Obstetrics, Gynaecology and Reproductive Medicine最新文献

The diagnosis of a congenital infection leads to feeling of anxiety and fear not only the pregnant woman but also in the medical practitioner caring for the woman. This is not surprising given that these conditions are rare events and so each clinician may only see a handful in their career. This article gives practical advice for when to suspect congenital infection, and to provide a framework for investigation, counselling and management of seven important congenital infections: toxoplasmosis, cytomegalovirus (CMV), zika virus, parvovirus B19, rubella, syphilis, and varicella zoster.

Childbirth related perineal trauma is extremely common after vaginal birth. Limited evidence suggests that subsequent complications such as wound infection or dehiscence occur frequently, yet interventions aimed at improving outcomes in this large group of women remain scarce. Here, we review the different types of tear after childbirth, their prevalence, risk factors, complications and best management, as well as exploring the evidence underlying current recommendations and practice.

Inequalities in maternal and perinatal outcomes related to ethnicity and socioeconomic deprivation are widening. Being of Black and Asian ethnicity independently increases the risk of maternal mortality and severe morbidity, as does living in the most deprived areas. Since a higher proportion of women of Asian and Black ethnicity live in the most deprived areas, this effect is compounded. Individual risks, such as obesity, are influenced by health and cultural beliefs and behaviour, social networks and norms, the environments in which we live, and access to and experience of healthcare, which are all intertwined with ethnicity and socioeconomic status. Clinicians can listen to women's and communities needs around ethnicity, race, and social determinants of health. Clinicians can also identify and use networks of community support and promote awareness within their practice and teams. Institutions can employ and retain diverse teams, measure health equity of services and develop an anti-discriminatory institutional culture.

Appropriate assessment of fetal growth is essential for safe clinical care. There have been many recent strategies to improve the detection of aberrant fetal growth patterns, one of which has been to optimize fetal growth centile charts. Over recent years there has been ongoing debates regarding the optimal growth chart for clinical usage. Controversy can arise where growth charts have demonstrated wide variance in the proportion of fetuses classified within the extremities of growth. Standards for growth charts need to be evidenced based and validated against pregnancy outcomes to demonstrate clinical utility and widespread usage. They should be supplied by high quality methodological reasoning and ideally evidenced through large prospective multicentre studies. Given the variable terminology to classify growth centile charts, including the variety of charts available, a complete understanding by healthcare professional can be troublesome to achieve. This practical guide aims to provide clarity on this diverse subject.

Doppler ultrasound is used to risk assess and monitor high-risk pregnancies to time delivery. Uterine artery (UtA) Doppler is a screening tool for placental dysfunction, as abnormal values represent an increased risk of hypertensive disorders and fetal growth restriction. Routine fetal growth assessment includes measuring the umbilical artery Doppler (UmA), as this reflects placental blood flow and can indicate placental dysfunction. In pregnancies with abnormal UmA Dopplers, assessment of the middle cerebral artery (MCA) and ductus venosus (DV) enables timely delivery by detecting developing hypoxia. In extremely preterm cases of severe growth restriction, the clinical challenge is timing birth so as not to replace the risk of stillbirth with the significant challenges of extreme preterm birth. Here, the DV Doppler is key, as this reflects cardiac function and identifies preterminal acidaemia. The use of each of these Doppler measurements will be described, illustrated and highlighted below using a case summary.

The potential therapeutic benefit of cervical cerclage for preventing pregnancy loss has been recognised for over 120 years; however, there remain many unanswered questions. There is considerable uncertainty regarding who is most suitable or will benefit most from cerclage, what type of suture should be used, such as low vaginal, high vaginal or transabdominal sutures, and indeed the suture technique, as well as when alternative or adjunctive therapies may be employed. This review presents a summary of recent guidance, new evidence and expectations for ongoing research to inform understanding of the role of cervical cerclage in 2024 and beyond.

Sexual assault is a prevalent problem which will affect 1 in 4 women, 1 in 6 men, and an even higher proportion of transgender individuals in their lifetime. It is likely that most medical practitioners will encounter a patient reporting sexual assault during their career. Adopting a trauma-informed approach and having a good understanding of the physical, psychological and sociological sequelae of sexual assault will improve outcomes for these patients. This includes knowing when to refer for psychological support, how to prescribe emergency contraception for the best outcome, and how to test for and treat sexually transmitted infections. Adopting a patient-centred approach is crucial to minimising the trauma experienced by these patients throughout their healthcare journey.

Puberty transforms a girl into a fertile woman, and its social importance is so great that any deviation from normality may be the cause of considerable embarrassment and anxiety. Delayed puberty in girls is defined as the absence of physical manifestations of puberty by the age of 13 years. Primary amenorrhoea is the absence of menarche and needs to be evaluated in the context of secondary sexual characteristics. Differential diagnoses can be classified according to the level of gonadotrophins. Differences in Sex Development and Complex Obstructed Mullerian Duct Anomalies should be investigated and managed in a specialist centre within a multidisciplinary team. Psychological support is essential.