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Introduction: This retrospective study investigated the hypothesis that maternal hemoglobin (Hb) levels in twin pregnancy fall between the first and second trimesters and that higher falls are associated with higher gestational age at birth and higher birthweight (BW). Material and Methods: The study population was defined as pregnant women with twin pregnancies delivering two live, phenotypically normal neonates, after 24+0 weeks of gestation, between October 2009 and September 2021 at an inner London maternity unit. Maternal Hb and mean corpuscular volume (MCV), at ≤14+0 weeks of gestation (Hb1) and again at 20+0–30+0 weeks gestation (Hb2) were recorded from the Hospital's perinatal database. MCV was used as a possible indicator of iron deficiency anemia. The association of Hb drop, defined as [Hb1(adjusted for gestational age) − Hb2], and MCV values with gestational age at birth, BW of both twins and delivery of small for gestational age (SGA) neonates, defined as BW <10th percentile for gestation, was evaluated. Results: 923 pregnant women with twin pregnancies were included. Maternal Hb1 did not correlate with any outcomes measured. However, a lower Hb2 and a larger Hb drop was associated with a higher gestational age at birth (p < 0.001), a larger BW of twin 1 and 2 (p < 0.001 for both) and a reduction in the incidence of delivering one or two SGA neonates (p < 0.001 for both). MCV values did not correlate significantly with these outcomes. Conclusions: This study showed that in twin pregnancy, a larger maternal Hb drop from the first to the second trimester is associated with a higher gestational age at birth and a larger BW. This change may represent a larger plasma volume expansion. [ABSTRACT FROM AUTHOR]

The article discusses the life and career of Frank Loeffler, who was born in India in 1931 and later became a prominent figure in obstetrics and gynecology. Loeffler's academic achievements and clinical work led to his appointment as the Editor-in-Chief of BJOG from 1973 to 1980. Known for his concise writing style and clinical expertise, Loeffler made significant contributions to the field before his passing in 2014. [Extracted from the article]

Objective: To investigate the hypothesis that risk factors in addition to an abnormal fetal heart rate pattern (aFHRp) are independently associated with adverse neonatal outcomes of labour. Design: Observational prospective cohort study. Setting: 17 UK maternity units. Sample: 585 291 pregnancies between 1988 and 2000 inclusive. Methods: Adjusted odds ratios (OR) with 95% confidence intervals (95% CI) were estimated from multivariable logistic regression. Main outcome measures: Adverse neonatal outcome at term (5‐minute Apgar score <7, and a composite measure comprising 5‐minute Apgar score <7, resuscitation by intubation and/or perinatal death). Results: Analysis was based on 302 137 vaginal births at 37–42 weeks inclusive. We found a higher odds of Apgar score at 5 minutes <7 with suspected fetal growth restriction (OR 1.34, 95% CI 1.16–1.53), induction of labour (OR 1.41, 95% CI 1.25–1.58), nulliparity (OR 1.48, 95% CI 1.34–1.63), booking body mass index ≥30 (OR 1.18, 95% CI 1.02–1.37), maternal age <25 (OR 1.23, 95% CI 1.10–1.39), black ethnicity (OR 1.21, 95% CI 1.03–1.43), early‐term birth at 37–38 weeks (OR 1.13, 95% CI 1.02–1.25), late‐term birth at 41–42 weeks (OR 1.14, 95% CI 1.01–1.28), use of oxytocin (OR 1.27, 95% CI 1.14–1.41), maternal pyrexia (OR 1.87, 95% CI 1.46–2.40), aFHRp and presence of meconium (aFHRp without meconium: OR 2.40, 95% CI 2.15–2.69; meconium without aFHRp: OR 2.20, 195% CI.94–2.49; both aFHRp and meconium: OR 4.26, 95% CI 3.74–4.87). The results were similar when the composite adverse outcome was considered. Conclusions: A range of risk factors, including suspicion of fetal growth restriction, maternal pyrexia and presence of meconium, are implicated in poor birth outcomes in addition to aFHRp. Interpretation of the fetal heart rate pattern alone is insufficient as a basis for decisions about escalation and intervention. [ABSTRACT FROM AUTHOR]

The document provides a detailed account of Geoffrey Victor Price Chamberlain, a prominent figure in the field of Obstetrics and Gynaecology. Chamberlain's career spanned various prestigious institutions, and he made significant contributions to the field through research and publications. Despite a controversial incident in his later years, Chamberlain's legacy includes the establishment of an award in his honor by the Royal College of Obstetricians and Gynaecologists. His work is recognized for its impact on obstetric practice and women's healthcare. [Extracted from the article]

