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Background : The value of obstetric ultrasound in high-income countries has been extensively explored but evidence is still lacking regarding the role of obstetric ultrasound in low-income countries. Objective : We aimed to explore experiences and views among physicians working in obstetric care in Tanzania, on the role of obstetric ultrasound in relation to clinical management. Design : A qualitative study design was applied. Data were collected in 2015, through 16 individual interviews with physicians practicing in obstetric care at hospitals in an urban setting in Tanzania. Data were analyzed using qualitative content analysis. Results : Use of obstetric ultrasound in the management of complicated pregnancy was much appreciated by participating physicians, although they expressed considerable concern about the lack of ultrasound equipment and staff able to conduct the examinations. These limitations were recognized as restricting physicians’ ability to manage complications adequately during pregnancy and birth. Better availability of ultrasound was requested to improve obstetric management. Concerns were also raised regarding pregnant women’s lack of knowledge and understanding of medical issues which could make counseling in relation to obstetric ultrasound difficult. Although the physicians perceived a positive attitude toward ultrasound among most pregnant women, occasionally they came across women who feared that ultrasound might harm the fetus. Conclusions : There seems to be a need to provide more physicians in antenatal care in Tanzania with ultrasound training to enable them to conduct obstetric ultrasound examinations and interpret the results themselves. Physicians also need to acquire adequate counseling skills as counseling can be especially challenging in this setting where many expectant parents have low levels of education. Providers of obstetric care and policy makers in Tanzania will need to take measures to ensure appropriate use of the scarce resources in the Tanzanian health care system and prevent the potential risk of overuse of ultrasound in pregnancy. Keywords: obstetric ultrasound; Tanzania; obstetricians; physicians; pregnancy; pregnant women; prenatal diagnosis; qualitative study; fetus; maternal rights (Published: 22 JJuly 2016) Citation: Glob Health Action 2016, 9 : 31062 - http://dx.doi.org/10.3402/gha.v9.31062

Graphical abstract, Highlights • McConnell’s sign may be an early sign of acute RV strain in amniotic fluid embolus. • TTE could be considered to facilitate timely diagnosis of amniotic fluid embolus. • The presence of RV dysfunction on TTE may help guide hemodynamic therapies.

Importance Gestational hypertension and preeclampsia are leading causes of maternal and perinatal morbidity and mortality worldwide. Τhe lack of effective screening and management policies appears to be one of the main reasons. Objective The aim of this study was to review and compare recommendations from published guidelines on these common pregnancy complications. Evidence Acquisition A descriptive review of guidelines from the National Institute for Health and Care Excellence, the Society of Obstetric Medicine of Australia and New Zealand, the International Society of Hypertension, the International Society for the Study of Hypertension in Pregnancy, the European Society of Cardiology, the International Federation of Gynecology and Obstetrics, the Society of Obstetricians and Gynaecologists of Canada, the American College of Obstetricians and Gynecologists, the International Society of Ultrasound in Obstetrics and Gynecology, the World Health Organization, and the US Preventive Services Task Force on gestational hypertension and preeclampsia was carried out. Results There is an overall agreement that, in case of suspected preeclampsia or new-onset hypertension, blood and urine tests should be carried out, including dipstick test for proteinuria, whereas placental growth factor-based testing is only recommended by the National Institute for Health and Care Excellence and the European Society of Cardiology. In addition, there is a consensus on the recommendations for the medical treatment of severe and nonsevere hypertension, the management of preeclampsia, the appropriate timing of delivery, the optimal method of anesthesia and the mode of delivery, the administration of antenatal corticosteroids and the use of magnesium sulfate for the treatment of eclamptic seizures, the prevention of eclampsia in cases of severe preeclampsia, and the neuroprotection of preterm neonates. The reviewed guidelines also state that, based on maternal risk factors, pregnant women identified to be at high risk for preeclampsia should receive low-dose aspirin starting ideally in the first trimester until labor or 36 to 37 weeks of gestation, although the recommended dose varies between 75 and 162 mg/d. Moreover, most guidelines recommend calcium supplementation for the prevention of preeclampsia and discourage the use of other agents. However, controversy exists regarding the definition and the optimal screening method for preeclampsia, the need for treating mild hypertension, the blood pressure treatment targets, and the postnatal blood pressure monitoring. Conclusions The development and implementation of consistent international protocols will allow clinicians to adopt effective universal screening, as well as preventive and management strategies with the intention of improving maternal and neonatal outcomes.

