Non‐statutory sites of importance for nature conservation in the West Midlands

Many counties in England have systems of non‐statutory sites of importance for nature conservation in addition to the statutory National Nature Reserves, Sites of Special Scientific Interest and Local Nature Reserves. The paper describes the evolution of such a system over the past 20 years in the metropolitan county of the West Midlands. The system has been recognized by the local planning authorities who have included appropriate policies for the conservation of these sites in statutory development plans. The authority of such a system derives from the use of published criteria for the selection of sites, consensus over the application of these criteria, and consultation with the owners and occupiers of the sites.     

Sustainable procurement in practice: Lessons from local government

By committing to green procurement, the UK government has taken a key initial step towards sustainable development. But can this be put into practice? This policy analysis explores the background to green procurement in English local government through desk research and data collection, including interviews with five local authorities. It finds that green procurement has been encouraged through legislation, providing information and dismantling barriers, but momentum was lost following the Gershon review. Implementation of the new action plan would ensure green procurement becomes embedded within government procurement. New information to link up green procurement with organisational goals would also expand the horizons of green procurement.     

Performance of comprehensive first trimester fetal anatomy assessment

Objective

Ultrasound assessment of the fetal anatomy and fetal echocardiography are feasible in the first trimester of pregnancy. This study was designed to assess the performance of a comprehensive fetal anatomy assessment in a high-risk population at a tertiary fetal medicine unit.

Methods

A retrospective review of high-risk patients undergoing comprehensive fetal anatomy ultrasound assessment between 11 weeks and 13 + 6 weeks of gestation was conducted. Findings of the early anatomy ultrasound scan were compared with those of the second trimester anatomy scan, and birth outcomes or post-mortem results.

Results

Early anatomy ultrasounds were performed in 765 patients. The sensitivity of the scan for detecting fetal anomalies compared to the birth outcome was 80.5% (95% CI 73.5–86.3) and specificity was 93.1% (95%CI 90.6–95.2). Positive and negative predictive values were 78.5% (95% CI 71.4–84.6) and 93.9% (95% CI 91.4–95.8), respectively. The most missed and overdiagnosed abnormalities were ventricular septal defects. The second trimester ultrasound had sensitivity of 69.0% (95% CI 55.5–80.5) and specificity of 87.5% (95% CI 84.3–90.2).

Conclusions

In a high-risk population, early assessments had similar performance metrics as the second trimester anatomy ultrasound. We advocate for a comprehensive fetal assessment in the care of high-risk pregnancies.