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24 results

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  • Chapter 6 - Vaginal Prolapse and Previous Prolapse Surgery

  • Edited by Swati Jha, Sheffield Teaching Hospital NHS Foundation Trust, Priya Madhuvrata, Sheffield Teaching Hospital NHS Foundation Trust
  • Book:
    Gynaecology for the Obstetrician
    Published online:
    14 July 2023
    Print publication:
    03 August 2023, pp 50-60

  • Summary

    Pelvic organ prolapse is a common gynaecological problem and often requires surgical management. It is therefore inevitable that vaginal prolapse will also be encountered in pregnancy. Antepartum prolapse is managed conservatively with pessaries and physiotherapy, though occasionally more active surgical intervention will be required. Intrapartum complications in women going into labour with a prolapse are uncommon, however may occur and the commonest problems encountered are cervical dystocia and cervical lacerations. Mode of delivery remains controversial. Women usually have a recurrence of prolapse post-natally and treatment needs to be tailored to patient preferences.

Gynaecology for the Obstetrician
  • Edited by Swati Jha, Priya Madhuvrata
  • Published online:
    14 July 2023
    Print publication:
    03 August 2023
  • In this era of specialisation, obstetricians are becoming increasingly skilled at their jobs and deskilled in areas outside their expertise. In recent years, the education and training curricula for obstetrics and gynaecology has changed, with obstetricians expected to manage women with complex gynaecological problems encountered during pregnancy and the postnatal period competently, despite training and curricula not covering these problems in detail. Exploring common gynaecological problems such as ovarian cysts, management of vaginal prolapse and female genital mutilation, this practical book offers guidance for managing these conditions throughout the different stages of pregnancy and post-partum. Each chapter has a section on good governance, discussing salient points for clinical practice to improve patient safety and satisfaction, as well as reducing complaints and litigation. This hands-on book provides obstetricians around the globe with the evidence-based knowledge needed to deliver high quality care to pregnant women.

  • Chapter 22 - Incontinence Surgery and Bladder Care

  • Edited by Swati Jha, Eloise Power
  • Book:
    Lessons from Medicolegal Cases in Obstetrics and Gynaecology
    Published online:
    22 April 2022
    Print publication:
    12 May 2022, pp 277-290

  • Summary

    The claimant was 35 years old at the time of referral for stress urinary incontinence and the index surgery (in 1999). She had previously undergone a hysterectomy five years prior to the index event. Urodynamic studies confirmed mixed urinary incontinence and conservative treatment in the form of pelvic floor muscle training had failed to alleviate her symptoms. The patient was overweight with a BMI of 34. She was offered an open colposuspension which she agreed to. This case predates the synthetic midurethral slings when colposuspension was the standard surgical procedure offered for stress urinary incontinence. At the time of surgery, she suffered serious blood loss requiring embolisation of the internal iliac artery.

  • Chapter 3 - Being a Medicolegal Expert and Report Writing

  • Edited by Swati Jha, Eloise Power
  • Book:
    Lessons from Medicolegal Cases in Obstetrics and Gynaecology
    Published online:
    22 April 2022
    Print publication:
    12 May 2022, pp 30-40

  • Summary

    The Civil Procedure Rules (CPR) defines an expert in general terms as a “person who has been instructed to give or prepare expert evidence for the purpose of proceedings”. A “single joint expert” is an expert instructed to prepare a report for the court on behalf of two or more of the parties (including the claimant) to the proceedings. When making decisions in negligence claims, the courts rely heavily on the advice and opinions of the experts, and in clinical negligence claims this is provided by clinicians. Experts should be used appropriately, and their duty is always to the court rather than as an advocate of either party. But as medicine is not an exact science, often there will be a difference of opinion even with the views of experts.

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