Best Practice & Research. Clinical Obstetrics & GynaecologyThis is an RSS file. You can use it to subscribe to this data in your favourite RSS reader, such as GoogleReader, or to display this data on your own website or blog. Subscribe to this data using MyMedWorm.Subscribe to this data using GoogleReader.Subscribe to this data using Bloglines.Subscribe to this data using MyYahoo.

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IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - September 3, 2009 Category: OBGYN Source Type: journals

Acute Gynaecology Volume 2: Infection, Uterine and Ovarian Pathology Multiple Choice Questions for Vol. 23, No. 5Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
At ultrasound examination the following is/are true of adnexal torsion:
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - September 3, 2009 Category: OBGYN Tags: Frontmatter Source Type: journals

Acute Gynaecology Volume 1: Early Pregnancy Complications Answers to Multiple Choice Questions for Vol. 23, No. 4Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
1. (a) T(b) F(c) F(d) F(e) F Explanations:
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - September 3, 2009 Category: OBGYN Tags: Frontmatter Source Type: journals

Aims and Scope/Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - September 3, 2009 Category: OBGYN Source Type: journals

IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - July 14, 2009 Category: OBGYN Source Type: journals

Acute Gynaecology Volume 1: Early Pregnancy Complications Multiple Choice Questions for Vol. 23, No. 4Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The following is/are true regarding surgical management of ectopic pregnancy:
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - July 14, 2009 Category: OBGYN Tags: Frontmatter Source Type: journals

Near Miss Audit in Obstetrics Answers to Multiple Choice Questions for Vol. 23, No. 3Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
1.(a) F(b) F(c) T(d) F(e) T Explanations:
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - July 14, 2009 Category: OBGYN Tags: Frontmatter Source Type: journals

Aims and Scope/Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - July 14, 2009 Category: OBGYN Source Type: journals

Detecting and treating common sexually transmitted diseasesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article focuses on the most important infections in women, and those in which management is changing. It also addresses the current status, and new developments around the syndrome of pelvic inflammatory disease (PID), which essentially is an STI.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - July 8, 2009 Category: OBGYN Authors: Phillip Hay, Austin Ugwumadu Source Type: journals

Bartholin's, vulval and perineal abscessesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Perineal infections are a common presenting complaint in women attending acutely to a gynaecology department. Specifically, Bartholin's abscesses can occur in approximately 2% of women. Conservative versus surgical approaches to manage these infections aims to reduce the need for hospital admission. We summarise the literature on the diagnosis and management of Bartholin's and other types of perineal infections and abscesses specific to gynaecology.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - July 6, 2009 Category: OBGYN Authors: Shabana A. Bora, George Condous Source Type: journals

Ovarian hyperstimulation syndrome and complications of ARTEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews serious clinical complications related to assisted reproductive technology (ART) procedures (ovarian stimulation and oocyte aspiration), including ovarian hyperstimulation syndrome (OHSS), bleeding and infection. These complications are rare, but can be severe and even life-threatening. It is important that general practitioners and gynaecologists are aware of these complications, because they will often be the first to be contacted by patients. Similarly, patients should be counselled before starting ART procedures that iatrogenic complications can be associated with ovarian stimulation and/or oocyte aspiration.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - July 6, 2009 Category: OBGYN Authors: Veerle Vloeberghs, Karen Peeraer, Anne Pexsters, Thomas D'Hooghe Source Type: journals

Rationalising acute gynaecology services: is it time to move away from ‘stand-alone’ early pregnancy units?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Women who present with a possible acute gynaecological problem can generally, although not exclusively, be categorised into those who have a condition related to pregnancy, those with non-pregnancy-related gynaecological pathology or others where the condition is neither gynaecological nor pregnancy related. It must of course always be remembered that any combination of the above may also occur; a positive pregnancy test does not exclude the possibility of a urinary tract infection or appendicitis. Clinicians faced with women in these circumstances need to have a relatively wide knowledge to deal with all possible clinical...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - June 29, 2009 Category: OBGYN Authors: Tom Bourne, George Condous Source Type: journals

