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Following the COVID‐19 pandemic, Northwestern Europe has experienced a marked increase in congenital parvovirus infections. This rise is attributed to social distancing measures which disrupted the usual seasonal variation of parvovirus B19. Fetal infection may cause severe anemia, thrombocytopenia, and hydrops fetalis, with significant risk of intrauterine death. Therefore, when acute parvovirus B19 infection is confirmed by maternal serology, serial ultrasound surveillance of the middle cerebral artery peak systolic velocity is recommended. Intrauterine transfusion remains the only established therapeutic option for cases of suspected fetal anemia or hydrops but carries risks of fetal loss and procedural‐related complications including fetal hemorrhage and exsanguination. This review critically examines current literature on diagnosis, management, perinatal outcomes, and long‐term neurodevelopmental sequelae following congenital parvovirus infection and intrauterine transfusion. Additionally, we report our tertiary fetal medicine center's experience during the 2024 epidemic, highlighting a novel conservative management approach for fetuses with parvovirus‐related anemia and hydrops fetalis. The 2024 rise in congenital parvovirus infections has created substantial demand on fetal medicine services, with an influx of referrals for surveillance and treatment of suspected anemia and hydrops. This review outlines the role of intrauterine transfusion while also describing cases of spontaneous fetal recovery under close monitoring. In addition, it summarizes current evidence on structural neurological injury in utero and long‐term neurodevelopmental outcomes following parvovirus infection and vertical transmission in pregnancy.

Background Caesarean section (CS) is widely perceived as protective against obstetric brachial plexus injury (BPI), but few studies acknowledge the factors associated with such injury. The objectives of this study were therefore to aggregate cases of BPI after CS, and to illuminate risk factors for BPI. Methods Pubmed Central, EMBASE and MEDLINE databases were searched using free text: (“brachial plexus injury” or “brachial plexus injuries” or “brachial plexus palsy” or “brachial plexus palsies” or “Erb’s palsy” or “Erb’s palsies” or “brachial plexus birth injury” or “brachial plexus birth palsy”) and (“caesarean” or “cesarean” or “Zavanelli” or “cesarian” or “caesarian” or “shoulder dystocia”). Studies with clinical details of BPI after CS were included. Studies were assessed using the National Institutes for Healthy Study Quality Assessment Tool for Case Series, Cohort and Case-Control Studies. Main results 39 studies were eligible. 299 infants sustained BPI after CS. 53% of cases with BPI after CS had risk factors for likely challenging handling/manipulation of the fetus prior to delivery, in the presence of considerable maternal or fetal concerns, and/or in the presence of poor access due to obesity or adhesions. Conclusions In the presence of factors that would predispose to a challenging delivery, it is difficult to justify that BPI could occur due to in-utero, antepartum events alone. Surgeons should exercise care when operating on women with these risk factors.

Placenta-mediated complications such as pre-eclampsia (PE), fetal growth restriction (FGR), and preterm birth (PTB) remain leading causes of maternal and perinatal morbidity. First-trimester screening tools, including the Fetal Medicine Foundation (FMF) algorithm and National Institute for Health and Care Excellence (NICE) criteria, help identify women at risk, but their predictive accuracy remains limited. This study evaluated whether second-trimester uterine artery (UtA) Doppler measurements provided additional risk stratification within risk groups defined by either FMF or NICE-based first-trimester screening. This was a retrospective cohort study which included 5518 singleton pregnancies managed at University College London Hospital between 2019 and 2022. Women were stratified into four risk groups based on first (1) and second (2) trimester assessments: L1L2 (low risk in both trimesters), L1H2 (low risk in first, high risk in second), H1L2 (high risk in first, low in second), and H1H2 (high risk in both trimesters). First-trimester risk was assessed using FMF or NICE models; second-trimester high risk was defined as a mean UtA pulsatility index (PI) ≥95th centile. Primary outcomes included the incidence of PE, small for gestational age (SGA; birthweight <10th centile), FGR (<3rd centile), PTB before 34 and 37 weeks, stillbirth, and a composite adverse outcome (PE, FGR, PTB, or stillbirth). Secondary outcomes were emergency cesarean section (EMCS), neonatal intensive care unit (NICU) admission, and NICU length of stay. This study was not designed to compare the intrinsic screening performance of NICE and FMF as first-trimester tools. Women classified as low risk in the first trimester but high risk in the second trimester had higher rates of adverse outcomes compared to those who remained low risk in both trimesters in both FMF- and NICE-based stratification. Notably, women classified as high risk in both trimesters had the highest rates of placenta-mediated complications, including PE, FGR, PTB, and stillbirth. This pattern was consistent across both first-trimester risk frameworks. Mid-gestational UtA Doppler assessment improves prediction of placenta-mediated complications when included with FMF or NICE screening. This two-step approach enhances identification of high-risk pregnancies and supports more personalized antenatal care.

