Background: Women with spinal cord injuries (SCI) represent a high risk population during pregnancy with comparatively few studies in the literature regarding their management and pregnancy outcomes, due to the relative rarity of the condition. Our objective was to assess pregnancy outcomes in women with spinal cord injury. Methods: We performed a retrospective observational study of pregnancy outcomes by reviewing maternity records of all pregnant women with SCI attending the National Spinal Injury Centre at Buckinghamshire NHS Trust between 1991 and 2016. The outcome measures were Maternal demographic data, antenatal complications, method of anaesthetic, intrapartum data (gestation at delivery, onset of labour, mode of delivery, indication for obstetric intervention) and neonatal outcomes (low birth weight, stillbirth, neonatal death). Results: Fifty women with a total of 68 pregnancies were identified. Five patients sustained SCI during pregnancy and the remaining 63 pregnancies were conceived at least 1 year after SCI, of which 45 pregnancies had a SCI at T10 or above (73%) and 23 pregnancies at T11 or below (27%). The most common antenatal complications in SCI patients were worsening of spasms (38%) and urinary tract infection (24%). Preterm delivery occurred in 18% of women. Vaginal delivery was achieved in 77% of pregnancies, including 14% instrumental delivery rate and 23% Caesarean delivery rate. Conclusions: Our findings support the current evidence that pregnancy outcomes are generally successful and that vaginal delivery can be safely achieved in the majority of women, independent of the level of SCI.

ObjectivesDelay in the induction of labour (IOL) process is associated with poor patient experience and adverse perinatal outcome. Our objective was to identify factors associated with delay in the IOL process and develop interventions to reduce delay.Design and settingsWe performed a retrospective cohort study of maternity unit workload in a large UK district general hospital. Electronic hospital records were used to quantify delay in the IOL process and linear regression analysis was performed to assess significant associations between delay and potential causative factors. A novel computer maternity unit simulation model, MUMSIM (Maternity Unit Management SIMulation), was developed using real-world data and interventions were tested to identify those associated with a reduction in delay.ParticipantsAll women giving birth at Stoke Mandeville Hospital, Buckinghamshire National Health Service (NHS) Trust in 2018 (n=4932).Primary outcome measureDelay in the IOL process of more than 12 hours.ResultsThe retrospective analysis of real-world maternity unit workload showed 30% of women had IOL and of these, 33% were delayed >12 hours with 20% delayed >24 hours, 10% delayed >48 hours and 1.3% delayed >72 hours. Delay was significantly associated with the total number of labouring women (p=0.008) and the number of booked IOL (p=0.009) but not emergency IOL, spontaneously labouring women or staffing shortfall. The MUMSIM computer simulation predicted that changing from slow release 24-hour prostaglandin to 6-hour prostaglandin for primiparous women would reduce delay by 4% (p<0.0001) and that additional staffing interventions could significantly reduce delay up to 17.9% (p<0.0001).ConclusionsPlanned obstetric workload of booked IOL is associated with delay rather than the unpredictable workload of women in spontaneous labour or emergency IOL. We present a novel maternity unit computer simulation model, MUMSIM, which allows prediction of the impact of interventions to reduce delay.

2Nester abundance is a key measure of the performance of the world's largest green 3 turtle rookery at Raine Island, Australia. Abundance surveys have been undertaken in waters 4 adjacent to Raine Island reef using mark-resight counts by surface observer (SO), underwater 5 video (UWV) and unmanned aerial vehicle (UAV) (since 1984, 2013 and 2016 respectively). 6UAV and UWV may provide more cost-effective and less biased alternatives, but estimates 7 must be comparable with the historical estimates. Here we compare the three methods. 8The relative likelihood of resighting a marked turtle was significantly higher by SO 9 than the other methods, which led to lower mark-resight population estimates than by UAV 10 or UWV. Most (96%) variation in resighting probabilities was associated with survey period, 11 with comparatively little variation between consecutive days of sampling or time of day. This 12 resulted in preliminary correction factors of 1.53 and 1.73 from SO-UWV and SO-UAV, 13 respectively. However, the SO and UWV estimates were the most similar when turtle 14 densities were the lowest, suggesting that correction factors need to take into account turtle 15 density and that more data are required. 16 We hypothesise that the UAV and UWV methods improved detection rates of marked 17 turtles because they allowed subsequent review and frame-by-frame analysis, thus reducing 18 observer search error. UAVs were the most efficient in terms of survey time, personnel 19 commitment and weather tolerance compared to the SO and UWV methods.20This study indicates that using UAVs for in-water mark-resight turtle abundance 21 estimation is an efficient and accurate method that can provide an accurate adjustment for 22 historical abundance estimates. Underwater video may continue to be useful as a backup 23 alternative to UAV surveys. 26

Pregnancy in women with spinal cord injury is considered high risk because it may exacerbate many of their existing problems, including autonomic dysreflexia, spasms, decubitus ulcers, urinary tract infections and respiratory infections. Due to the relative rarity of spinal cord injury in the general obstetric population, clinicians often lack familiarity of these specific problems and the women themselves are usually more experienced in their own management than their obstetric team. However, studies have demonstrated that pregnancy outcomes are generally good with appropriate and experienced obstetric care. In this review, we examine the available literature and provide advice on pre-conception counselling and the antenatal, intrapartum and postnatal management of pregnant women with spinal cord injury.

ObjectiveTo describe perinatal outcomes of babies predicted to be large‐for‐gestational age in non‐diabetic pregnancies for women attempting vaginal birth.MethodsThis was a prospective population‐based cohort study of patients from a single tertiary maternity unit in the UK offering universal third trimester ultrasound and practising expectant management of suspected large‐for‐gestational age until 41 to 42 weeks. All women with a singleton pregnancy and an estimated due date between January 2014 to September 2019 were included. Women delivering before 37 weeks, with pre‐existing or gestational diabetes, fetal abnormalities, and those who did not have a third trimester scan were excluded for the assessment of perinatal outcomes of LGA by ultrasound after implementation of universal scan period. Association of LGA and perinatal adverse outcome were assessed for birth during universal ultrasound screening with the exposures of interest being EFW 90‐95th, EFW>95th and EFW >99th centiles. The reference group was fetuses with EFW 30‐70th. Analysis was performed using multivariate logistic regression. Neonatal composite adverse outcomes include: 1) Admission to NICU, APGARS <7 at 5 minutes, or arterial cord pH <7.1; 2) stillbirth, neonatal death, or hypoxic ischaemic encephalopathy. Secondary maternal outcomes were induction of labour, mode of birth, postpartum haemorrhage, shoulder dystocia, obstetric anal sphincter injury.ResultsBabies with an estimated fetal weight (EFW) on universal third trimester scan above 95th centile were at increased risk of CAO1 (aOR 2.18 [1.69‐2.80]) and CAO2 (aOR 2.58 [1.05‐16.0]). However, babies with EFW 90‐95 had a smaller risk of CAO1 and were not at increased risk of CAO2. All pregnancies were at increased risk of secondary maternal outcomes except for obstetric anal sphincter injury; the risk of adverse maternal outcome was higher with increasing EFW. Post hoc exploration of data suggests shoulder dystocia has a limited contribution for neonatal composite adverse outcomes in LGA babies (population attributable fraction of 10.8% for CAO1 and 29.1% for CAO2)ConclusionBabies with EFW >95th centile are at increased risk of adverse perinatal outcome and these results should aid antenatal counselling of the associated risks and birth options.This article is protected by copyright. All rights reserved.