Obstetrics and Gynaecology

Development and design of a Delphi protocol to produce a consensus core information set for caesarean section (2025)

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Type of publication:

Conference abstract

Author(s):

Greenfield B.; *Elsmore A.; Frizelle J.; Bradley F.; Kingdon C.; Merriel A.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BMFMS Abstracts 2024. Liverpool United Kingdom. 132(Supplement 1) (pp 70), 2025. Date of Publication: 01 Jan 2025.

Abstract:

Objectives: Core information sets are a standardised way to guide discussions with patients to aid decision making for surgical procedures. 1-3 Informed decision making is foundational for ensuring women have agency and autonomy towards their pregnancy and reproductive choices.4 This work will produce a consensus expert opinion, via a Delphi method,5 of relevant information necessary for decision making regarding caesarean sections. Method(s): A scoping review of peer-reviewed publications was undertaken using electronic databases, alongside internet searches for patient information relating to caesarean section. Qualitative and mixed-method studies were reviewed to inform domains and questions. Think Aloud interviews with stakeholders (healthcare professionals and lay people) were conducted to ensure correct syntax and legibility, prior to Delphi distribution. Result(s): A total of 305 studies were identified, from which 345 information points were collected. Patient information leaflets, focus-group interviews, and surveys identified 60, 54 and 12 separate points, respectively. These were collated into 64 questions across 11 domains including indications, risks/benefits, and patient experience of elective/emergency caesarean sections. These questions were refined by 7 Think Aloud interviews until no further changes were identified. The resultant online Delphi (REDCap) is ready for distribution. There will be two rounds prior to a stakeholder consensus meeting in Q1 2024. Conclusion(s): The need for a core information set for caesarean section is evidenced by the disparate nature of current decision aids and proliferation of public information. This work has produced an information set ready for prioritisation by a Delphi panel to provide consistent information regarding caesarean sections.

DOI: 10.1111/1471-0528.18006

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Development of a core information set for caesarean section - A scoping review of patient information leaflets (2025)

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Type of publication:

Conference abstract

Author(s):

*Elsmore A.; Merriel A.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BMFMS Abstracts 2024. Liverpool United Kingdom. 132(Supplement 1) (pp 56-57), 2025. Date of Publication: 01 Jan 2025

Abstract:

Objectives: Good clinical practice mandates that women have full choice and autonomy for their care in pregnancy and childbirth and are armed with key information points to facilitate informed decision making.1 Development of a core information set will allow women to access consistent, accurate information, containing facts that are important to them.2 As part of this work, a scoping review of patient information leaflets was performed to identify information points. Method(s): We performed an internet search for patient information leaflets, articles, and electronic information sources, such as national and international medical, midwifery, or nursing organisations, from health providers (e.g. NHS), and non-governmental organisations. The search terms were 'caesarean section', 'caesarean section UK', and 'caesarean section patient information leaflet'. Data points were extracted and entered into a database in Microsoft ExcelTM. Result(s): Information points were extracted from 50 sources with 60 separate information points collected. Data collection ceased at 50 sources as saturation was reached. Sources included national organisations, trust patient information leaflets, private care providers, and patient organisations. The number of information points per source ranged from 2 to 40. The type of anaesthetic was the most common information point found, in 78% of sources (39/50); the least common was increased risk of neonatal death in first 28 days in 2% of sources (1/50). Conclusion(s): A large degree of heterogeneity of information points within patient information leaflets was noted, reinforcing the need for the development of a core information set for caesarean section. Women must be provided with consistent information regarding different types of delivery

DOI: 10.1111/1471-0528.18006

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Remote home cardiotocography: A systematic review and meta-analysis (2026)

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Type of publication:

Systematic Review

Author(s):

Le Vance, Jack; *Adeoye, Adekunle; Man, Rebecca; Eltaweel, Nashwa; Gurney, Leo; Morris, R Katie; Hodgetts Morton, Victoria.

Citation:

PLOS Digital Health. 5(1):e0001184, 2026 Jan.