Universities have been developing online learning facilities for doctors and medical students for many years. Now they are turning to the virtual world of Second Life, reports Daniel Stott

Patient and Public Involvement and Engagement (PPIE) is an essential element of any clinical trial, to ensure that the research design and resources are acceptable and the trial produces findings that are relevant to research participants and service-users. The WILL (When to Induce Labour to Limit risk in pregnancy hypertension) Trial Management Team involved a group of patient and public members to develop an infographic, for service-users and -providers, to communicate the risks of chronic and gestational hypertension at term gestational age. Based on national resources in the UK for PPIE, including those from the National Institute for Health and Care Research (NIHR) and Health Research Authority, active trial sites (all in the UK) were approached to invite women with pregnancy hypertension to the PPIE group, and advertisements were placed on the Action on Pre-Eclampsia Charity (APEC) and NIHR People in Research websites. PPIE resources were established by the Trial Management Team and virtual meetings with the PPIE members held to co-design and develop the infographic from existing trial materials, using Microsoft Publisher. Seven diverse PPIE members were involved, six from NIHR People in Research and one from APEC. No members were engaged from active sites. From initial set-up to REC approval of the infographic took 9 months, and a considerable time commitment from the Trial Manager and Senior Research Midwives, to navigate practicalities (e.g. team consensus-building). Four meetings were held and 15 iterations of the infographic were developed with the group. The infographic incorporated requests from PPIE members for a design that was inclusive of all races, cultures, abilities and genders. Discussions with PPIE group members improved our understanding of the acceptability of the trial intervention to some cultures. The Research Ethics Committee (REC) requested revisions to PPIE-approved wording about the risk of stillbirth, from '1 in 1000' to 'small increased risk' prior to issuing approval for use. More practical support would be useful for researchers seeking to establish PPIE groups, and RECs reviewing resources that are co-produced. Our case study provides a practical, step-by-step account of establishing a PPIE group without a funded co-lead, highlighting strengths such as the diversity of members, the incorporation of cultural perspectives, and the development of inclusive patient-facing materials. These findings add to PPIE practice by offering operational guidance, lessons learned and a summary checklist as an additional resource that can complement existing high-level frameworks.

Background Patient and Public Involvement and Engagement (PPIE) is an essential element of any clinical trial, to ensure that the research design and resources are acceptable and the trial produces findings that are relevant to research participants and service-users. The WILL (When to Induce Labour to Limit risk in pregnancy hypertension) Trial Management Team involved a group of patient and public members to develop an infographic, for service-users and -providers, to communicate the risks of chronic and gestational hypertension at term gestational age. Methods Based on national resources in the UK for PPIE, including those from the National Institute for Health and Care Research (NIHR) and Health Research Authority, active trial sites (all in the UK) were approached to invite women with pregnancy hypertension to the PPIE group, and advertisements were placed on the Action on Pre-Eclampsia Charity (APEC) and NIHR People in Research websites. PPIE resources were established by the Trial Management Team and virtual meetings with the PPIE members held to co-design and develop the infographic from existing trial materials, using Microsoft Publisher. Results Seven diverse PPIE members were involved, six from NIHR People in Research and one from APEC. No members were engaged from active sites. From initial set-up to REC approval of the infographic took 9 months, and a considerable time commitment from the Trial Manager and Senior Research Midwives, to navigate practicalities (e.g. team consensus-building). Four meetings were held and 15 iterations of the infographic were developed with the group. The infographic incorporated requests from PPIE members for a design that was inclusive of all races, cultures, abilities and genders. Discussions with PPIE group members improved our understanding of the acceptability of the trial intervention to some cultures. The Research Ethics Committee (REC) requested revisions to PPIE-approved wording about the risk of stillbirth, from ‘1 in 1000’ to ‘small increased risk’ prior to issuing approval for use. Conclusions More practical support would be useful for researchers seeking to establish PPIE groups, and RECs reviewing resources that are co-produced. Our case study provides a practical, step-by-step account of establishing a PPIE group without a funded co-lead, highlighting strengths such as the diversity of members, the incorporation of cultural perspectives, and the development of inclusive patient-facing materials. These findings add to PPIE practice by offering operational guidance, lessons learned and a summary checklist as an additional resource that can complement existing high-level frameworks. Trial registration ISRCTN77258279, registered on 05 December 2018.