Chronic hypertension in pregnancy accounts for a substantial proportion of maternal morbidity and mortality and is associated with adverse perinatal outcomes, most of which can be mitigated by appropriate surveillance and management protocols. The aim of this study was to review and compare recommendations of published guidelines on this condition. Thus, a descriptive review of influential guidelines from the National Institute for Health and Care Excellence, the Society of Obstetric Medicine of Australia and New Zealand, the International Society of Hypertension, the International Society for the Study of Hypertension in Pregnancy, the European Society of Cardiology, the International Federation of Gynecology and Obstetrics, the Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists on chronic hypertension in pregnancy was conducted. All guidelines agree on the definition and medical management, the need for more frequent antenatal care and fetal surveillance and the re-evaluation at 6–8 weeks postpartum. There is also a consensus that the administration of low-dose aspirin is required to prevent preeclampsia, although the optimal dosage remains controversial. No universal agreement has been spotted regarding optimal treatment blood pressure (BP) targets, need for treating mild-to-moderate hypertension and postnatal BP measurements. Additionally, while the necessity of antenatal corticosteroids and magnesium sulfate for preterm delivery is universally recommended, the appropriate timing of delivery is not clearly outlined. Hence, there is a need to adopt consistent practice protocols to optimally manage these pregnancies; i.e. timely detect and treat any potential complications and subsequently reduce the associated morbidity and mortality.

The prevalence of acute medical complications of pregnancy is increasing, partly due to demographic and lifestyle factors. In most industrialized nations, mothers are delaying childbearing until later in life; older women are at higher risk of complications such as venous thromboembolism and cardiovascular disease. ‘Indirect’ causes (medical and psychiatric) now dominate the list of leading causes of maternal death; some women suffer morbidity caused by medical conditions during or soon after pregnancy. An important part of the solution is to educate and train clinicians in the management of medical problems in pregnancy. Acute symptoms such as chest pain, breathlessness, headache and fever require prompt and thorough assessment. Pregnant women can develop a number of common medical conditions, as well as a few that are specific to pregnancy. Investigations and treatment should not be delayed or withheld simply because a patient is pregnant: most medications and radiological tests can be used in pregnancy.

Aim To update obstetric care providers about asthma management. Summary Asthma is the most frequent comorbid chronic illness in pregnancy. Convincing evidence shows that uncontrolled asthma magnifies the risk of maternal, fetal and neonate complications. Unfortunately, one in four women take no inhaler during pregnancy, and it is likely that decreased adherence, rather than changes in pathology, explains uncontrolled maternal asthma. Patient surveys reveal a need for information and reassurance. Although some molecules are preferred in pregnancy, there is currently no basis to withhold any asthma medication – old or new. Biomarkers such as blood eosinophils and fractional exhaled nitric oxide are an effective way to assess the risk of asthma attacks and the likelihood of responding to inhaled steroids. Furthermore, practice-changing trials in mild asthma show that switching reliever-only regimens to as-needed ‘controller-and-reliever’ therapy is effective. We suggest that applying these changes can alleviate women’s concerns and improve outcomes.

Technological advances, a deeper understanding of disease processes and increased sophistication of therapeutic methods have all led to better outcomes in rare diseases which previously had devastating effects on many women’s lives. The inevitable result of this progress is that women, who in the past did not contemplate pregnancy because of significant morbidity, now get to adulthood and are reasonably “disease free” enough to have their own families. The ever expanding, but relatively new specialty of Obstetric medicine seeks to further improve the outcome in pregnant women with intercurrent disease by enhancing the literature base, thereby contributing to the creation of appropriate guidance in the management of these patients. This article is a brief but useful guide for the busy obstetrician who may have limited experience in dealing with multiple sclerosis in pregnant women.