Urgent care in gynaecology: Resuscitation and management of sepsis and acute blood lossEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Sepsis and/or acute blood loss can be encoutered as an emergency condition in gynaecology, especially in women with ectopic pregnancy/miscarriage, acute pelvic inflammatory disease (PID)/tuboovarian abscesses, post-puerperal sepsis/haemorrhage and even in postoperative scenarios. If underestimated or suboptimally treated, both can lead to an inadequate tissue perfusion (defined as shock) and the development of multi-organ failure. Morbidity and mortality after development of one of the shock syndromes (septic or haemorrhagic) correlates directly with the duration and severity of the malperfusion. The patient's prognosis de...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - June 25, 2009 Category: OBGYN Authors: Daniela Fischerova Source Type: journals

Abnormal uterine and post-menopausal bleeding in the acute gynaecology unitEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Abnormal uterine bleeding is one of the most common presentations in the acute gynaecology unit. The general principles of emergency care, including assessment of haemodynamic state, symptomatic relief as well as determination of underlying aetiology, apply to these women. We review different strategies in the diagnosis and investigation of abnormal uterine bleeding in both pre- and post-menopausal women. Transvaginal ultrasound (TVS) with colour Doppler is the cornerstone of initial management. TVS, in experienced hands, can reliably exclude the most common intra-cavitary pathologies including endometrial polyps and submu...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - June 18, 2009 Category: OBGYN Authors: Tommaso Bignardi, Thierry Van den Bosch, George Condous Source Type: journals

Dealing with complications in laparoscopyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article sets out to classify complications associated with laparoscopy according to the phases of the surgery; assess the incidence, the mechanisms, the presentations; and recommend methods for preventing and dealing with complications in laparoscopic surgery. Its aim is to promote a culture of risk management based on the development of strategies to improve patient safety and outcome.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - May 12, 2009 Category: OBGYN Authors: Alan Lam, Yuval Kaufman, Su Yen Khong, Andy Liew, Stephen Ford, George Condous Source Type: journals

Aims and Scope/Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - May 7, 2009 Category: OBGYN Source Type: journals

IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - May 7, 2009 Category: OBGYN Source Type: journals

Characterising acute gynaecological pathology with ultrasound: an overview and case examplesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article summarises the ultrasound features of a number of gynaecological emergencies: ectopic pregnancy, haemorrhagic corpus luteum, twisted adnexa, pelvic inflammatory disease, acute myoma necrosis, haematocolpos and haematometra. The basis of all diagnosis in women with acute gynaecological conditions is history and clinical examination. An ultrasound examination should only be performed if it is likely to provide information that would change the likelihood of the diagnosis suspected on the basis of clinical data. If ultrasound findings are abnormal, then it is important to thoroughly evaluate if they do explain th...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 16, 2009 Category: OBGYN Authors: Lil Valentin Source Type: journals

Near Miss Audit in Obstetrics Multiple Choice Questions for Vol. 23, No. 3Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The prevalence of severe maternal morbidity in high income countries:
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 13, 2009 Category: OBGYN Tags: Frontmatter Source Type: journals

Contraception and Sexual Health Answers to Multiple Choice Questions for Vol. 23, No. 2Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
1.(a)F(b)F(c)T(d)T(e)T Explanations:
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 13, 2009 Category: OBGYN Tags: Frontmatter Source Type: journals

Recognising gestational trophoblastic diseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Gestational trophoblastic disease (GTD) is a group of interrelated tumours originating from the placenta. Hydatidiform molar (HM) pregnancy is the most common form of GTD; this includes both partial hydatidiform molar (PHM) and complete hydatidiform molar (CHM) pregnancies. The importance of such a condition derives from its potential for persistent trophoblastic disease; this is noted to be more common after a CHM (10–20%) compared to a PHM (0.1–11%). The recent routine use of high-resolution trans-vaginal ultrasound (TVS) in early pregnancy has improved the recognition and thus pre-surgical diagnosis of molar pregnan...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 6, 2009 Category: OBGYN Authors: Dalya Alhamdan, Tommaso Bignardi, George Condous Source Type: journals

