{"title":"CPD and SBA questions for volume 26 issue 3","authors":"Justin C Konje","doi":"10.1111/tog.12942","DOIUrl":"https://doi.org/10.1111/tog.12942","url":null,"abstract":"","PeriodicalId":509656,"journal":{"name":"The Obstetrician & Gynaecologist","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anangsha Kumar, Kathryn Hunt, Manju M Nair, Alice Clack
{"title":"Women's health, the climate crisis and the pathway to a net‐zero health system","authors":"Anangsha Kumar, Kathryn Hunt, Manju M Nair, Alice Clack","doi":"10.1111/tog.12934","DOIUrl":"https://doi.org/10.1111/tog.12934","url":null,"abstract":"","PeriodicalId":509656,"journal":{"name":"The Obstetrician & Gynaecologist","volume":"33 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141701565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pelvic pathologies such as fibroids, polyps, congenital uterine anomalies, intrauterine adhesions, hydrosalpinges, adenomyosis, endometriosis and ovarian cysts may have a negative impact on fertility and the success of assisted reproductive technology (ART). If pelvic pathologies are identified during the course of investigations for subfertility, information based on the latest available evidence should be provided so that individuals can make informed decisions about how they wish to proceed. In some situations, surgical intervention prior to ART is strongly recommended, but in others, the evidence is more limited/conflicting. To learn more about how and why pelvic pathologies such as fibroids, polyps, congenital uterine anomalies, intrauterine adhesions, hydrosalpinges, adenomyosis, endometriosis and ovarian cysts affect fertility and outcomes following ART treatment. To understand when surgical intervention is (and equally is not) indicated in the management of different pelvic pathologies in women with subfertility who are contemplating ART. To appreciate the different options on how to manage women with different pelvic pathologies identified before and during an ART cycle. To smooth the transition between secondary/tertiary NHS care and ART providers so that women are given consistent advice and managed according to evidence based recommendations.
子宫肌瘤、息肉、先天性子宫畸形、宫腔粘连、输卵管积水、子宫腺肌病、子宫内膜异位症和卵巢囊肿等盆腔病变可能会对生育和辅助生殖技术（ART）的成功产生负面影响。如果在检查不孕症的过程中发现盆腔病变，应提供基于现有最新证据的信息，以便患者在知情的情况下决定如何进行治疗。在某些情况下，强烈建议在进行 ART 之前进行手术干预，但在其他情况下，证据较为有限/相互矛盾。进一步了解子宫肌瘤、息肉、先天性子宫畸形、宫腔粘连、输卵管积水、子宫腺肌症、子宫内膜异位症和卵巢囊肿等盆腔病变如何以及为何会影响 ART 治疗后的生育能力和治疗效果。了解在 ART 治疗周期之前和期间发现不同盆腔病变的妇女有哪些不同的治疗方案。使国家医疗服务体系的二级/三级医疗机构与 ART 提供者之间的过渡更加顺畅，从而使妇女获得一致的建议，并根据循证建议进行治疗。
{"title":"Gynaecological pathology and assisted reproductive treatment: can we increase the chances of successful treatment by optimising the pelvis?","authors":"Alison Richardson, Susie Jacob, Ellissa Baskind","doi":"10.1111/tog.12937","DOIUrl":"https://doi.org/10.1111/tog.12937","url":null,"abstract":"\u0000Pelvic pathologies such as fibroids, polyps, congenital uterine anomalies, intrauterine adhesions, hydrosalpinges, adenomyosis, endometriosis and ovarian cysts may have a negative impact on fertility and the success of assisted reproductive technology (ART).\u0000If pelvic pathologies are identified during the course of investigations for subfertility, information based on the latest available evidence should be provided so that individuals can make informed decisions about how they wish to proceed.\u0000In some situations, surgical intervention prior to ART is strongly recommended, but in others, the evidence is more limited/conflicting.\u0000\u0000To learn more about how and why pelvic pathologies such as fibroids, polyps, congenital uterine anomalies, intrauterine adhesions, hydrosalpinges, adenomyosis, endometriosis and ovarian cysts affect fertility and outcomes following ART treatment.\u0000To understand when surgical intervention is (and equally is not) indicated in the management of different pelvic pathologies in women with subfertility who are contemplating ART.\u0000To appreciate the different options on how to manage women with different pelvic pathologies identified before and during an ART cycle.\u0000To smooth the transition between secondary/tertiary NHS care and ART providers so that women are given consistent advice and managed according to evidence based recommendations.\u0000","PeriodicalId":509656,"journal":{"name":"The Obstetrician & Gynaecologist","volume":"1996 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141707353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"What I’ve learnt… with Eddie Morris","authors":"Kate Harding, Edward Morris","doi":"10.1111/tog.12944","DOIUrl":"https://doi.org/10.1111/tog.12944","url":null,"abstract":"","PeriodicalId":509656,"journal":{"name":"The Obstetrician & Gynaecologist","volume":"33 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Odendaal, Fiona L Mackie, Sofia Tosounidou, Swati Ghosh, Ellen Knox