Objective Sepsis is a life-threatening syndrome caused by the body's response to infection. The Global Maternal Sepsis Study (GLOSS) suggests sepsis plays a larger role in maternal morbidity and mortality than previously thought. We therefore sought to compare national and international guidelines for maternal sepsis to determine their consistency with each other and the Third International Consensus for Sepsis and Septic Shock (SEPSIS-3). Study design Using Cochrane Database of Systematic Reviews, PubMed, Google Scholar, and organization Web sites, we identified seven guidelines on maternal sepsis in the English language-The American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Society of Obstetric Medicine of Australia and New Zealand, Royal College of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland Institute of Obstetricians and Gynaecologists, and World Health Organization. Guidelines were reviewed to ascertain the commonality and variation, if any, in definitions of maternal sepsis, tools and criteria utilized for diagnosis, obstetric warning systems used, as well as evaluation and management of maternal sepsis. These variables were also compared with SEPSIS-3. Results All guidelines provided definitions consistent with a version of the SEPSIS, although the specific version utilized were varied. Clinical variables and tools employed for diagnosis of maternal sepsis were also varied. Evaluation and management of maternal sepsis and septic shock were similar. Conclusion In conclusion, national and international maternal sepsis guidelines were incongruent with each other and SEPSIS-3 in diagnostic criteria and tools but similar in evaluation and management recommendations. Key points · Definitions for maternal sepsis and septic shock are varied.. · Maternal sepsis guidelines differ in proposed criteria and tools.. · Maternal sepsis guidelines have similar management recommendations..

Eclampsia is a common complication of preeclampsia patients and can be life-threatening for both the mother and the fetus. Hence, timely intervention and appropriate management of this detrimental condition are extremely crucial. Eclampsia is described as the occurrence of generalized convulsions in patients with preeclampsia. Magnesium sulfate (MgSO4) is the drug of choice for treating and preventing eclampsia. This review aims to study and analyze the available literature on the pathogenesis of eclampsia, the pharmacology of MgSO4, and its effectiveness in the management of eclampsia. Other proposed treatments and their comparative study with MgSO4 are also discussed. Additionally, we examine the data regarding the impact of eclampsia, its public health burden, and the cost-effectiveness of MgSO4. One of the major drawbacks associated with the use of MgSO4 in low-income countries has been the cost of treatment and the lack of resources. We have analyzed the trials that have proposed alternate treatment regimens which could shape new guidelines to resolve these issues. For this review, we extensively studied abstract and full-text articles from multiple databases. This article discusses the pathophysiology of eclampsia, the pharmacology of MgSO4, the issues surrounding eclampsia management, and how MgSO4 benefits these patients.

