Bulletin Number 195

Welcome to the July Bulletin. The weather and attempts at holiday plans or travel seem to be taking us on wide swings ranging from great optimism to the lows of ongoing uncertainty. A timely reminder that we can take very little for granted.

Nothing indeed should be taken for granted when considering the theme covered in this issue − namely maternal and child health. Bill Kirkup, working as an independent investigator with several years of experience, summarises lessons learnt from well-publicised failures of care in UK maternity services (pp 380–381). He indicates that better scrutiny of all unexpected perinatal deaths and expansion of medical examiner input could help identify poorly performing services with scope for corrective action before scandals occur. His concerns were mirrored in the recent report on maternity services in England, produced by the Health and Social Care Committee.

The report from the Health Safety Investigation Branch (HSIB) highlights opportunities for learning from maternal death investigations during the first wave of the COVID-19 pandemic (pp 386–389). Patient safety concerns were noted not just from the disease itself, but from behaviour changes in patient and staff appreciation of risk with resultant changes in patient pathways and access to services.

The importance of placental pathology is also emphasised in helping HSIB investigations in giving families an explanation when faced with adverse outcomes and planning care for future pregnancies where there is risk of recurrence. Moreover, ongoing scrutiny and learning from events are the hallmarks of the successful UK-wide SHOT haemovigilance scheme (pp 392–395), with a need to stay alert to old and new challenges towards prevention of haemolytic disease of the fetus and newborn.

Postpartum haemorrhage remains an important global cause of maternal morbidity and mortality and it is encouraging to see large trials, despite difficulties, in this challenging setting (pp 384–386). Maternal anaemia is a significant public health issue affecting more than a third of pregnant women worldwide with serious potential consequences for mothers and babies. Expert authors report on their experience from the UK (pp 395–397) and also on the specific challenges faced in sub-Saharan Africa (pp 398–400).

Developments within paediatric laboratory medicine have helped focus on the specific medical needs of children, however, issues around workforce and training for the pathologists involved need to be addressed (pp 382–383). Inherited disorders are a significant cause of death in childhood or result in disability or hospitalisation. It is gratifying to see that the UK now has an exceptionally well-regulated system for neonatal screening of over 750,000 of infants each year with rapid turnaround of results (pp 389–392).

Our ‘Small is beautiful’ article, fitting appropriately with items highlighted within the Bulletin theme, throws a spotlight on paediatric and perinatal pathology (pp 435–437). Although a relatively small specialty in terms of training and consultant posts, this is a wide-ranging subject with opportunities to become a ‘super-specialist’.

COVID-19 continues to challenge health services with genomic testing helping to track the spread of emerging variants that threaten attempts to ease lockdowns around the world (pp 405–407). Highly successful vaccine programs have been adapted in the face of rare but fatal side effects (pp 407–409). The College has developed a series of short videos to address some of the most common myths circulating about the COVID vaccines, including targeting UK communities where English is not the first language (pp 411–412).

The pandemic continues to shape our approach to both teaching in medical schools (pp 428–429) and service delivery (pp 432–434), with the need for ongoing review and adaption. Active public engagement initiatives are proceeding virtu-ally with successful book clubs (pp 412–413) and expert-led secondary school sessions on medical ethics around organ donation, genomic data and inherited disease (pp 413–414).

The incoming College International team also clearly recognises the ever-increasing need to work collaboratively in medicine and science to tackle challenges not contained by borders (pp 417–422). The members outline their experience and background essential to achieving the objectives of the College’s Pathology is global strategy, supporting training and high professional standards overseas with international colleagues forming at least 20% of our membership.

The subject theme for the October issue will be cancer, with significant backlogs of cases impacting on prompt screening, diagnosis and timely management. This topic will no doubt continue to raise ongoing challenges for us all.