID-II) at corrected age of 2 years. Results Fifty-eight women were randomized to the study. Two babies were excluded from the analysis because of termination of pregnancy for lethal anomaly, leaving 56 participants (28 assigned to serial amnioinfusion and 28 to expectant management) recruited between 2002 and 2009. There was no significant difference in perinatal mortality (19/28 vs 19/28; relative risk ( RR) 1.0 (95% CI, 0.70-1.43)) and maternal or neonatal morbidity. The overall chance of surviving without long-term respiratory or neurodevelopmental disability was 4/56 (7.1%); 4/28 (14.3%) in the amnioinfusion group and 0/28 in the expectant group ( RR 9.0 (95% CI, 0.51-159.70)). Conclusions This pilot study found no major differences in maternal, perinatal or pregnancy outcomes. The study was not designed to show a difference between the groups and the number of survivors was too small to draw any conclusions about long-term outcomes. It does, however, signal that a larger definitive study to evaluate amnioinfusion for improvement in healthy survival is needed. The pilot suggests that, with appropriate funding, such a study is feasible. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Aim: To explore the associations between a clinical diagnosis of maternal infection (CDMI) and findings on the initial cranial ultrasound scan in very preterm infants. Methods: Among infants born at less than 32 weeks gestation, cases of CDMI and controls were identified on the basis of routinely available obstetric data. Neonatal cranial ultrasound scans carried out soon after birth were retrospectively reviewed for evidence of parenchymal echodensity (PED), intraventricular haemorrhage (IVH) or PED contiguous with IVH. Results: Any PED was identified in 20/40 (50%) cases of CDMI and 9/30 (30%) of controls. Logistic regression was used to adjust for differences between the two study groups. When compared with normal scans, isolated PED was more likely with CDMI odds ratio, OR (95% confidence interval, CI), 41.8 (2.64, 662) and lower Apgar score at 5 min 2.89 (1.05, 7.98). IVH was more likely with lower gestational age, OR for each completed week of gestation 0.64 (0.46, 0.88) and a protective effect of female sex, OR 0.25 (0.063, 0.98), PED contiguous with IVH was more likely with lower gestational age OR 0.59 (0.336, 1.04). Conclusions: CDMI may be associated with isolated PED in very preterm infants. We speculate that isolated PED (including "flares") identify infants who have sustained early brain injury because of intrauterine infection. Isolated PED may be a useful intermediate outcome in perinatal cohort studies. [ABSTRACT FROM AUTHOR]

Deals with a study which investigated the expression of arginine transporters and endothelial nitric oxide synthase in human placental microvascular endothelial cells (HPMEC). Measurement of radiolabeled arginine uptake; Characteristics of active arginine transporters in HPMEC; Implication of arginine transport on the expression of endothelial cells.

This article presents the medical case report of a patient with Noonan's syndrome. A 27 year old primigravida, with Noonans syndrome and pulmonary stensosis booked at a tertiary maternity unit at 9 weeks of gestation. Antenatal surveillance was carried out by a multidisciplinary team involving a cardiologist, anaesthetist, fetal medicine consultant, haematologists and a neonatalogist. The woman was admitted to the delivery suite with significant vaginal bleeding at 34 weeks of gestation. Recurrent vaginal bleeds prompted the decision for emergency caesarean section after appropriate arrangements were made for cardiothoracic and anaesthetic support due to the maternal cardiac condition. Noonans syndrome is characterised by various anomalies including cardiac valvular malformations, skeletal and orofacial anomalies and occasional bleeding tendencies.

Presents a letter to the editor in response to the article "A career in O&G? No thanks!."

The article focuses on the new guideline from the National Institute for Health and Clinical Excellence (NICE), which advises not to use antibiotic prophylaxis against infective endocarditis in obstetrics. It presents the basis of the guideline related to bacteraemia in women and evidences of prophylaxis' efficacy to prevent endocarditis with the risk of cardiac lesions. It also relates the need to gather reliable data on prophylaxis and to involve women in clinical decision-making.

The objective of this study was to measure the independent effects of clinical factors and non-clinical factors, such as provider and sociodemographic characteristics, on the number of antenatal visits made by women in England and Wales. The study was based on a survey of the secondary case records of 20,771 women with singleton pregnancies who were delivered between 1 August 1994 and 31 July 1995. The women in the survey attended one of nine maternity units in Northern England and North Wales selected within those areas to reflect geographical variations, as well as variations in the size and teaching status of the institution. A multivariate Poisson regression model was developed to examine differences in the number of antenatal visits made by women with different clinical and non-clinical characteristics. After controlling for non-clinical factors, primiparous women identified as high risk at booking made 1.0% more visits than primiparous women identified as low risk at booking (p = 0.196). Multiparous women identified as high risk at booking made 3.5% more visits than their low risk counterparts (p<0.001). High risk-defining criteria during antenatal care led to a 0.3% weekly increase in the number of antenatal visits amongst primiparous women (p <0.001) and a 0.4% weekly increase in the number of antenatal visits amongst multiparous women (p < 0.001). Several notable results, not reported elsewhere in the literature, were revealed by the regression analyses. After all independent variables were controlled for, women who were booked into urban teaching hospitals made 10% fewer antenatal visits than the women who were booked into the urban non-teaching hospitals. Women of Pakistani origin made 9.1% fewer antenatal visits than women of white British origin. Similar results were revealed for women of Indian origin and women from other ethnic groups. Non-smokers made 6.0% more antenatal visits than smokers. The planned pattern of antenatal care, number of carers seen, gestation at first presentation and maternal age also had significant independent impacts on the number of antenatal visits. The study highlights the sizeable impact of non-clinical factors on the antenatal care delivery process and indicates ways in which variations in antenatal care might be reduced. [ABSTRACT FROM AUTHOR]