Sarcoidosis is an uncommon multi‐system disorder characterised by the presence of non‐caseating granulomas. It has a peak incidence between the ages of 20–40 years old. The pathogenesis of sarcoidosis is uncertain; however, it is known to be associated with an exaggerated T helper 1 (TH1) immune response leading to systemic inflammation and granuloma formation. Suppression in TH1 responses in pregnancy leads to disease remission in the majority of pregnancies. Nevertheless, the potential for decompensation in a subgroup remains, and consideration should be given to the pre‐pregnancy state. Sarcoidosis is associated with increased risk of maternal‐fetal morbidity, including growth restriction and pre‐eclampsia. Clinical management should focus on medication optimisation and mitigation of this increased risk. To understand the clinical features, pathogenesis and diagnosis of sarcoidosis. To understand the effect of pregnancy on sarcoidosis. To understand the effect of sarcoidosis on pregnancy and the related obstetric outcomes. To understand the management of sarcoidosis in pregnancy. There can be difficulties in appropriate management of medical disorders, such as sarcoidosis, with a limited obstetric evidence base. There are challenges in decision‐making regarding continuation of pregnancy in severe disease with an uncertain evidence base.
肉样瘤病是一种不常见的多系统疾病，以出现非酪氨酸肉芽肿为特征。肉样瘤病的发病机理尚不明确，但已知与 T 辅助细胞 1（TH1）免疫反应过强导致全身炎症和肉芽肿形成有关。肉样瘤病与母胎发病风险增加有关，包括生长受限和先兆子痫。了解肉样瘤病的临床特征、发病机制和诊断，了解妊娠对肉样瘤病的影响，了解肉样瘤病对妊娠的影响及相关的产科结果，了解妊娠期肉样瘤病的管理。
{"title":"Sarcoidosis in pregnancy","authors":"J. Odendaal, Fiona L Mackie, Sofia Tosounidou, Swati Ghosh, Ellen Knox","doi":"10.1111/tog.12917","DOIUrl":"https://doi.org/10.1111/tog.12917","url":null,"abstract":"\u0000\u0000\u0000Sarcoidosis is an uncommon multi‐system disorder characterised by the presence of non‐caseating granulomas. It has a peak incidence between the ages of 20–40 years old.\u0000\u0000The pathogenesis of sarcoidosis is uncertain; however, it is known to be associated with an exaggerated T helper 1 (TH1) immune response leading to systemic inflammation and granuloma formation.\u0000\u0000Suppression in TH1 responses in pregnancy leads to disease remission in the majority of pregnancies. Nevertheless, the potential for decompensation in a subgroup remains, and consideration should be given to the pre‐pregnancy state.\u0000\u0000Sarcoidosis is associated with increased risk of maternal‐fetal morbidity, including growth restriction and pre‐eclampsia. Clinical management should focus on medication optimisation and mitigation of this increased risk.\u0000\u0000\u0000\u0000\u0000To understand the clinical features, pathogenesis and diagnosis of sarcoidosis.\u0000\u0000To understand the effect of pregnancy on sarcoidosis.\u0000\u0000To understand the effect of sarcoidosis on pregnancy and the related obstetric outcomes.\u0000\u0000To understand the management of sarcoidosis in pregnancy.\u0000\u0000\u0000\u0000\u0000There can be difficulties in appropriate management of medical disorders, such as sarcoidosis, with a limited obstetric evidence base.\u0000\u0000There are challenges in decision‐making regarding continuation of pregnancy in severe disease with an uncertain evidence base.\u0000\u0000","PeriodicalId":509656,"journal":{"name":"The Obstetrician & Gynaecologist","volume":"154 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"CPD and SBA questions for volume 26 issue 2","authors":"Justin C Konje","doi":"10.1111/tog.12925","DOIUrl":"https://doi.org/10.1111/tog.12925","url":null,"abstract":"","PeriodicalId":509656,"journal":{"name":"The Obstetrician & Gynaecologist","volume":"169 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140783078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Re: Information sharing and communication in management of large for gestational age babies in non‐diabetic mothers","authors":"Ben Simpson","doi":"10.1111/tog.12920","DOIUrl":"https://doi.org/10.1111/tog.12920","url":null,"abstract":"","PeriodicalId":509656,"journal":{"name":"The Obstetrician & Gynaecologist","volume":"126 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140793192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"What I'm learning… with Holly Baker‐Rand","authors":"Holly Baker‐Rand, Jo Morrison","doi":"10.1111/tog.12922","DOIUrl":"https://doi.org/10.1111/tog.12922","url":null,"abstract":"","PeriodicalId":509656,"journal":{"name":"The Obstetrician & Gynaecologist","volume":"252 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140781509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adolescent heavy menstrual bleeding (HMB) is commonly related to hypothalamic pituitary ovarian axis immaturity, which improves with age. This article outlines when and how to investigate for underlying pathological causes. Medical treatment for adolescent HMB consists predominantly of hormonal contraceptives. Preparation choice depends upon patient preference, comorbidities and co‐existing conditions. Acute adolescent HMB is rare; a suggested framework for assessing and managing such cases is provided within this article. To understand how to clinically evaluate adolescent HMB. To understand when and how to investigate adolescent HMB. To understand the different medical treatment options for HMB, their efficacy, risks and alternatives. To understand the management of acute adolescent HMB. Duties of confidentiality must be balanced against safeguarding concerns.
