Obstetrics, Gynaecology and Reproductive Medicine最新文献

The process of screening aims to reduce the burden of disease. In pregnancy this is relevant to both the mother and her baby. There are national screening programmes for infectious disease, haemoglobinopathy and fetal anomalies, all of which have the potential to reduce the life-long burden of disease in the newborn. But screening extends beyond these programmes and when risk factors are identified, interventions might be instigated to reduce the impact of disease on pregnancy outcomes. This article reviews screening in its broadest sense. It describes the various screening opportunities and considers the actions that can be taken to optimize the health of the mother and her baby. The process of screening continues throughout pregnancy, in the same way that risks evolve as pregnancy progresses.

Bladder pain syndrome (BPS) is a benign condition of chronic bladder pain or discomfort that can significantly disrupt normal daily activities and reduce quality of life. It can be difficult to diagnose as it’s a diagnosis of exclusion and symptoms are vague. Refractory cases are difficult to manage due to poorly understood aetiology and few universally effective treatments. Over the last two decades, there have been important efforts directed at understanding the syndrome's aetiology and therapeutic challenges. This article reviews the current literature on BPS aetiology, clinical presentation, diagnosis, and treatment options.

From 2019 to 2021, 241 women in the UK died during pregnancy or in the 6-week period postpartum, as a direct or indirect result of the pregnancy, a mortality rate of almost 1 in 10,000. In 14% of cases, care was considered ‘good’, but in 52%, opportunities to improve care were identified that might have altered the outcome in a positive way. The admission rate to intensive care units for women who are pregnant or within the first six postnatal weeks exceeds 1 in 500 maternities, and is more common among women of black ethnic origin, older age, or those with severe obesity. Reasons for admission range from provision of close observation with or without invasive monitoring, to multi-organ support including extracorporeal therapies. An understanding of the types of organ support available, along with their indications and objectives, is important for all medical professionals caring for such women. This review describes the range of critical care organ support modalities available and how the physiology of pregnancy influences their use. The non-clinical challenges faced by professionals caring for these women who are critically unwell, from logistical to psychological, are also discussed.

The previous lack of national UK guidance on the use of Prenatal and Pre-implantation Genetic Testing (PND and PGT-M) for Monogenic Disorders for Germline Cancer Susceptibility Gene Variants (gCSGV) has led to disparities in care across the UK, and inequitable access to reproductive options for families living with cancer susceptibility syndromes. In 2023, the UK Cancer Genetics Group and Fetal Genomics Group of the British Society of Genetic Medicine developed joint consensus guidance seeking to provide healthcare professionals with a clear counselling framework to support individuals/couples during their reproductive decision-making process. The guidance is for healthcare professionals, individuals and couples with a gCSGV and their families, policy makers and charities supporting people with cancer susceptibility syndromes. Details about the consensus group participants, the main workshop's format, and the pre- and post-workshop nationwide surveys, are available in the full document.

Most newborns are born vigorous and do not require resuscitation. However, the World Health Organization has estimated that 10% of all newborn infants need some intervention at birth and approximately 0.5% will require cardiopulmonary resuscitation. Frequently, the need for resuscitation may be anticipated based on maternal and obstetric history, but this is not always the case and therefore anyone involved in the delivery of newborn infants should be trained in resuscitation.