Obstetrics, Gynaecology and Reproductive Medicine最新文献

Pregnancy that continues beyond 42 weeks of gestation (post-term) confers increased antepartum and intrapartum fetal risk. Maternal risk may also be associated with post-term pregnancy, for example increased likelihood of delivery via emergency Caesarean section. The increased likelihood of adverse perinatal outcomes associated with post-term pregnancy derives mainly from increasing fetal size and placental ageing. The key intervention currently available to manage the risks associated with prolonged pregnancy is to offer delivery. In the UK, induction of labour is routinely offered at 41 weeks. Although offering induction of labour to manage post-term pregnancy is intended to minimize risk, women should feel supported by healthcare professionals if they opt for expectant management or decline induction of labour.

Stage at diagnosis is one of the key factors determining survival rates of gynaecological cancers. Rapid access pathways were developed in the UK nearly two decades ago, aimed at diagnosing cancers at an earlier stage. Also known as cancer pathways, these consist of standardised referral methods to specialist clinics, where patients undergo diagnostic investigations, receive results and commence treatment swiftly. National cancer waiting time targets exist in conjunction with these pathways and have evolved in recent years to place an emphasis on confirming or excluding cancer within shorter timeframes. In this article we shall consider these UK-based pathways and targets in more detail, along with the challenges hospital trusts face in meeting them. We shall also outline the investigations required to diagnose the four most common gynaecological cancers - uterine, ovarian, cervical and vulval.

Male factor infertility is the commonest single reason for infertility in couples trying to have children. This article summarizes the aetiology, classification, and management of male factor infertility. The cause for male infertility can be broadly classified into pre-testicular, testicular and post testicular causes depending on the underlying pathology. A detailed history and examination are crucial alongside investigations to delineate the cause. The management for male infertility varies depending on the cause of male infertility. Treatment includes lifestyle modifications, medical management, surgical management, and surgical sperm retrieval followed by assisted reproduction.

The impact of frailty, a state of vulnerability to insult with reduced likelihood of full recovery, resulting in suboptimal clinical outcomes following medical intervention has been recognized for some years. Pelvic floor dysfunction is common in frail older women and, as greater proportions of women survive into late life, the number requiring treatment is likely to increase. This article discusses the assessment of frailty, its impact on management of women with PFD and presents what is known about the management of PFD in frail older women from conservative to surgical therapies.

Hypertensive disorders affect approximately 8–10% of all pregnancies and include pre-eclampsia, gestational hypertension and pre-existing chronic hypertension, which may be primary or secondary. New onset hypertension in pregnancy is defined as a sustained systolic blood pressure (sBP) ≥140 mmHg and/or diastolic blood pressure (dBP) ≥90 mmHg, and severe hypertension diagnosed when sBP ≥160 mmHg and/or dBP ≥110 mmHg. Gestational hypertension and pre-eclampsia are most common, affecting 4.2–7.9% and 1.5–7.7% respectively. Chronic hypertension affects 0.6–2.7% of pregnancies but may be under-reported due to early physiological adaptations in pregnancy lowering blood pressure or unknown preconception blood pressure. New onset hypertension developing at any stage of pregnancy requires a full history, examination, and investigations to delineate an underlying cause, assess for target organ damage and the presence of pre-eclampsia to assign risk. Developing a hypertensive disorder in pregnancy is associated with increased life-long cardiometabolic risk and other cardiovascular risk factors should be minimised to improve a woman's long-term health.

During the COVID-19 pandemic clinical practice in obstetrics and gynaecology (O&G) underwent swift and dramatic changes, some transient, others permanent. Training, continuous professional development, educational supervision, and other non-patient facing roles were initially paused. Trainees and trainers saw unprecedented changes to their working patterns. With these changes it is unsurprising there was a significant effect on training in O&G. For the majority obstetric training was unaffected. However, most trainees reported a reduction to their gynaecological training. Furthermore, three quarters of trainees reported COVID had negatively impacted on both their physical and mental well-being. Training recovery has been proactively managed and the impact on progression for many mitigated. There is no doubt the COVID-19 impacted training in O&G. The pandemic has had a greater impact on gynaecological training than obstetric training. The impact on gynaecological operative training persists. The long-term effects on trainees remain to be seen.

Fetal anaemia is a relatively rare occurrence, but it carries a risk of significant fetal morbidity and mortality. The most common causes of fetal anaemia are haemolytic disease of fetus and newborn and parvovirus B19 infection. The only diagnostic test for fetal anaemia is fetal blood sampling, but this is an invasive test with associated risk of miscarriage, preterm membrane rupture or intrauterine fetal death. Therefore it is only performed if there is a strong suspicion of fetal anamia based on the patient's history and ultrasound findings of raised peak systolic velocity in middle cerebral artery and/or fetal hydrops. The treatment for fetal anaemia is symptomatic rather than curative in most of the cases. In severely anaemic fetuses intrauterine blood transfusion is undertaken which corrects the anaemia but does not deal with the underlying cause. The aim of this intervention is to reach the gestation when the delivery is safer.

Hirsutism is the abnormal excessive growth of coarse terminal hair over androgen-sensitive body areas. It is a very common endocrine pathology, affecting up to 10% of young females and has been linked with multiple conditions. Polycystic ovary syndrome (PCOS) and Idiopathic hirsutism encompass 90% of the cases. Patients presenting with hirsutism may require additional investigations and a plan with options for treatment. Mechanical hair removal is first-line management, along with lifestyle changes. Laser and phototherapy have been gaining popularity. The combined contraceptive pill is the preferred initial medical treatment offered, if not contraindicated, followed by anti-androgen therapy. Other emerging therapeutic options are inositol and vitamin D, especially in patients with PCOS. Treatment options should be discussed with patients, irrespective of the clinical severity, as they could be addressing underlying psychosocial concerns.