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Cognitive complaints are common amongst young mothers. When tested, only those with psychological co-morbidity have neuropsychological impairment.

In a monitoring protocol based on ductus venosus and cardiotocography in early fetal growth restriction (26-31 weeks of gestation), the impact of middle cerebral artery Doppler and its ratios on outcome is modest and less marked than birthweight and delivery gestation. It is unlikely that middle cerebral artery Doppler and its ratios are informative in optimizing the timing of delivery in fetal growth restriction before 32 weeks of gestation. The umbilicocerebral ratio allows for a better differentiation in the abnormal range than the cerebroplacental ratio.

Topics: Systems-based Practice, Obstetric Complications E lective repeat cesarean delivery (CD) contributes sig-

Objective To analyse the predicted 10-and 30-year risk scores for cardiovascular disease (CVD) in patients who experienced preeclampsia (PE) 5-10 years previously compared with healthy parous controls.Design Observational study.Setting Tertiary referral hospital in the Netherlands.Population One hundred and fifteen patients with a history of PE and 50 controls. PE patients were categorised into two groups, hypertensive (n = 21) and normotensive (n = 94), based on use of antihypertensive medication, and next categorised into subgroups based on the onset of PE: early-onset PE (n = 39) and late-onset PE (n = 76).Methods All participants underwent cardiovascular risk screening 5-10 years after index pregnancy. We measured body mass, height and blood pressure. Blood was analysed for fasting glucose, insulin and lipid levels. All participants completed a validated questionnaire. The 10-and 30-year Framingham risk scores were calculated and compared.Main outcome measures Estimated Framingham 10-and 30-year risk scores for CVD.Results The overall 10-and 30-year CVD median risks weighing subjects' lipids were comparable between formerly PE women and controls; 1.6 versus 1.5% (P = 0.22) and 9.0 versus 9.0% (P = 0.49), respectively. However, hypertensive formerly PE women have twice the CVD risk as normotensive formerly PE women: 10-and 30-year CVD median risks were 3.1 versus 1.5% (P < 0.01) and 19.0% versus 8.0% (P < 0.01), respectively. Risk estimates based on BMI rather than lipid profile show comparable results. Early-onset PE clustered more often in the hypertensive formerly PE group and showed significantly higher 10-and 30-year CVD risk estimates based on lipids compared with the lateonset PE group: 1.7 versus 1.3% (P < 0.05) and 10.0 versus 7.0% (P < 0.05), respectively.Conclusions Women who are hypertensive after preeclampsia, have a twofold risk of developing CVD in the next 10-30 years. Formerly PE women who are normotensive in the first 10 years after their preeclamptic pregnancy have a comparable future cardiovascular risk to healthy controls.

During normotensive pregnancy, most cardiac geometric indices change from the second trimester onwards. Both LVM and RWT increase, by 20% and 10%, respectively, consistent with concentric rather than eccentric remodeling. Cardiac adaptation in hypertensive pregnancy deviates from that in healthy pregnancy by a greater change in LVM (95% increase from reference) and RWT (56% increase from reference). Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Objectives Left-ventricular

Background Phaeochromocytoma and paraganglioma (PPGL) in pregnancy, if not diagnosed antepartum, pose a high risk for mother and child. Objective To examine the clinical clues of antepartum and postpartum/postmortem diagnosis of PPGL. Search strategy Case reports on PPGL in pregnancy published between 1 January 1988 and 30 June 2019 in English, German, Dutch or French. Selection criteria Case reports containing a predefined minimum of clinical data on PPGL and pregnancy. Data collection and analysis Two authors independently performed data extraction and assessed data quality. We calculated odds ratios (OR) (with 95% confidence intervals) and used uni‐ and multivariable logistic regression analysis. Main results Maternal and fetal/neonatal mortalities were 9.0% (18/200) and 14.2% (29/204), respectively. Maternal mortality was 42‐fold higher with PPGL diagnosed postpartum/postmortem (17/58; 29.3%) than antepartum (1/142; 0.7%) (adjusted OR 45.9, 95% CI 5.67–370, P = 0.0003). Offspring mortality was 2.6‐fold higher with PPGL diagnosed postpartum/postmortem than antepartum (OR 3.1, 95% CI 1.38–6.91, P = 0.0044). Hypertension at admission (OR 2.29, 95% CI 1.12–4.68, P = 0.022), sweating (OR 3.14, 95% CI 1.29–7.63, P = 0.014) and a history of PPGL, a known PPGL‐associated gene mutation or adrenal mass (OR 8.87, 95% CI 1.89–41.64, P = 0.0056) were independent factors of antepartum diagnosis. Acute onset of symptoms (OR 8.49, 95% CI 3.52–20.5, P < 0.0001), initial diagnosis of pre‐eclampsia (OR 6.34, 95% CI 2.60–15.5, P < 0.0001), admission for obstetric care (OR 10.71, 95% CI 2.70–42.45, P = 0.0007) and maternal tachycardia (OR 2.72, 95% CI 1.26–5.85, P = 0.011) were independent factors of postpartum diagnosis. Conclusion Several clinical clues can assist clinicians in considering an antenatal diagnosis of PPGL in pregnancy, thus potentially improving outcome. Tweetable abstract Systematic review of 204 pregnant patients with phaeochromocytoma identified clinical clues for a timely antepartum diagnosis.