Challenging concepts in obstetrics and gynaecology : cases with expert commentary

363 Pages·2015·16.729 MB·English

by  Natasha Hezelgrave, Danielle Abbott, Andrew Shennan

Challenging Concepts in Obstetrics
and Gynaecology
Titles in the Challenging Concepts in series
Anaesthesia (Edited by Dr Phoebe Syme, Dr Robert Jackson, and
Professor Tim Cook)
Cardiovascular Medicine (Edited by Dr Aung Myat, Dr Shouvik
Haldar, and Professor Simon Redwood)
Emergency Medicine (Edited by Dr Sam Thenabadu, Dr Fleur Cantle,
and Dr Chris Lacy)
Infectious Disease and Clinical Microbiology (Edited by Dr Amber
Arnold and Professor George Griffin)
Interventional Radiology (Edited by Dr Irfan Ahmed, Dr Miltiadis
Krokidis, and Dr Tarun Sabharwal)
Neurology (Edited by Dr Krishna Chinthapalli, Dr Nadia Magdalinou,
and Professor Nicholas Wood)
Neurosurgery (Edited by Mr Robin Bhatia and Mr Ian Sabin)
Obstetrics and Gynaecology (Edited by Dr Natasha Hezelgrave,
Dr Danielle Abbott, and Professor Andrew Shennan)
Oncology (Edited by Dr Madhumita Bhattacharyya, Dr Sarah Payne,
and Professor Iain McNeish)
Oral and Maxillofacial Surgery (Edited by Mr Matthew Idle and
Group Captain Andrew Monaghan)
Respiratory Medicine (Edited by Dr Lucy Schomberg and
Dr Elizabeth Sage)
Challenging Concepts in
Obstetrics and Gynaecology
Cases with
Expert Commentary
Edited by
Dr Natasha Hezelgrave
NIHR Clinical Research Fellow in Obstetrics, Women’s Health Academic Centre,
King’s College London, UK.
Dr Danielle Abbott
Clinical Research Fellow, Women’s Health Academic Centre,
King’s College London, UK.
Professor Andrew H. Shennan
Professor of Obstetrics, Women’s Health Academic Centre,
King’s College London, UK
Series editors
Dr Aung Myat BSc (Hons) MBBS MRCP
BHF Clinical Research Training Fellow, King’s College London British Heart Foundation Centre of
Research Excellence, Cardiovascular Division, St Thomas’ Hospital, London, UK
Dr Shouvik Haldar MBBS MRCP
Electrophysiology Research Fellow & Cardiology SpR, Heart Rhythm Centre, NIHR Cardiovascular
Biomedical Research Unit, Royal Brompton & Harefiled NHS Foundation Trust, Imperial College London,
London, UK
Professor Simon Redwood MD FRCP
Professor of Interventional Cardiology and Honorary Consultant Cardiologist, King’s College London
British Heart Foundation Centre of Research Excellence, Cardiovascular Division and Guy’s and
St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK
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FOREWORD
I feel honoured to be asked to write the foreword for this new book Challenging
Concepts in Obstetrics and Gynaecology as I believe that it offers the reader a new
learning experience. It is well recognised in educational circles that each of us learns
in different ways and the majority use a plurality of methods to embed knowledge,
skills, and attitudes. The use of storytelling in learning is increasingly acknowl-
edged as a powerful part of the teaching armamentarium. This new book combines
the stories of women presenting with complex clinical conditions with a holistic
exploration of the issues that the obstetrician and gynaecologist needs to consider in
order to manage these patients most effectively.
The cases cover all areas of obstetrics and gynaecology without being a reading
list ticking off elements of the curriculum. Each case is written by a doctor in post-
graduate medical training supported by a local mentor with comments and further
emphasis on essential learning points from international experts. It is therefore up
to date and relevant to cases that the reader will face in their practice.
The layout makes it easy to read extracts and presents learning points, clinical
tips, and identifies the evidence base for further reading. I would recommend this
book as a must to all in Obstetrics and Gynaecology as a readily available resource
to deliver best care to your patients and as a teaching aid to learn or pass on those
clinical gems we all value so much.
