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OBJECTIVE This study assessed prevalence of connective tissue disease (CTDs), systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS) and antiphospholipid antibodies (aPL) in women with previous adverse pregnancy outcome compared with uncomplicated livebirths. DESIGN Retrospective case-control study. SETTING UK Primary Care. POPULATION OR SAMPLE Records of women, 18 years and older, within the Clinical Practice Research Datalink (CPRD) (1 January 2000-31 December 2013). METHODS Clinical Practice Research Datalink was searched for pregnancy terms to identify adverse pregnancy outcome. Each identified case was matched to five livebirths. MAIN OUTCOME MEASURES Diagnosis of SLE, CTD, APS or autoimmune antibodies. Poisson regression was performed to calculate relative risk ratios (RR), comparing adverse pregnancy outcome with livebirth cohorts. RESULTS Clinical Practice Research Datalink identified 20 123 adverse pregnancy outcomes matched to 97 323 livebirths, with a total of 875 590 person-years follow up. Median follow up from study entry was 7.29 years (SD 4.39). Compared with women with an uncomplicated livebirth, women with adverse pregnancy outcome had an increased risk of developing CTD or autoimmune antibodies (RR 3.20, 95% CI 2.90-3.51). Risk was greatest following a stillbirth (RR 5.82, 95% CI 4.97-6.81). For CTD and SLE, the risk was greatest within the first 5 years of adverse pregnancy outcome. Risk for aPL and APS diagnosis was highest ≥5 years from adverse pregnancy outcome. CONCLUSIONS Adverse pregnancy outcome is associated with increased risk of developing maternal CTD, including SLE. Either immunological factors predispose women to adverse pregnancy outcome and subsequent CTD diagnosis or, alternatively, adverse pregnancy outcome initiates autoimmune events which culminate in CTD in later life. TWEETABLE ABSTRACT Stillbirth is associated with increased maternal risk of developing systemic lupus erythematosus (SLE).

Objective To determine the impact of the COVID-19 pandemic and service modification on obstetric outcomes. Design: Single centre retrospective study Setting: Royal Bolton Hospital, United Kingdom. Population or Sample: Obstetric population in the prepandemic and pandemic periods. Methods Data on Obstetric services and pregnancy outcomes of women during the pandemic was compared to those of women prior to the pandemic and introduction of service modification. Statistical analysis was performed using SPSS, with data comparison between both groups done using nonparametric Chi-square test. Main Outcome Measures: Comparable perinatal and maternal outcomes. Results There was no significant difference in the induction of labour rates (38.8% pre-pandemic vs 38.3% pandemic, p= 0.78), use of epidural anaesthesia in labour (13.2% prepandemic vs 15.9% pandemic, p= 0.06), instrumental deliveries (13.0% prepandemic vs 12.3% pandemic, p= 0.56) and caesarean sections (28.9% prepandemic vs 31.7% pandemic, p= 0.09). There was significant reduction in the use of general anaesthesia for caesarean sections (8.9% vs 4.9%, p= 0.03) as well as antenatal admissions during the pandemic (23.9% vs 18.5%, p=

The delivery of oxygen to the fetus is dependent on adequate maternal blood oxygen concentration, uterine blood supply, placental transfer and fetal gas transport. Any disturbance in these factors, singly or in combination, can result in progressive fetal hypoxia and acidosis. The term fetal distress is non-specific but is usually applied to certain characteristic features on electronic fetal monitoring, confirmed if possible by fetal blood sampling. The aim of intrauterine fetal resuscitation (IUFR) measures is to increase oxygen delivery to the placenta and umbilical blood flow in an attempt to reverse fetal hypoxia and acidosis, so that labour may continue safely or to improve the fetal condition whilst arranging urgent delivery. IUFR measures include maternal re-positioning into left lateral (or alternatives, i.e. right lateral or knee-elbow if necessary), maternal oxygen administration at 15 litres/minute via non-rebreathing mask, rapid infusion of 1000 ml crystalloid (except in fluid restricted or pre-eclamptic patients), decreasing uterine contractions by stopping oxytocics and administering acute tocolytics (terbutaline 250 μg subcutaneously or intravenously (IV), glyceryl trinitrate 60–180 μg IV or sublingual spray, two puffs). A vasopressor (i.e. ephedrine) may be required in cases of maternal hypotension.

Cord prolapse is an obstetric emergency that complicates 0.1–1% of all deliveries with significant perinatal morbidity and mortality. Early diagnosis and swift management improves fetal outcomes. Immediate interventions include manual elevation of the presenting part, altered maternal position and filling of the bladder. Delivery is usually by Caesarean section unless the cervix is fully dilated when an instrumental delivery can be considered. Face presentation accounts for 0.2% of all live births. The overall vaginal delivery rate is 60–70% with the majority being in mento-anterior position. Those in persistent mento-posterior position usually require Caesarean section. Forceps delivery can be performed for prolonged second stage or abnormal CTG in mento-anterior position. Primary dysfunctional labour is very common. Interventions to consider include intravenous hydration, amniotomy and oxytocin. Oxytocin reduces the length of labour but does not alter the mode of delivery. Continuous fetal monitoring must be employed when utilizing oxytocin.

Maternal obesity is defined as a body mass index of 30 or above. It is a common clinical problem and its incidence is increasing. It is associated with an increase in both maternal and perinatal mortality and morbidity. Super-obesity in particular poses unique challenges during the antenatal, intrapartum and postnatal periods and may require the involvement of specialists from a number of fields. Women who are obese are a high-risk group and must be carefully risk assessed in order to optimize their care.