RSS 1.0Family Health Division
Recent Submissions
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The use and abuse of oxytocinKey content Oxytocin is a well-established drug with a long history of use. The generation of intrauterine pressure is a result of myometrial activity, but is attenuated by a softening cervix. The introduction of active management regimens have not changed the outcome of labour as we envisaged. Too many babies suffer asphyxia as a result of misuse of oxytocin. Some form of education programme must be developed to warn of the dangers of this very useful drug. Better training and education programmes must be in place for midwives and obstetricians for labour management and cardiotography interpretation. Learning objectives To outline the history of the development of oxytocin. To understand the mechanism of intrauterine pressure development. To understand the methods of intrauterine pressure measurement and assessment. To understand the development of principles of active management with a discussion of the subsequent studies analysing the results of such labour management. To outline the medicolegal aspects of labour augmentation, with particular reference to oxytocin use. To discuss possible implications for the future. Ethical issues Should all women be given the information that oxytocin augmentation of slow labour may reduce the duration of labour by several hours but does not change the mode of delivery, whilst carrying a risk of causing fetal asphyxia? Should women sign informed consent before their labours are augmented? Should augmentation of labour only be undertaken under the direct supervision of a senior clinician?
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Endometrial ablation and steam vaporisation : the true first generation ablative techniqueThis BJOG Perspectives article explores the history of endometrial ablation and steam vaporisation as techniques to treat women with menstrual disorders, drawing on the work of G. F. Blacker in 1902.
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Then and now : outcomes of surgical treatment for early cervical cancer 1902This BJOG Perspectives article provides a historical snapshot of the surgical techniques available in the early twentieth century for the treatment of cervical cancer, drawing on the work of Thomas Wilson (BJOG. 1902;1(5):526-46. doi: 10.1111/j.1471-0528.1902.tb10544.x.).
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Vaginal sub-total hysterectomy — an early minimally invasive procedureThis BJOG Perspectives article summarises an early minimally invasive procedure developed by Arthur J. Wallace (1867–1913).
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Quantitative assessment of multiorgan sequestration of parasites in fatal pediatric cerebral malariaChildren in sub-Saharan Africa continue to acquire and die from cerebral malaria, despite efforts to control or eliminate the causative agent, Plasmodium falciparum. We present a quantitative histopathological assessment of the sequestration of parasitized erythrocytes in multiple organs obtained during a prospective series of 103 autopsies performed between 1996 and 2010 in Blantyre, Malawi, on pediatric patients who died from cerebral malaria and controls. After the brain, sequestration of parasites was most intense in the gastrointestinal tract, both in patients with cerebral malaria and those with parasitemia in other organs. Within cases of histologically defined cerebral malaria, which includes phenotypes termed "sequestration only" (CM1) and "sequestration with extravascular pathology" (CM2), CM1 was associated with large parasite numbers in the spleen and CM2 with intense parasite sequestration in the skin. A striking histological finding overall was the marked sequestration of parasitized erythrocytes across most organs in patients with fatal cerebral malaria, supporting the hypothesis that the disease is, in part, a result of a high level of total-body parasite sequestration. Keywords: Africa; Malawi; autopsy; cerebral malaria; pathology; pediatrics
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Paediatric palliative careChildren with palliative care needs are increasing in prevalence and complexity of need. 49,000 children (under 19 years) were estimated to be living in the UK in 2012 with a life limiting/life threatening condition that might require palliative care. Palliative care requires a total and active approach, with transparent, communicated, agreed provision of appropriate and proportionate care. Planning improves care, supported by documentation of plans. Advance planning enables management of both reversible and chronic aspects of the condition, as well as utilising parallel planning when end of life approaches. Challenges in palliative care include the commissioning of sustainable services across organisations to deliver, often over years, but sometimes briefly and rapidly, 24/7 access to skilled palliative care, including hands on care at the end of life. Care is integrally intertwined with other clinical, social, education and voluntary services to ensure that families receive the spectrum of care required throughout their journey. Keywords advance care; best interest; end of life; life limiting; palliative; parallel planning; planning; sustainable
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The African maternity health link : report on a visit to Freetown, Sierra LeoneLast year, five midwives from the UK visited Freetown, Sierra Leone, to teach, update and support midwives working in a range of midwifery units across the region. Helena White reports on the trip's success.
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Realist evaluation of faculty development for clinical educators : what works for who, in what context and whyE-poster presentation abstract EP12.079 in the section 'Quality Improvement, Education, Simulation and Patient Safety (EP12)' of the RCOG World Congress 2016, 20–22 June 2016, ICC Birmingham, United Kingdom.
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Postpartum haemorrhage (PPH) – oxytocin or syntometrine? Is it nice to follow NICE (National Institute of Clinical Excellence)?E-poster presentation abstract EP8.272 in the section 'Labour and Obstetric Complications (EP8)' of the RCOG World Congress 2016, 20–22 June 2016, ICC Birmingham, United Kingdom.
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Two years experience of cervical HPV testing and genotyping indicates that colposcopic predictive value is reduced to 50% – an analysis of histology outcome before and after the introduction of HPV genotypingE-poster presentation abstract EP3.003 in the section 'Oncology and Colposcopy (EP3)' of the RCOG World Congress 2016, 20–22 June 2016, ICC Birmingham, United Kingdom.
