Beyond the numbers: obstetric anaesthesia and maternal deaths.

A recent report on maternal deaths in Japan attributed to anaesthesia highlights the value of a national enquiry process which can review each death to determine the likely cause. It is through national enquiries, such as the UK Confidential Enquiries into Maternal Deaths, that deficiencies in care, including anaesthetic practice, can be identified and improvements made to effect better patient outcomes. The report also underlines that safe anaesthetic practice, particularly in the challenging environment of obstetrics, is best delivered by specialists trained in anaesthesia but who might be in short supply, even in large developed countries such as Japan.

Predicting outcomes of expectant and medical management in early pregnancy miscarriage using machine learning to develop and validate multivariable clinical prediction models.

Objective: To determine whether readily available patient, ultrasound and treatment outcome data can be used to develop, validate and externally test two machine learning (ML) models for predicting the success of expectant and medical management of miscarriage respectively.

Methods: A retrospective, multi-site study of patients opting for expectant or medical management of miscarriage was undertaken. A total of 1075 patients across two hospital early pregnancy units were eligible for inclusion.

How women understand and use a tool to predict early pregnancy outcome: A qualitative analysis.

Objective: To explore how women, understand, interpret and use a validated individualised early pregnancy outcome prediction score tool.

Study Design: Qualitative interview study nested within a larger quantitative randomised controlled trial (RCT) within the Early Pregnancy Unit of a London teaching hospital. Women with an ultrasound diagnosis of an early intrauterine pregnancy of uncertain viability (PUV) were randomised to receive a validated outcome prediction score or routine care.

Fetal bilateral hyperechogenic kidneys: Prenatal progression and long-term postnatal outcome.

Objective: To determine the prenatal progression and long-term outcome of fetal bilateral hyperechogenic kidneys (HK).

Design: Retrospective study 2005-2016. Fetal/maternal demographics, scan findings, postnatal diagnoses and outcomes were collected from electronic patient records and post-mortem reports.

Clinical utility of ultrasonography in pediatric and adolescent gynecology: retrospective review of 1313 ultrasound examinations.

Objectives: Ultrasound is the first-line imaging modality of the pelvis in the pediatric and adolescent gynecology (PAG) population. Ultrasound findings in pre- and postpubertal PAG patients differ from those in adults. Diagnostic models for adnexal pathology have not been validated in this cohort.

The role of umbilical vein blood flow assessment in the prediction of fetal growth velocity and adverse outcome: a prospective observational cohort study.

Background: Identifying fetal growth restriction and distinguishing it from a constitutionally small fetus can be challenging. The umbilical vein blood flow is a surrogate parameter of the amount of oxygen and nutrients delivered to the fetus, providing valuable insights about the function of the placenta. Nevertheless, currently, this parameter is not used in the diagnosis and management of fetal growth restriction.

Perception of Telemedicine and Remote Learning Following the COVID-19 Pandemic: A Health Education England Survey of London Obstetrics and Gynaecology Trainees.

Purpose: To determine the level of uptake of telemedicine among postgraduate obstetrics and gynaecology (O&G) trainees in London, and how they perceive its impact on their training.

Methods: A mixed-methods survey aimed at exploring trainee perspectives of telemedicine use in clinical practice and its implications for training. Study participants were O&G specialist doctors on the London (UK) training programme.

Evidence-based guideline: premature ovarian insufficiency.

Study Question: How should premature/primary ovarian insufficiency (POI) be diagnosed and managed based on the best available evidence from published literature?

Summary Answer: The current guideline provides 145 recommendations on symptoms, diagnosis, causation, sequelae, and treatment of POI.

What Is Known Already: Premature ovarian insufficiency (POI) presents a significant challenge to women's health, with far-reaching implications, both physically and emotionally. The potential implications include adverse effects on quality of life; fertility; and bone, cardiovascular, and cognitive health.

Evidence-based guideline: Premature Ovarian Insufficiency.

Study Question: How should premature/primary ovarian insufficiency (POI) be diagnosed and managed, based on the best available evidence from published literature?

Summary Answer: The current guideline provides 145 recommendations on symptoms, diagnosis, causation, sequelae and treatment of POI.

