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Objective To study the effect of COVID-19 on pregnancy and neonatal outcomes. Study design Prospective cohort study in a large tertiary maternity unit within a university hospital with an average annual birth of over 10,000 births. We prospectively collected and analysed data for a cohort of 23 pregnant patients including singleton and multiple pregnancies tested positive for COVID-19 between February 2020 and April 2020 inclusive to assess the effect of COVID-19 on pregnancy, and neonatal outcomes. Results Twenty-three pregnant patients tested positive for COVID-19, delivering 20 babies including a set of twins, with four ongoing pregnancies at the time of manuscript submission. 16/23 (70 %) whom tested positive were patients from Asian (Indian sub-continent) background. The severity of the symptoms ranged from mild in 13/23 (65.2 %) of the patients, moderate in 2/23 (8.7 %), and severe in 8/23 (34.8 %). Four out of total 23 COVID-19 pregnant patients (17.4 %) developed severe adult respiratory distress syndrome complications requiring ICU support, one of whom led to maternal death 1/23 (4.3 %). 11/23 (48 %) of the patients had pre-existing co-morbidities, with morbid obesity 5/23 (21.7 %) and diabetes 4/23 (17.4 %) being the more commonly represented. Of the 23 pregnant patients 19 were in their third trimester of pregnancy and delivered; 7/19 (36.8 %) had preterm birth, 3/19 (15.8 %) developed adult respiratory distress syndrome before delivery, and 2/19 (10.5 %) had pre-eclampsia. 16/19 (84 %) of patients delivered by C-section. Out of the 20 new-borns, 18 were singletons with a set of twin. Conclusion COVID-19 is associated with high prevalence of preterm birth, preeclampsia, and caesarean section compared to non−COVID pregnancies. COVID-19 infection was not found in the newborns and none developed severe neonatal complications.

National Institute for Health Research and Medical Research Council.

Intravenous (IV) iron therapy is widely used in iron deficiency anaemias when oral iron is not tolerated or ineffective. Administration of IV-iron is considered a safe procedure, but severe hypersensitivity reactions (HSRs) can occur at a very low frequency. Recently, new guidelines have been published by the European Medicines Agency with the intention of making IV-iron therapy safer; however, the current protocols are still non-specific, non-evidence-based empirical measures which neglect the fact that the majority of IV-iron reactions are not IgE-mediated anaphylactic reactions. The field would benefit from new specific and effective methods for the prevention and treatment of these HSRs, and the main goal of this review was to highlight a possible new approach based on the assumption that IV-iron reactions represent complement activation-related pseudo-allergy (CARPA), at least in part. The review compares the features of IV-iron reactions to those of immune and non-immune HSRs caused by a variety of other infused drugs and thus make indirect inferences on IV-iron reactions. The process of comparison highlights many unresolved issues in allergy research, such as the unsettled terminology, multiple redundant classifications and a lack of validated animal models and lege artis clinical studies. Facts and arguments are listed in support of the involvement of CARPA in IV-iron reactions, and the review addresses the mechanism of low reactogenic administration protocols (LRPs) based on slow infusion. It is suggested that consideration of CARPA and the use of LRPs might lead to useful new additions to the management of high-risk IV-iron patients. AbbreviationsADRs, adverse drug reactions; API, active pharmaceutical ingredient; CARPA, complement activation-related pseudoallergy; CHMP, Committee for Medicinal Products for Human Use; EMA, European Medicinal Agency; HMW-ID, high molecular weight iron dextran; HSRs, hypersensitivity reactions; ID, intravenous dextran; IV-iron, intravenous iron; LMW-ID, low molecular weight iron dextran; LRP, low reactogenic administration protocol; Mab, monoclonal antibody; MBL, mannose binding lectin; MRI, magnetic resonance imaging; SPIO, superparamagnetic iron oxide; WAO, World Allergy Organisation BJP British Journal of Pharmacology