Aims and Scope/Editorial BoardEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Source Type: journals

Contraception and sexual healthEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
It is a pleasure to write a preface to this exciting volume, updating knowledge and practice in the key field of contraception and (in Chapters 7 and 8) at its interface with sexual health. I use the words ‘key field’ advisedly, since it is surprisingly recently that contraception has at last achieved the recognition it deserves, as an important sub-specialty in the practice of obstetrics and gynaecology rather than somewhat of a ‘Cinderella’ specialty.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Authors: John Guillebaud Source Type: journals

Contraception in historical and global perspectiveEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This chapter describes the rise in contraceptive practice and fall in fertility from around 1880 to the present day. Two main phases are identified: the first confined to European populations and involving methods of low efficacy, and the second embracing the whole planet involving modern methods. Today, sub-Saharan Africa is the only region where low levels of contraceptive use and high fertility persist. Nevertheless, nearly half of pregnancies worldwide are still unintended, and much scope remains for improvement in contraceptive protection. The main international priority is Africa, where demographic factors jeopardize...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Authors: John Cleland Source Type: journals

Principles of contraceptive care: choice, acceptability and accessEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Unintended pregnancy, abortion and sexually transmitted infection rates are high in the UK. Research shows that women and men do know about contraception, but do not always use it or use it poorly and inconsistently. This chapter addresses the issues around contraceptive decision-making and choice, and the influences that affect uptake and use.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Authors: Toni Belfield Source Type: journals

Health economics of contraceptionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Unintended pregnancies constitute a global problem associated with substantial costs to health and social services, and emotional distress to women, their families and society as a whole. Provision of contraception has been demonstrated to be a particularly cost-effective healthcare intervention as, besides preventing a significant number of unintended pregnancies, it also results in great cost-savings to society. Male and female sterilization and long-acting reversible methods (such as the copper-T intra-uterine device and the subdermal implant) constitute the most cost-effective contraceptive options, followed by other h...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Authors: Ifigeneia Mavranezouli Source Type: journals

Understanding contraceptive failureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Contraceptive failure is a major source of unintended pregnancy. This chapter will review sources of data and measurement of contraceptive failure, summarize results from the literature on the risks of contraceptive failure during typical and perfect use for available methods of contraception, provide a tool for communicating risks of contraceptive failure to clients, examine determinants of contraceptive failure, and identify methodological pitfalls in the published literature.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Authors: James Trussell Source Type: journals

Contraception and gynaecological careEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Hormonal contraception, through suppression of ovarian activity or endometrial proliferation, can be used to treat and prevent a range of gynaecological disorders. There is evidence to support the effectiveness of the levonorgestrel intra-uterine system (LNG-IUS), combined oral contraceptive pill (COC) and progestogen-only injectable depot-medroxyprogesterone acetate for treating heavy menstrual bleeding and dysmenorrhoea. COCs are also an effective treatment for acne and hirsuitism, and may lessen the symptoms of premenstrual syndrome. There is good evidence that COCs can significantly reduce the risk of both ovarian and ...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Authors: Sharon Cameron Source Type: journals

Developments and challenges in emergency contraceptionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Emergency contraception (EC) methods, available in oral and intra-uterine forms, seek to prevent pregnancy after unprotected intercourse or contraceptive failure. Levonorgestrel EC is more effective and has fewer side effects than the previously used combined oral hormonal method; the Yuzpe regimen. In recent years, levonorgestrel has increased in use, and has become available over the counter in pharmacies in many countries. Compared with oral methods, the copper intra-uterine device offers greater protection against unplanned pregnancy but requires a clinical consultation. The much hoped for potential of EC methods to re...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Authors: Kirsten I. Black Source Type: journals

