Key content The incidence of caesarean sections performed at full dilatation is increasing, and may now represent around 8000 deliveries in the UK each year. Delivery can be technically challenging due to fetal impaction into the pelvis, and may be associated with greater maternal and fetal morbidity even without failed attempt at vaginal delivery. Guidelines are needed to define optimal management, including the use of new devices to teach or assist safe delivery. Best practice should be incorporated into structured training programmes such as Managing Obstetric Emergencies and Trauma (MOET). Learning objectives Assess the reasons for the increasing incidence of full dilatation caesarean section at full dilatation. Describe the associated maternal and neonatal risks compared with operative vaginal delivery. Describe the current evidence for optimal management and define areas for research. Ethical issues Further research is needed to define long‐term morbidity and address the risk/benefit of second‐stage caesarean section at full dilatation versus attempted vaginal delivery.

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Purpose of Review Current treatments for chronic hepatitis B (CHB) are associated with low rates of cure. Functional cure has been accepted as a viable treatment end point in CHB. There have been substantial advances in the field of RNA interference (RNAi) therapeutics across a wide range of specialties, and the clinical pipeline now encompasses CHB. This review will highlight some of the challenges in therapeutic development, the data for RNAi in CHB, and future directions for the field. Recent Findings Early phase clinical trials have reported good safety data for RNAi therapies in CHB and demonstrated significant reductions in quantitative HBsAg levels (qHBsAg). Animal models however suggest that in HBeAg-negative individuals, HBsAg may be derived from hepatitis B DNA integrated into the host genome, which cannot be targeted by current RNAi therapies, and may prove to be a limitation. Preliminary data is being presented from combination therapy, which may result in more robust reductions in qHBsAg; however, trials are in the early stages of recruitment. Summary Despite promising data that RNAi may be an effective therapeutic strategy in CHB, it is unlikely to be in the form of monotherapy. The goal for the community will be to find the right combination of RNAi therapy with other antiviral or immunomodulatory agents, to achieve functional cure with a cessation of therapy. Early phase clinical trials are continuing to recruit, and data from combination studies will provide a “pivot point” in determining whether RNAi therapies can provide a backbone to finite duration and curative CHB regimens.

Quinoline antimalarials cause drug-induced electrocardiograph QT prolongation, a potential risk factor for torsade de pointes. The effects of currently used antimalarials on the electrocardiogram were assessed in pregnant women with malaria. Pregnant women with microscopy-confirmed parasitaemia of any malaria species were enrolled in an open-label randomised controlled trial on the Thailand-Myanmar border in 2010–2016. Patients were randomised to the standard regimen dihydroartemisinin-piperaquine (DP), artesunate-mefloquine (ASMQ), or an extended regimen of artemether-lumefantrine (AL+). Recurrent vivax infections were treated with chloroquine. Standard 12-lead electrocardiograms were assessed on day 0, 4-6 hour following the last dose and day 7. QT was corrected for the heart rate by a linear mixed-effects model derived population-based correction formula (QTcP = QT/RR0.381). A total of 86 AL+, 82 ASMQ, 88 DP and 21 chloroquine treated episodes were included. No patients had an uncorrected QT interval nor QTcP > 480ms at any time. QTcP corresponding to peak drug concentration was longer in DP group (adjusted predicted mean difference 17.84 ms, 95% CI 11.58 to 24.10, p<0.001) and chloroquine group (18.31 ms, 95% CI 8.78 to 27.84, p<0.001) than in the AL+ group, but not different in the ASMQ group (2.45 ms, 95% CI -4.20 to 9.10, p=0.47). There was no difference between DP and chloroquine (p=0.91). QTc prolongation resulted mainly from widening of JT interval. In pregnant women, none of the antimalarial drug treatments exceeded conventional thresholds for an increased risk of torsade de pointes.