Obstetrics and Gynaecology

Management of post-menopausal women who are high-risk HPV positive with normal, borderline, or mildly dyskaryotic cytology and unsatisfactory colposcopy (2026)

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Type of publication:

Conference abstract

Author(s):

Stout A.; *Sutherland D.; China S.; Byrom J.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BGCS 2026 Book of Abstracts. Bristol United Kingdom. 133(Supplement 2) (pp S80-S81), 2026. Date of Publication: 01 Jun 2026.

Abstract:

Background: Unsatisfactory colposcopy is common, occurring in 10-20% of women. Post-menopausal women who are high-risk HPV positive with normal, borderline, or mildly dyskaryotic cytology and unsatisfactory colposcopy represent an increasing management dilemma. Currently, there is no guideline for this group. Management among UK colposcopists is thought to vary. Objective(s): Our survey aimed to collate opinions of BSCCP members regarding management of this patient group, and identify a consensus opinion. We sought to compare trends with a similar survey conducted in 2018, following the introduction of primary HPV screening. Method(s): All BSCCP members were invited to complete an online survey conducted between 29/01/2026 and 05/03/2026. Result(s): We received 141 responses from medical and nursing colposcopists, the majority being experienced practitioners. Management strategies varied considerably. 60.7% would perform see-and-treat LLETZ in all or high-risk patients, while 17.9% would never offer treatment at first review. If histology was not obtained initially, 52.9% recommended repeat cytology and colposcopy at 12 months. For persistent disease >24 months, 52.2% recommended LLETZ, with an additional 45.6% considering treatment based on patient preference or risk factors. Hysterectomy was offered by 84.9% in persistent cases with risk factors or on request. Compared with 2018, see-and-treat LLETZ was more common, follow-up intervals were longer, and MDT discussion less frequent. Conclusion(s): Practice among UK colposcopists in this patient group remains variable, and demand for national guidance is high. Our survey demonstrated variety in practise on initial presentation, with a preference for excisional treatment or hysterectomy in cases of persistent disease.

DOI: 10.1111/1471-0528.70281

Variation in antenatal anaemia guidelines across the NHS in the United Kingdom: A cross-sectional study (2026)

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Type of publication:

Journal article

Author(s):

Haynes S.; Balboula I.; Collins P.; *Parry-Smith W.; Fye H.; *Elsmore A.; Collis R.; De Lloyd L.; Churchill D.; Bell S.F.; Stanworth S.J.

Citation:

British Journal of Haematology. (no pagination), 2026. Date of Publication: 2026. [epub ahead of print]

Abstract:

Antenatal anaemia affects up to 30% of pregnant women in the United Kingdom and is a recognised clinical priority. National management guidance is published by the British Society of Haematology (BSH), but the extent to which local National Health Service (NHS) guidelines align with it is unknown. We conducted a cross-sectional document analysis of antenatal anaemia guidelines from 49 NHS sites across the United Kingdom, obtained through two national research programmes. Two reviewers independently extracted data on screening, diagnosis, treatment and monitoring, using the 2020 BSH guideline as the national reference standard. The included guidelines represented approximately 33% of annual UK births. Screening and diagnostic haemoglobin thresholds were broadly consistent with BSH guidance, whereas substantial variation was concentrated in treatment and monitoring: oral iron indications, dosing and duration; haemoglobin thresholds and clinical criteria for intravenous iron; and the timing, biomarkers and response definitions used after treatment. Ferritin thresholds, reassessment intervals and response criteria were frequently absent or divergent. Variation was greatest in domains where the underlying evidence base is least resolved. These findings characterise the nature and extent of guideline-level variation across NHS maternity care and identify priority areas for future research and national guideline development.

DOI: 10.1111/bjh.70780

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Improving the Obstetrics & Gynaecology Induction Process (2026)

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Type of publication:

Service improvement case study

Author(s):

*Alessandra Fraser-Pye, *Isabel Barber-Chavez, *Emily Drage

Citation:

SaTH Improvement Hub, May 2026

SMART Aim:

Improve the induction process for Obstetric & Gynaecology for medical colleagues by the 31st May 2026 as evidenced by an increase in self rated job confidence via a survey of the Tier 1 doctors.

Link to PDF poster

Quality improvement programme for 2 week wait Gynaecology suspected cancer referrals 90-day review (2026)

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Type of publication:

Service improvement case study

Author(s):

*Claire Carr

Citation:

SaTH Improvement Hub, April 2026

SMART Aim:

To improve the triage system for patients on the FDS pathway for suspected gynaecological cancers by 1st October 2025 as evidenced by more people being seen within the 28 days target. The data was reviewed at the end of February 2026.

Link to PDF poster

Consensus Statements on the Definition of Surgical Success Following Obstetric Urinary Pelvic Floor Fistula Repair: An IUGA-ICS Proposal (2026)

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Type of publication:

Journal article

Author(s):

Maljaars LP; Corcos J; Ghoniem G; Goh JTW; Greenwell TJ; Kupualor D; Pope R; *Rachaneni S; Regmi MC

Citation:

International Urogynecology Journal. 2026 Mar 18.

