Obstetrics, Gynaecology and Reproductive Medicine最新文献

Hypertension is common during pregnancy, complicating ∼10–15% of all pregnancies in the UK. The number of women who enter pregnancy affected by chronic hypertension is less clear, but has been estimated at ∼3%. Risk factors for chronic hypertension include maternal race and ethnicity, age, and body mass index (BMI). The changing demographics of today's antenatal population mean that pre-existing hypertension in pregnancy is an increasing clinical problem. Chronic hypertension in pregnancy can be defined as hypertension known to be present prior to conception or first recognised before 20 weeks of gestation. Patients with chronic hypertension are at risk of a variety of adverse maternal and fetal outcomes, and hence should have a comprehensive plan of care. Optimal care includes pre-conceptual counselling, frequent antenatal visits during pregnancy, timely delivery, appropriate intrapartum monitoring, and postpartum follow up. The relative risk of superimposed pre-eclampsia in women with chronic hypertension is nearly eightfold higher than in the general population, and all adverse neonatal outcomes are at least twice as likely to occur compared to the general population.

Assisted reproductive therapy (ART) is not currently included in UK national guidelines as an indication for specific antenatal, intrapartum or postpartum care even though ART pregnancies have a higher risk of complications compared to spontaneous conception singleton pregnancies. Risks include venous thromboembolism, hypertensive disorders, psychological sequelae and preterm birth. ART alone is not an indication for early induction of labour or continuous electronic fetal monitoring in labour or closer postpartum surveillance. Albeit ART pregnancies may have pregnancy complications that require obstetric-led care. Holistic and personalised care is a priority for all pregnancies and this should include pregnancies after ART with their increased risks related to the therapy itself and/or the underlying cause of infertility. This article outlines the considerations clinicians caring for a pregnancy following ART may need to contemplate.

Sexual violence is a significant social problem and rates of victimisation are high. Women face a disproportionate risk of sexual violence, and the impacts and consequences are considerable. These consequences can be physical, psychological, emotional, social and interpersonal. Sexual violence is not commonly disclosed and many women presenting in gynaecologic, obstetric and reproductive medicine practice will have had experiences of sexual violence in their lifetime. These experiences can impact upon experiences of engagement with heath care. Clinicians should be aware of the forms, prevalence and impact of sexual violence in the lives of women and its potential consequences for health care. Sensitive and trauma-informed practices, particularly around intimate examinations, are vital.

Venous thromboembolism (VTE) in pregnancy remains a leading cause of maternal morbidity and mortality. As rates of pregnancy in women with additional risk factors and underlying diagnoses continue to rise, it is crucial that all obstetricians understand how to approach thromboprophylaxis at all stages of pregnancy. In this review we seek to provide a roadmap to understanding the physiology, pathology and pharmacology of VTE in pregnancy for the obstetrician in order to facilitate a greater understanding of how to best support all women at risk of VTE throughout their pregnancy journey from pre-conception to post-natally. Recent developments and emerging evidence to support changes in practice are explored as well as consideration of some more complex scenarios and discussion of ethical considerations in the hope of providing a comprehensive overview of the subject.

Medicolegal issues in gynaecology pose unique challenges to the healthcare system. This article explores the complex landscape of legal considerations in gynaecological practice, including informed consent, medical negligence, patient autonomy, and ethical dilemmas. Gynaecological procedures such as reproductive interventions and pelvic surgeries often involve sensitive and intimate matters, making the medicolegal framework critical for protecting patient rights and ensuring good-quality care. Through a comprehensive review of relevant literature and case studies, this article highlights the need for interdisciplinary collaboration among healthcare providers, legal professionals, and policymakers to navigate these complex issues. It also highlights the importance of clear guidelines, education and training to promote ethical decision-making, accountability and avoidance of litigation. By addressing medicolegal challenges in gynaecology, the healthcare system will be able to uphold patient welfare, safeguard the rights of patients and maintain the highest standards of care.

Fibroids are uterine smooth muscle tumours which are commonly found. They can vary in their number, location and size. Depending on the location and the size, fibroids can be symptomatic. Symptoms include menstrual dysfunction, pressure or subfertility. The treatment strategies will depend on the patient's characteristics, of which the most important is the wish to preserve the uterus. In this review all treatment modalities will be discussed with their risks. Clinicians need to be aware of the very rare risk of these benign tumours developing into malignancy.

Obstetric anaesthetists are becoming more frequently involved in many women's maternity care. During the antenatal period, many women will visit the antenatal anaesthetic clinic to discuss risk factors for anaesthetic intervention and how these may affect the woman's individual birth plan. Prior planning and the involvement of multidisciplinary teams allows for risk mitigation, and a personalised plan to be created for each woman with her involvement. An increasing number of women are also requiring surgical intervention as part of their maternity care. An understanding of the factors which affect the anaesthetic used for each woman, and the risks but also benefits of each one allows better appreciation of the decision-making principles involved. In a period that requires quick decisions to ensure the best outcomes possible, clear communication within the team allows for interventions to be fully optimised.

This review of invasive cervical cancer explores the aetiology with HPV infection and prevention through vaccination. Diagnosis, imaging studies and the most recent FIGO staging are discussed. Management of stages 1A1-1B2 with surgery and stages 1B3-IV with chemoradiation are outlined. Fertility-sparing approaches along with exenteration and palliative treatments are also summarised.