Background Pregnancies in women with sickle cell disease (SCD) are known to have high rates of maternal and fetal mortality and morbidity. Given these pregnancy-associated problems for women with SCD, advice both about pregnancy planning and about effective contraception are of paramount importance. This study sought to discover the contraception methods used by women with SCD, what complications women with SCD encounter with contraception, and their experiences of pre-pregnancy counselling and pregnancy planning, and how such issues may have changed over the past two decades. Method The study was a multicentre, interview-based, cross-sectional study. Interviews were carried out with 102 women with SCD, in north and central London during 2010, concerning their current and previous contraceptive use, their pregnancy history, their menstrual history, and the advice they received concerning pregnancy planning and contraception. Patient information was anonymised and ethical approval was obtained. These data were compared with data from a similar study undertaken in 1993. Results There were significant differences in a number of key areas: the number of unplanned pregnancies decreased from 64% in 1993 to 53% in 2010. The number of women with SCD who were advised not to become pregnant also fell, from 36% to 15%. The use of combined oral contraceptive pills declined, from 45% of the women in 1993 to 31% in 2010. Conversely the use of depot medroxyprogesterone acetate contraception (DMPA) and the levonorgestrel intrauterine system (LNG-IUS) both increased. Conclusions Significant changes in the contraceptive methods used by women with SCD are demonstrated in the London population. LNG-IUS use in SCD has not been investigated before. There has been an encouraging decrease in the number of women with SCD who are advised not to become pregnant, perhaps reflecting an improvement in their overall health. Although the number of unplanned pregnancies has fallen, it remains high – emphasising the continuing need for women with SCD to have access to informed advice about pregnancy-associated issues and contraception.

Background As a pragmatic randomised timing-of-birth trial, WILL adapted its trial procedures in response to the COVID-19 pandemic. These are reviewed here to inform post-pandemic trial methodology. Methods The trial (internal pilot) paused in March 2020, re-opened in July 2020, and is currently recruiting in 37 UK NHS consultant-led maternity units. We evaluated pandemic adaptations made to WILL processes and surveyed sites for their views of these changes (20 sites, videoconference). Results Despite 88% of sites favouring an electronic investigator site file (ISF), information technology requirements and clinical trial unit (CTU) operating procedures mandated the ongoing use of paper ISFs; site start-up delays resulted from restricted access to the CTU. Site initiation visits (SIVs) were conducted remotely; 50% of sites preferred remote SIVs and 44% felt that it was trial-dependent, while few preferred SIVs in-person as standard procedure. The Central team felt remote SIVs provided scheduling and attendance flexibility (for sites and trial staff), the option of recording discussions for missing or future staff, improved efficiency by having multiple sites attend, and time and cost savings; the negative impact on rapport-building and interaction was partially mitigated over time with more familiarity with technology and new ways-of-working. Two methods of remote consent were developed and used by 30/37 sites and for 54/156 recruits. Most (86%) sites using remote consenting felt it improved recruitment. For remote data monitoring (5 sites), advantages were primarily for the monitor (e.g. flexibility, no time constraints, reduced cost), and disadvantages primarily for the sites (e.g. document and access preparation, attendance at a follow-up meeting), but 81% of sites desired having the option of remote monitoring post-pandemic. Conclusions COVID adaptations to WILL trial processes improved the flexibility of trial delivery, for Central and site staff, and participants. Flexibility to use these strategies should be retained post-pandemic. Trial registration ISRCTN77258279. Registered on 05 December 2018.

They can protect doctors and patients, says Daniel Stott , but there are also challenges