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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]

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]

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]

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.

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.

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.

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

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

Background: Re-exploration following caesarean birth and the associated maternal morbidity has not been investigated in the UK. Our aims were to determine the national incidence and identify the associated risk factors., Methods: We conducted a prospective observational case-control study across 194 UK consultant-led maternity units in women whose caesarean birth was complicated by a re-exploration. Independent factors for re-exploration were analysed using multivariable multi-level mixed effects logistic regression., Results: Over the study period (1 June 2021 and 31 May 2022) 238,423 caesarean births were recorded across the UK of which 187 women underwent re-exploration, giving an incidence of one re-exploration per 1282 caesarean births (95%CI 1:1099-1:1471). Haemorrhage (124/187, 66.3%) and sepsis (31/187, 16.6%) were the most common findings at re-exploration. Median (IQR [range]) time interval to re-exploration following the caesarean birth was 1 (0-4 [0-28]) day. Mechanical ventilation was required in 34 (18.6%) women, cardiac arrest was reported in 5 (2.7%) and 3 (1.6%) women died. Independent preceding factors associated with a re-exploration included: receipt of blood transfusion (adjusted OR (95%CI) 8.25 (2.66-25.61)); use of a general anaesthetic (adjusted OR (95%CI) 3.33 (1.61-6.88)); pre-eclampsia (adjusted OR (95%CI) 3.27 (1.55-6.91)); black ethnicity (adjusted OR (95%CI) 3.14 (1.39-7.11)); postpartum haemorrhage (adjusted OR (95%CI) 2.82 (1.81-4.37)); use of anticoagulants or antiplatelet drugs pre-caesarean birth (adjusted OR (95%CI) 2.26 (1.35-3.81)); and emergency caesarean birth (adjusted OR (95%CI) 1.89 (1.01-3.57))., Conclusion: Re-exploration following caesarean birth in the UK is uncommon but is associated with significant maternal morbidity and mortality. These study findings will help guide informed consent and encourage appropriate surveillance of high-risk women postpartum., (© 2024 Association of Anaesthetists.)

Objective: Direct current cardioversion (DCCV) in pregnancy is rarely required and typically only documented in single case reports or case series. A recent UK confidential enquiry reported on several maternal deaths where appropriate DCCV appeared to have been withheld., Design: Retrospective cohort study., Setting: Seventeen UK and Ireland specialist maternity centres., Sample: Twenty-seven pregnant women requiring DCCV in pregnancy., Main Outcome Measures: Maternal and fetal outcomes following DCCV., Results: Twenty-seven women had a total of 29 DCCVs in pregnancy. Of these, 19 (70%) initial presentations were to Emergency Departments and eight (30%) to maternity settings. There were no maternal deaths. Seventeen of the women (63%) had a prior history of heart disease. Median gestation at DCCV was 28 weeks, median gestation at delivery was 35 weeks, with a live birth in all cases. The abnormal heart rhythms documented at the first cardioversion were atrial fibrillation in 12/27 (44%) cases, atrial flutter in 8/27 (30%), supraventricular tachycardia in 5/27 (19%) and atrial tachycardia in 2/27 (7%). Fetal monitoring was undertaken following DCCV on 14/29 (48%) occasions (10 of 19 (53%) at ≥26 weeks) and on 2/29 (7%) occasions, urgent delivery was required post DCCV., Conclusions: Direct current cardioversion in pregnancy is rarely required but should be undertaken when clinically indicated according to standard algorithms to optimise maternal wellbeing. Once the woman is stable post DCCV, gestation-relevant fetal monitoring should be undertaken. Maternity units should develop multidisciplinary processes to ensure pregnant women receive the same standard of care as their non-pregnant counterparts., (© 2023 John Wiley & Sons Ltd.)

Objective: To determine the characteristics and outcomes of pregnancy in women with Turner syndrome., Design: Retrospective 20-year cohort study (2000-20)., Setting: Sixteen tertiary referral maternity units in the UK., Population or Sample: A total of 81 women with Turner syndrome who became pregnant., Methods: Retrospective chart analysis., Main Outcome Measures: Mode of conception, pregnancy outcomes., Results: We obtained data on 127 pregnancies in 81 women with a Turner phenotype. All non-spontaneous pregnancies (54/127; 42.5%) were by egg donation. Only 9/31 (29%) pregnancies in women with karyotype 45,X were spontaneous, compared with 53/66 (80.3%) pregnancies in women with mosaic karyotype 45,X/46,XX (P < 0.0001). Women with mosaic karyotype 45,X/46,XX were younger at first pregnancy by 5.5-8.5 years compared with other Turner syndrome karyotype groups (P < 0.001), and more likely to have a spontaneous menarche (75.8% versus 50% or less, P = 0.008). There were 17 miscarriages, three terminations of pregnancy, two stillbirths and 105 live births. Two women had aortic dissection (2.5%); both were 45,X karyotype with bicuspid aortic valves and ovum donation pregnancies, one died. Another woman had an aortic root replacement within 6 months of delivery. Ten of 106 (9.4%) births with gestational age data were preterm and 22/96 (22.9%) singleton infants with birthweight/gestational age data weighed less than the tenth centile. The caesarean section rate was 72/107 (67.3%). In only 73/127 (57.4%) pregnancies was there documentation of cardiovascular imaging within the 24 months before conceiving., Conclusions: Pregnancy in women with Turner syndrome is associated with major maternal cardiovascular risks; these women deserve thorough cardiovascular assessment and counselling before assisted or spontaneous pregnancy managed by a specialist team., Tweetable Abstract: Pregnancy in women with Turner syndrome is associated with an increased risk of aortic dissection., (© 2021 John Wiley & Sons Ltd.)

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., (© 2017 Royal College of Obstetricians and Gynaecologists.)

Objective: To identify factors that are predictive of late initiation of antenatal care in England and Wales., Design: A multivariate binomial regression model was constructed to examine the association between clinical, provider and sociodemographic characteristics and late initiation of antenatal care., Setting: Nine maternity units in Northern England and North Wales., Population: A total of 20,771 women with a singleton pregnancy who delivered a liveborn or stillborn baby between 1 August 1994 and 31 July 1995. All analyses were based on the 17,765 (85.5%) women for whom information on gestational age at initial presentation for antenatal care and other variables incorporated into the regression model was retrievable from the case records., Results: Primiparous women of high obstetric risk were 13.4% more likely to initiate antenatal care after 10 weeks of gestation than a low risk reference group (adjusted OR 1.134, 95% CI 1.011, 1.272; P = 0.0312), and 34.3% more likely to initiate antenatal care after 18 weeks of gestation (adjusted OR 1.343, 95% CI 1.046, 1.724; P = 0.0208). This association between high obstetric risk status and late initiation of antenatal care was not replicated among multiparous women. When the effects of other independent variables on gestational age at booking were examined, the following characteristics were associated with failure to initiate antenatal care by 10 weeks of gestation (P < or = 0.05): maternal age at booking, smoking status, ethnicity, type of hospital at booking, the planned pattern of antenatal care and the planned place of delivery. Adopting a criterion of 18 weeks of gestation exacerbated the association between clinical and sociodemographic characteristics and late initiation of antenatal care, but appeared to dilute the association between provider characteristics and late initiation of antenatal care., Conclusions: There is a pressing need for further research to identify the specific concerns of late bookers, to identify areas where new interventions might encourage the uptake of services and to gauge the likely impact of increased dissemination of information about the availability of antenatal care services.