Objective— The investigation of the histology of the placental bed spiral arteries in normal pregnancy and in pregnancies complicated by hypertension, with or without proteinura. Design— An observational study, based on women having caesarean sections for clinical reasons. Subjects— 17 normal pregnant women, 43 with gestational hypertension, of whom 39 had proteinuria, 17 with chronic hypertension, of whom 6 had proteinuria, and 5 with unclassified hypertension. Interventions— Placental bed biopsies obtained during caesarean section. Main outcome measures— Histological appearance of sections stained with haematoxylin and eosin PAS and Lendrum's MSB. Results— Biopsies containing spiral arteries were obtained from 6 normotensive and 44 hypertensive women. Trophoblastic invasion was present in 5 of the 6 normotensive biopsies but absent in the majority of those with hypertension. Subintimal proliferation was seen in all the normotensive biopsies but in only 8 of 28 from those with gestational hypertension and proteinuria. Other features seen predominantly or only in the hypertensive biopsies, in order of frequency, were medial hyperplasia, fibrin deposits, acute atherosis, endothelial vacuolation and thrombosis. Conclusion— Absence of physiological changes may not be peculiar to preeclampsia but may be associated or even a result of various forms of hypertension in pregnancy. Spiral arteries show a spectrum of changes in hypertensive pregnancies that do not appear to bear a clear‐cut relation to the clinical signs.

Key Points• Fibtem is an early and rapidly available biomarker for predicting progression of moderate to severe postpartum hemorrhage.• Fibtem was predictive of need for blood transfusion and invasive procedures, bleeds .2500 mL, duration of bleed, and time in high dependency.

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The educational experiences and attainment of looked-after children and young people (LACYP) remains an issue of widespread international concern. Within the UK, children and young people in care achieve poorer educational outcomes compared to individuals not in care. Despite proliferation of research documenting the reasons for educational disadvantage amongst this population, there remains limited empirical consideration of the lived experiences of the educational system, as perceived by LACYP themselves. This paper draws upon qualitative research with 67 care-experienced children and young people in Wales. The sample was aged 6-27 years, and comprised 27 females and 40 males. Participants had experienced a range of care placements. Findings focus on how educational policies and practices alienate LACYP from dominant discourses of educational achievement through assignment of the 'supported' subject position, where children and young people are permitted and even encouraged not to succeed academically due to their complex and disrupted home circumstances. However, such diminished expectations are rejected by LACYP, who want to be pushed and challenged in the realisation of their potential. The paper argues that more differentiated understandings of LACYP's aspirations and capabilities need to be embedded into everyday practices, to ensure that effective educational support systems are developed.