Objective: To examine the factors associated with unexpectedly high rates of conversion to open label oxytocin in the CONDISOX trial of continuation versus discontinuation of oxytocin infusion during induced labour. Design: Secondary retrospective analysis of data from a prospective randomised controlled trial. Setting Nine hospitals in Denmark and one in the Netherlands between 8 April 2016 and 30 June 2020. Population or sample: 1200 women having labour induced. Methods: Analysis of outcomes by actual management. Main outcome measures: Mode of delivery and associated variables. Results: Switching to open label oxytocin (42.4% overall) was associated with nulliparity, an unripe cervix, larger babies and higher rates of delivery by caesarean section. Conclusions: In the CONDISOX trial, slow labour was associated with features suggesting a higher 'resistance to progress', often prompting the use of open‐label oxytocin infusion rather than study medication. Linked article: This article is commented on by G. J. Hofmeyr, pp. 643–644 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17377. [ABSTRACT FROM AUTHOR]

Objective: To quantify the incidence of intrapartum risk factors in labours with an adverse outcome, and compare them with the incidence of the same indicators in a series of consecutive labours without adverse outcome. Design: Case–control study. Setting: Twenty‐six maternity units in the UK. Population or sample: Sixty‐nine labours with an adverse outcome and 198 labours without adverse outcome. Methods: Observational study. Main outcome measures: Incidence of risk factors in hourly assessments for 7 hours before birth in the two groups. Results: A risk score combining suspected fetal growth restriction, tachysystole, meconium in the amniotic fluid and fetal heart rate abnormalities (baseline rate and variability, presence of decelerations) gave the best indication of likely outcome group. Conclusions: Accurate risk assessment in labour requires fetal heart rate abnormalities to be considered in context with additional intrapartum risk factors. [ABSTRACT FROM AUTHOR]

Objective: To determine whether screening for gestational diabetes mellitus (GDM) in the third trimester and managing those who are screen positive on a diabetes pathway affects obstetric and neonatal outcomes. Design: Retrospective study of prospectively collected data. Setting: London Teaching Hospital. Population or sample: A total of 14 366 women delivering between 1 January 2018 and 31 December 2020. Methods: Retrospective chart analysis. Main outcome measures: Diagnosis of late‐onset GDM, obstetric and neonatal outcomes. Results: Five hundred and thirty‐one women were tested by home glucose monitoring for late‐onset GDM from 33 weeks of gestation. In all, 244 were diagnosed as having GDM (group 1) and managed accordingly, and 287 (group 2) were returned to normal care. A total of 1415 women had GDM diagnosed by oral glucose tolerance test before 33 weeks of gestation (group 3). Of the women in group 2, 49.5% had a spontaneous onset of labour compared with only 25.8% and 27% in groups 1 and 3. However, women in group 2 were significantly more likely to have a macrosomic baby (≥4000 g, 25.4%) than groups 1 (16.0%) or 3 (7.2%), and their babies were more likely to be admitted to special care (5.2% versus 2% in group 1). Macrosomic babies were associated with significantly higher rates of shoulder dystocia, third‐ and fourth‐degree tears and postpartum haemorrhage. Conclusions: Apparent late‐onset GDM affects a significant proportion of women, and targeted intervention was associated with better obstetric and neonatal outcomes. These results suggest that all pregnancies with risk factors for late‐onset GDM might benefit from active GDM management irrespective of specific glucose thresholds. Women with risk factors for GDM in the third trimester, and their babies, would probably benefit from active management of their blood sugars irrespective of threshold values. Women with risk factors for GDM in the third trimester, and their babies, would probably benefit from active management of their blood sugars irrespective of threshold values. Linked article: This article is commented on by Jane Hirst, pp. 2184 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.17184 [ABSTRACT FROM AUTHOR]

Objective: To determine maternal, obstetric and neonatal outcomes in a cohort of women with cerebrovascular malformations (CVMs) that include arterial venous malformations (AVMs) and cavernomas. Design: Retrospective cohort study. Setting: Six specialist centres managing pregnant women with neurological disorders. Population: Sixty‐three women with CVMs in 83 pregnancies of ≥20 completed weeks' gestation. Methods: Retrospective case notes review. Main outcome measures: Neurological outcomes including rates of acute cerebral bleeding in pregnancy and reported seizures during pregnancy. Maternal outcomes included number of women with a livebirth and the proportion of women being delivered by caesarean section. Results: Most women had a good pregnancy outcome with high rates of vaginal delivery (73%) at term. There were no maternal deaths. Six women had an acute cerebral bleed, all of whom were delivered by planned caesarean section. In total, ten women had seizures in pregnancy (of whom four also had a bleed). Six (7%) babies were admitted to a neonatal unit. There was no significant difference in outcomes between women with AVMs and those with cavernomas. Conclusion: In the majority of cases, pregnancy outcomes were favourable, with most women having a vaginal delivery. All cases of cerebral bleeds that occurred were at a remove from the peripartum period. Women with cerebrovascular malformations have high rates of vaginal delivery. Women with cerebrovascular malformations have high rates of vaginal delivery. [ABSTRACT FROM AUTHOR]

