Current obstetrics & gynaecology最新文献

Sporadic vaginal bleeding that is not related to the menstrual period is a common but usually innocent symptom. However, it can also be a marker for the more sinister pathologies of endometrial and cervical carcinoma, and consequently, the foremost principle of management is to exclude these carcinomas. The assessment of each case should proceed in a logical manner based on the patients’ age, hormonal status and general health. This article presents four case studies of women presenting with sporadic vaginal bleeding and explores the investigation and management of each.

Cancer in pregnancy is rare, however, prognosis is often compromised by delayed diagnosis. Management decisions are complicated by fears for fetal safety and the emotional burden on affected families is immense. In volume 12 issue 4 of this journal, the general principles of managing pregnancies complicated by cancer were discussed. The case histories chosen for this article illustrate these concepts well and underline the individualised approach needed for managing pregnant women with co-existing malignant disease.

Malignant disease in pregnancy represents a complex situation with medical and ethical issues. Delayed diagnosis occurs when symptoms are attributed to pregnancy. Once malignancy is diagnosed, gestational age becomes important in further management. Magnetic resonance imaging is safe in pregnancy and can be used for staging purposes. Maternal counselling is of paramount importance in decision-making.

There is continued controversy surrounding the detection and management of gestational diabetes mellitus (GDM). This review summarises those areas where there is agreement or where a consensus is emerging. Patients with GDM are best managed in a combined clinic with close collaboration between the obstetric and diabetic teams.

Menorrhagia or heavy menstrual bleeding is a common and debilitating condition, and affects work, family and social life. Investigations and management should be evidence based. When management options are discussed there should be the flexibility to provide an acceptable solution for each individual woman.

Much of the contemporary management of pelvic organ prolapse (POP) is based on knowledge and surgery developed over 100 years ago. There is a clearer picture emerging of the anatomical defects that result in prolapse, and the cause of those defects. The importance of assessing symptomatology is highlighted, with the use of validated prolapse-specific questionnaires. A simplified version of the POP quantification system is described, which should be used by all clinicians dealing with the condition in order to communicate examination findings more accurately. There is a brief discussion of conservative management, and a more detailed review of the current surgical management options for each compartment. The use of graft material in reconstructive procedures is considered, and emerging minimal access techniques are described to illustrate how improved anatomical understanding has led to site-specific procedures to address those defects.

Worldwide maternal mortality is the health index that shows greatest disparity between developing and affluent countries. Many of the deaths in developing countries could be avoided by improving the availability of simple clinical interventions. In the UK, maternal deaths are infrequent, but many are associated with sub-standard care and avoidable deaths still occur. The Confidential Enquiry into Maternal Deaths (CEMD) had been instrumental in highlighting causes and possible solutions for more than 50 years. Recent reports have highlighted the importance of suicide and high-risk social and personal features.