Objective To evaluate placental morphology in pregnancies complicated by early-and late-onset pre-eclampsia (PET) with and without fetal growth restriction (FGR) using stereological techniques.Design A total of 69 pregnant women were studied. Twenty women had pregnancies complicated by PET, 17 by FGR and 16 by both PET and FUR; the remaining 16 were from gestationalage-matched controls. Each group was further classified into early onset (<34 weeks) and late onsets (>34 weeks) based on gestational ages.Setting NPIMR at Northwick Park and St Marks Hospital.Population placentae from pregnant women.Methods Formalin-fixed, wax-embedded sections stained with anti-CD34 antibodies and counterstained with haematoxylin.Main outcome measures Volumes, surface areas, lengths, diameters and shape factors of the villous tissues and fetal vasculature in the intermediate and terminal villi of all the groups studied.Results Terminal villi volume and surface area were compromised in early-onset PET cases, late-onset PET had no impact on peripheral villi or vasculature features. The morphology of the vascular and villous subcomponents in the intermediate and terminal villi was significantly influenced by late-onset FGR, whereas early-onset FGR caused a reduction in placental weight. Length estimates were not influenced by PET, FGR or age of onset. Intermediate arteriole shape factor was significantly reduced in late-onset FGR.Conclusions Isolated early-onset PET was associated with abnormal placental morphology, but placentas from late-onset PET were morphologically similar to placentas from gestational-age-matched controls, confirming the existence of two subsets of this condition and supporting the hypothesis that late-onset PET is a maternal disorder and not a placental disease.

-Prescribing errors are a recognised problem on admission to acute medical wards which may be detrimental to patient care. The authors had anecdotal evidence that prescribed medicines do not always reach patients and the aim of this audit was to quantify this problem. Admission prescription charts on two separate occasions were studied in detail and all drugs prescribed but not given in the first 48 hours were recorded along with the reason given for omission. In total, 271 patient charts were analysed. Of these, 20% of prescriptions affecting 17% of patients did not reach patients. The two dominant reasons for medications not being given to patients were that the medication was not available on the ward (38% of omissions) or that the patient was nil by mouth (32% of omissions). In 10% of cases the patient refused the medication, in 19% no reason for omission was given and in only a minority (0.3%) was the patient off the ward. This audit demonstrates that even when medications are prescribed they are not always given. This may lead to increased morbidity and length of stay. Strategies need to be put in place to reduce this problem. The current system that permits omission of medications with inadequate justification must be revised.

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