Objective To report outcomes in a recent series of pregnancies in women with pulmonary hypertension (PH).Design Retrospective case note review. Setting Tertiary referral unit (Chelsea and Westminster and Royal Brompton Hospitals).Sample Twelve pregnancies in nine women with PH between 1995 and 2010.Methods Multidisciplinary review of case records.Main outcome measures Maternal and neonatal mortality and morbidity.Results There were two maternal deaths (1995 and 1998), one related to pre-eclampsia and one to arrhythmia. Maternal morbidity included postpartum haemorrhage (five cases), and one post-caesarean evacuation of a wound haematoma. There were no perinatal deaths, nine live births and three first-trimester miscarriages. Mean birthweight was 2197 g, mean gestational age was 34 weeks (range 26-39), and mean birthweight centile was 36 (range 5-60). Five babies required admission to the neonatal intensive care unit, but were all eventually discharged home. All women were delivered by caesarean section (seven elective and two emergency deliveries), under general anaesthetic except for one emergency and one elective caesarean performed under regional block.Conclusions Maternal and fetal outcomes for women with PH may be improving. However, the risk of maternal mortality remains significant, so that early and effective counselling about contraceptive options and pregnancy risks should continue to play a major role in the management of such women when they reach reproductive maturity.

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The human zona binding test is the most predictive test of sperm function yet the availability of human zona severely restricts its clinical use. The primary aim of this study was to use a commercially available in-vitro transcription and translation system to produce immobilized recombinant human ZP3 (rhuZP3) on agarose beads. The biological activity of this preparation was examined using sperm binding and the acrosome reaction. Significantly higher levels of sperm binding to rhuZP3 beads (n = 12, P < 0.05) compared with controls were observed and there was a significant induction (n = 12, P < 0.01) in the acrosome reaction after overnight incubation at 37 degrees C in 5% CO2 in air. In conclusion, the in-vitro transcription and translation system can produce sufficient quantities of purified immobilized biologically active rhuZP3. These preliminary experiments will enable further refinements to be made so that a solid-phase sperm function test based on rhuZP3 coated beads is likely to be developed in the near future.

SummaryWe contacted the duty obstetric anaesthetist in 219 of the 220 consultant-led maternity units in the UK (99.5%) and asked about departmental and individual practice regarding temperature management during Caesarean section. Warming during elective Caesarean section was routine in 35 units (16%). Intravenous fluid warmers were available in 213 units (97%), forced air warmers were available in 211 (96%) and warming mattresses were available in 42 (19%). Only 18 (8%) departments had specific guidelines for temperature management during Caesarean section. Personal intra-operative practice was variable, although all of those contacted would initiate some form of active temperature management after a mean (SD) volume of blood loss of 1282 (404) ml, length of surgery of 78 (24) Peri-operative hypothermia in non-obstetric cases has been found to increase wound infection rates and length of hospital stay [1], operative blood loss [2], and anaesthetic recovery time [3]. Few studies have included obstetric patients but although Caesarean sections are relatively short procedures, there is still a risk of hypothermia [4][5][6][7] and it has been recently suggested that all mothers should be warmed during Caesarean section [8]. We wished to ascertain which, if any, methods of warming were being used in the UK. MethodsWe identified consultant-led obstetric units from the Birth Choice website (http://www.birthchoiceuk.com) and one of two investigators contacted the duty obstetric anaesthetist by telephone during office hours (0800-1800, Monday to Friday) over a period of 5 months. If the anaesthetists were busy, we called back on another day and spoke to someone else. We asked, using a standard questionnaire, about the availability of different warming devices and departmental practice regarding temperature management during elective Caesarean section and in recovery. We also asked the individual anaesthetists about their personal thresholds for initiating temperature measurement and for active warming during Caesarean section. ResultsWe were able to contact anaesthetists in 219 of the 220 units listed (99.5%), the other unit not having dedicated obstetric anaesthetic cover during office hours. Twentyfour (11%) were senior house officers ⁄ specialist trainees (years 1-2), 89 (40%) were specialist registrars ⁄ specialist trainees (years 3-5), 65 (30%) were staff grades ⁄ associate specialists and 41 (19%) were consultants. The median (IQR [range]) time that the anaesthetists had spent in the department was 1.0 (0.3-6.0 [0.2-22.0]) years. None had been contacted by us at a previous unit before rotating to a new one.

Summary To better understand outcomes in postpartum patients who receive peripartum anaesthetic interventions, we aimed to assess quality of recovery metrics following childbirth in a UK‐based multicentre cohort study. This study was performed during a 2‐week period in October 2021 to assess in‐ and outpatient post‐delivery recovery at 1 and 30 days postpartum. The following outcomes were reported: obstetric quality of recovery 10‐item measure (ObsQoR‐10); EuroQoL (EQ‐5D‐5L) survey; global health visual analogue scale; postpartum pain scores at rest and movement; length of hospital stay; readmission rates; and self‐reported complications. In total, 1638 patients were recruited and responses analysed from 1631 (99.6%) and 1282 patients (80%) at one and 30 days postpartum, respectively. Median (IQR [range]) length of stay postpartum was 39.3 (28.5–61.0 [17.7–513.4]), 40.3 (28.5–59.1 [17.8–220.9]), and 35.9 (27.1–54.1 [17.9–188.4]) h following caesarean, instrumental and vaginal deliveries, respectively. Median (IQR [range]) ObsQoR‐10 score was 75 ([62–86] 4–100) on day 1, with the lowest ObsQoR‐10 scores (worst recovery) reported by patients undergoing caesarean delivery. Of the 1282 patients, complications within the first 30 days postpartum were reported by 252 (19.7%) of all patients. Readmission to hospital within 30 days of discharge occurred in 69 patients (5.4%), with 49 (3%) for maternal reasons. These data can be used to inform patients regarding expected recovery trajectories; facilitate optimal discharge planning; and identify populations that may benefit most from targeted interventions to improve postpartum recovery experience.