{"title":"Heavy menstrual bleeding in adolescence: who to investigate and how to manage it","authors":"S. L. Walter, S. Channing, N. S. Crouch","doi":"10.1111/tog.12924","DOIUrl":"https://doi.org/10.1111/tog.12924","url":null,"abstract":"\u0000Adolescent heavy menstrual bleeding (HMB) is commonly related to hypothalamic pituitary ovarian axis immaturity, which improves with age. This article outlines when and how to investigate for underlying pathological causes.\u0000Medical treatment for adolescent HMB consists predominantly of hormonal contraceptives. Preparation choice depends upon patient preference, comorbidities and co‐existing conditions.\u0000Acute adolescent HMB is rare; a suggested framework for assessing and managing such cases is provided within this article.\u0000\u0000To understand how to clinically evaluate adolescent HMB.\u0000To understand when and how to investigate adolescent HMB.\u0000To understand the different medical treatment options for HMB, their efficacy, risks and alternatives.\u0000To understand the management of acute adolescent HMB.\u0000\u0000Duties of confidentiality must be balanced against safeguarding concerns.\u0000","PeriodicalId":509656,"journal":{"name":"The Obstetrician & Gynaecologist","volume":"83 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140769248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Farrah Pradhan, Simon Cunningham, Suzette Woodward
In obstetrics and gynaecology, things often ‘go well’ because clinicians make sensible adaptations in response to situations to ensure safety, often within a highly pressurised environment. The adaptations and performance variables that are made under these complex circumstances are not explicitly understood. Understanding the performance variability of clinicians as well as the environmental context that enables good or successful outcomes may bring awareness of how to build adaptive capacities and capabilities in clinicians when working in unpredictable and unanticipated highly pressurised environments. To be aware of the current research in safety‐II and the concept of resilience engineering in illustrating the nature of adaptations that happen in complex clinical contexts. To understand the concept of capability mindfulness, which can help clinicians to focus on their environment and to be alert and aware of correcting errors before they occur. To be aware of these concepts (behaviour and skills) through the lens of ‘what went well’ in clinicians’ responses to unforeseen and unpredictable situations.
{"title":"A proactive safety approach to delivering safer care in obstetrics and gynaecology","authors":"Farrah Pradhan, Simon Cunningham, Suzette Woodward","doi":"10.1111/tog.12919","DOIUrl":"https://doi.org/10.1111/tog.12919","url":null,"abstract":"\u0000In obstetrics and gynaecology, things often ‘go well’ because clinicians make sensible adaptations in response to situations to ensure safety, often within a highly pressurised environment.\u0000The adaptations and performance variables that are made under these complex circumstances are not explicitly understood.\u0000Understanding the performance variability of clinicians as well as the environmental context that enables good or successful outcomes may bring awareness of how to build adaptive capacities and capabilities in clinicians when working in unpredictable and unanticipated highly pressurised environments.\u0000\u0000To be aware of the current research in safety‐II and the concept of resilience engineering in illustrating the nature of adaptations that happen in complex clinical contexts.\u0000To understand the concept of capability mindfulness, which can help clinicians to focus on their environment and to be alert and aware of correcting errors before they occur.\u0000To be aware of these concepts (behaviour and skills) through the lens of ‘what went well’ in clinicians’ responses to unforeseen and unpredictable situations.\u0000","PeriodicalId":509656,"journal":{"name":"The Obstetrician & Gynaecologist","volume":"92 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140377647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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