Introduction The aim of this study was to investigate the planned place of delivery for women antenatally diagnosed with abnormally invasive placenta (AIP) in England and identify how many units regard themselves to be “specialist centers” for the management of AIP. Material and methods Observational study of obstetric‐led units in England. An anonymous survey was sent to the delivery suite lead clinician in all 154 consultant‐led units throughout England. The main outcome measures were whether each unit planned to manage AIP “in‐house”, the estimated number of AIP cases delivered in the previous 5 years and whether the unit considered itself a “specialist center” for AIP management. Results In all, 114 of 154 units responded (74%): 80 (70%) manage AIP cases “in‐house”, 23 (29%) of these report that they regard themselves “specialist centers” for AIP. The 23 “specialist centers” managed significantly more cases than “non‐specialist centers” (5.4, 95% confidence interval (CI) 4.3‐7.3 vs 2.3, 95% CI 1.5‐3.1 cases/unit/year; P < .001); nearly one‐third of “non‐specialist centers” manage less than 1 case per year. Extrapolating the reported number of cases to all 154 obstetrician‐led delivery units produces an estimate of 5.2 cases per 10 000 births over the last 5 years. Conclusions Most units plan to manage AIP “in‐house” despite encountering few cases each year. Centralizing care would allow the multidisciplinary team in each “specialist center” to develop significant experience in the management of this rare condition, leading to improved outcomes for the women.

The objective was to explore if chest X-ray severity, assessed using a validated scoring system, predicts patient outcome on admission and when starting continuous positive pressure ventilation (CPAP) for COVID-19. DesignThe study was a retrospective case-controlled study. ParticipantsThere were 163 patients with COVID-19 deemed candidates for CPAP on admission, including 58 who subsequently required CPAP. Outcome measuresOn admission, we measured the proportion of patients meeting a composite 'negative' outcome of requiring CPAP, intubation or dying versus successful ward-based care. For those escalated to CPAP, 'negative' outcomes were intubation or death versus successful de-escalation of respiratory support. ResultsOur results were stratified into tertiles, those with 'moderate' or 'severe' X-rays on admission had significantly higher odds of negative outcome versus 'mild' (odds ratio (OR) 2.32; 95% confidence interval (CI) 1.121-4.803; p=0.023; and OR 3.600; 95% CI 1.681-7.708; p=0.001, respectively). This could not be demonstrated in those commencing CPAP (OR 0.976; 95% CI 0.754-1.264; p=0.856). ConclusionsWe outline a scoring system to stratify X-rays by severity and directly link this to prognosis. However, we were unable to demonstrate this association in the patients commencing CPAP.

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