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Objective-To investigate the clinical effects of regulating umbilical cord clamping in preterm infants.Design-A prospective randomised study.Setting-The Queen Mother's Hospital, Glasgow. Subjects-36 vaginally delivered infants over 27 and under 33 weeks' gestation.Intervention-Holding the infant 20 cm below the introitus for 30 seconds before clamping the umbilical cord ("regulated" group, 17 patients), or conventional management ("random" group, 19 patients).Main outcome measures-Initial packed cell volume, peak serum bilirubin concentrations, red cell transfusion requirements, and respiratory impairment (assessed by ventilatory requirements, arterial-alveolar oxygen tension ratio over the first day in ventilated infants, and duration of dependence on supplemental oxygen).Results-There were statistically significant differences between the two groups in mean initial packed cell volume (regulated group 0 564, random group 0.509) and median red cell transfusion requirements (regulated group zero, random group 23 ml/kg). 13 infants from each group underwent mechanical ventilation and showed significant differences in mean minimum arterial-alveolar oxygen tension ratio on the first day (regulated group 0-42, random group 0.22) and in median duration of dependence on supplemental oxygen (regulated group three days, random group 10 days). Differences in final outcome measures such as duration of supplemental oxygen dependence and red cell transfusion requirements were mediated primarily through arterial-alveolar oxygen tension ratio and also packed cell volume.Conclusions-This intervention at preterm deliveries produces clinical and economic benefits.

Takayasu's arteritis should be regarded as a risk factor for aortic dissection. It is important to treat systemic hypertension in Takayasu's arteritis patients and suspect the diagnosis of aortic dissection in any pregnant patient complaining of chest pain as dissection is a leading cause of maternal mortality in the developed world.

Key content Screening for Down syndrome is available in the first or second trimester. In the absence of aneuploidy and structural anomalies, abnormal maternal serum levels of first and second trimester markers are associated with adverse obstetric outcome. As the number of markers increases and their value becomes more extreme the likelihood of adverse obstetric outcome increases. Although many of the associations between maternal serum markers for adverse maternity outcome are statistically significant, the positive predictive value for individual outcomes are too low for them to be clinically useful as screening tests. Potential management strategies for care of women with abnormal serum markers are yet to be established. Pregnancies complicated by pre‐eclampsia, fetal growth restriction, pre‐term delivery, fetal demise and spontaneous miscarriage have been associated with abnormal deviations in either one or several components of these markers. Learning objectives To review the relationship between abnormal first and second trimester maternal markers and adverse obstetric outcomes. Ethical issues Despite evidence of increased pregnancy complications with unexplained abnormal quadruple screen, the optimal method to manage them is unclear. The cost of screening and emotional anxiety caused to patients must be outweighed by the benefits of early detection and the ability to reduce the overall risk. It is a great dilemma for obstetricians on how to proceed when confronted with an unexplained abnormal serum screen.