Abstract:

Cardiotocography (CTG) is a common investigative modality in obstetrics to evaluate the fetal condition. Advancements in digital technology has enabled the innovation of CTG monitoring for usage in the home setting. This review aims to comprehensively examine the current evidence on the effectiveness and applicability of home antenatal CTG monitoring. MEDLINE, EMBASE, Cochrane, Web of Science, and PubMed databases were searched from inception to June 2025. Primary studies examining home antenatal CTG were included. For randomised controlled trials (RCTs), the joint primary outcomes were perinatal mortality and emergency caesarean section. For observational studies, the feasibility, diagnostic accuracy, qualitative and economic burden of home CTG were evaluated. RCTs were eligible for meta-analysis using risk ratio or mean difference, with 95% confidence intervals. Included observational studies were narratively described due to significant methodological heterogeneity. 39 studies (28 observational, seven RCTs and four qualitative studies), comprising of 7240 participants were included. Home antenatal CTG monitoring was non-inferior to conventional care across all meta-analysed maternal, perinatal and healthcare usage outcomes. GRADE assessments were low/very low quality of evidence. Home CTG monitoring was feasible in several settings and remote interpretation was graded as moderate to excellent. Transmission failures were frequently low but commonly occurred due to infrastructure and/or equipment errors. Remote CTG monitoring demonstrated comparative capabilities to conventional CTG with respect to coincidence and beat-to-beat variability. Overall acceptability ratings were high for patient and providers. Often implementation costs were high but accrued back by non-fixed savings when compared against routine care. High-quality studies were underrepresented, particularly when assessing service-led and safety outcomes. Home antenatal CTG monitoring demonstrates noninferiority to conventional care across several outcomes, representing a promising avenue for antenatal management However, current evidence is of low quality and additional high-quality evidence with sufficient methodological detail and standardised outcome assessment is required prior to making definitive recommendations.

DOI: 10.1371/journal. pdig.0001184

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An audit of testosterone referrals to the menopause clinic (2024)

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Type of publication:

Conference abstract

Author(s):

*Clark M.; *Magar C.P.; *Ritchie J.

Citation:

Post Reproductive Health. Conference: 33rd British Menopause Society Annual Scientific Conference, BMS 2024. Kenilworth United Kingdom. 30(1 Supplement) (pp 12S), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Objective: Referrals to the menopause clinic for testosterone and low libido have steadily increased. Locally, we have written prescribing information for primary care to follow, after testosterone initiation in the menopause clinic. This prescribing information adheres to British Menopause Society (BMS) guidelines but has only recently been introduced. The objective of this audit was to determine if the BMS guidelines are currently being followed. Method(s): Retrospective case note review of a selection referrals to the Menopause by two speciality registrars training in Menopause. The electronic patient records were reviewed using pre-determined criteria and recorded on the same secure spreadsheet. Result(s): A total of 245 patient notes were reviewed, of these patients 35 had been specifically referred to request testosterone. 33 of these 35 patients were able to fully discuss testosterone in the menopause clinic. All patients were already taking Hormone replacement therapy (HRT). 32 patients reported that their libido had changed around the time of the menopause. Only 15 patients were already taking vaginal estrogen. 6 patients did not have a baseline testosterone level prior to commencement of testosterone. 24 patients were subsequently started on testosterone. Only 10 patients had reported testosterone levels at 3 months. 4 were referred for psychosexual counselling. Conclusion(s): This audit demonstrated how locally we would benefit from keeping a specific log of patients on testosterone. This is to ensure that patients have their baseline testosterone levels and subsequent monitoring, to make sure testosterone levels are being kept in the physiological range. Our audit showed only a small proportion of patients were already using vaginal estrogen, Vaginal dryness can be a contributing factor to low libido. By increasing uptake in vaginal estrogen this may help some patients prior to their referral or potentially reduce the need for referral. In addition, psychosexual counselling was provided for some of these patients and identified further contributing factors towards low libido, highlighting the importance of a holistic approach to the management of low libido. In those where testosterone was not commenced, this was mostly due to low estrogen levels therefore HRT regimes were altered to optimise absorption prior to considering testosterone.

DOI: 10.1177/20533691241273937

Postmenopausal bleeding in women taking HRT - Quality improvement project (2024)

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Type of publication:

Conference abstract

Author(s):

*Magar C.K.P.; *Radothra A.; Gbenga A.; *Ritchie J.;

Citation:

