General population screening for cystic fibrosis carrier status in the United Kingdom would detect 72% of at‐risk couples. Proper counselling would allow these couples to make informed reproductive choices, including the possibility of prenatal diagnosis and the termination of an affected pregnancy. However, children with cystic fibrosis born in this decade, given optimum treatment, now have an average life expectancy of 40 years, and there is no unanimity of opinion on how, where, when, or even if, screening should be offered. The purpose of this questionnaire‐based study was to examine the attitudes of an adult clinic population who have grown up with cystic fibrosis, and of their parents, towards genetic screening programmes and the controversies and ethical dilemmas surrounding such programmes in cystic fibrosis. Both patients and parents supported prenatal screening (88% and 90%) and the option of terminating an affected pregnancy (68% and 84%). Only 22% of patients and 10% of parents felt that screening should be limited to families with a history of cystic fibrosis, and 19% and 6%, respectively, that prenatal diagnosis should be restricted to those with a previous child with cystic fibrosis. Despite the negative aspects of any screening programme and the acknowledged ethical problems peculiar to cystic fibrosis, the conclusion of our patients and parents who have lived intimately with the illness is that there should be the option of utilising information available from genetic screening for cystic fibrosis to guide reproductive choices. Pilot programmes to define the optimum management of such screening should continue.

Women with a positive fFN result received different treatment to those with a negative fFN. Use of fFN test in routine clinical practice allows management and resources to be targeted more appropriately and may limit unnecessary interventions.

This case regards a morbidly obese lady presenting with a massive ovarian tumour herniating through the umbilicus. Six months previously she had suffered from a life-threatening pulmonary embolus requiring supportive ventilation at the same hospital. Herniation of the ovary directly into the umbilicus is very rare and here we provide pictoral evidence and advice regarding the management of this patient.A 55-year-old post-menopausal Maori lady was admitted under the surgeons with a 7-day history of tenderness and redness in her umbilicus, with worsening abdominal pain, lethargy and urine retention. Six months previously, she had been on the intensive care unit at the same hospital with nearfatal massive pulmonary and right ventricular emboli, which were treated with streptokinase infusion and significant respiratory support. Abdominal examination at the time was reported as "nothing abnormal".She was referred to the gynaecologists following abdominal ultrasound and CT scanning. Abdominal examination revealed a morbidly obese woman of 158 Kg (Basal Metabolic Index (BMI) of 45) (Fig. 1), with massive abdominal distension secondary to a solid mass thought to be arising from an ovary. There appeared to be an incarcerated herniation of the mass through the umbilicus, causing a localised tender spot at the base of the umbilicus. The patient was unable to stand unaided, and complained that her abdominal girth had been increasing for 2 years, despite advice by previous medical staff to lose weight to reduce her size.Tumour markers were elevated, with a CA125 of 224 kU/l, haemoglobin of 7.03 mmol/l but otherwise normal renal and liver function tests. Chest X-ray did not reveal any extraperitoneal masses, and abdominal CT scan showed a 41 cm × 33 cm mass, consisting of mainly fat but also some calcified areas and septae.Following anaesthetic review and an informed discussion regarding the significant risks associated with surgery, the patient was booked for midline laparotomy. The midline incision site was marked preoperatively (Fig. 1).At operation, in a left lateral tilt, entry into the abdomen was difficult due to a loss of the natural tissue plains secondary to inflammation and adhesions between the mass and the anterior abdominal wall. A lobule of tumour was found to be herniating through the umbilicus, causing a true umbilical hernia (Fig. 2). Following extensive dissection, a right oophorectomy was performed. The entire umbilicus was removed and the rectus sheath resutured. The uterus and remaining ovary were left in situ to minimise on table operative time and the risks of haemorrhage. Thromboprophylaxis was continued with high-dose subcutaneous low molecular weight heparin until the day of discharge, 7 days post-operatively.

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The Royal College of Obstetricians and Gynaecologists supports the Department of Health recommendation to increase consultant presence outside current working hours. Resident, 24‐hour consultant cover exerts considerable pressure on staff. Whether permanent consultant presence improves standards of care is unclear. Learning objectives: To explore the relationship between evidence in support of a permanent consultant presence and pregnancy outcomes. To appreciate the advantages, disadvantages and practical considerations of 24‐hour resident consultant cover. Ethical issues: Is it possible to balance improvements in the standard of maternity care with potential detrimental effects on NHS staff? Please cite this article as: Edmonds S, Allenby K. Experiences of a 24‐hour resident consultant service. The Obstetrician & Gynaecologist 2008;10:107–111.