What Is Known Already: Premature ovarian insufficiency (POI) presents a significant challenge to women's health, with far-reaching implications, both physically and emotionally. The potential implications include adverse effects on quality of life; fertility; and bone, cardiovascular and cognitive health.

Evidence-based guideline: premature ovarian insufficiency.

Study Question: How should premature/primary ovarian insufficiency (POI) be diagnosed and managed, based on the best available evidence from published literature?

Summary Answer: The current guideline provides 145 recommendations on symptoms, diagnosis, causation, sequelae and treatment of POI.

What Is Known Already: POI presents a significant challenge to women's health, with far-reaching implications, both physically and emotionally. The potential implications include adverse effects on quality of life, on fertility and on bone, cardiovascular and cognitive health.

Do very young oocyte donors negatively impact live birth rates in their recipients?

To understand whether there was an association between very young oocyte donors and adverse outcomes, this was a single centre retrospective study (Lister Fertility Clinic, London) examining data collected between 1st January 2010 and 31st December 2021. A total of 1,182 oocyte donors were included in the final analysis. Data was categorised by donor age in years; ≤22, 23-25, 26-28, 29-31, 32-34.

Familial chylomicronaemia syndrome in pregnancy - report of two cases managed with plasma exchange.

Familial chylomicronaemia syndrome (FCS) is a rare genetic disorder characterised by significantly elevated triglyceride levels which increases the risk of acute pancreatitis. Due to the changes in lipid metabolism during pregnancy, triglyceride levels may rise further, particularly in the third trimester, and cause challenges in the management of these patients. Apart from strict dietary restriction of all fats, there is limited evidence on the efficacy of pharmacological treatment with omega-3 fatty acids and fibrates in maintaining triglyceride levels below the desired threshold of 10 mmol/L.

Tackling inequalities in preconception health and care: barriers, facilitators and recommendations for action from the 2023 UK preconception EMCR network conference.

Reducing inequalities in preconception health and care is critical to improving the health and life chances of current and future generations. A hybrid workshop was held at the 2023 UK Preconception Early and Mid-Career Researchers (EMCR) Network conference to co-develop recommendations on ways to address inequalities in preconception health and care. The workshop engaged multi-disciplinary professionals across diverse career stages and people with lived experience (total = 69).

Conflicts of Interest Anesthesia Practice: Relationships with Industry, Responsibility to the Health Care System, and Research Integrity.

Conflicts of interest (COIs) between clinical obligations and other roles and responsibilities occur throughout health care, including anesthetic practice. In some circumstances, these conflicts are unavoidable. This article describes some of the potential conflicts and explores approaches to managing them in 3 key areas: relationships with industry, responsibility to the health care system, and obligations in research.

Elinzanetant for the Treatment of Vasomotor Symptoms Associated With Menopause: OASIS 1 and 2 Randomized Clinical Trials.

Importance: Safe and effective nonhormonal treatments for menopausal vasomotor symptoms (VMS) are needed.

Objective: To evaluate the efficacy and safety of elinzanetant, a selective neurokinin-1,3 receptor antagonist, for the treatment of moderate to severe menopausal vasomotor symptoms.

Design, Setting, And Participants: Two randomized double-blind phase 3 trials (OASIS 1 and 2) included postmenopausal participants aged 40 to 65 years experiencing moderate to severe vasomotor symptoms (OASIS 1: 77 sites in the US, Europe, and Israel from August 27, 2021, to November 27, 2023, and OASIS 2: 77 sites in the US, Canada, and Europe from October 29, 2021, to October 10, 2023).

A deep learning approach to identify the fetal head position using transperineal ultrasound during labor.

Objectives: To develop a deep learning (DL)-model using convolutional neural networks (CNN) to automatically identify the fetal head position at transperineal ultrasound in the second stage of labor.

Material And Methods: Prospective, multicenter study including singleton, term, cephalic pregnancies in the second stage of labor. We assessed the fetal head position using transabdominal ultrasound and subsequently, obtained an image of the fetal head on the axial plane using transperineal ultrasound and labeled it according to the transabdominal ultrasound findings.