Post Reproductive Health. Conference: 33rd British Menopause Society Annual Scientific Conference, BMS 2024. Kenilworth United Kingdom. 30(1 Supplement) (pp 33S-34S), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Objective: Since the 'Davina Effect', there has been rise in the demand for HRT, with a significant increase in HRT prescriptions up by 35% compared to 2021/22, as result there has been an increase in patients presenting with Postmenopausal bleeding on HRT attending our one stop hysteroscopy clinic. The aim of this study was to identify the number of cancers in patients presenting with postmenopausal bleeding who are taking HRT attending our one stop hysteroscopy clinic. Method(s): Prospective study with a sample size of 100 cases. Patient selection – Any patient coming to one stop hysteroscopy clinic with Postmenopausal bleeding on HRT. Sample period: 1st January 2023 to end of August 2023. Data was collected from the patient directly in the designed proforma then scanned to the Microsoft Excel. Result(s): 91% were postmenopausal with average age of 50-59 years and 90% of patient were taking continuous combined HRT. 9% were premenopausal on sequential HRT. 61% of women were on HRT for >12 months however 4% were referred within 3 months of HRT and 10% within 3-6 months. Following transvaginal ultrasound scan, 9% of patients were reassured and discharged, 36% underwent endometrial biopsy and 55% underwent hysteroscopy and endometrial biopsy. 2% were diagnosed with endometrial cancer and 89% had normal histology with a benign cause to explained their postmenopausal bleeding. Of the two patients diagnosed with endometrial cancer, one patient had a endometrial thickness (ET) of 4mm and one of 13mm. The patient with an ET of 4mm was also low risk with a normal BMI, and had been on HRT for 6 months. Conclusion(s): Cancer rate detected in our population is 2% which is very similar to the national rate (1-2%). This result highlights the importance of investigating patients with Postmenopausal bleeding on HRT with endometrial thickness of >=4 mm.

DOI: 10.1177/20533691241273937

Streamlining administrative processes by analysing how delayed benign histology results letters were done for 2-Weeks- Wait (2WW) gynaecology oncology patients (2024)

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Type of publication:

Conference abstract

Author(s):

*Khanh Kieu X.M.; *Sahu B.; *Ghumaann M.K.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BGCS ASM 2024. Liverpool United Kingdom. 131(Supplement 4) (pp 34), 2024. Date of Publication: 01 Oct 2024.

Abstract:

Aims: A quality improvement project to identify bottlenecks to the delayed result letters to patients on the 2WW pathway and evaluate the use of a template letter that can be beneficial to both staff and patients. Background(s): The aim of the 2-week- wait pathway is to expedite the diagnosis and treatment of potential cancer cases. From the patient's point of view, the 2WW pathway would not officially end until the final histology result reached the patient. Method(s): We conducted two retrospective audits before and after the implementation of the benign histology template in a span of one month. The date of the primary care referral is day 0. The date and time for the 2WW patients' histology final report can be obtained from SATH's medical electronic platform called Portal. We can then calculate how many days it will take for the result letter to be ready from day 0 of the initial referral. Result(s): Roughly 80% of these patients have benign histology results. Yet, the average time for a 2WW benign histology result letter to be issued is 51 days, counting from their initial 2WW referral. After implementation of template letter, the average waiting time for result has decreased to 37 days. Conclusion(s): The implementation proposal depends greatly on the Trust budget, and further consideration for speech recognition technology training will need a thorough discussion. A benign histology result template would be a cost-effective solution to reduce the unnecessary typing delay.

DOI: 10.1111/1471-0528.17941

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Feasibility of same day discharge following total laparoscopic hysterectomy in District General Hospital (2024)

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Type of publication:

Conference abstract

Author(s):

*Malik N.; *Sahu B.; *Parry-Smith W.; *Elsheikh M.;

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: RCOG 2024. Muscat Oman. 131(Supplement 5) (pp 20), 2024. Date of Publication: 01 Oct 2024.

Abstract:

Introduction: Hysterectomy is one of the commonest gynecologic surgical procedures and an increasing number of hysterectomies are being completed minimally invasively. Previously, hysterectomies have been performed as in-patient operative procedures to manage post-operative pain and monitor post-operative complications such as symptomatic anemia or delayed return of bowel function. Studies have described same-day discharge after laparoscopic hysterectomy to be safe and acceptable and same-day discharge can reduce hospital costs and decrease iatrogenic complications associated with hospitalization such as venous thromboembolic complications due to delayed mobilization or infections. A quality improvement project to assess the feasibility of implementing same-day discharge protocols for patients undergoing total laparoscopic hysterectomy (TLH) in district general hospital in west midlands. <br/>Design(s): A quality improvement project was conducted to evaluate success rates of same-day discharge, adherence to pre and postoperative protocols, incidence of complications, readmission rates, and patient satisfaction levels. Material(s) and Method(s): The project involved analysing clinical records of patients who underwent TLH for benign and oncological indications over a six-month period (May2023 to October 2023) at shrewsbury and telford NHS Trust. Compliance with multimodal perioperative protocols, readmission rates, and patient satisfaction were assessed retrospectively. Result(s): Out of 40 cases of Total laparoscopic hystrectomies, 12 cases (30%) were successfully discharged on the same day. Further analysis revealed that oncological cases had a higher same-day discharge rate (40%) compared to benign cases (12%). Reasons for overnight stay were, anxiety (5 patients), Haematuria (2 patients), Surgeons decision (10 patients), drain insitu (3 patients) social reasons (5 patients) and no reason was documented in three patients. Two patients were readmitted in 24-48 h with pain and infection symptoms. Conclusion(s): In gynecology, laparoscopic hysterectomy has become increasingly prevalent due to its minimally invasive nature. This shift aims to enhance patient outcomes and reduce healthcare costs. The findings of this study indicate that same-day discharge following TLH is feasible without compromising patient safety. Key factors contributing to successful implementation include standardized techniques, collaboration with anesthestists and theatre teams, adequate postoperative nursing care, and comprehensive preoperative patient counseling. This study underscores the importance of a coordinated approach involving various healthcare professionals to ensure successful same-day discharge protocols for TLH patients. By optimizing perioperative care pathways and patient education, hospitals can effectively implement same-day discharge practices, thereby improving patient experience and resource utilization.

DOI: 10.1111/1471-0528.17946

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Menopause training among obstetrics & gynaecology trainees in UK: Are we getting it right? (2024)

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Type of publication:

Conference abstract

Author(s):

*Malik N.; *Sahu B.; *Wood M.; *Afzal M.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: RCOG 2024. Muscat Oman. 131(Supplement 5) (pp 129-130), 2024. Date of Publication: 01 Oct 2024.

Abstract:

Background: The menopause has garnered significant media attention in recent times due to the rising number of working menopausal women, accounts of women being disregarded, and anxiety surrounding the prescription and usage of hormone replacement therapy (HRT) due to lack of training and knowledge gap among physicians. It is a normal, natural, and inevitable part of ageing. Yet for too long, too many people experiencing menopause have struggled with societal stigma, inadequate diagnosis and treatment, workplace detriment and discrimination. The management of menopausal symptoms requires a comprehensive understanding and specialized training, particularly among obstetrics and gynecology trainees in UK. The national survey was conducted among obstetrics and gynecology trainees to evaluate the depth of knowledge with regards to management of menopause and menopause services provided at their hospital and training opportunities. Participants and Methods: This online Menopause Training review surveyed 103 postgraduate obstetrics and gynecology trainees in the UK from September 2023 to October 2023. The national survey was distributed to all deaneries in the UK for circulation to all their trainees via social media, WhattsApp groups and emails. The survey comprised of questions regarding trainees' level of training, country of training, menopause clinics in their hospital, their clinic regularity, and any designated lead clinician for menopause clinics in their hospital, management of menopause, the trainees' confidence advising patients with menopausal symptoms, and any benefit from their patient care. Result(s): The majority of responders 70 (68.63%) belonged to England followed by 21 (20.59%) Wales and Ireland 11 (10.78%). About 56 (54.36%) had a menopause clinic in their hospital and 46 (45.10%) responders conducting regular clinics. Approximately 44 (42.72%) had a designated lead clinician present in their hospital. Specific trust guidelines on the management of menopause were applied in 30 (29.13%). About 21 (20.39%) respondents felt confident advising patients with menopausal symptoms and 99 (96.12%) participants thought that going through additional formal menopause training could benefit patient care.It is imperative to adopt a novel pedagogical strategy for teaching menopause in healthcare curriculum. Conclusion(s): The survey emphasized that the need for ongoing evaluation and enhancement of menopause training programs for obstetrics and gynaecology trainees in the UK to ensure optimal patient care during this critical life stage.

DOI: 10.1111/1471-0528.17946

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Oxygen Prescriptions for Gynaecology Inpatients (2025)

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Type of publication:

Service improvement case study

Author(s):

*William Roberts

Citation:

SaTH Improvement Hub, December 2025

SMART Aim:

Trust policy for all inpatients to have a target oxygen saturation identified on admission. Widespread issue with poor oxygen prescription compliance across the country. 47% (n = 15) of gynae inpatients had no oxygen prescribed. Incorrect/absent prescriptions have the potential to cause harm. Target compliance 80%

Link to PDF poster