Objectives  To estimate the national incidence of eclampsia in the UK and to describe the management and associated outcomes since the introduction of magnesium sulphate. Design  A population‐based descriptive study using the newly established UK Obstetric Surveillance System (UKOSS). Setting  All 229 hospitals with consultant‐led maternity units in the UK. Population  All women in the UK delivering between February 2005 and February 2006. Methods  Prospective case identification through the monthly mailing of UKOSS. Main outcome measures  Incidence and mortality rates with 95% confidence intervals. Results  Data collection was complete for 94% of women. The incidence of eclampsia was 2.7 cases per 10 000 births (95% CI 2.4–3.1). Thirty‐eight percent of women had established hypertension and proteinuria in the week before their first fit. Ninety‐nine percent of women were treated with magnesium sulphate. No women in the study died. Fifty‐four women (26%) had recurrent fits. One hundred and nineteen women (56%) were admitted to intensive care or obstetric high dependency units for a median of 2 days (range 1–9). Twenty‐two women (10%) were reported to have other severe morbidity after the eclamptic episode. Outcomes were known for 222 infants (204 singletons and 18 twins). Eight infants were stillborn and five died in the neonatal period (perinatal mortality 59/1000 births [95% CI 32–98]). Conclusions  The incidence of eclampsia and its complications have decreased significantly in the UK since 1992, following the introduction of management guidelines for eclampsia and pre‐eclampsia. These results are consistent with the findings of the randomised controlled trials of magnesium sulphate. This study has shown the practical benefits of the incorporation of research evidence into practice.

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(BJOG. 2018;125:604–612) Primary autoimmune thrombocytopenia (ITP) is an acquired autoimmune disease that is commonly detected in women of reproductive age. ITP is a hemorrhagic disorder characterized by a decrease in platelet count that can carry an increased risk of bleeding. ITP has been reported to occur in 1 in 1000 to 1 in 10,000 pregnancies, but determining the incidence of severe ITP is challenging due to the rarity of the disorder, changing diagnostic criteria, and difficulty determining the cause of thrombocytopenia. The authors hypothesized the risks of maternal and neonatal morbidity and mortality would be elevated in parturients with ITP. This study aimed to determine the incidence of severe ITP in pregnancy in the United Kingdom, as well as current management strategies and maternal and fetal outcomes.

There are a variety of causes of acute heart failure in children including myocarditis, genetic/metabolic conditions, and congenital heart defects. In cases with a structurally normal heart and a negative personal and family history, myocarditis is often presumed to be the cause, but we hypothesise that genetic disorders contribute to a significant portion of these cases. We reviewed our cases of children who presented with acute heart failure and underwent genetic testing from 2008 to 2017. Eighty-seven percent of these individuals were found to have either a genetic syndrome or pathogenic or likely pathogenic variant in a cardiac-related gene. None of these individuals had a personal or family history of cardiomyopathy that was suggestive of a genetic aetiology prior to presentation. All of these individuals either passed away or were listed for cardiac transplantation indicating genetic testing may provide important information regarding prognosis in addition to providing information critical to assessment of family members.

Objective To identify factors associated with progression from pregnancy-associated severe sepsis to death in the UK.Design A population-based case-control analysis using data from the UK Obstetric Surveillance System (UKOSS) and the UK Confidential Enquiry into Maternal Death (CEMD).Setting All pregnancy care and death settings in UK hospitals.Population All non-influenza sepsis-related maternal deaths (January 2009 to December 2012) were included as cases (n = 43), and all women who survived severe non-influenza sepsis in pregnancy (June 2011 to May 2012) were included as controls (n = 358).Methods Cases and controls were identified using the CEMD and UKOSS. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals.Main outcome measures Odds ratios for socio-demographic, medical, obstetric and management factors in women who died from sepsis, compared with those who survived.Results Four factors were included in the final regression model. Women who died were more likely to have never received antibiotics [aOR = 22.7, 95% confidence interval (CI) 3.64-141.6], to have medical comorbidities (aOR = 2.53, 95%CI 1.23-5.23) and to be multiparous (aOR = 3.57, 95%CI 1.62-7.89). Anaemia (aOR = 13.5, 95%CI 3.17-57.6) and immunosuppression (aOR = 15.0, 95%CI 1.93-116.9) were the two most important factors driving the association between medical comorbidities and progression to death.Conclusions There must be continued vigilance for the risks of infection in pregnant women with medical comorbidities. Improved adherence to national guidelines, alongside prompt recognition and treatment with antibiotics, may reduce the burden from sepsis-related maternal deaths.