Linked article: This is a mini commentary on Wright et al., pp. 78–87 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.17296. [ABSTRACT FROM AUTHOR]

Key content: Oxytocin is a well‐established drug with a long history of use.The generation of intrauterine pressure is a result of myometrial activity, but is attenuated by a softening cervix.The introduction of active management regimens have not changed the outcome of labour as we envisaged.Too many babies suffer asphyxia as a result of misuse of oxytocin.Some form of education programme must be developed to warn of the dangers of this very useful drug.Better training and education programmes must be in place for midwives and obstetricians for labour management and cardiotography interpretation. Learning objectives: To outline the history of the development of oxytocin.To understand the mechanism of intrauterine pressure development.To understand the methods of intrauterine pressure measurement and assessment.To understand the development of principles of active management with a discussion of the subsequent studies analysing the results of such labour management.To outline the medicolegal aspects of labour augmentation, with particular reference to oxytocin use.To discuss possible implications for the future. Ethical issues: Should all women be given the information that oxytocin augmentation of slow labour may reduce the duration of labour by several hours but does not change the mode of delivery, whilst carrying a risk of causing fetal asphyxia?Should women sign informed consent before their labours are augmented?Should augmentation of labour only be undertaken under the direct supervision of a senior clinician? [ABSTRACT FROM AUTHOR]

Objective To assess the relationship between race and spontaneous abortion, whether the relationship varies by risk factors, and the effect of spontaneous abortions on subsequent pregnancies. Methods A retrospective study was undertaken using data collected in London, UK, between 1988 and 2000. Logistic regression evaluated histories of spontaneous abortion and associations with small-for-gestational-age and preterm births in black African, black Caribbean, and South Asian women relative to white European women. Interactions with risk factors were assessed. Results Overall, 196 040 women were included. Compared with white Europeans, the odds of a previous spontaneous abortion were increased in black African (adjusted odds ratio [aOR] 1.20; 95% confidence interval [CI] 1.12–1.29) and black Caribbean women (aOR 1.31; 95% CI 1.21–1.41). The strength of the association with black African race increased with age ( P = 0.002), and the association with South Asian race increased with age and body mass index ( P < 0.001 for both). Spontaneous abortion was associated with preterm birth in all races, but was strongest in black African women (aOR 1.47; 95% CI 1.29–1.67). Conclusion The greater incidence of spontaneous abortion in black African and black Caribbean women should prompt further study of risk factors in relation to race. The interaction with age in black African and South Asian women could be important for counseling in relation to timing of pregnancy. [ABSTRACT FROM AUTHOR]

Objective To determine the optimum mode of delivery for women in preterm breech labour at a gestational age of 26 to 32 weeks. Design A multicentre randomised controlled trial. Setting Twenty-six hospitals in England, UK. Participants Women with a singleton breech fetus in spontaneous preterm labour between 26 and 32 completed weeks of gestation, with no clear indication for a caesarean section or vaginal breech delivery. Intervention Random allocation to either 'intention to delivery vaginally' or 'intention to deliver by caesarean section'. Main outcome measures Perinatal mortality, neonatal morbidity, maternal morbidity and gestation at delivery. Results The trial was closed after 17 months because of low recruitment, by which time substantial numbers of women had been in the eligible gestation period. Thirteen women from six hospitals were recruited. One infant, randomised to and delivered vaginally, was stillborn. Three fetal presentations were cephalic at delivery despite a diagnosis of breech presentation at trial entry. No formal statistical analysis was performed due to the small numbers. Conclusions No conclusions about the optimum mode of delivery for women in preterm labour with a fetus presenting by the breech can be drawn from this trial. The low accrual rate was due to clinicians' reluctance to randomise eligible women, reflecting the circumstances and nature of the trial. [ABSTRACT FROM AUTHOR]

We investigated the possibility of preterm birth misclassification as a determinant of variation in its reported rates. Using a database of 497,105 deliveries from 17 hospitals, the best estimate of gestational age made at delivery and entered into the database at that time was recalculated from the menstrual dates and mid-trimester ultrasound scan. The recalculated completed weeks of gestation at delivery was compared with that made at birth. Calculation of estimated gestational age varied between hospitals due to inconsistencies in‘rounding’ and‘truncating’ the weeks of gestation at delivery. This resulted in preterm birth misclassification rates of up to 10.1%. [ABSTRACT FROM AUTHOR]

