Obstetrics, Gynaecology and Reproductive Medicine最新文献

Ovarian, fallopian tube and primary peritoneal cancer has the poorest survival outcomes of all gynaecological malignancies. The majority of women present with advanced stage, high grade disease following a period of generalised abdominal symptoms. There is currently no effective screening programme. Diagnosis is based on imaging and histology. Stratification of adnexal masses into benign and malignant categories has helped ensure appropriate patients are referred to the gynaecology oncology team. The mainstay of treatment is surgery and chemotherapy, with removal of all residual disease being one of the most important prognostic factors. Recent advances in targeted therapies are also beginning to improve outcomes.

Genito-urinary fistula describes an abnormal connection between an epithelial surface of the female genital tract and the urological tract. The UK incidence is 100–120 cases per year with the majority caused by iatrogenic injury during pelvic surgery, most commonly involving the bladder. Women describe continuous vaginal leakage of urine. If the bladder fistula is diagnosed within 6 weeks of the index injury conservative treatment with an indwelling catheter on free drainage is recommended. Surgical repair ideally is performed by vaginal approach, with the abdominal approach reserved for ureteric fistula. Surgery is best performed in one of the high volume supra-regional fistula centres.

The importance of menopause and the short and long term effects of this have been underestimated and under discussed. With the media currently highlighting issues that affect women, it is important to understand menopause, the effects of this and how to mitigate these effects. When prescribing any drug or treatment, the risks must be properly discussed and women given as much information as possible to make an informed choice about their health. This is likely to look different for every woman who comes for a consultation as menopause and subsequent reactions to HRT are individual.

A malpresentation is diagnosed when any part of the baby is presenting to the maternal pelvis other than the vertex of the fetal head. A malposition is diagnosed when the fetal head is in any position other than occipito-anterior (OA) flexed vertex. Both malpresentation and malposition are associated with prolonged or obstructed labour, fetal and maternal morbidity, and potential mortality, if not managed in labour effectively. Malpresentations can be further classified by the lie of the fetus, be it normal or abnormal. The most common fetal malpresentation in longitudinal lie is breech presentation which itself can be further subdivided into subtypes. Other malpresentations in longitudinal lie include face, brow and compound. The fetus in non-longitudinal lie may be oblique or transverse, with shoulder, arm or cord presentations. Malpositions, such as occipito-posterior (OP) and occipito-transverse (OT), can be further described by the degree of deflexion and asynclitism. This practical review considers the potential fetal abnormal presentations and positions, their risk factors, and how these should be managed during labour.

Primary dysmenorrhoea, described as period pain in the absence of identifiable pelvic pathology, is the most common gynaecological condition worldwide. It has a significant impact on quality of life and contributes to difficulties in educational attainment, work productivity and gender inequality. Symptoms can be normalised and self-medication or self-help techniques are commonplace. The mainstay of management currently is non-steroidal anti-inflammatory medication and combined hormonal contraceptive pills. However, this may prove inadequate for up to a quarter of women and there is a growing body of evidence to support an individualised multifaceted approach including lifestyle modifications, non-pharmacological and pharmacological agents. Surgery may have a role in severe refractory cases.

Radiology plays an essential role in the management of benign gynaecological conditions and includes: ultrasound; computed tomography and magnetic resonance imaging. Each modality has a different role in diagnosis, treatment selection and follow-up. This review discusses the different imaging modalities, their recommended roles in the imaging and imaging findings of common female pelvic pathology.

Radiology plays an essential role in the management of malignant gynaecological conditions. Multiple imaging modalities are utilised to investigate suspected gynaecological malignancy including: ultrasound, computed tomography, magnetic resonance imaging and positron emission tomography/computed tomography. Each modality has a different role in diagnosis, staging, treatment selection and follow-up. This review discusses the different imaging modalities and their recommended roles in the imaging of malignant gynaecological disease. The imaging findings of common female pelvic pathology are discussed and illustrated.