Contraception for adolescentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Ensuring that sexually active adolescents are using contraception consistently and correctly is an effective means of reducing unplanned pregnancy. Use of highly effective long-acting reversible methods, such as subdermal implants, is low. We need to challenge the perception that the pill and condoms, the most commonly used contraceptive methods, are always the most suitable methods for young people. Changes in adolescent sexual behaviour, including increased number of sexual partners, is consistent with a rise in sexually transmitted infections. No contraceptive methods, with the exception of male or female sterilisation,...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Authors: Rebecca S. French, Frances M. Cowan Source Type: journals

Non – contraceptive benefits and risks of contraceptionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Contraception is primarily used to prevent pregnancy. However, a user should be aware of both the possible non-contraceptive benefits she/he may experience and any potential risks to her/his health. These issues should be discussed as fully as possible, using current, evidence-based information prior to commencing a method. Some methods may be prescribed solely for their non-contraceptive benefits for a woman who does not require it for contraception. Potential risks to a woman's health may make certain methods unacceptable if concurrent medical problems or lifestyle issues exist. This chapter discusses the main non-contra...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Authors: Zara Haider, Rachel D'Souza Source Type: journals

Highly effective contraception and acquisition of HIV and other sexually transmitted infectionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A key question for clinicians is whether an aetiological association exists between highly effective contraceptive methods and women's risk of acquiring sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). The authors searched the peer-reviewed literature for prospective studies published from January 1966 to August 2008 that assessed contraception and STI/HIV risk. The focus was on combined oral contraceptives (OCs), depot-medroxyprogesterone acetate (DMPA), the T380a copper intra-uterine device (IUD) and the risk of infection with HIV, Chlamydia trachomatis and Neisseria gonorrhoeae. Curr...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Authors: Charles S. Morrison, Abigail Norris Turner, LaShawn B. Jones Source Type: journals

IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Source Type: journals

Contraception and Sexual Health Multiple Choice Questions for Vol. 23, No. 2Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The following statement(s) is/are true in relation to adolescent use of depot medroxyprogesterone acetate (DMPA) injections:
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Tags: Frontmatter Source Type: journals

Menopause and Menopause Transition Answers to Multiple Choice Questions for Vol. 23, No. 1Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
1.(a) F(b) F(c) T(d) T(e) F Explanations:
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Tags: Frontmatter Source Type: journals

Diagnosing miscarriageEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Miscarriage is the most common serious pregnancy complication affecting approximately 30% of biochemical pregnancies and 11–20% of clinically recognised pregnancies. The diagnosis of miscarriage is made most commonly by trans-vaginal ultrasound (TVS) assessment. Evidence-based criteria should be employed for the diagnosis of delayed and incomplete miscarriage. Complete miscarriage should not be diagnosed with TVS alone without serial biochemical confirmation (unless an intrauterine gestation sac has previously been visualised). After a clinical assessment suggesting complete miscarriage, 45% of women will have retained ...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - April 1, 2009 Category: OBGYN Authors: Cecilia Bottomley, Tom Bourne Source Type: journals

Taking the management of early-pregnancy complications seriouslyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Historically, managing early-pregnancy complications has often been delegated to the most junior member of the medical team. The result has been that the care and management options available to women at a very distressing time in their lives have often been limited by a lack of knowledge or facilities. In some countries such as the UK the care of women with early-pregnancy problems has been rationalised into discrete units, with the patients usually scanned by nurses or technicians. This has achieved a great deal. However, the medical back-up for these units is often less than ideal, with inexperienced doctors usually att...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - March 31, 2009 Category: OBGYN Authors: Tom Bourne, George Condous Source Type: journals

Managing bleeding, fluid absorption and uterine perforation at hysteroscopyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article discusses the physiology, implications and treatment of these cases. Uterine perforation is encountered in nearly 1% of cases. We describe the precautions to avoid this perforation and the methods to treat it.The article also discusses excessive bleeding, which occurs in 3% of operative hysteroscopies and describes strategies to avoid and to deal with this complication. Emergency hysterectomy and other surgical interventions are rarely indicated and are seen in 2% of cases. Finally, death due to septicaemia or fluid overload has been reported only very rarely (0.1%). These different complications are discussed in detail.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - March 31, 2009 Category: OBGYN Authors: Olav Istre Source Type: journals