Dr Sholapurkar has drawn attention to the remarkably low perinatal mortality and morbidity in the INFANT trial,[[1]] and we agree that this may in part be due to the Hawthorne effect. However, the purpose of the INFANT trial was to address the specific hypothesis that some intrapartum care givers are unable to interpret fetal heart rate (FHR) patterns and this hypothesis was not supported by the results. A fetal tachycardia of 162 bpm with variable decelerations but preserved baseline variability in the context of a rapidly progressing labour with clear amniotic fluid and a maternal temperature of 37°C is more likely to be associated with a good outcome than a similar pattern in a prolonged labour with meconium staining of the amniotic fluid and a maternal pyrexia. [Extracted from the article]

The article offers a profile of Stanley Clayton, focusing on his career in obstetrics and gynaecology. He was born on September 13, 1911 and had obtained his medical training at King's College Hospital in England, where he later became a professor of obstetrics and gynaecology until his retirement. It discusses Clayton's achievements, the scientific papers he published, and his tenure as Editor-in-Chief of the "Journal of Obstetrics and Gynaecology of the British Commonwealth" for 10 years.

The article examines need for written consent in case of emergency caesarean section in Great Britain.

Lorthe et al in their study of the outcome of planned mode of delivery of the preterm breech published in this issue (BJOG, 2018) address a topic that has been studied for over forty years. Early observational studies were unequivocal in their support for delivery by caesarean section rather than the previous norm of vaginal birth. Ingemarsson et al (Lancet 1978;8082:172-5) reported that "Delivery by caesarean section significantly reduced the frequency of severe prolonged asphyxia, and neonatal mortality was reduced from 14.6% to 4.8%". This article is protected by copyright. All rights reserved. [ABSTRACT FROM AUTHOR]

The article discusses the issue relating to the damage to ilioinguinal nerve in low transverse abdominal incisions including abdomen pain and the diagnosis of ilioinguinal neuralgic pain.

The author offers insights on the use of the medical term 'abortion' in pregnancy termination cases. Topics discussed include legal issues associated with the distinction between spontaneous and induced abortion, the use of the term 'miscarriage' by patients that suffered from pregnancy loss, and the definition of 'abortion' according to the National Health Service (NHS) Choices information service.

The author offers insights on the use of Latin terms in medicine. Topics discussed include the importance of using appropriate terminology in science and medicine to ensure accurate communication, the Greek origin of technical medical terms despite the use of Latin language by scholars such as Galileo Galilei and Isaac Newton, and the observed misuse of the Latin language in the field of obstetrics and gynaecology.

The article suggests the benefits of continuous electronic fetal monitoring (cEFM) over intermittent auscultation in fetal surveillance during labour. Topics include statistical data on reduction in stillbirth and neonatal convulsions using cEFM, the importance of posture during labour, and why the supine position should be discouraged.

The article discusses the statistics related to perinatal mortality in England and Wales between 1955 and 1988 and presents the results of a study on 122 women who had booked for maternity care in 1989.

The article offers information on James Young, former Editor-in-Chief of the periodical "BJOG." It mentions Young published a paper on the risk of recurrence the need for antenatal supervision from an early stage in the event of the subsequent pregnancy should be explained to the patient. It also mentions acceptance of his research into the causes of eclampsia.

The article presents author's views on model proposed by Jeremy Hunt, the UK Secretary of State, to compensate victims of worse outcomes resulting form midwifery errors while childbirth. Topics discussed include legal claims reported by the National Health Service (NHS) Litigation Authority, birth injuries, and disabled children.

The author presents insights on the changing views on external cephalic version (ECV) of delivering an infant. Topics discussed include its practice in Europe, the reasons why the procedure is not practiced in Great Britain, and the fetal mortality from the procedure in 1956. Also mentioned are experiences of the author in performing ECV.

The article discusses various reports published within the issue, including one by Austin Ugwumadu and Julia Hussein regarding issues on infections in pregnancy, one by Huusom and colleagues on tocolysis, and another by Mier-Cabrera and colleagues on research concerning lymphocytes in females with endometriosis.

The article presents an obituary for George Comyns Berkeley, former editor of "BJOG: An International Journal of Obstetrics & Gynaecology."

The article provides information on recommendations for repeat caesarean section and decision of pregnant to agree for it. Topics discussed include surgical outcome of vaginal birth after caesarean (VBAC), financial pressure on women and family to claim high compensation, and documentation of medical devices.

An obituary for Eardley Holland, one of the most eminent obstetricians and gynaecologists and Editor-in-Chief of the British Journal of Obstetrics & Gynaecology (BJOG).

The article discusses various reports published within the issue including one by J. Wen, Q. Y. Cai, F. Deng, and Y. P. Li on population control and another by I. M. Claesson on weight control during pregnancy.

The article discusses various reports published within the issue including one by P. Priest and colleagues about the effectiveness of cervical cancer screening in New Zealand and another one by V.M.H. Coupe and colleagues about the failure of women to attend screening in Great Britain.

The article discusses various reports published within the issue, including one by Boon Heng on the globalisation of the fertility industry and another by Jae Hong on the higher perinatal mortality at holiday times in Korea.