Diana Hamilton-Fairley MD, FRCOG,
Consultant Obstetrician and Gynaecologist,
Director for Health Education and Quality,
South London
CONTENTS
Expert Faculty Profiles vii Case 12 The challenges and controversies of
Contributors x pregnancy and diabetes 147
Abbreviations xii Case 13 HIV in pregnancy: the dilemmas of
management 161
MRCOG syllabus: curriculum map xvi
ATSM curriculum guide xvii Case 14 SLE in pregnancy: lupus nephritis flare
or pre-eclampsia—a diagnostic challenge 177
Case 1 A ‘classic’ case of heavy menstrual bleeding? 1
Case 15 Management of a pregnant woman with
Case 2 Severe endometriosis in a young woman morbid obesity 191
with unexpected end-organ failure 15
Case 16 Early-onset preeclampsia: balancing
Case 3 Pregnancy of unknown location: a diagnostic maternal and neonatal morbidity 201
and management dilemma 31
Case 17 Vaginal birth after caesarean section 213
Case 4 Pre-implantation genetic diagnosis in
Case 18 Maternal pyrexia: challenges in optimal
oligozoospermia 49
perinatal management 229
Case 5 Recurrent miscarriage: is conservative
Case 19 Forewarned is forearmed in massive
management the best we can offer? 59
obstetric haemorrhage 243
Case 6 Lethal congenital abnormalities: the
Case 20 Premature ovarian failure: not the same as
importance of a multidisciplinary approach 73
the ‘normal’ menopause 259
Case 7 Monochorionic diamniotic twin pregnancy
Case 21 Treating urinary incontinence: an evolving
complicated by twin–twin transfusion
challenge for us all 269
syndrome 81
Case 22 Post-menopausal bleeding 287
Case 8 ‘Rescue’ cerclage after bulging membranes at
22 weeks: delaying the inevitable? 97 Case 23 Recurrent ovarian cancer 303
Case 9 Early-onset fetal growth restriction 111 Case 24 Cervical cancer 319
Case 10 Dilemmas of preterm birth 121
Index 335
Case 11 Pulmonary hypertension in pregnancy 133
EXPERT FACULTY PROFILES
Professor Susan Bewley, Professor of Complex Obstetrics, Women’s Health Academic
Centre, King’s College London, UK
Dr Sarah P Blagden, Consultant Medical Oncologist and Academic Senior Lecturer,
West London Cancer Network and Ovarian Cancer Action Research Centre, Imperial
College London, London, UK
Dr Fiona Denison, Senior Lecturer and Honorary Consultant in Maternal and Fetal
Medicine, MRC Centre for Reproductive Health, Queen’s Medical Research Institute,
Edinburgh, UK
Dr Ben Fitzwilliams, Consultant Obstetric Anaesthetist, Guy’s and St Thomas’ NHS
Foundation Trust, London, UK
Dr Christina Fotopoulou Consultant and Adjunct Professor in Gynaecological
Oncology, West London Gynaecological Cancer Centre and Ovarian Cancer Action
Research Centre, Imperial College Healthcare Academic NHS Trust, London UK
Professor Ian Greer, Consultant Obstetrician and Gynaecologist, Faculty of Health &
Life Sciences, University of Liverpool, Liverpool, UK
Dr Mohamad Hamady, Consultant and Honorary Senior Lecturer in Clinical and
Interventional Radiology, Imperial College Healthcare NHS Trust, London, UK
Dr Judith Hamilton, Consultant Gynaecologist, Early Pregnancy & Acute Gynaecology
Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Dr Kate Harding, Consultant Obstetrician, Guy’s and St Thomas’ NHS Foundation
Trust
Professor Jenny Higham, Professor and Honorary Consultant Gynaecologist, Imperial
College Healthcare NHS Trust, London, UK
Dr Fuad Hussain, Consultant Radiologist, Royal Surrey County Hospital, Guildford,
UK
Mr Lawrence W Impey, Consultant Obstetrician, John Radcliffe Hospital, Oxford
University, Oxford, UK
Dr Ed Johnstone, Clinical Senior Lecturer in Obstetrics and Fetal Medicine, University
of Manchester, UK
viii
Expert Faculty Profiles
Professor Sean Kehoe, Lawson Tait Professor of Gynaecological Cancer, School of
Cancer Studies, University of Birmingham, UK
Mr Con Kelleher, Consultant Gynaecologist, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK
Mr Andrew Kent, Consultant Gynaecologist, Royal Surrey County Hospital,
Guildford, UK
Professor Henry Kitchener, Professor of Gynaecological Oncology, Institute of Cancer
Sciences, University of Manchester, UK.
