Objective To show the increased risk of adverse outcomes in labour and fetomaternal morbidity in obese women (BMI > 30). Design A population-based observational study.Setting University Hospital of Wales. The study sample was drawn from the Cardiff Births Survey, a population-based database comprising of a total of 60,167 deliveries in the South Glamorgan area between 1990 and 1999. Population Primigravid women with a singleton uncomplicated pregnancy with cephalic presentation of 37 or more weeks of gestation with accurate information regarding height and weight recorded at the booking visit (measured by the midwives) were included in the study. Methods Comparisons were made between women with a body mass index of 20-30 and those with more than 30. SPSS version 10 was used for statistical analysis. Student's t test, m 2 and Fisher's exact tests were used wherever appropriate. Main outcome measures Labour outcomes assessed were risk of postdates, induction of labour, mode of delivery, failed instrumental delivery, macrosomia and shoulder dystocia. Maternal adverse outcomes assessed were postpartum haemorrhage, blood transfusion, uterine and wound infection, urinary tract infection, evacuation of uterus, thromboembolism and third-or fourth-degree perineal tears. Fetal wellbeing was assessed using Apgar <7 at 5 minutes, trauma and asphyxia, cord pH < 7.2, babies requiring neonatal ward admissions, tube feeding and incubator.

The aim of this study was to ascertain any potential link between threatened miscarriage and obstetric outcome. Threatened miscarriage was associated independently with an increased incidence of abruption (OR 2.8, 2.0-3.7), unexplained antepartum haemorrhage (APH) (OR 2.3, 1.1-5.1) and preterm delivery (OR 2.0, 1.3-3.3). The incidence of low and very low birth weight deliveries, although significantly higher compared with the control population, was not affected independently by this early pregnancy complication on logistic regression (OR 1.3, 0.8-1.9). The early neonatal mortality rates were significantly higher in the threatened miscarriage group, which on logistic regression was due independently to preterm delivery, placental abruption and low birth weight deliveries. All forms of APH were significantly higher in term deliveries complicated by threatened miscarriage. Pregnancies presenting with threatened miscarriage should be highlighted as 'high risk' for a suboptimal obstetric outcome and a prospective observational trial followed by a randomised-controlled trial may be needed to establish whether the need exists for increased feto-maternal surveillance in this cohort of women.

Denial of pregnancy has been implicated in potentially jeopardising prenatal care and subsequent safe planned deliveries. This population-based study of hospital deliveries over an 11-year period, reveals that concealed pregnancies have an incidence of one in 2,500 deliveries. Among this cohort, 12% were married and 58% were multiparous with 8% having had a previous caesarean section. Some 20% of women had a medical disorder complicating the antenatal period. There was a preponderance of concealed pregnancies in the winter months compared with booked deliveries (p = 0.02). Mode of delivery was similar between the booked and concealed pregnancies with a low incidence of maternal morbidity in the latter. Prematurity rates (p = 0.0002) were significantly higher in the concealed pregnancy cohort. A total of 20% of infants had depressed Apgar scores at 1 min and 8% at 5 min. There was no documentation of counselling or follow-up in this group. Despite the low incidence of maternal morbidity, these women should be regarded as high-risk labour due to the increased perinatal morbidity. Greater effort needs to be made towards ensuring these women have adequate counselling and follow-up during the postnatal period.

Objective-To examine whether birth weight is related to systolic blood pressure during adolescence.Design-Retrospective (comparative) cohort study. The observers who traced and studied the subjects were unaware oftheir case-control status.

It has been suggested that factors which influence low birth weight at term may be associated with reduced lung function in later life. This hypothesis was investigated in a comparative (retrospective) cohort study of 164 matched pairs of subjects where the observers responsible for tracing and studying the subjects were unaware of their case or control status. The subjects, born in Cardiff between 1975 and 1977, were of mean age 15*7 years. Cases (low birth weight (<2500 g) at term) were matched with controls (normal birth weight (3000-3800 g) at term) for sex, parity, place of birth, date of birth, and gestation. Lung function was measured using a portable spirometer.The corrected mean differences (95% confidence interval) in forced vital capacity (FVC) and flow when 500/0 or 25% of the FVC remains in the lungs between the cases and controls were respectively -41 ml (-140 to 58), -82 nml/sec (-286 to 122), and -83 nml/sec (-250 to 83). None of these differences were statistically significant. These results are inconsistent with the hypothesis that low birth weight at term is associated with reduced lung function in adolescence.