Objective To investigate management and outcomes of incidences of shoulder dystocia in the 12 years following the introduction of an obstetric emergencies training programme.Design Interrupted time-series study comparing management and neonatal outcome of births complicated by shoulder dystocia over three 4-year periods: (i) Pre-training (1996-99) Method A bi-monthly multi-professional 1-day intrapartum emergencies training course, that included a 30-minute practical session on shoulder dystocia management, commenced in 2000.Main Outcomes Neonatal morbidity (brachial plexus injury, humeral fracture, clavicular fracture, 5-minute Apgar score <7) and documented management of shoulder dystocia (resolution manoeuvres performed, traction applied, head-to-body delivery interval).Results Compliance with national guidance improved with continued training. At least one recognised resolution manoeuvre was used in 99.8% (561/562) of cases of shoulder dystocia in the late training period, demonstrating a continued improvement from 46.3% (150/324, P < 0.001) pre-training, and 92% (241/262, P < 0.001) in the early training period. In parallel there was reduction in the brachial plexus injury at birth (24/324 [7.4%, P < 0.01], pre-training, 6/262 [2.3%] early training, and 7/562 [1.3%] late training.Conclusions There are significant benefits to long-term, embedded training programmes with improvements in both management and outcomes. A decade after the introduction of training there were no cases of brachial plexus injury lasting over 12 months in 562 cases of shoulder dystocia.

Background Vulval lichen sclerosus (VLS) is a common condition. Despite this, there is a paucity of research investigating the impact on women’s lives. Some women with VLS utilise online forums to discuss their priorities and concerns. This dialogue gives insight into the experiences of women living with VLS. Methods We identified the most popular public forums containing discussions between women with VLS. Inductive, thematic analysis was applied to 202 online posts spanning a six-year period. Results Five key themes were identified. Theme 1 pertained to difficulties with diagnosis. Women experience frequent delays and misdiagnosis. They report health care professionals (HCPs) with poor knowledge of their condition and some that were dismissive of their symptoms. Upon diagnosis women expressed relief and frustration. Theme 2 related to rationalisation and validation of their experience. Women expressed a desire to know why they were affected, what caused their symptoms and gain reassurance. Theme 3 dealt with women’s motivation to control their condition. Women want to know what triggers a flare-up so they can limit their relapses. They want to self-manage their condition and have an active role in partnership with HCPs. Theme 4 related to women sharing and seeking advice from the forums. The lived experiences of other women is valued by fellow sufferers. In particular, women are keen to try other treatments, conventional and alternative. The final theme related to the social repercussions of the condition. Sociocultural factors may prevent women from talking about their condition to friends, family and HCPs. They feel embarrassed by their symptoms. Some women reported relationship breakdown as a repercussion of the disease. Conclusions Improving the knowledge of HCPs with regards to VLS may reduce problems with diagnosis. In addition, delivering improved women’s health education in schools may reduce the taboo attached to women’s health. This may empower women to talk about their condition and seek help sooner. Once diagnosed, clinicians with the appropriate expertise should care for women with VLS. Women should be encouraged to take an active role in managing their condition in partnership with clinicians. Future research priorities include identifying the aetiology, triggers for flare-ups and novel therapies.

Aims. To record demographics, symptoms, signs, and laboratory features of confirmed leptospirosis cases in the Hawke’s Bay area of New Zealand to aid clinicians in diagnosis and recognition of severity. Methods. Review of suspected leptospirosis cases referred to the reference laboratory from hospitals in the Hawke’s Bay region between March 2003 and March 2012. Inclusion criteria were IgM positivity and diagnosis confirmed with either polymerase chain reaction (PCR) or microscopic agglutination test (MAT). A retrospective systematic review of case notes was completed for demographic and laboratory data. Results. Forty-three cases were included. Most common presenting symptoms were pyrexia (93%), myalgia, and headache (both 86%). 93% of patients worked in the farming or meat industries. The most common biochemical abnormalities were elevated CRP (100%) and abnormal urinalysis (93%). There was no difference in disease severity between icteric and anicteric patients. Compared to other studies, patients in New Zealand have less severe disease. Conclusion. Contrary to popular understanding, this study has not found icteric leptospirosis to be related to more severe disease. Anicteric leptospirosis should be a differential diagnosis in patients presenting with pyrexia, myalgia, and headache who have elevated CRP and abnormal urinalysis.

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Aims/Objectives We aim to establish which measure of obesity is most useful in predicting mode of delivery. Background Obesity is a major risk factor for adverse events in pregnancy. ‘Body mass index’ (BMI) has been the widely accepted measure of obesity. However, ‘waist to hip ratio’ (WHR) is thought to better reflect central adiposity.1 If we are to identify obesity as a risk factor for adverse pregnancy and delivery outcome it is crucial that we explore different measures of obesity. Methods We aimed to recruit all women who reached the inclusion criteria in two hospitals over a five-month period. Data was collected on demographics, BMI, thigh, hip and waist circumference. The primary outcome measure was mode of delivery, defined as either vaginal delivery or caesarean section. Results We recruited 120 women to the study. Repeatability analysis demonstrated small mean differences (15 mm – 50 mm) between measurements. The best predictor of mode of delivery and emergency delivery (emergency caesarean and instrumental deliveries) was BMI and waist measurement (see graphs). Waist-hip ratio did not appear to correlate with mode of delivery. Summary and conclusions This study has demonstrated that additional measurements were feasible and measurements were repeatable. There may be a suggestion that BMI or waist measurements are best predictors of mode of delivery. A larger study is planned to enable analysis of maternal and fetal antenatal complications. Abstract PPO.18 Figure Reference 1Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, et al. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet. 2005;366:1640–9

Key content Contemporary energy devices utilise advanced bipolar, ultrasound, hybrid technology, plasma beam and laser energy. Each energy modality has specific characteristics influencing its particular benefits and disadvantages. Gynaecologists must be aware of the available energy modalities to select the optimum device. Minimal access surgeons must demonstrate a comprehensive understanding of their instruments to ensure surgical success and safety. Learning objectives To understand the biophysics of advanced energy devices and their practical applications. To review advantages, disadvantages and safety issues associated with each modality and offer practical tips and problem‐solving for commonly available devices. To enable surgeons to select the optimal device for their surgical tasks. Ethical issues Trainee minimal access surgeons should have solid theoretical knowledge of energy devices before performing hands‐on surgery. Consideration of the safety aspects of energy devices will enable surgeons to minimise harm to their patients. Potentially high investment costs necessitate consideration of the anticipated benefits of energy devices to ensure value for money.