Obstetrics and Gynaecology

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%

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A Multicomponent Intervention to Improve Maternal Infection Outcomes (2025)

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Type of publication:

Journal article

Author(s):

Lissauer, David; Gadama, Luis; Waitt, Catriona; Whyte, Sonia; Burnside, Girvan; Anilkumar, Aiswarya; Makuluni, Regina; Okwaro, Peace; Yang, Liu; Waitt, Peter; Musopole, Owen; Bilesi, Rosemary; Maseko, Bertha; Lwasa, Joel; Mugahi, Richard; Olaro, Charles; Lamorde, Mohammed; Makuta, Mirriam; Kachiwaya, Chimwemwe; Mkandawire, Tionge; Malunga, Adrian; Chitsulo, Nyadani; Abitimo, Prisca; Ayabo, Tabitha; Weeks, Andrew; Martin, James; Hemming, Karla; Gallos, Ioannis; Monk, Edward J M; Riches, Jennifer; Chapuma, Chikondi; Nanyondo S, Judith; Lorencatto, Fabiana; Monahan, Mark; Allegranzi, Benedetta; Dunlop, Catherine; Atkins, Lou; Rosala-Hallas, Anna; Roberts, Tracy; Gamble, Carrol; Malata, Address; Desmond, Nicola; Kommwa, Edward; Merriel, Abi; *Parry-Smith, William; Smith, Rebecca; Ndumu, Ivy; Williams, Eleanor; Faque, Bob; Banda, Gertrude; Nyondo-Mipando, Alinane L; Twimukye, Adelline; Chater, Tim; Diplas, Aristotelis; Brizuela, Vanessa; Souza, Joao Paulo; Rylance, Jamie; Cheshire, James; Hawker, Lydia; Coomarasamy, Arri; Bonet, Mercedes.

Citation:

New England Journal of Medicine.  2025 Nov 19.

Abstract:

BACKGROUND: Maternal infection and sepsis are major causes of maternal death and severe illness worldwide, particularly in low- and middle-income countries. Inconsistent implementation of evidence-based recommendations for infection prevention and management and delays in detection and treatment of maternal sepsis contribute to the number of preventable deaths.

METHODS: We conducted a cluster-randomized trial to assess a multicomponent intervention, the Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) program. This program was designed to support health care providers in achieving three goals: adherence to World Health Organization (WHO) hand-hygiene standards; adoption of evidence-based practices for maternal infection prevention and management; and early detection of sepsis and use of the FAST-M (fluids, antibiotics, source control, transfer if required, and monitoring) treatment bundle. Usual care was provided in the control group, along with dissemination of guidelines. The primary outcome was a composite of infection-related maternal death, infection-related near-miss event (events in which women survived a life-threatening complication), or severe infection-related illness (deep surgical-site, deep perineal, or body-cavity infection) among women who were pregnant or had recently been pregnant.

RESULTS: We randomly assigned 59 health facilities (where 431,394 women gave birth during the trial) in Malawi and Uganda to the intervention group (30 clusters) or the usual-care group (29 clusters). A primary-outcome event occurred in 1.4% of the patients in the intervention group and in 1.9% of those in the usual-care group (risk ratio, 0.68; 95% confidence interval, 0.55 to 0.83; P<0.001). This effect was generally consistent between countries and among facilities of difference sizes and was sustained over time.

CONCLUSIONS: Implementation of the APT-Sepsis program led to a significantly lower risk of a composite of infection-related maternal death, infection-related near-miss event, or severe infection-related illness than usual care. (Funded by the Joint Global Health Trials scheme and others; APT-Sepsis ISRCTN number, ISRCTN42347014.).

DOI: 10.1056/nejmoa2512698

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Elective Hub High Flow List- Gynae (2025)

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Type of publication:

Service improvement case study

Author(s):

*Martyn Underwood

Citation:

SaTH Improvement Hub, July 2025

SMART Aim:

To increase utilisation on an all day theatre list on the 16th of July 2025. Sub aim: To increase number of cases on an all day theatre list by 1 on the 16th of July 2025.

Link to PDF poster

Evaluation of outcomes in patients with pelvic pain in paediatric gynaecology clinics (2025)

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Type of publication:

Conference abstract

Author(s):