Introduction: The term humanize refers us to care that values the quality of care from a technical point of view, associated with respect for the patient's rights, their subjectivity and cultural references, as well as the valuation of the professional and of intra- and inter-team dialogue. The moment of delivery, involves many biological, social and psychological issues for the woman and her baby, the doctor needs to understand the sensitivity that surrounds the pregnant woman at that time. Methodology: It is a narrative review of the literature The data used in this research are characterized as secondary, that is, based on data already treated, taken from books and works to show the concept, treatment and its particularities.Results: The need of trained and sensitized health professionals in prenatal care and in the delivery period is of fundamental importance, since this is a painful and uncomfortable moment for women. Therefore, making it less traumatic should be one of the goals of the entire care team. Conclusion: After reading and analyzing the articles, it was found that for nursing to contribute to improving the quality of women's health care, it is essential that the interventions carried out can guarantee physical and mental health, respect and dignity, offering humanized care throughout the pregnancy and childbirth cycle, understanding pregnancy and childbirth as physiological events, developing the role of the woman in childbirth, where she actively participates in decisions being able to express their wishes and choices, deciding together with the team the best method to be adopted. Introducción: El término humanizar nos refiere a una asistencia que valora la calidad de la atención desde un punto de vista técnico, asociado al respeto de los derechos del paciente, su subjetividad y referentes culturales, así como la valorización del profesional y el Diálogo intra e interequipo El momento del parto, involucra muchas cuestiones biológicas, sociales y psicológicas para la mujer y su bebé, el médico necesita comprender la sensibilidad que envuelve a la gestante en ese momento. Metodología: Es una revisión narrativa de la literatura Los datos utilizados en esta investigación se caracterizan como secundarios, es decir, basados ​​en datos ya tratados, extraídos de libros y obras para mostrar el concepto, tratamiento y sus particularidades. Resultados: La necesidad de Profesionales de la salud capacitados y sensibilizados en la atención prenatal y en el parto es de fundamental importancia, ya que este es un momento doloroso e incómodo para la mujer. Por lo tanto, hacerla menos traumática debe ser una de las metas de todo el equipo de atención.Conclusión: Luego de leer y analizar los artículos, se encontró que para que la enfermería contribuya a mejorar la calidad de la atención de salud de la mujer, es fundamental que puede garantizar la salud física y mental, el respeto y la dignidad, ofreciendo cuidados humanizados durante todo el ciclo del embarazo y parto, entendiendo el embarazo y el parto como eventos fisiológicos, desarrollando el rol de la mujer en el parto, donde participa activamente en las decisiones pudiendo expresarse sus deseos y elecciones, decidiendo junto con el equipo el mejor método a adoptar. Introdução: O termo humanizar nos remete a uma assistência que valorize a qualidade do cuidado do ponto de vista técnico, associado ao respeito dos direitos do paciente, de sua subjetividade e referências culturais, como também a valorização do profissional e do diálogo intra e interequipes.O momento do parto, envolve muitas questões biológicas, sociais e psicológicas para a mulher e seu bebe, o medico precisa entender a sensibilidade que envolve a gestante nesse momento. Metodologia:Trata-se de uma revisão narrativa da literatura Os dados utilizados nesta pesquisa caracterizam-se como secundários, ou seja, fundamentados em dados já tratados, retirados de livros e obras para mostrar o conceito, tratamento e suas particularidades.Resultados: A necessidade de profissionais de saúde capacitados e sensibilizados na assistência ao pré-natal e no período do parto é de fundamental importância, visto que esse é um momento doloroso e desconfortável para a mulher. Portanto, torná-lo menos traumático deve ser um dos objetivos de toda equipe assistencial.Conclusão: Após a leitura e análise dos artigos, verificou-se que para a enfermagem possa contribuir na melhoria da qualidade da assistência á saúde da mulher, é fundamental que as intervenções realizadas possam garantir a saúde física e psíquica, o respeito e a dignidade, oferecendo assistência humanizada durante todo o ciclo gravídico puerperal, entendendo a gestação e o parto como eventos fisiológicos, desenvolvendo o protagonismo do parto à mulher, onde participa ativamente das decisões podendo expressar seus desejos e escolhas, decidindo junto com a equipe o melhor método a ser adotado.

Thrombocytopenia in pregnancy is a common occurrence, affecting up to 10% of women by the time of birth. These recommendations aim to provide pragmatic guidance on the investigation, diagnosis and management of thrombocytopenia in pregnancy; including safety of neuraxial anaesthesia and precautions required for birth. Management of neonatal thrombocytopenia is also addressed. The authors are clinicians representing haematology, obstetric medicine, maternal-fetal medicine, and anaesthesia. Each author conducted a detailed literature review then worked collaboratively to produce a series of unanimous recommendations. The recommendation strength is limited by the lack of high-quality clinical trial data, and represents level C evidence.

Treating fetal disease in utero is a specialized aspect of obstetric medicine that continues to develop as new technology and better imaging techniques are introduced. Surgical interventions may improve outcomes in fetal diseases such as fetal anemia, spina bifida, and congenital diaphragmatic hernia; however, the addition of a dedicated fetal treatment center to an established busy labor and delivery unit requires facility resources and support. Fetal medicine and labor and delivery leaders can develop a successful fetal therapy service when they partner with fetal medicine specialists, obstetric providers, anesthesia professionals, nursing staff members, and sterile processing department members. By working together, multidisciplinary team members should be able to provide excellent and cost-effective collaborative care while maintaining patient safety. This article provides an overview of key components that should assist perioperative leaders when developing a successful fetal surgery program.

