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External reference on reflection
Reflective practice in health care and how to reflect effectively
Koshy K, Limb C et al. International Journal of Surgical Oncology. 2017 2:e20
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British Association for Sexual health and HIV
For healthcare professionals
British Association for Sexual Health and HIV
Women's health - Special interest
Symposium: Women's health
|Complications following termination of pregnancy
25 Mar 2022
Serious complications during or after termination of pregnancy are rare. However, they can be associated with significant morbidity and mortality, and occasionally can complicate future pregnancies. The risk of pelvic infection is around 10% and this is usually due to exacerbation of a pre-existing infection. The most common causes of bleeding include: retained products of conception; infection and trauma to the cervix or uterus, especially at > 10 weeks’ gestation.
|GPs have key role in identifying women at risk of pre-eclampsia
25 Mar 2022
Pre-eclampsia is an important cause of maternal morbidity and mortality. It is a multisystem disorder of pregnancy characterised by new onset hypertension after 20 weeks’ gestation, usually accompanied by proteinuria. If a urine dipstick is positive for protein, the amount should be quantified: a protein: creatinine ratio = 30 mg/mmol is abnormal. There should be a high index of suspicion for pre-eclampsia if there is biochemical disturbance consistent with the diagnosis or evidence of fetal growth restriction when plotted on a customised growth chart.
Special reports 2018-2019
|Management of hypertensive disorders in pregnancy
07 Aug 2019
Hypertension is the most common medical complication of pregnancy, affecting 8-10% of pregnancies in the UK. It is associated with risks to both the woman and the fetus, with increased risks of pre-eclampsia, preterm delivery, fetal growth restriction, placental abruption and perinatal death. Any new onset of hypertension after 20 weeks or symptoms or signs suspicious of pre-eclampsia should be referred for same day assessment at a secondary care antenatal assessment unit.
|Prompt detection vital in postpartum mood disorders
24 Jun 2019
Common mental health disorders affect around one in five women during pregnancy and the first year following childbirth. Depression and anxiety disorders are the most prevalent mental health disorders during this period as they are at other times of life. It is important to distinguish postnatal depression from baby blues, which is common and requires no treatment, although it is a potential risk factor for postnatal depression. Postpartum psychosis affects 1 in 1,000 women and can develop very quickly in the first two weeks postpartum, often requiring urgent admission to a specialised mother and baby unit. One in six women with bipolar disorder will develop postpartum psychosis.
Research reviews: Obstetrics and gynaecology
Miscarriage associated with raised risk of premature death
22 Apr 2021
A history of one or more miscarriages appears to be associated with an increased risk of dying before the age of 70, an analysis of data from the US Nurses’ Health Study II has found. When the cause of death was examined, the strongest association was with cardiovascular disease.
Are prescription opioids safe to use in pregnancy?
22 Mar 2021
Prescription opioids used in early pregnancy are not associated with a substantial increase in the risk of most congenital malformations, although a small increase in the risk of oral clefts associated with their use is possible, a large US study has found.
Special report 2014
|Diagnosis and management of miscarriage
22 May 2014
Miscarriage is the most common complication of pregnancy. It is defined as a pregnancy failure occurring before the completion of 24 weeks of gestation. It has been estimated that 10 to 15% of all pregnancies end in early spontaneous first trimester miscarriage i.e. before the end of the completed twelfth week of pregnancy. The risk of miscarriage decreases with increasing gestational age, and late miscarriages, from 12 to 24 weeks’ gestation, occur in only 1-4% of cases. While miscarriage is rarely associated with significant health problems, it can cause significant psychological distress to the woman and her partner. [With external links to the current evidence base]
Urinary incontinence
|Managing urinary incontinence in women
22 May 2019
A detailed patient history is key to the assessment of patients with urinary incontinence and to guiding initial investigation and management. Clinical examination should include abdominal palpation to assess for masses, including an enlarged bladder. Visual inspection of the perineum and vagina helps determine whether the patient may be hypo-oestrogenic and can confirm the presence and grading of pelvic organ prolapse. Digital vaginal examination enables detection of masses, and an assessment of pelvic floor muscle strength. Urinalysis should also be carried out. Most patients will have either stress, urgency, or mixed urinary incontinence.
|Improving the management of urinary incontinence
20 Mar 2014
Urinary incontinence is a common condition that is likely to be under-reported. Its frequency increases with age, parity, high BMI, and associated comorbidities. The history should include the circumstances in which the incontinence occurs, the duration and how it affects the patient’s quality of life. The initial assessment should include enquiring for symptoms of urinary tract infection and carrying out a urine dipstick test. [With external links to the current evidence base]
Ovarian cancer
|Detecting ovarian disorders in primary care
20 Mar 2014
Ovarian cysts occur more often in premenopausal than postmenopausal women. Most of these cysts will be benign, with the risk of malignancy increasing with age. Symptoms which may be suggestive of a malignant ovarian cyst, particularly in the over 50 age group, include: weight loss, persistent abdominal distension or bloating, early satiety, pelvic or abdominal pain and increased urinary urgency and frequency. [With external links to the current evidence base]
|Improving early detection of ovarian cancer
22 Jun 2011
Ovarian cancer is the fifth most common cancer in women. The incidence has increased over the past 20-25 years, particularly in the 65 and over age group. The outcome for women with ovarian cancer is generally poor, with an overall five-year survival rate of less than 35%. The survival rates for women with ovarian cancer in the UK are significantly lower than the European average. Despite recommendations, published by NICE in 2005, on referral of patients with suspected cancer, the majority of women diagnosed with ovarian cancer are not electively referred via the ovarian cancer two-week pathway. They are often referred to the wrong specialty or present as emergencies. NICE has now published a clinical guideline on the diagnosis and initial management of ovarian cancer. [With external links to current evidence and summaries]
Editorials
|Perinatal depression linked to psychosis in offspring
25 May 2020
The children of mothers who experience perinatal depression are more likely to report psychotic experiences at the age of 18, a UK prospective cohort study has found. A joint analysis found an association between maternal antenatal depression symptoms and both offspring psychotic experiences and depression at age 18. Most of those with psychotic symptoms will not go on to develop psychosis or schizophrenia. However, they are still at increased risk of low educational and occupational achievement, social impairment, harmful drinking and substance misuse.
|One in three doctors suffer burnout
24 Mar 2020
Nearly a third of doctors who responded to an online survey had high levels of burnout, and just over a quarter had high levels of secondary traumatic stress, a UK study has found. Only 6% of doctors had the optimal combination of low burnout, low secondary traumatic stress and high compassion satisfaction, whereas 8% had the worst combination of high burnout, high secondary traumatic stress and low compassion satisfaction.
Sexual health: women and men
Relationship structure and sexual health
21 Dec 2020
Consensually nonmonogamous partnerships, including open relationships, comprise a substantial proportion of sexual relationships in the USA, a national population-based survey has concluded. It is important to be non-judgemental when eliciting sexual histories, to discuss risks and offer the right tests to the right people to minimise STI/HIV transmission.
LARC uptake increases in young women
24 Mar 2020
There has been a significant increase in the use of long-acting reversible contraception in women under 25 over the past decade, a national survey has found. However, condoms and the oral contraceptive pill are still the most commonly used methods.
Photoguide
|Pregnancy related conditions
21 Feb 2011
- Superficial thrombophlebitis
- Polymorphic eruption of pregnancy
- Chloasma
- Naevi
- Jaundice
