The physiological changes in liver function in pregnancy are commonly transient, rarely permanent. Disorders arising in pregnancy, such as pre-eclampsia and eclampsia, acute fatty liver of pregnancy (AFLP), haemolysis, elevated liver enzyme and low platelets (HELLP) syndrome, cholestasis, hyperemesis gravidarum and isolated cases of raised liver enzymes can have serious implications. Proper interpretation of liver function tests (LFTs) at an early stage can lead to timely management and may reduce complications in both mother and fetus. Normal LFTs do not always mean that the liver is normal. A number of pitfalls can be encountered in the interpretation of basic blood LFTs. The commonly used LFTs primarily assess liver injury rather than hepatic function. Abnormal LFTs may indicate that something is wrong with the liver, and they can provide clues to the nature of the problem but this is not always the case. The various biochemical tests, their pathophysiology, and an approach to the interpretation of abnormal LFTs are discussed in this review. Commonly available tests include alanine transaminase, aspartate transaminase, alkaline phosphatase, bile acid, serum bilirubin, serum albumin and prothrombin time.

Symphysis pubis dysfunction is a relatively common and debilitating condition affecting pregnant women. It is painful and can have a significant impact on quality of life, which can lead to potentially serious complications such as depression. Effective management remains difficult to determine because of a variation in reported occurrence rates and symptomatology. There is little published assessment of treatments and no standardised management protocols are available. This article describes recent developments and discusses the controversies surrounding its treatment. With an improved knowledge of the condition and incorporation of the recommendations in this article it is hoped that healthcare professionals will be able to reduce the severity of the symptoms in those women affected.

The percentage of second stage caesarean sections is on the rise. The delivery of a deeply engaged head in the second stage by caesarean section is an experience feared by most junior registrars. Among the different delivery techniques described, the pull technique has been proven to have a lesser morbidity than the push technique. However, trainees do not receive any structured training in either of these methods. We undertook a survey among 150 UK trainees in SPROGS 2008 in order to understand their experience in dealing with a deeply engaged head in second stage by CS, to ascertain whether trainees feel that they need training to deal with the situation and to discover the means by which this training can be delivered. The questionnaire return rate was 94%. More than 80% agreed that they had faced difficulties in the past while trying to deliver a deeply engaged head. Only 20% used the recommended semi-lithotomy position during caesarean section for an impacted head. Among the trainees who had received only UK training, only 42% were confident of doing a pull method if the need arose. More than 80% of the trainees agreed that supervised sessions to teach alternative techniques for delivery, such as the reverse breech/pull method would be useful and that it would improve their confidence when doing a trial of vaginal delivery. The RCOG agreed that there is little formal training in delivery of a deeply engaged head and is considering recommending trainees complete 2 OSATS (Objective Structured Assessment Tools) in this area. It has also asked the authors to form a skills and drills protocol, which the authors have done and submitted to the RCOG.

A questionnaire survey was conducted to determine if pregnant women and healthcare professionals were aware of the correct use of a seatbelt and if advice was given. A total of 154 pregnant women and 56 health professionals were included in the study. A total of 115 (74.6 %) pregnant women wore seatbelts as drivers; 51 (33.1%) women were concerned about wearing the seatbelt in pregnancy; eight (14.2 %) received advice from health professionals. Incorrect positioning of a seatbelt was indicated by 67 (43.5 %) pregnant women and nine (16 %) health professionals. The majority of the doctors and community midwives advised women on seatbelt use only if asked. This study shows that almost half of pregnant women are ignorant of the correct use of a seatbelt, which puts them at risk for injuries. Well-informed prenatal care providers should substantially influence the practice among pregnant women through education.

Thromboembolic diseases during pregnancy are usually managed by conventional anticoagulation and patients are at high risk of pulmonary embolism. Inferior Vena Cava (IVC) filters can be used in cases of documented pulmonary embolism (PE) where anticoagulation is contraindicated or has failed. In our case the patient was diagnosed as having a deep vein thrombosis (DVT) and was started on anticoagulant therapy. Twenty four hours afterwards she went into labor and an IVC filter was inserted due to the risk of pulmonary embolism. She was managed successfully during labor and postpartum period. This shows that IVC filters can be used during labor to try and prevent pulmonary emboli.