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Symposium: Women's health

GPs have a key role in the management of miscarriage

22 Mar 2021Registered users

First trimester miscarriage affects up to one in four pregnancies. While some women will experience bleeding and pain, others have no symptoms and are given the diagnosis at their 12-13 week booking scan. In 50-85% of cases the cause is due to a spontaneous chromosomal abnormality, most commonly trisomy. Many women suffer from psychological sequelae including PTSD, anxiety and depression. GPs should offer a follow-up appointment to all women who have had a miscarriage to: discuss any questions the woman has regarding her miscarriage; assess the woman’s psychological wellbeing and offer counselling if appropriate.

Optimising the assessment and management of osteoporosis

22 Mar 2021Registered users

Osteoporosis affects around 40% of women and 13% of men at some point in their lives. While almost any bone can fracture as the result of osteoporosis, the most common sites are the wrist, spine, hip and humerus. The presence of one or more clinical risk factors in individuals aged 50 and over is an indication for a fracture risk assessment. There is a strong evidence base for drug treatment in DXA proven osteoporosis and those with low trauma vertebral fractures.

 

Special reports 2018-2019

Management of hypertensive disorders in pregnancy

07 Aug 2019Paid-up subscribers

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 2019Registered users

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

Are prescription opioids safe to use in pregnancy?

22 Mar 2021Registered users

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.

HPV vaccination lowers risk of invasive cervical cancer

24 Nov 2020Registered users

Introduction of the quadrivalent human papilloma virus (HPV) vaccination programme in girls and young women in Sweden has led to a substantially reduced risk of invasive cervical cancer at population level, a national study has shown.

 

Special report 2014

Diagnosis and management of miscarriage

22 May 2014Paid-up subscribers

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 2019Paid-up subscribers

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 2014Paid-up subscribers

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 2014Paid-up subscribers

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 2020Registered users

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 2020Registered users

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 2020Registered users

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 2020Paid-up subscribers

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 2011Registered users

  • Superficial thrombophlebitis
  • Polymorphic eruption of pregnancy
  • Chloasma
  • Naevi
  • Jaundice