PRACTICEFor the full versions of these articles see bmj.com benefit and should not be given for this purpose. The evidence for added calcium in the prevention of hypertensive disorders is conflicting and confusing, and more research is needed in this area. Chronic hypertension Preconception• Tell women taking angiotensin converting enzyme inhibitors and angiotensin II receptor blockers that taking these drugs during pregnancy increases the risk of congenital abnormalities, and that they should discuss other antihypertensive treatments with their healthcare professional if they are planning pregnancy. • Tell women taking chlorothiazide diuretics that taking these drugs during pregnancy increases the risk of congenital abnormalities and neonatal This is one of a series of BMJ summaries of new guidelines based on the best available evidence; they highlight important recommendations for clinical practice, especially where uncertainty or controversy exists Further information about the guidance, a list of members of the guideline development group, and the supporting evidence statements are in the full version on bmj.com. Why read this summary?Hypertensive disorders of pregnancy cover a spectrum of conditions, including chronic (pre-existing) hypertension, pre-eclampsia, and gestational hypertension (box 1). These conditions are associated with increased perinatal mortality and morbidity. Hypertensive disorders cause one in 50 stillbirths in normal babies and 10% of all preterm births. They contribute to a third of cases of severe maternal morbidity. 1 Pre-eclampsia is one of the most common causes of maternal death in the United Kingdom. 2 This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on how to manage hypertensive disorders during pregnancy. 3 Recommendations NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group's experience and opinion of what constitutes good practice. Evidence levels for the recommendations are in the full version of this article on bmj.com.Reducing the risk of hypertensive disorders in pregnancy • Advise pregnant women of their risk of developing hypertensive disorders during pregnancy (in particular pre-eclampsia; see box 2) and of the need to seek immediate advice from a healthcare professional if they experience symptoms of preeclampsia (severe headache; problems with vision, such as blurring or flashing before the eyes; severe pain just below the ribs; vomiting; sudden swelling of face, hands, or feet). • Advise women with at least one high risk factor for pre-eclampsia or at least two moderate risk factors for pre-eclampsia (box 2) to take 75 mg of aspirin daily from 12 weeks until the birth of the baby. • Although several drugs (nitric oxide donors, progesterone, diuretics, and low molecular weight heparin) and vitamin and nutrient supplement...

BackgroundInvestigating severe maternal morbidity (near-miss) is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. This study aims to i. document the frequency and nature of maternal near-miss at hospital level in Damascus, Capital of Syria, ii. evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities.MethodsRetrospective facility-based review of cases of near-miss and maternal mortality that took place in the years 2006-2007 at Damascus Maternity University Hospital, Syria. Near-miss cases were defined based on disease-specific criteria (Filippi 2005) including: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. Main outcomes included maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality indices and proportion of near-miss cases and mortality cases to hospital admissions.ResultsThere were 28 025 deliveries, 15 maternal deaths and 901 near-miss cases. The study showed a MNMR of 32.9/1000 live births, a MMR of 54.8/100 000 live births and a relatively low mortality index of 1.7%. Hypertensive disorders (52%) and haemorrhage (34%) were the top causes of near-misses. Late pregnancy haemorrhage was the leading cause of maternal mortality (60%) while sepsis had the highest mortality index (7.4%). Most cases (93%) were referred in critical conditions from other facilities; namely traditional birth attendants homes (67%), primary (5%) and secondary (10%) healthcare unites and private practices (11%). 26% of near-miss cases were admitted to Intensive Care Unit (ICU).ConclusionNear-miss analyses provide valuable information on obstetric care. The study highlights the need to improve antenatal care which would help early identification of high risk pregnancies. It also emphasises the importance of both: developing protocols to prevent/manage post-partum haemorrhage and training health care professionals to manage infrequent but fatal conditions like sepsis. An urgent review of the referral system and the emergency obstetric care in Syria is highly recommended.

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Background Social skills programmes (SSP) are treatment strategies aimed at enhancing the social performance and reducing the distress and di iculty experienced by people with a diagnosis of schizophrenia and can be incorporated as part of the rehabilitation package for people with schizophrenia. Objectives The primary objective is to investigate the e ects of social skills training programmes, compared to standard care, for people with schizophrenia. Search methods We searched the Cochrane Schizophrenia Group's Trials Register (November 2006 and December 2011) which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. We inspected references of all identified studies for further trials. A further search for studies has been conducted by the Cochrane Schizophrenia Group in 2015, 37 citations have been found and are currently being assessed by review authors. Selection criteria We included all relevant randomised controlled trials for social skills programmes versus standard care involving people with serious mental illnesses. Data collection and analysis We extracted data independently. For dichotomous data we calculated risk ratios (RRs) and their 95% confidence intervals (CI) on an intention-to-treat basis. For continuous data, we calculated mean di erences (MD) and 95% CIs. Main results We included 13 randomised trials (975 participants). These evaluated social skills programmes versus standard care, or discussion group. We found evidence in favour of social skills programmes compared to standard care on all measures of social functioning. We also found that rates of relapse and rehospitalisation were lower for social skills compared to standard care (relapse: 2 RCTs, n = 263, RR 0.52 CI 0.34 to 0.79, very low quality evidence), (rehospitalisation: 1 RCT, n = 143, RR 0.53 CI 0.30 to 0.93, very low quality evidence) and participants' mental Social skills programmes for schizophrenia (Review)