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Cerebral palsy : the obstetrician is ‘off the hook’ … almostThis Mini Commentary responds to Strand KM, Andersen GL, Haavaldsen C, Vik T, Eskild A. Association of placental weight with cerebral palsy: population-based cohort study in Norway. BJOG. 2016 Dec;123(13):2131-2138. doi: 10.1111/1471-0528.13827. Epub 2015 Dec 22.
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Re: Laparoscopic morcellation : an acceptable risk or an Achilles heel? Are there safer alternatives to morcellation?This BJOG Exchange comment piece responds to Garry R. Laparoscopic morcellation: an acceptable risk or an Achilles heel? BJOG. 2015 Mar;122(4):458-60. doi: 10.1111/1471-0528.13045. Epub 2014 Sep 19.
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Recurrent pelvic organ prolapse : International Urogynecological Association Research and Development Committee opinionIntroduction and hypothesis: This committee opinion paper summarizes available evidence about recurrent pelvic organ prolapse (POP) to provide guidance on management. Method: A working subcommittee from the International Urogynecological Association (IUGA) Research and Development Committee was formed. The literature regarding recurrent POP was reviewed and summarized by individual members of the subcommittee. Recommendations were graded according to the 2009 Oxford Levels of Evidence. The summary was reviewed by the Committee. Results: There is no agreed definition for recurrent POP and evidence in relation to its evaluation and management is limited. Conclusion: The assessment of recurrent POP should entail looking for possible reason(s) for failure, including persistent and/or new risk factors, detection of all pelvic floor defects and checking for complications of previous surgery. The management requires individual evaluation of the risks and benefits of different options and appropriate patient counseling. There is an urgent need for an agreed definition and further research into all aspects of recurrent POP. Keywords: Cost; Definition; Diagnosis; Etiology; Incidence; Pelvic organ prolapse; Prevalence; Recurrent; Treatment.
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Blended foods for tube-fed children : a safe and realistic option? A rapid review of the evidenceWith the growing number of children and young people with complex care needs or life-limiting conditions, alternative routes for nutrition have been established (such as gastrostomy feeding). The conditions of children and young people who require such feeding are diverse but could relate to problems with swallowing (dysphagia), digestive disorders or neurological/muscular disorders. However, the use of a blended diet as an alternative to prescribed formula feeds for children fed via a gastrostomy is a contentious issue for clinicians and researchers. From a rapid review of the literature, we identify that current evidence falls into three categories: (1) those who feel that the use of a blended diet is unsafe and substandard; (2) those who see benefits of such a diet as an alternative in particular circumstances (eg, to reduce constipation) and (3) those who see merit in the blended diet but are cautious to proclaim potential benefits due to the lack of clinical research. There may be some benefits to using blended diets, although concerns around safety, nutrition and practical issues remain. Keywords: blended diet; children; enteral; gastrostomy; young people.
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Are we steering full circle in our methods of labour induction?A BJOG Perspectives piece on the history of the induction of labour in maternity.
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What is the result of vaginal cleansing with chlorhexidine during labour on maternal and neonatal infections? A systematic review of randomised trials with meta-analysisBackground: Infection with vaginal microorganisms during labour can lead to maternal and neonatal mortality and morbidity. The objective of this systematic review is to review the effectiveness of intrapartum vaginal chlorhexidine in the reduction of maternal and neonatal colonisation and infectious morbidity. Methods: Search strategy - Eight databases were searched for articles published in any language from inception to October 2016. Selection criteria - Randomised controlled trials were included. Data Collection and analysis - Publications were assessed for inclusion. Data were extracted and assessed for risk of bias. Relative risks from individual studies were pooled using a random effects model and the heterogeneity of treatment was evaluated using Chi2 and I2 tests. Results: Eleven randomised controlled trials (n = 20,101) evaluated intrapartum vaginal chlorhexidine interventions. Meta-analysis found no significant differences between the intervention and control groups for any of the four outcomes: maternal or neonatal colonization or infection. The preferred method for chlorhexidine administration was vaginal irrigation. Conclusions: Meta-analysis did not demonstrate improved maternal or neonatal outcomes with intrapartum vaginal chlorhexidine cleansing, however this may be due to the limitations of the available studies. A larger, multicentre randomised controlled trial, powered to accurately evaluate the effect of intrapartum vaginal chlorhexidine cleansing on neonatal outcomes may still be informative; the technique of douching may be the most promising. Keywords: Chlorhexidine; Infection; Infection prevention; Maternal; Neonatal; Systematic review.
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Lymphoepithelioma-like carcinoma of the vagina : case report and literature review of a rare cancerPoster abstract IGCS8-0771 of the 17th Biennial Meeting of the International Gynecologic Cancer Society, Kyoto, Japan, September 14-16, 2018.
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Assessment of pre-operative factors in breast cancer patients to avoid the use of one step nucleic acid amplification analysis of the sentinel lymph nodePoster abstract 0358 of the Association of Surgeons in Training (ASiT) 2018 Conference, 6-8 April 2018, Edinburgh, UK.
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Prepectoral immediate implant-based reconstruction using Braxon® acellular dermal matrix – national audit from the United KingdomPoster abstract P5-16-05 of the 2018 San Antonio Breast Cancer Symposium; December 4-8, 2018; San Antonio, Texas.
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Cystic fibrosis, lockdown and CFTR modulators - a perfect stormConference abstract WS20.05 in the section 'Complex psychosocial/nursing case studies' of the oral sessions of the 45th European Cystic Fibrosis Conference, 8-11 June 2022, Rotterdam, The Netherlands.