Full autopsy. A combination of external examination, radiological investigations, evisceration, dissection and subsequent full organ examination with detailed histological evaluation. This is the current “gold standard” of care against which other approaches are compared.

In the European Union, it is estimated that 36,000 children are born every year with congenital heart disease and that a further 3000 who are diagnosed with congenital heart disease die as a result of termination of pregnancy, late fetal death or early neonatal death. In a normal population, the risk of a woman having a child with a congenital heart malformation is of the order of 0.8–1%, the risk rising to 2–3%, if a previous pregnancy was affected by heart disease and approaching 6% if the mother herself has a congenital heart defect. There is great variation between countries in the antenatal detection of heart defects, being lowest in those countries without ultrasound antenatal screening programmes (8–11%), but in Western Europe the detection rates vary between 19% and 48%. High-resolution echocardiography enables assessment of precise structures during the second trimester or even earlier.

Thyrotoxicosis affects approximately 1:500 women of reproductive age. Untreated or poorly controlled thyrotoxicosis in pregnancy is associated with significant maternal and perinatal morbidity. Recognition and diagnosis of new onset thyrotoxicosis in pregnancy can be challenging as many of the symptoms can be misattributed to physiological adaptation of normal pregnancy. Women with hyperemesis gravidarum (HG) often have biochemical, but not clinical evidence of thyrotoxicosis, which does not need treatment with anti-thyroid drugs (ATDs). For women with clinical thyrotoxicosis, uncertainty regarding the risks of teratogenicity due to ATDs has led to new guideline recommendations for their use in pregnancy. Women with autoimmune diseases such as type I diabetes and who have thyroid peroxidase antibodies (TPOAb) are at an increased risk of developing postpartum thyroiditis, which can result in permanent hypothyroidism. This review summarises the management of thyrotoxicosis in pregnancy and highlights controversial areas for which conclusive evidence is still lacking.

From a scientific point of view, the answer to the question might be quite straightforward in favour of routinely screening all pregnant women for pre-eclampsia (PE) during the first trimester of pregnancy. However, irrespective of the large amount of good evidence and expert opinion favourable for universally screening for obstetric syndromes, such as PE, public health policies do not always align with pure clinical science.