Obstetrics, Gynaecology and Reproductive Medicine最新文献

Stillbirth describes the delivery of a baby with no signs of life in relation to thresholds of either gestational age or birthweight. In the UK, a stillbirth is legally defined as the delivery of a baby at or after 24 weeks’ gestation or 500 g where gestation is unknown. A history of previous stillbirth remains one of the strongest risk factors for subsequent stillbirth and other adverse outcomes in a subsequent pregnancy. According to World Health Organization (WHO), there are nearly 2 million stillbirths globally every year. There is a drive to reduce the rate of stillbirths by 50% in England by 2025 and a global target of 12 or fewer stillbirths per 1000 total births in every country by 2030. The significant psychological burden placed on parents following a stillbirth and the associated increased risk of complications in subsequent pregnancies need appropriate management. This article covers the investigation and management of stillbirth reflecting current UK practice.

The Department of Health's ‘Safer Maternity Care’ report extended the ‘Maternity 4 Safety Ambition’ to include reducing preterm births from 8% to 6%. This new element focuses on three areas of intervention to improve outcomes; prediction and prevention of preterm birth, and better preparation when preterm birth is unavoidable. This article describes how the preterm birth prevention clinic operates at the University Hospitals of Leicester, and uses a variety of clinical scenarios to illustrate this.

The introduction of vaccination against COVID-19 was associated with widespread misinformation on social media concerning, among other things, the potential effect of the vaccine in reducing fertility and increasing the risk of miscarriage among recipients. Tackling misinformation requires an understanding of the context in which it spreads and careful use of the doctor's knowledge and communication skills. Research into ways of tackling disinformation is still at an early stage, but some measures that are likely to be effective include content moderation, misinformation labelling and improving the level of scientific discussion in public media. Health professionals have a duty to provide unbiased and accurate information, including through the use of social media. This requires the maintenance of empathy, trustworthiness and openness in the face of what may at times be malicious intent.

The incidence of obesity is rising worldwide. This is contributing to an increase in complexity around perioperative care in all surgical specialties including gynaecology. A holistic approach is essential when managing obese women requiring surgery. A multidisciplinary team is strongly advised in the process of selecting women for surgery. Careful emphasis must be placed on pre-operative and postoperative care with focus on prevention of additional complications associated with obesity. Weight management clinics may have an important role in the pre-operative planning stage. It may be safer to defer surgery in selected cases whilst conditions are optimised or cancel surgical options altogether when surgery is deemed too high risk. This may include women with gynaecological cancers who would otherwise be advised surgery. We aim to outline the challenges encountered in the management of obesity in gynaecology and discuss various methods to optimise care when surgery is necessary.

Pelvic floor dysfunction represents a huge burden of disease globally. Poor bladder care in labour and the postnatal period is a risk factor for the development of pelvic floor disorders, in particular voiding dysfunction, which can have a long-lasting detrimental impact on a woman's quality of life, physical and mental wellbeing. If left untreated postpartum urinary retention can lead to repetitive overdistension injury and permanent detrusor muscle damage. It is therefore imperative to raise awareness of the need for bladder care in labour and postpartum, and to develop strategies that will improve recognition of the symptoms of voiding dysfunction and lead to more timely intervention. This paper will provide an overview of peripartum bladder care, summarise the current evidence, make recommendations for best practice and suggest opportunities for further research.

Gestational diabetes (GDM) is a common medical condition in pregnancy, and is associated with a range of short and long term maternal and infant complications including pre-eclampsia, pre-term birth, caesarean section, stillbirth, macrosomia and large-for-gestational age, neonatal hypoglycaemia, and increased risk of later type 2 diabetes in both mother and offspring. The incidence of complications can be reduced and pregnancy outcomes for these women are generally good with effective management of hyperglycaemia using regular monitoring of blood glucose, antenatal care with a multidisciplinary team, diet and lifestyle intervention, and pharmacotherapy. Risk of recurrence in future pregnancies, and of later development of type 2 diabetes is high in women with GDM. Attention should be given to screening and reducing risk in women who have experienced GDM, with encouragement of breastfeeding, diet and lifestyle intervention, weight management, and possibly metformin.