Pregnancies of unknown location.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A 'pregnancy of unknown location' is a descriptive term used to classify a pregnancy when a woman has a positive pregnancy test, but no pregnancy can be visualised on transvaginal ultrasound (TVS). Women should be followed up until the final pregnancy outcome is known which includes: failing PUL, intra-uterine pregnancy, ectopic pregnancy and persisting PUL. Expectant management has been shown to be safe and surgical intervention in the form of uterine curettage and diagnostic laparoscopy should not be undertaken routinely. Serum human chorionic gonadotrophin levels, progesterone levels and mathematical models all have...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - March 30, 2009 Category: OBGYN Authors: Kirk E, Condous G, Bourne T Tags: Best Pract Res Clin Obstet Gynaecol Source Type: journals

The management of miscarriage.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Women diagnosed with incomplete and delayed miscarriage are faced with three options for their subsequent management: expectant, medical or surgical. Health-care practitioners must empower patients to make educated decisions about their own management by providing them with sufficient information in a readily understandable format. This can be difficult both for the patient and the staff in what is often an understandably, highly emotional situation. Detailed counselling is an essential part of the process as psychological outcomes have been shown to be improved when women feel in control of the decision-making process...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - March 19, 2009 Category: OBGYN Authors: Sur SD, Raine-Fenning NJ Tags: Best Pract Res Clin Obstet Gynaecol Source Type: journals

Maternal near miss - towards a standard tool for monitoring quality of maternal health care.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article presents the proposed definition and the identification criteria of maternal near miss cases. It also suggests procedures to make maternal near miss audits operational in monitoring/evaluating quality of obstetric care. The practical implementation of maternal near miss concept should provide an important contribution to improving quality of obstetric care to reduce maternal deaths and improve maternal health. PMID: 19303368 [PubMed - as supplied by publisher]
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - March 18, 2009 Category: OBGYN Authors: Say L, Souza JP, Pattinson RC, Tags: Best Pract Res Clin Obstet Gynaecol Source Type: journals

Characterising pelvic masses using ultrasound.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article will concentrate on the characterisation of pelvic masses that may be encountered by any examiner in the course of an assessment of the female pelvis. PMID: 19303367 [PubMed - as supplied by publisher]
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - March 18, 2009 Category: OBGYN Authors: Testa AC, Bourne TH Tags: Best Pract Res Clin Obstet Gynaecol Source Type: journals

Diagnosing twins in early pregnancyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Multiple pregnancy has increased in frequency as a result of the ageing maternal population as well as the advent and wider availability of assisted reproductive technologies. Higher-order pregnancies are associated with increased morbidity and mortality for both the foetuses and mother. The introduction of transvaginal ultrasound has made accurate diagnosis of twin pregnancy, determination of chorionicity and subsequent planning of these high-risk pregnancies a common part of obstetric care. In this article, we critically evaluate the role of transvaginal ultrasound in the diagnosis of twin pregnancies.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - March 18, 2009 Category: OBGYN Authors: Dalya Alhamdan, Shabana Bora, George Condous Source Type: journals

Diagnosis and management of ovarian cyst accidents.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Ovarian cyst accidents include cyst rupture, haemorrhage and torsion. Torsion commonly occurs to the whole adnexa and is not necessarily associated with an ovarian cyst. Suspected adnexal torsion should always be managed with early laparoscopy and de-torsion of the twisted tube or ovary. Ovarian cyst rupture and haemorrhage usually occur in association with physiological (functional) cysts and are generally self-limiting. Laparoscopy may be necessary in cases where the diagnosis is in doubt or for haemodynamic compromise. Clinical features of ovarian cyst accidents are nonspecific. Ultrasound is the first-line investig...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - March 17, 2009 Category: OBGYN Authors: Bottomley C, Bourne T Tags: Best Pract Res Clin Obstet Gynaecol Source Type: journals

