Increasing maternal age is an independent risk factor for operative delivery, and perineal trauma. However, maternal age has no significant effect on admission of infants into the NICU during the first 24 h following delivery.

Juvenile dermatomyositis has variable clinical presentations both in and outside of pregnancy. A literature review indicated that optimal maternal and fetal outcomes can be anticipated when the pregnancy is undertaken while the disease is in remission. Poorer outcomes are associated with flare-up of the disease in early pregnancy compared with exacerbation in the second or third trimester, when fetal prognosis is usually good. We present a case of JDM in pregnancy with disease exacerbation late in pregnancy and review of the relevant literature.

Ectopic pregnancy is a common complication of early pregnancy. We present a very atypical case of an ectopic gestation in a woman who presented with a negative pregnancy test, a large pelvic mass, weight loss and bowel obstruction.

Key content Caring for and making decisions on behalf of incompetent adults can be a complicated process. The Mental Capacity Act (MCA) 2005 provides a legal framework that protects mentally incapacitated individuals and guides decision makers during the decision‐making process. A gynaecologist can easily undertake the determination of mental capacity using the two‐stage test of capacity. The best interests meeting is an appropriate way of facilitating the decision‐making process by bringing together the relevant people involved in the care of the individual who has lost decision‐making ability. Learning objectives To understand mental capacity in relation to the MCA 2005. To understand the test of mental capacity. To understand the different decision‐making models, as applied to mental capacity. To be able to apply the MCA statutory checklist in the determination of best interests. Ethical issues There may be conflicts of interest between the medical team and surrogate decision maker in the best interest meeting. A dispute among the members of the best interest team could delay the treatment of the mentally incapacitated individual, and such delay may not be in the best interest of the patient.