Background Increasing maternal obesity trends and accompanying risks have led to the development of guidelines internationally. However, the evidence-base is poor for effective intervention, and there is a lack of representation from the perspective of obese pregnant women in guidelines. Women's engagement with weight management support services is low.Objective To explore obese pregnant women's experiences to better understand factors which need to be considered when developing services that women will find acceptable and utilize.Population Obese women referred to an antenatal dietetic service in the Northeast of England, UK.Methods Low-structured depth-interviews allowed women to freely discuss their own experiences. Discussion prompts were included; however, issues that women raised were explored thoroughly. Women summarized what they considered most important to ensure the analyses placed appropriate emphasis on factors women perceived as important. Thematic analysis identified common themes. Saturation was confirmed after 15 interviews.Results Key issues included: women's weight; families; experience of negativity; and priorities and desired outcomes. These combined represented women's perspectives of issues which they considered important and integral to their lived experience of being obese and pregnant. The theme incorporates women's pregnancy-related experiences, as well as life experiences which contributed to how they felt about their weight during pregnancy. 969

Objective: To understand the lived experiences and views of being referred to an antenatal dietetic service from the perspective of pregnant women with obesity.Design: A qualitative, interpretive approach using one-to-one in-depth interviews to explore the lived experience of pregnant women with obesity following referral to an antenatal dietetics service. Thematic content analysis was carried out by two researchers independently to develop data-driven themes.Setting: One NHS Trust maternity and dietetic services, North East England, UK Participants: Fifteen pregnant women with a booking body mass index ≥30kg/m 2 attending an obesity-specific antenatal dietetic service. All women were White, parity between 0-2, and BMI range 30-51kg/m 2 .Findings: Four themes were identified within this concept. 1) Women's overall experience of the service: experiences were predominately positive with only two negative cases identified.2) Process of referral: women placed importance on informative and in-person communication about the service, with health professionals, at the point of referral. 3) 2 Delivery of the service: dietitians were considered to be the experts and women wanted more frequent contact. 4) Content of the service: tailored advice enabled behaviour change, and women desired increased physical activity support and weight monitoring.Key conclusions: Women reported an overall positive experience and thought that dietitians were the expert health professionals to support them. Women in this study felt that tailoring advice specific to their personal circumstances helped them implement changes, and had a strong interest in the nutritional benefits for fetal development. Women considered weight monitoring to be a positive element of the service; however, further research is required given the limited and conflicting evidence-base.Implications for practice: It is important to incorporate women's experiences in the development and delivery of antenatal weight management services to facilitate personcentred care. Communication by health professionals at the point of referral is particularly important to provide accurate expectations of services and to reduce anxieties. Dietitians are considered to be appropriate experts to deliver these services, although they may need additional support to address women's physical activity needs in pregnancy.Keywords obesity, body mass index, dietetic, qualitative, experience, pregnancy IntroductionMaternal obesity (body mass index (BMI) ≥30kg/m 2 ) is increasing in prevalence internationally (Brynhildsen et al., 2006;Ray et al., 2007;Heslehurst et al., 2010;Fisher et al., 2013) and is associated with complex inequalities, including deprivation and ethnic minority groups (Heslehurst et al., 2010(Heslehurst et al., , 2012. There are significantly increased associations with adverse outcomes for women and babies including congenital anomalies, perinatal mortality, macrosomia, gestational diabetes, maternal infections and preterm birth (Heslehurst et al., 2008;Stothard et al., 2009;Tenn...

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Background Twins have a much higher stillbirth rate than singletons with causes of intrauterine death frequently unexplained. In the North of England the stillbirth rate in twins is higher than the national rate. Aim To audit antenatal surveillance of twin pregnancy resulting in antepartum stillbirth against regional consensus standards of care. Methods A retrospective, case-note analysis of all antepartum stillbirths in twins delivered 2005–2009, identified from the population-based Northern Survey of twin and multiple pregnancy. Antenatal care was reviewed independently by two consultants. Results There were 43 antepartum stillbirths in 38 pregnancies. 21 were DCDA, 14 MCDA, one MCMA and in two cases the chorionicity was unknown. Autopsy was performed in 18 (47%) pregnancies. Major causes of stillbirth were acute or chronic antepartum hypoxia (n=25) and twin-to-twin transfusion (TTTS n=14, 9 pregnancies). Case-note review clarified causes of death in 22 cases confirming TTTS in 8 pregnancies affecting 13 twins. 66% pregnancies were delivered within 24 h of diagnosis of death, 53% by Caesarean section. The review of case notes highlighted a number of cases where elements of antenatal care might have been improved with antenatal surveillance in the majority being in line with regional standards. Conclusion Sometimes in spite of exemplary antenatal care, stillbirths in twins may not be avoidable. The issues arising from the review will be fed back for discussion at a regional workshop. Regional datasets facilitate discussion of practice between maternity units and enable areas for improvement to be identified.

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Thyroid function tests are the most commonly requested endocrine investigations in both primary and secondary care. Attention to detail is vital, as the appropriate interpretation may point to conditions other than thyroid disease itself. We describe two cases of hypopituitarism masquerading as borderline thyroid function tests.

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