How We Really WHO: Assessing Completeness, Team Engagement, Distractions and Authority Gradient During 'Time Out' Component of WHO Safer Surgery Checklist.

Background: Anecdotal experience suggests that WHO Safer Surgery Checklist has become a 'tickbox' exercise, resulting in variable team engagement and efficacy.

Aims: To observe the quality and completeness of 'Time Out', together with the level of team engagement during obstetrics and gynaecology procedures.

Materials And Methods: Observational study where the following data were collected during 'Time Out': % of the 19 items correctly responded to after 'challenge'.

Pregnancy complicated by massive incisional hernia: challenges in management and review of literature.

Pregnancy complicated by incisional hernia is rare but can become an obstetric challenge if the gravid uterus becomes displaced or incarcerated into the hernial sac or if there is ulceration of the overlying dermis as a result of increased intra-abdominal pressure being transmitted to the skin. We report a case of a pregnant woman presenting with a large incisional hernia at 19 weeks of gestation and discuss how problems encountered with progressing pregnancy were managed conservatively by adopting a multidisciplinary team approach (which included surgeons and radiologists). She underwent a caesarean section at 35 weeks of gestation due to active bleeding from the ulcerated skin and foetal growth restriction with subsequent staged secondary hernia repair at a tertiary centre.