Objective— The investigation of the histology of the placental bed spiral arteries in normal pregnancy and in pregnancies complicated by hypertension, with or without proteinura. Design— An observational study, based on women having caesarean sections for clinical reasons. Subjects— 17 normal pregnant women, 43 with gestational hypertension, of whom 39 had proteinuria, 17 with chronic hypertension, of whom 6 had proteinuria, and 5 with unclassified hypertension. Interventions— Placental bed biopsies obtained during caesarean section. Main outcome measures— Histological appearance of sections stained with haematoxylin and eosin PAS and Lendrum's MSB. Results— Biopsies containing spiral arteries were obtained from 6 normotensive and 44 hypertensive women. Trophoblastic invasion was present in 5 of the 6 normotensive biopsies but absent in the majority of those with hypertension. Subintimal proliferation was seen in all the normotensive biopsies but in only 8 of 28 from those with gestational hypertension and proteinuria. Other features seen predominantly or only in the hypertensive biopsies, in order of frequency, were medial hyperplasia, fibrin deposits, acute atherosis, endothelial vacuolation and thrombosis. Conclusion— Absence of physiological changes may not be peculiar to preeclampsia but may be associated or even a result of various forms of hypertension in pregnancy. Spiral arteries show a spectrum of changes in hypertensive pregnancies that do not appear to bear a clear‐cut relation to the clinical signs.

Key Points• Fibtem is an early and rapidly available biomarker for predicting progression of moderate to severe postpartum hemorrhage.• Fibtem was predictive of need for blood transfusion and invasive procedures, bleeds .2500 mL, duration of bleed, and time in high dependency.

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The educational experiences and attainment of looked-after children and young people (LACYP) remains an issue of widespread international concern. Within the UK, children and young people in care achieve poorer educational outcomes compared to individuals not in care. Despite proliferation of research documenting the reasons for educational disadvantage amongst this population, there remains limited empirical consideration of the lived experiences of the educational system, as perceived by LACYP themselves. This paper draws upon qualitative research with 67 care-experienced children and young people in Wales. The sample was aged 6-27 years, and comprised 27 females and 40 males. Participants had experienced a range of care placements. Findings focus on how educational policies and practices alienate LACYP from dominant discourses of educational achievement through assignment of the 'supported' subject position, where children and young people are permitted and even encouraged not to succeed academically due to their complex and disrupted home circumstances. However, such diminished expectations are rejected by LACYP, who want to be pushed and challenged in the realisation of their potential. The paper argues that more differentiated understandings of LACYP's aspirations and capabilities need to be embedded into everyday practices, to ensure that effective educational support systems are developed.

This article explores the experiences of young people leaving state care during COVID-19. Twenty-one young people, predominantly from Wales, engaged in semi-structured interviews and/or contributed poems and artwork conveying their experiences of the pandemic. The data generated offered insights into young people’s daily lives, including their routines and relationships, as well as access to resources and services. The study found stark disparity in young people’s experiences, with some reassured by support responses, and others feeling neglected and forgotten. As an already disadvantaged group, the challenges presented by COVID-19 further hinder young people’s transitions to adulthood. The ‘massive struggles’ faced by some young people reflect immediate difficulties which also have the potential for longer-term impacts. The recommendations of the study, informed by care-experienced young people, seek to positively influence policy and practice.

Purpose The purpose of this paper is to “read across” a sample of domestic homicide reviews (DHRs), mental health homicide reviews (MHHRs) and adult practice reviews (APR) to identify the cross-cutting themes. Design/methodology/approach The study involved a qualitative comparative analysis of 20 Welsh reviews: 10 DHRs, 6 APRs and 4 MHHRs. Each review was triple coded by a multi-disciplinary team of researchers (representing criminology, social work and law). Findings Five overarching themes were identified from this diverse sample of cases: crossing boundaries, including transitions between services and geographical boundaries; hoodwinking, where there was manipulation of the presentation of self; faulty assessment, which was not always holistic and only based on certain aspects of behaviour; tunnel vision, resulting from the initial underpinning narrative rarely being challenged; and knowledge, with certain types being privileged over others, especially professional over that of families and para-professionals. Research limitations/implications Further research into death reviews should adopt a comparative, multi-disciplinary approach. Practical implications The research highlights the possibility for duplication across the different types of reviews. Further, it suggests that review processes could be streamlined. Originality/value Five cross-cutting themes have been developed through the very first study “reading across” three types of reviews (DHRs, APRs and MHHRs). Findings suggest the need for streamlining review processes and highlight the importance of adopting a multi-disciplinary perspective when researching death reviews.

BackgroundPostpartum haemorrhage (PPH) is a major cause of maternal morbidity. Bleeding is caused by a combination of physical causes, such as failure of the uterus to contract or operations, and is made worse by impairment of the blood clotting system. A number of studies have shown that low levels of the blood clotting factor fibrinogen are associated with progression of bleeding, the need for invasive interventions and transfusions of red blood cells and fresh frozen plasma (FFP). This trial will investigate whether early infusion of fibrinogen concentrate during a major PPH, with the aim of correcting a low fibrinogen to a level that is normal for delivery, based on the Fibtem test, reduces the total number of allogeneic blood products (red blood cells, FFP, cryoprecipitate and platelets) transfused after study medication until discharge, compared to placebo.Methods/designThis is a prospective, randomised, double-blind placebo controlled trial. Women will enter an observational phase and if their Fibtem levels fall they will be randomised in the interventional phase. A total of 60 women will be randomised and women are eligible for the trial if they meet all of the following inclusion criteria: age 18 years or over, gestation ≥24 + 0 weeks, haemorrhage of about 1500 ml and on-going bleeding without another complication or haemorrhage of about 1000 ml and caesarean section/uterine atony/placental abruption/placenta praevia/cardiovascular instability or microvascular oozing. Participants with a Fibtem A5 < 16 mm will be randomly allocated to receive either a bolus infusion of fibrinogen concentrate or placebo (isotonic saline). The dose of fibrinogen concentrate or placebo will be calculated based on the woman’s ideal body weight for height and the measured Fibtem A5 with the aim of increasing the Fibtem A5 to 23 mm.DiscussionThe trial aims to provide evidence on the efficacy and safety of fibrinogen concentrate during acute bleeding in an obstetric setting.Trial registrationISRCTN ref: ISRCTN46295339 (01.07.2013); EudraCT: 2012-005511-11 (28.11.2012), UKCRN ref: 13940.

This study explores the significance of food and mealtimes in relation to the transition into foster care and the therapeutic settling of the child in a new family. In doing so, we draw upon an in‐depth, qualitative case study of 10 experienced foster families in the UK focusing on what helped them to be successful. At the time of the study, there were 16 foster children, aged 9–16, living with the families. Data collection included semi‐structured qualitative interviews and audio‐diaries with all family members who wished to be involved as well as eco‐maps produced by the young people. Thematic analysis and data extracts are reproduced in the study to demonstrate that meals and food preferences can function to affirm identities, membership and boundaries of family life as well as provide a site of conflict and control.