Background Multiple hypertension guidelines recommend out-of-office measurements for the diagnosis of hypertension in non-pregnant adults, whereas pregnancy guidelines recommend in-office blood pressure measurements. The objective of our study was to determine how Canadian Obstetric Medicine and Maternal Fetal Medicine specialists measure blood pressure in pregnancy. Methods An email survey was sent to 69 Canadian Obstetric Medicine and Maternal Fetal Medicine specialists in academic centers across Canada to explore the practice patterns of blood pressure measurement in pregnant women. Results The response rate was 48%. The majority of respondents (63.6%) preferred office blood pressure measurement for diagnosing hypertension, but relied on home blood pressure readings for ongoing monitoring and management of hypertension during pregnancy (59.4%). The preferred method of out-of-office blood pressure measurement was home monitoring; 24-hour ambulatory blood pressure monitoring was not used due to limited availability and cost. Conclusions There is wide practice variation in methods of measuring blood pressure among Canadian specialists managing hypertension in pregnancy.

2020 will be remembered by most of us as an “annus horribilus.” Many things that we took for granted are now a distant memory;most of us have been unable to travel and the wider Obstetric Medicine community has not been able to meet in person. Our community has always thrived on discussing cases and sharing ideas with each other in auditoriums and during coffee breaks. Networking opportunities and lifelong collaborations have been forged at various conference dinners. All in-person meetings have either been cancelled or changed to a virtual format over this past year. Unmuting oneself and transitioning into breakout rooms have become the most important skills to have when participating in a virtual meeting.There are many positives to take away from this experience. Despite the mental and physical toll of this pandemic, our determination and motivation to better serve our patients have never been stronger. The COVID-19 pandemic has catalysed the progression of digital medical education. We wish to share some examples of what has occurred in Obstetric Medicine.

In this clinical review we highlight aspects of the diagnosis and management of pulmonary embolism (PE) in pregnancy and post-partum and how this may impact on antenatal and postnatal management. Investigation for PE in pregnancy is challenging and includes appropriate patient selection and knowledge of the risks and benefits of pulmonary imaging modalities. The complete Society of Obstetric Medicine of Australia and New Zealand Position Statement on Pulmonary Embolism in Pregnancy and Post-Partum comprehensively reviews all aspects of diagnosis, investigation and management and is accessible at https://www.somanz.org/guidelines.asp. It includes a summary of all recommendations and a guide to developing a management plan for birth in women on anticoagulation.

Introduction Venous thromboembolism risk is higher in the puerperium and pulmonary embolism (PE) is a leading cause of maternal death. IV unfractionated heparin (UFH) is considered first line treatment but favourable outcomes following thrombolysis have been recorded. The ESC guidelines recommend the use of a multidisciplinary team to plan the management of these women.1 Aim To review the management and outcomes of pregnant and post-partum women admitted to a tertiary referral centre with intermediate-high risk (IHR) and high risk (HR). Method A retrospective case notes review of pregnant and post-partum patients admitted with IHR and HR PEs between 2014 and 2019. All patients were reviewed by PELT (comprising specialists in respiratory, haematology, interventional radiology and obstetric medicine in conjunction with imaging, PESI score, troponin and NT-proBNP). All treatment decisions were made in conjunction with informed patient consent. Results Seven patients with IHR or HR PE (6 pregnant and 1 post-partum) were admitted. Of these, 4 were transferred from other hospitals. Three of the patients (gestations 10/40, 22/40 and 37+4/40) received UFH alone, two (gestations 31/40 and 38/40) were treated with catheter directed thrombolysis (CDT) and one patient (gestation 22/40) received half-dose systemic thrombolysis after haemodynamic collapse. One patient presented 4 weeks post-partum and received CDT. There were no major and only one minor bleeding complications. All patients clinically improved, with resolution of echocardiographic changes and improvement in cardiac biomarkers. There was no maternal mortality. One woman who initially presented with vaginal bleeding at 10 weeks, was treated with UFH and went on to suffer a miscarriage. All other patients went on to complete pregnancy successfully. One patient who underwent CDT had an elective caesarean section during her inpatient stay. Conclusion The management of PEs in pregnancy is difficult and treatment decisions should be patient specific. Thrombolysis and CDT give good outcomes in carefully selected patients. A PELT team with the input of Obstetric Medicine specialists is invaluable in making these decisions. Reference Konstantinides, et al. 2019. ‘ESC Guidelines for the diagnosis and management of the acute pulmonary embolism developed in collaboration with the ERS’. ERJ. Vol 56Issue 2.

