Obstetrics, Gynaecology and Reproductive Medicine最新文献

Ovarian cysts are common among post-menopausal women. Although ovarian cancer is a significant cause of mortality in menopausal women, large population-based studies demonstrate that the majority of adnexal masses are benign. In most cases, a pelvic mass or ovarian cyst is an incidental finding, generally corresponding to a benign cyst and easily diagnosed by conventional ultrasound. However, an ovarian tumour may be malignant and should be treated as early as possible. Several diagnostic modalities exist including ultrasound, blood tumour markers, advanced imaging modalities such as magnetic resonance imaging, and computerized tomography to diagnose and characterize the ovarian masses. Complex ovarian masses with malignant characteristics are then discussed in gynaecology oncology multidisciplinary team meetings to decide on treatment modality and hospital - whether a cancer unit or centre would provide the agreed treatment. Adnexal masses with benign morphological and functional properties may be periodically monitored as an alternative to surgery since malignant transformation is rare.

Normal labour reflects the culmination of several complex and complimentary processes, relying on hormonal, biochemical and mechanical interdependence. The four phases of parturition (quiescence, activation, stimulation and involution) in short reflect the transition from gestation to initiation and propagation of labour, delivery of the fetus and placenta, and recovery to the non-pregnant state. Appropriate physiological regulation of this process is key to achieving maturity for the neonate and prevention of associated maternal and neonatal morbidity. Myometrial acontractility and cervical structural integrity are maintained throughout gestation chiefly by progesterone. As gestation advances, functional withdrawal of progesterone, as well as other hormonal influences, mechanical stretch and a cascade of inflammatory processes stimulate the initiation and propagation of labour. Mechanically, labour may only progress when effective uterine contractions occur in conjunction with satisfactory fetal and maternal pelvic dimensions. The three clinical stages of labour reflect regular uterine activity and cervical dilatation up to four centimetres, delivery of the fetus, and the placenta, respectively. Labour represents a challenge for both birthing person and fetus, therefore robust knowledge of normal processes and physiological responses is essential to our understanding of how to appropriately care for and monitor those in labour, and to recognize when clinical intervention is indicated, such that maternal and fetal morbidity may be reduced.

Male and female sterilisation are important forms of contraception worldwide despite declining popularity in developed countries and limited access during the Covid-19 global pandemic. Vasectomy is the only highly reliable form of male contraception. Appropriate counselling about permanent methods of contraception in both sexes is vital and should include information about irreversibility, failure rates and complications. The alternatives to sterilisation, particularly long-acting reversible contraception (LARC), should be discussed in detail as they are at least as effective and have the advantage of reversibility. Hysteroscopic techniques for female sterilisation are no longer available. In males the no-scalpel technique vasectomy requires minimal operating time and results in less post-operative discomfort than the incisional method. Regret after sterilisation and requests for reversal are more common in patients under 30 years and in men with no children.

Genetic disease can occur due to imbalance of whole chromosomes, smaller chromosome microdeletions or duplications, or at the single-gene level where even a single base change can cause significant disease. This review focuses on the methods available to achieve genetic diagnosis of a fetus in pregnancy, both in the context of a family history of a known disease-causing gene variant and where there is clinical suspicion of a genetic disorder based on ultrasound findings. The indications for rapid trio whole exome sequencing in the prenatal setting will be considered. Until relatively recently, genetic testing of a fetus invariably required invasive procedures to sample fetal tissue, with associated risk of miscarriage. However, non-invasive methods of achieving prenatal diagnosis by sampling fetal DNA present in maternal blood have undergone considerable development. Current applications of invasive and non - invasive prenatal testing are discussed with clinical case studies.

Women with inherited bleeding disorders in pregnancy are a group of pregnant women with varied and often complex healthcare needs. The antenatal, intrapartum and postnatal care of these women and their babies may require specialist planning and support. This article outlines the key principles of care and provides a summary of the existing Royal College of Obstetricians and Gynaecologists’ guidelines on the management of inherited bleeding disorders in addition to practical advice from clinical experience of looking after these women and their pregnancies.