Objectives: To determine cardiovascular, obstetric and neonatal outcomes of pregnancies in women who have a Fontan circulation.Methods: A retrospective case note review of all women with a Fontan circulation who attended the joint obstetric cardiac antenatal clinic at St Mary's Hospital, Manchester (UK) between 2004 and 2016 was performed.Results: In total, there were 19 pregnancies in 9 women with a history of Fontan repair. 23 women with univentricular physiology attended in this time period. 10 pregnancies (53%) resulted in live births; 1 in a stillbirth at 31 weeks gestation and 8 in miscarriage. Cardiovascular complications occurred in 2 pregnancies (11%). There were no thrombotic events, arrhythmias, myocardial infarction, or endocarditis in the antenatal or postnatal period. Obstetric complications included miscarriage (26% first trimester, 16% second trimester), along with premature delivery (24-36+6) (80%) and fetal growth restriction (70%). The majority of women were delivered by caesarean section (60%).Conclusions: Women who become pregnant following a Fontan repair carry an increased risk of cardiovascular complications. Fetal and neonatal complication rates are high and emphasize the importance of thorough, multidisciplinary, pre-conceptual assessment and counseling to allow patients to make informed decisions regarding future pregnancy. [ABSTRACT FROM AUTHOR]

Background: There is little consensus regarding the hypothesised link between obstetric consultant presence and maternal and neonatal outcomes.Objectives: To pool existing data on the impact of consultant presence on the outcomes of women who have given birth in UK National Health Service (NHS) maternity units.Search Strategy: Twelve databases, grey literature, and reference lists were searched.Selection Criteria: Studies conducted in UK NHS maternity units comparing outcomes during lesser consultant presence versus increased consultant presence that reported mode of delivery and adverse maternal or neonatal outcomes.Data Collection and Analysis: Studies were divided into three groups by type of comparison: (1) hours of rostered consultant presence during the weekend versus hours of rostered consultant presence during the week; (2) hours per week of rostered consultant presence pre-increase versus hours per week of rostered consultant presence post-increase; and (3) no rostered consultant presence versus rostered consultant presence. A random-effects meta-analysis was performed.Main Results: Fifteen studies fulfilled the inclusion criteria, presenting data from 125 856 births. Overall, there was no significant difference between lesser and increased consultant presence for any outcome. When data were stratified by comparison type, the likelihood of emergency caesarean section was significantly lower (odds ratio, OR 0.91; 95% confidence interval, 95% CI 0.86-0.96) and the likelihood of non-instrumental vaginal delivery was significantly higher (OR 1.07; 95% CI 1.02-1.12) when the rostered hours of consultant presence per week were increased.Conclusions: Increased consultant presence has some effect on mode of delivery, but no evidence for a benefit for adverse outcomes was found.Tweetable Abstract: Increasing hours of NHS obstetric consultant presence may increase chance of non-instrumental vaginal delivery. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Factors Relating to a Rising Incidence of Major Postpartum Haemorrhage."

The Royal College of Anaesthetists have set the standard that 85% of emergency caesarean sections should be carried out under regional anaesthesia. Reducing the frequency of caesarean sections carried out under general anaesthesia may serve to reduce maternal morbidity and mortality, which has been shown over recent years. A retrospective audit was carried out at a tertiary referral centre investigating the mode of anaesthesia and fetal outcome after emergency caesarean section. The proportion carried out under regional anaesthesia was less than recommended. Despite a longer time taken to induce anaesthesia there was no increase in adverse fetal outcome, supporting the use of regional anaesthesia wherever possible to keep maternal complications to a minimum. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 40-year-old nulliparous woman who was transferred to a tertiary care unit after a contraceptive failure. Findings of fetal ultrasound scans during 20 and 23 weeks of pregnancy were normal. However, an anhydramnios was detected after 27 weeks. It notes that the patient was advised to discontinue her lisinopril medication. It also mentions that no ruptured membranes and fetal bladder absence were noticed during the examination.

The article provides information concerning the comparative case study of uterine collagen in a woman suffering with osteogenesis imperfecta (OI) type 1 in Great Britain. According to the study, differences were indicated in the amount and type of collagen in the uterus of the woman with OI Type 1. The author infers that osteogenesis imperfecta is a disorder which bears on many different organs.

An abstract of the article "AMIPROM: a pilot RCT on serial transabdominal amnioinfusion versus expectant management in very early PROM," by D. Roberts, C. Beardsmore, B. Shaw, W. Martin, S. Vause, L. Bricker, S. A. Walkinshaw, and Z. Alfirevic is presented.

The article examines the recurrent themes covered during pre-conceptual counseling of women with spina bifida at Saint Mary's Hospital in Manchester, England. The authors report that for women with spina bifida, a preconceptual consultation provides an opportunity to reinforce advice regarding folic acid. The authors add that preconceptual counseling also reduces anxieties about pregnancy.