A 33-year-old teacher (BMI 28 kg/m 2 ) saw her general practitioner (GP) due to primary infertility. She was previously fit and healthy apart from a history of hirsutism which had been treated by laser therapy in her 20s. As part of her initial diagnostic work-up, she was identified to have Type 2 diabetes and polycystic ovaries on a transvaginal ultrasound scan. Her recent HbA 1c was 7.7% (DCCT) (IFCC 60.7 mmol/mol). She was referred to a structured education programme and a dietician. She was also started on metformin and the dose was gradually increased to 2 g/day. Her total cholesterol was 6.2 mmol/l and her blood pressure was 144/86 mmHg. Her case was brought to the Ealing multidisciplinary group meeting for further discussion. Ways to think about the problemWhat is the likely cause of her infertility?In the UK, approximately one in seven heterosexual couples experience problems conceiving and investigations reveal a cause in 75% of these. The most frequent causes of subfertility are outlined in Table 1 Why this matters to mePolycystic ovarian syndrome (PCOS) is a frequently encountered condition in general practice and can have a significant impact on the quality of life of young women. Apart from addressing ovulatory problems in these women, it is important to remember to screen for other associated conditions such as Type 2 diabetes, hypertension or hypercholesterolaemia. This article outlines the pathophysiology of PCOS and its diagnostic pathways and also summarises the safety of medical management for the metabolic complications in pregnant women. It is important for healthcare professionals to be aware of the latest guidance for treatment of PCOS in order to provide high-standard evidencebased care.

Aims To determine current practice and outcomes in women admitted to antenatal ward with diagnosis of transverse or unstable lie. Background Fetal lie (other than longitudinal) at term may predispose to prolapse of cord or fetal arm and uterine rupture. Local guidelines recommend admission at 37+0 (RCOG guidelines after 37+6 weeks) but give no specific recommendations regarding further management. Methods A retrospective study was conducted at St Thomas’ Hospital, London from 2009–2012 of all women admitted with unstable/transverse lie. The diagnosis was based on ultrasound examination. Women with placenta praevia and non-singleton deliveries were excluded. Results Study included 198 cases of unstable/transverse lie. 58% were admitted before 38 weeks. The average length of admission was 7 days (IQR 4–11). There were no cases of cord prolapse or need for an immediate caesarean section from the antenatal ward. 73% of women had a caesarean section at a median gestation of 39+1 weeks (IQR 38+4 – 40+2) although almost half of these (41%) had a cephalic presentation at the time of elective caesarean sections. None of these had an absolute indication for Caesarean section. Discussion and conclusions The diagnosis of unstable/transverse lie leads to a prolonged inpatient stay and a high Caesarean section rate. From our study and the evidence from the available literature, we recommend delaying admission until at least 38 weeks and awaiting spontaneous version. Future research should focus on the safety of outpatient management with consideration of utilising techniques such as cervical length and fetal fibronectin.