Background Sufficient exposure to rarer medical problems around pregnancy is a challenge during short rotations in obstetric medicine (OM). A Canadian research group created online clinical cases, the CanCOM cases, to overcome this. Methods We conducted an exploratory study to document the use and perceived utility of the CanCOM cases. 77 residents doing an OM rotation participated in our study. We used a survey to document their perception of CanCOM cases (12 items, 7-point scale), clinical exposure to several conditions (pre and post rotation; 41 items, 7-point scale) and use of the educational tool (1 item, 4-option scale). Results CanCOM cases was perceived as an accessible and useful tool. Participants completed a median of 6/20 cases (range 1–20), and highly recommended the cases (6.48 ± 0.73 SD on a 7-point Likert scale). Conclusion Despite some technical limitations, CanCOM cases was shown to contribute to clinical exposure to rare but essential medical conditions.

Background Simulation-based training’s impact on learning outcomes may be related to cognitive load or emotions during training. We evaluated the association of validated measures of cognitive load and emotion with learning outcomes in simulation-based obstetric internal medicine cases. Methods All internal medicine learners (n = 15) who completed the knowledge test pre-training, post-training (knowledge acquisition), and at 3–6 months (knowledge retention) for all three simulation cases were included. Results Mean knowledge scores differed over time in all three cases (p Conclusion Simulation-based education for obstetric internal medicine can be effective in select cases. Attention to cognitive load and emotion may optimize learning outcomes.

Background: Immune reconstitution inflammatory response syndrome (IRIS) is a recovery disease that may be triggered after starting ARV therapy in some individuals. The incidence of adverse pregnancy-fetal outcomes with IRIS has not been studied in Kenya among pregnant women, with focus only, on improved immune response and PMTCT after ART initiation. The indirect effect of ART, the maternal HIV - IRIS on pregnancy outcome has not been elucidated. More than 10% of the global burden of disease is due to pregnancy complications and adverse pregnancy and related birth outcomes and despite recent advances in obstetric medicine, pregnancy complications and adverse birth outcomes are a growing public health concern and economic burden on the health-care system. This has substantial burden of adverse pregnancy-fetal outcomes with prevalence of preterm birth, low birth weight, and small gestational age infants of 19.8%, 14.2%, and 12.6%, respectively, and of still birth and neonatal mortalityat1.9% and 0.4%, respectively. The aim of this study was to evaluate the effect of maternal HIV immune reconstitution inflammatory response syndrome on the risk of adverse pregnancy-fetal outcomes in HIV-1 positive; ART initiated pregnant women of reproductive age in selected hospitals, Nairobi, Kenya. Methodology: The study was conducted among 204 HIV-1 positive, ART initiated pregnant women of reproductive age in selected hospitals, Nairobi, Kenya. A prospective cohort study design was used where the subjects were recruited and followed from the end of first trimester for six and half months after they were confirmed to be HIV positive, and put on ARV treatment using a pretested data collection tool. Bivariate analyses with chi-square test to establish the association between the variables at p-value < 0.05. Logistic regression analysis was performed to identify independent outcome predictors. Adjusted relative risk at 95% confidence interval was determined. Results: The study indicated that, adverse pregnancy-fetal outcome cumulative incidence was 26.47% among women diagnosed with IRIS compared to 10.78% among women not diagnosed with IRIS. The incidence rate estimate was 0.012 and 0.0045 per person’s week respectively with a rate ratio of 012/.0045=2.7. Women with IRIS had 2.46 times the risk of experiencing an adverse pregnancy-fetal outcome compared to those who did not [OR=3; 95%CI: 1.4-6.4; P=.004]. LBW cumulative incidence was the highest with 11 (10.8%) among IRIS exposed women and 3 (2.9%) among non-IRIS exposed women and same case with PTB 8 (7.8%) and 3 (2.9%) respectively. Conclusion: There was a significant relationship of maternal HIV-immune reconstitution inflammatory response syndrome diagnosis with adverse pregnancy-fetal outcomes as a result of ART initiation among HIV-1 positive, pregnant women of reproductive age. This study observes that, being diagnosed with maternal HIV-IRIS following ART initiation during pregnancy among ART naive women is associated with experiencing an adverse pregnancy outcome. This should be a concern in clinical practice as IRIS has self-resolution, it may on the other hand affect pregnancy outcome negatively. PMTCT should integrate monitoring of suspected IRIS cases using the latest defined criteria for its diagnosis in pregnant women starting ant-retroviral therapy especially in resource limited areas. Article visualizations