*Wadi T.; SudhakarKalaivani N.; George A.; McCan A.; *Ritchie J.; O'Mahony F.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: RCOG World Congress 2025. London United Kingdom. 132(Supplement 5) (pp 137), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background: Pelvic pain is a common problem encountered in the paediatric and adolescent gynaecology clinic. Pelvic pain has an impact of the patients attendance at school, mood and quality of life. Diagnosing conditions such as endometriosis can be challenging in adolescents as most of the literature and guidelines are for adults. Objective(s): To evaluate the outcomes for patients with primary presentation of non-acute pelvic pain, reviewing the management offered and assessing the response. Design(s): This study employs a retrospective design, analyzing patient data from two secondary care clinics to evaluate treatment pathways for adolescents with chronic pelvic pain. By reviewing patient journeys from referral to discharge, we aim to assess treatment effectiveness and identify gaps in care. Method(s): Both clinic database's were screened to include all patients who attended, for 12 months for the tertiary unit and 18 months for the smaller DGH. All consultations were screened for reason for attendance, and only those who attended for non-acute pelvic pain were followed up for the outcomes. Follow up consultations were additionally reviewed. <br/>Result(s): Initial screening of 438 referrals found 104 patients at tertiary centre and 20 at DGH attended with pelvic pain. In both majority were offered and managed medically with hormonal treatment. One patient at DGH was offered and booked for surgery but this was later cancelled by the patients as her symptoms were improved with medical management. Two are currently on the surgical waiting list at the tertiary centre. Across both sites, all patients diagnosis relied upon clinical history first line, supported by optimal medical management, thus adhering the ESHRE endometriosis guidelines. Conclusion(s): With increasing awareness of conditions l ike endometriosis there are increasing number of referrals for pelvic pain. Optimising medical management can prevent the immediate need for diagnostic laparoscopy, which is beneficial due to the long waiting lists for surgery Reassuring most were managed with medical management and showed improvement in symptom control.This is important as the guidance on managing endometriosis in adolescents is still unclear.

DOI: 10.1111/1471-0528.18215

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Barriers to the safe discussion of the experience and management of menopausal symptoms: A systematic literature review (2025)

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Type of publication:

Journal article

Author(s):

Thavabalan, Karish; *Ovenell, Alistair; Pierce, Poppy; Sutaria, Aman; Parkhouse, Annabelle; Baydemir, Numan; Lally, Theodore.

Citation:

Maturitas. 201:108683, 2025 Aug 05.

Abstract:

As the number of women experiencing menopause continues to rise each year, the need for open and supportive discussions around the experience and management of menopausal symptoms becomes more imperative. Although research has identified numerous challenges women face during this life stage, many studies examine these barriers in isolated settings. Furthermore, how these challenges impact women's ability to safely discuss menopause remains poorly understood. This systematic literature review
sought to identify and synthesise the barriers that hinder safe discussions about the experience and management of menopausal symptoms. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, 21 qualitative studies were included. Six themes were identified regarding symptom experience: lack of support from friends and family, lack of workplace support, fear of menopause onset, variation in symptom experience, poor-quality information, and societal judgement. Two themes were identified regarding symptom management: perceived onus to endure symptoms and poor experiences with healthcare professionals. Notably, the themes revealed widespread shortcomings that collectively hinder safe discussions about menopause. Future work should prioritise intersectional approaches that tackle barriers across home, social, work, and healthcare settings. Proactive measures, such as placing a greater emphasis on menopause in medical education and developing culturally relevant resources, are crucial for fostering safe, informed discussions and improving care for all women.

DOI: 10.1016/j.maturitas.2025.108683

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Effects of Race, Ethnicity and Socioeconomic Deprivation on Postpartum Haemorrhage in High-Income Countries: A Systematic Review and Meta-Analysis (2025)

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Type of publication:

Systematic Review

Author(s):

*Elsmore, Amy; Alayande, Gbenga; Mainwaring, Elizabeth; Jafarpour, Mahfam; Rimmer, Michael P; Cockburn, Neil; *Curtis, Jason; *Ilaalagan, Ragave; Al-Wattar, Bassel; Bell, Sarah; *Karunakaran, Bala; *Parry-Smith, William; Wu, Pensee.

Citation:

BJOG: An International Journal of Obstetrics & Gynaecology.  2025 Jul 09.

Abstract:

BACKGROUND: Postpartum haemorrhage (PPH) is a leading cause of mortality and morbidity globally. While individual studies have revealed disparities in outcomes, a comprehensive summary of PPH risk across diverse groups is lacking.

OBJECTIVES: To quantify the association between ethnicity, deprivation and risk of PPH in high-income countries (HICs).

SEARCH STRATEGY: A systematic search of MEDLINE, CINAHL, EMBASE and Google Scholar from inception to 20 August 2024.

SELECTION CRITERIA: Observational and experimental studies from HICs that reported the outcome of PPH in at least two ethnic or socioeconomic groups.

DATA COLLECTION AND ANALYSIS: Two reviewers performed independent data extraction. A random-effects model was used to estimate the risk. A subgroup analysis was performed by geographical region and time period.

MAIN RESULTS: A total of 79 studies with 169 579 388 women were included, spanning 15 HICs. Ethnic minority women experienced a higher risk of PPH compared to the majority White or European group. This was seen across Black (OR 1.16, 95% CI 1.09, 1.23), Asian (OR 1.33, 95% CI 1.27, 1.39), Hispanic (OR 1.20, 95% CI 1.12, 1.29) and women from the minority ethnic group within a given study (OR 1.13, 95% CI 1.03,1.24). Due to data limitations, eight studies on PPH and socioeconomic status were summarised
narratively, indicating a higher PPH risk for those experiencing deprivation.

