We have safely conducted a clinical trial of a drug not routinely used during pregnancy. Sildenafil in the escalating dose regimen 20-80 mg tid was well tolerated, with no increase in maternal or fetal morbidity or mortality but did not prolong pregnancy duration in women with preeclampsia. (ClinicalTrials.gov number, NCT 00141310).

Abnormal karyotype was more common when CDH was associated with other anomalies. In multivariate analysis, lower birthweight and prenatal diagnosis had a significant impact on survival. Only prenatally diagnosed CDH survival figures should be utilised in prenatal counselling.

Acute effects may have been lost as sildenafil administration occurred many hours prior to myography. Plasma sildenafil levels may have been lower than required for vascular response.

Background: Gastroschisis can be associated with short bowel syndrome (SBS). We present 4 cases with significant bowel shortening with very different ante- and postnatal presentations. Cases: Three of the cases demonstrated ‘vanishing' gastroschisis with progressively worsening antenatal intra-abdominal bowel dilatation with no defect present at birth. The fourth case followed an uneventful course antenatally but developed SBS considered secondary to gastroschisis-related atresia and necrosis. All 4 cases were classified as having SBS and were enrolled within the paediatric Intestinal Rehabilitation Programme. This involves autologous gastrointestinal reconstruction following a period of bowel expansion with concomitant parenteral and enteral nutrition. Discussion: These cases demonstrate that the serious complication of significant bowel loss cannot always be anticipated. Early multidisciplinary discussion with the parents enables a shared understanding of potential outcomes. It can aid the recognition of ‘vanishing' gastroschisis enabling expedient investigations and early intervention, minimising morbidity and maximising bowel length.

Background In clinical practice, postpartum blood loss is usually estimated visually. Studies have demonstrated visual estimation of blood loss is inaccurate in comparison to other methods, but little attention has been given to gravimetric measurement (weighing). Objective To determine the difference between gravimetric measurement of blood loss (MBL) and visual estimation of blood loss (EBL) after delivery. Methods A prospective study recruited women in labour or having elective caesarean section. Blood-stained items from delivery were weighed, and the total dry weight of items subtracted from total blood-stained weight. Blood weight (g) was converted into blood volume (ml). Results There were 60 normal vaginal deliveries, 24 instrumental deliveries and 25 caesarean sections (n=109). MBL was significantly higher than EBL in instrumental deliveries (p=0.018, Mann–Whitney) and caesarean sections (p=0.0268, Mann Whitney). There was no significant difference in MBL and EBL in normal vaginal deliveries. Blood loss was underestimated in 75% of women, and overestimated in 23%. In EBL <249 ml median difference to MBL was underestimation of 55 ml (range overestimation 80 ml – underestimation 420 ml). In EBL 250–499 ml median difference to MBL was underestimation of 65 ml (range overestimation 219 ml – underestimation 760 ml). In EBL ≥500 ml median difference to MBL was underestimation of 272 ml (range overestimation 115 ml – underestimation 1375 ml). Conclusions Gravimetric measurement is economical and easy to perform. It should be employed as an adjunct to visual estimation with blood loss greater than 250 ml, and should be utilised in instrumental deliveries and caesarean sections.

Background Pulmonary embolism (PE) is a leading cause of maternal death. While many normal symptoms of pregnancy mimic those of venous thromboembolism (VTE), making diagnosis difficult, management of possible VTE in pregnant and postpartum women is further complicated by the potential risks of investigations. The management was therefore assessed against local guidelines. Methods 90 women who underwent investigation for VTE between January 2008 and May 2010 were identified from the Radiology database. The notes were analysed against the local management of suspected VTE in pregnancy guidelines. Results In this cohort, 5/90 (6%) investigations were positive (1 deep vein thrombosis), four PE). Most women presented with symptoms suggestive of PE and were referred via obstetric services or accident and emergency; there was poor adherence to guidelines via both routes. In particular the choice of scan (V/Q or CTPA) was incorrect in 25.4%. Women seen via obstetrics were more likely to have senior review (39% vs 8%, p<0.05 Fisher's exact test), less likely to have D-dimer (13% vs 37%, p<0.05) and more likely to be admitted (69% vs 31%, NS). Overall VTE Risk Assessment was poor (8%), as was documentation concerning risks of scans (44%). Conclusion Improvements in the management of suspected VTE are required. Guidelines were poorly followed and a large number of negative scans, with an associated radiation risk to mother and fetus, were undertaken. The development of pre-test probability scores may help rationalise those women who require scans, thereby reducing unnecessary hospital admission and/or radiation.

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