Professor Sailesh Kumar, Professor of Fetal Medicine, Obstetrics & Gynaecology,
Mater Research Institute, University of Queensland, Brisbane, Australia
Professor Pippa Kyle, Professor of Fetal Medicine, Fetal Medicine Unit, Guy’s and
St Thomas’ NHS Foundation Trust, London, UK
Dr Kate Langford, Consultant Obstetrician/Deputy Medical Director Guy’s &
St Thomas’ NHS Foundation Trust, London, UK
Professor William Leigh Ledger, Professor and Head of Discipline of Obstetrics and
Gynaecology, University of New South Wales, Royal Hospital for Women, Sydney,
Australia
Dr Geraint Lee, Consultant Neonatologist, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK.
Professor David Luesley, Emeritus Professor of Gynaecological Oncology, School of
Cancer Sciences, University of Birmingham, UK
Professor Neil Marlow, Professor of Neonatology, Institute for Women’s Health,
University College London, UK
Professor David R McCance, Consultant Physician/ Honorary Professor of
Endocrinology, Regional Centre for Endocrinology and Diabetes, Royal Victoria
Hospital, Belfast, UK
Professor Catherine Nelson-Piercy, Professor of Obstetric Medicine, Women’s Health
Academic Centre, King’s Health Partners, Consultant Obstetric Physician, GSTFT
and Imperial College Health Care Trust, London, UK
Dr Susan E Robinson, Consultant Haemotologist, Guy’s and St Thomas’ NHS
Foundation Trust, London, UK
Professor Timothy A Rockall, Consultant Surgeon, Director of Minimal Access
Therapy Training Unit, Royal Surrey County Hospital, Guildford, UK
ix
Expert Faculty Profiles
Dr Annemiek de Ruiter, Consultant in Genitourinary Medicine and and HIV, Guy’s
& St Thomas’ NHS Foundation Trust, London, UK
Professor Janice Rymer, Professor of Gynaecology, Women’s Health Academic
Centre, King’s College London, UK
Professor Andrew H Shennan, Professor of Obstetrics, Women’s Health Academic
Centre, King’s College London, UK.
Professor Philip J Steer, Emeritus Professor of Obstetrics, Imperial College London,
Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster
Hospital, London, UK
Dr Lorna Swan, Consultant Cardiologist/Clinical Lead for Adult Congenital Heart
Disease, Royal Brompton Hospital, London, UK
Dr Jason Waugh, Consultant in Obstetrics and Maternal Medicine, Newcastle upon
Tyne NHS Foundation Trust, Newcastle, UK
External Reviewers
Dr Deborah Bruce, Dr Kate Langford, Dr Lucy Chappell, Mr Geoff Lane, Dr Johanna
Trinder, Dr Alex Digesu, Mr James English, Dr Sharmistha Guha, Dr Vik Khullar,
Dr Kate Harding, Mr Con Kelleher, Professor Pippa Kyle, Dr Joanna Girling, Dr Melanie
Allan, Dr Jane Norman, Professor Andrew Shennan, Professor Scott Nelson, Dr Sonji
Clarke, Professor Sailesh Kumar, Mr Kumar Kunde, Miss Diana Hamilton-Fairley