CONCLUSIONS: Women from an ethnic minority background or exposed to socioeconomic deprivation had an increased risk of PPH in HICs. Standardisation of data collection for ethnicity and socioeconomic status is recommended to accurately quantify and address these disparities.

DOI: 10.1111/1471-0528.18278

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Induction of labour versus standard care to prevent shoulder dystocia in fetuses suspected to be large for gestational age in the UK (the Big Baby trial): a multicentre, open-label, randomised controlled trial (2025)

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Type of publication:

Randomised controlled trial

Author(s):

Gardosi, Jason; Ewington, Lauren Jade; Booth, Katie; Bick, Debra; Bouliotis, George; Butler, Emily; *Deshpande, Sanjeev; Ellson, Hanna; Fisher, Joanne; *Gornall, Adam; Lall, Ranjit; Mistry, Hema; Naghdi, Seyran; Petrou, Stavros; Slowther, Anne-Marie; Wood, Sara; Underwood, Martin; Quenby, Siobhan.

Citation:

Lancet. 2025 May 01.

Abstract:

BACKGROUND: The benefits and harms of early induction of labour to reduce shoulder dystocia in fetuses suspected to be large for gestational age (LGA) are uncertain. We aimed to investigate whether early induction of labour is associated with a reduced risk of shoulder dystocia compared with standard care.

METHODS: In this open-label, randomised controlled phase 3 trial, women aged >=18 years with a suspected LGA fetus (estimated fetal weight >90th customised percentile) as identified by ultrasound scan between 35 weeks and 0 days (35+0 weeks) of gestation and 38+0 weeks' gestation, recruited from 106 hospitals across England, Scotland, and Wales in the UK, were randomly assigned (1:1) by web app to standard care or induction of labour between 38+0 weeks' gestation and 38+0 weeks' gestation using minimisation, balancing site, estimated fetal weight percentile (<=95th EFW percentile or >95th EFW percentile), and maternal age (<=35 years or >35 years). Key exclusion criteria included drug-treated diabetes, gestational diabetes, and elective caesarean section or induction already planned or indicated for any reason. Our primary outcome was incidence of shoulder dystocia, assessed by a masked independent expert adjudication panel who reviewed participants' delivery notes. Induction of labour was anticipated to result in birth 10.5 days earlier with a 300 g lower birthweight on average than standard care. We did an intention-to-treat (ITT) analysis in all participants for whom we had primary outcome data, and a per-protocol analysis in participants in the induction group who went into labour or were induced at 38+0 to 38+0 weeks' gestation versus participants in the standard care group who had not started labour, been induced, or had an elective caesarean section before 38+0 weeks' gestation. This study was registered with ISRCTN (18229892) and is no longer recruiting.

FINDINGS: Between June 8, 2018, and Oct 25, 2022, 2893 women were randomly assigned to induction of labour (n=1447) or standard care (n=1446); the trial was terminated before the target of 4000 participants was reached on advice of the data monitoring committee following the lower-than-expected incidence of shoulder dystocia in the standard caregroup. Two participants in the induction group and seven in the standard care group had missing data for the primary outcome and were excluded from the ITT analysis. In the ITT analysis, 33 (2.3%) of 1445 babies in the induction group versus 44 (3.1%) of 1439 in the standard care group had shoulder dystocia (risk ratio [RR] 0.75 [95% CI 0.51-1.09]; p=0.14) with a mean difference of -6.0 days' (95% CI -6.3 to -5.6) gestation and -163.6 g (-190.0 to -137.1) birthweight between trial groups. 355 (24.6%) of 1446 mothers in the standard care group were induced, delivered, or went into labour at or before 38+0 weeks' gestation. In the per-protocol analysis, 27 (2.3%) of 1180 babies in the induction group versus 40 (3.7%) of 1074 in the standard care group had shoulder dystocia (RR 0.62 [0.41-0.92]; p=0.019), and there was a mean difference of -8.1 days' (-8.4 to -7.9) gestation and -213.3 g (-242.0 to -184.6) birthweight between trial groups. One neonatal death occurred from perinatal asphyxia after shoulder dystocia in the standard care group, and one neonatal death occurred following sepsis and congenital pneumonia in the induction group. 88 (6.1%) of 1447 mothers in the induction group had an adverse event versus 108 (7.5%) of 1446 in the standard care group (RR 0.81 [0.62 to 1.06]; p=0.13). Similar numbers of serious adverse events were reported in both groups.

INTERPRETATION: No significant difference in incidence of shoulder dystocia was found between trial groups in the ITT analysis, probably due to the high proportion of earlier-than-expected deliveries in the standard care group reducing the intended between-group differences in gestational age and birthweight. However, in the per-protocol analysis, compared with all deliveries after 38+0 weeks' gestation, induction of labour between 38+0 weeks' gestation and 38+0 weeks' gestation did show a significant reduction in shoulder dystocia. This study provides pregnant women with suspected LGA fetuses and their clinicians important information about choices and decision making for timing and mode of birth.

DOI: 10.1016/ S0140-6736(25)00162-X

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