Obstetric medicine is an emerging area of interest within Internal Medicine in Europe. Despite that, “OM” is still an unpopular concept and an unrecognised subspecialty in South Europe. A considerable number of internists and medical specialists deal with maternal medical problems in association with obstetricians and other specialists on a daily basis. Due to their interest and mostly part-time dedication to maternal care, a growing mass of physicians are getting specific training in the field either locally or, less frequently, abroad, and are also building specific clinics, inpatient care services and other new bonds with obstetricians in numerous tertiary care centres. In this article, we aim to describe the state of the growing field of obstetric medicine in Portugal, Italy, France and Spain, the particular clinical, educational and academic efforts and steps that have recently been developed by internists in each country, as well as planned initiatives for the future.

Herein I provide a reflection on the ethical and moral complexities that surround foetal surgery. Foetal surgery is an ethically complex area within obstetric medicine, which requires clinicians to exercise their own judgement about morality and personhood in making decisions about treatment. I reflect on my experience of observing a foetal medical procedure as a student and summarise the complex ethical challenges that arise during such procedures. I provide learning points at the end of the discussion that should stimulate medical students and junior medical team members to reflect on their own practice and how they use their experiences of morally complex cases to improve their future practice.

A career in obstetrics and gynaecology can be stimulating and rewarding. The specialty is wide ranging and there are opportunities to pursue different career paths depending on your interests and abilities. In years six and seven of specialty training, trainees undertake advanced training skills modules (ATSMs) or subspecialty training. The choice of ATSM is important as it will determine the special interests you follow in future consultant posts. You only need to complete two ATSMs to gain your certificate of completion of training (CCT) but if resources allow you can complete additional ones. There are 20 ATSMs to choose from.1 They are acute gynaecology and early pregnancy; advanced labour ward practice; advanced laparoscopic surgery for the excision of benign disease; benign abdominal surgery: open and laparoscopic; benign gynaecological surgery: hysteroscopy; clinical research; colposcopy; fetal medicine; high risk pregnancy; labour ward lead; medical education; menopause; obstetric medicine; oncology; paediatric and adolescent gynaecology; safe practice in abortion care; sexual health; subfertility and reproductive health; …

Access to better care and advances in obstetric medicine have led to a global reduction in maternal mortality rate. Although obstetric-related causes of death have decreased, the numbers of deaths relating to injuries have remained static. Suicide has been recognised as a significant cause of overall perinatal mortality. However there has been less consideration of the role of maternal homicide as a contributor to pregnancy-associated mortality. This review reports on international literature on maternal homicide. Rates were reported from 0.97 to 10.6 per 100 000 live births. Pregnancy-associated homicide rates were higher in the United States compared with other countries; it is unclear whether this is due to better case identification or represents an actual difference in risk. Women murdered in the perinatal period constituted a highly vulnerable group: they were younger, more likely to be from minority ethnic groups and unmarried. Domestic violence was a significant risk factor for attempted and completed homicide. This review demonstrates pregnancy–associated homicide is an important contributor to maternal mortality with rates comparable to suicide. Central to any strategy will be the identification of those at risk and these findings add to the importance of screening for current and previous domestic violence.

Background: Gynecological examination is important technique for protecting the reproductive health of woman. Aim: was to assess care given to woman undergoing gynecological examination. Setting: The study was conducted at gynecological unit at obstetric medicine department affiliated at Benha university hospital. Design: A descriptive study design was utilized. Sampling: a systematic random sample included 286 woman were recruited in the study. Tools: Three tools were utilized for data collection first, structured interviewing questionnaire, observational check list and womens’ satisfaction assessment tool. Results: The present study revealed that 50.2% of studied women had a satisfactory care during gynecological examination, 27.0% of them had a satisfactory care after examination Conclusion: more than half of the studied women were satisfied regarding care presented during gynecological examination. Recommendation: Developing training programs regarding gynecological examination are recommended for the nurses working at obstetric and gynecological units to improve quality of care given.