Conservative management of tubal ectopic pregnancy.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In this chapter an overview is given of the best available evidence on the conservative treatment for tubal ectopic pregnancy, i.e., expectant management and medical treatment with systemic methotrexate. From the two randomized controlled trials on expectant management, no conclusions can be drawn yet. It may be that women with low serum hCG levels need not be treated at all, but more research needs to be done in this subgroup of women to reach firm conclusions. Systemic methotrexate in a fixed multiple-dose i/m regimen can be recommended for hemodynamically stable women with an unruptured tubal ectopic pregnancy and n...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - March 17, 2009 Category: OBGYN Authors: van Mello NM, Mol F, Mol BW, Hajenius PJ Tags: Best Pract Res Clin Obstet Gynaecol Source Type: journals

Criterion-based clinical audit in obstetrics: bridging the quality gap?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The Millennium Development Goal 5 - reducing maternal mortality by 75% - is unlikely to be met globally and for the majority of low-income countries. At this time of heightened concern to scale-up services for mothers and babies, it is crucial that not only shortfalls in the quantity of care - in terms of location and financial access - are addressed, but also the quality. Reductions in maternal and perinatal mortality in the immediate term depend in large part on the timely delivery of effective practices in the management of life-threatening complications. Such practices require a functioning health system - includin...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - March 17, 2009 Category: OBGYN Authors: Graham WJ Tags: Best Pract Res Clin Obstet Gynaecol Source Type: journals

Characterising pelvic masses using ultrasoundEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article will concentrate on the characterisation of pelvic masses that may be encountered by any examiner in the course of an assessment of the female pelvis.
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - March 12, 2009 Category: OBGYN Authors: Antonia C. Testa, Tom H. Bourne Source Type: journals

Dating and growth in the first trimester.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Measurement of embryonic or foetal size using the greatest length of the embryo or foetal crown rump length can be used to accurately determine the gestational age of a normal first trimester pregnancy to within three to five days. Transvaginal ultrasound scan can be used to measure the size of an embryo and gestation sac earlier than transabdominal ultrasound. The original Robinson curve used for dating pregnancies is still valid in most cases. Ultrasound dating in the first trimester is now recommended for all women with spontaneous pregnancies, even those with certain menstrual dates. First trimester growth in norm...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - March 10, 2009 Category: OBGYN Authors: Bottomley C, Bourne T, Tags: Best Pract Res Clin Obstet Gynaecol Source Type: journals

The management of miscarriageEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Women diagnosed with incomplete and delayed miscarriage are faced with three options for their subsequent management: expectant, medical or surgical. Health-care practitioners must empower patients to make educated decisions about their own management by providing them with sufficient information in a readily understandable format. This can be difficult both for the patient and the staff in what is often an understandably, highly emotional situation. Detailed counselling is an essential part of the process as psychological outcomes have been shown to be improved when women feel in control of the decision-making process.In ...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - March 9, 2009 Category: OBGYN Authors: Shyamaly D. Sur, Nicholas J. Raine-Fenning Source Type: journals

Organizing an acute gynaecology service: equipment, setup and a brief review of the likely conditions that are managed in the unit.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Gynaecological practice has traditionally been divided into emergency and elective services. Emergency gynaecological services provide care for women who have miscarriages, ectopic pregnancies, and acute non-pregnancy related symptoms such as pelvic pain. Early Pregnancy Units (EPU) offer an efficient way of organizing services for women experiencing early pregnancy complications. More recently the concept of outpatient treatment by a multidisciplinary team has been expanded to incorporate all emergency gynaecological care. This decreases attendances to the Accident and Emergency unit or the on call "out of hours" gyna...
Source: Best Practice & Research. Clinical Obstetrics & Gynaecology - March 7, 2009 Category: OBGYN Authors: Jones K, Pearce C Tags: Best Pract Res Clin Obstet Gynaecol Source Type: journals

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