Inflammatory processes are involved in the initiation and maintenance of labor, suggesting that Toll-like receptor (TLR) activity within gestation-associated tissues, such as the placenta, might contribute to the process of parturition. Expression of transcripts for TLR1-TLR10 was examined in term (>37 wk of gestation) human placentas collected in the absence of labor (elective caesarean sections; ECS; n = 11) and after the completion of labor (normal vaginal delivery; NVD; n = 12). Placental explants were cultured in the presence of agonists for TLR2, TLR3, TLR4, TLR5, TLR7, TLR8, and TLR9, and cytokine production after 24 h was examined. All placentas expressed transcripts for TLR1-TLR10. Reactivity to all agonists except CpG oligonucleotides was observed, indicating that, other than TLR9, all of the receptors studied yielded functional responses. Placental explants prepared from NVD placentas (n = 17) produced significantly more TNFA in response to lipopolysaccharide (TLR4 agonist) and resiquimod (TLR7/8 agonist) than explants from ECS placentas (n = 17). In contrast, gene expression analysis revealed that only transcripts for TLR2 and TLR5 were significantly elevated in association with labor. The human term placenta expresses a variety of functional TLRs, indicating that this family of receptors has an important role in parturition via as yet undetermined cell types and signaling pathways.

Toll‐like receptors (TLR) have emerged as key upstream mediators of inflammation at many tissue sites in humans. Inflammatory processes are involved in the process of parturition suggesting that TLR activity within gestation‐associated tissues might have an important role in the initiation and/or maintenance of normal term labour and in various pathological states of pregnancy such as infection‐associated preterm labour. Either TLRs or their signalling molecules might be excellent therapeutic targets for prevention of preterm labour.

Objective To examine a cohort of women with positive cervical smears, but negative colposcopy, in order to ascertain whether there is a subsequent difference in the incidence of squamous dyskaryosis and cervical intraepithelial neoplasia when compared with a control group.Design Prospective follow up study.Setting Colposcopy clinics, antenatal clinics, GP surgeries.Methods A study group of 255 women with reported abnormal cervical smears but negative colposcopy was subdivided into three groups according to referral smears suggesting high grade dyskaryosis (n = 34), mild dyskaryosis (n = 120) and borderline changes (n = 101). They were followed for at least five years and were compared with a control group of 726 women followed up after a negative smear, using the first and worst follow up smears over a five year recall period. Main outcome measuresResults The control group had a similar incidence of squamous dyskaryosis as that expected in the screening population. Forty-six per cent of the study group with colposcopically unconfirmed ('false positive') cervical smears subsequently had abnormal smears. When the three groups were compared with controls using a x' test, their incidence of abnormal smears was significantly increased. Cervical intrepithelial neoplasia was found in 19% of the study group, and in 3% of the control group ( P < 0~0001). ConclusionsThe analysis demonstrates that women with so-called 'false positive' smears defined by negative colposcopy have an increased risk of subsequent abnormal smears and cervical intrepithelial neoplasia, suggesting that lesions may have been missed on colposcopy. However, in a significant proportion of women, further abnormalities were not detected during the follow up period, indicating that there may be other causes for positive smears and negative colposcopy.Incidcnce of subsequent cervical cytological and histological abnormalities.

Key content Polyhydramnios is a common obstetric condition, but its management can often be challenging. Mild polyhydramnios resolves frequently and is not usually associated with adverse perinatal outcomes. There is a higher prevalence of aneuploidy (10–20%) in severe polyhydramnios. Unexplained polyhydramnios has been associated with increased rates of perinatal morbidity and mortality. Learning objectives To gain an overview of the aetiology and investigations for polyhydramnios in singleton pregnancies. To understand the implications of mild and unexplained polyhydramnios for both mother and fetus. To develop an evidence‐based approach for managing this condition and provide a surveillance strategy. Ethical issues Can we justify the benefits of early induction in unexplained polyhydramnios in the face of associated risks?