Abstract:

INTRODUCTION: Standardized definitions for surgical success after obstetric urinary pelvic floor fistula (UPF) repair are lacking. This study aimed to establish a consensus among fistula surgeons on defining surgical success for UPF repair caused by obstetric (childbirth-related) injuries.

MATERIALS AND METHODS: A working group was initiated by the International Urogynecology Association (IUGA) in collaboration with the International Continence Society (ICS). Following a systematic literature review, statements were developed, and a Delphi method was applied to reach a consensus on each statement.

RESULTS: Consensus was reached on 34/44 statements (77.3%). These were grouped into five categories: (1) definition of outcome, (2) treatment and outcome assessment, (3) post-fistula repair urinary incontinence, (4) incurable fistula, and (5) quality of life.

DISCUSSION: The consensus group recommends defining surgical success as anatomical closure of the fistula without residual urinary incontinence, as closure alone is insufficient. Women with residual urinary incontinence should not be classified as cured and require further diagnostic and therapeutic intervention. A postoperative dye test at catheter removal is advised as an objective measure of surgical success. The group also underscores the importance of basic urodynamic evaluation to assess residual incontinence following fistula closure. A diagnosis of "incurable" fistula should only be considered after three failed repairs and requires independent assessments by two expert surgeons. Finally, clinical success should include improvements in patient quality of life, and a specialized, validated quality-of-life questionnaire is essential to evaluate the physical, social, and emotional impact of UPF on patients and to assess treatment effectiveness from the patient's perspective.

CONCLUSION: The consensus statements aim to standardize the definition of successful outcomes in obstetric UPF repair, guiding future research and patient counseling. The group encourages further investigation into existing knowledge gaps in obstetric urinary pelvic floor fistula.

DOI: 10.1007/s00192-025-06413-6

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Unscheduled PMB and HRT-An analysis of urgent unscheduled bleeding referrals in accordance with BMS 2024 guidelines (2026)

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Type of publication:

Conference abstract

Author(s):

Chopra S.; Kaur H.; *Chai A.; *Sahu B.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BGCS 2026 Book of Abstracts. Bristol United Kingdom. 133(Supplement 2) (pp S25), 2026. Date of Publication: 01 Jun 2026.

Abstract:

Background: Management of unscheduled bleeding on HRT is an integral part of investigating endometrial cancer, due to the increasing referrals to the Urgent Suspicion of Cancer Pathway (USCP). Objective(s): We aimed to retrospectively assess the impact that this pathway will have on our clinical practice. Method(s): Patients referred to the gynaecology cancer services at Shrewsbury and Telford Hospitals (SaTH) between March and October 2024 were retrospectively included. Under the BMS 2024 guidelines, data was extracted, including but not limited to demographics, time since menopause, HRT duration, parity, cancer risk factors, and amendment status during primary care. The recorded biopsy results served as the outcome. Result(s): Of the 1308 referrals identified, 627 (47.9%) were referred while actively using HRT. The rate of endometrial cancer diagnosis was significantly lower in the HRT cohort (0.15% (1/627)) when compared to the non-HRT cohort (4.55% (31/681)). Age was not included as a major risk factor, despite higher predictive value for uterine cancer in women over 55. The BMS pathway, although designed primarily for use in primary care, was complex and difficult to apply within a standard 10-min GP consultation when identifying patients requiring secondary care referral. Conclusion(s): We developed a simplified modified pathway to support our GP colleagues. We incorporated age as an additional risk factor and tailored the pathway to reflect best practice and the needs of our local population. The success of this initiative may support the development and adoption of similar pathways in other services.

DOI: 10.1111/1471-0528.70281

Obstetric Bleeding Study UK (OBS UK): protocol for a stepped wedge cluster randomised trial investigating the clinical and cost-effectiveness of a maternity quality improvement programme to reduce excess bleeding and need for transfusion after childbirth (2026)

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Type of publication:

Journal article

Author(s):

Kotecha S.J.; Potter C.; Hope-Bell J.; Riddell N.S.; Munnery K.; Onyimadu O.; Liberty C.; Taylor H.; Dop C.; De Lloyd L.; *Parry-Smith W.; Townson J.; Pallmann P.; Moody G.; Moriarty Y.; Deere R.; Barlow C.; Dhadda A.; *Elsmore A.; Willson S.; *Millward H.; *Siddall K.; Sanders J.; Stanworth S.J.; Black M.; Petrou S.; Rai T.; Slade P.; Hinton L.; Fye H.; Gur Geden A.; Collis R.E.; Collins P.; Bell S.

Citation:

BMJ open. 16(8) (pp e118723), 2026. Date of Publication: 20 Aug 2026.

Abstract:

INTRODUCTION: Bleeding during and after childbirth (postpartum haemorrhage, PPH) is the leading cause of severe maternal morbidity in the UK. Between 2017 and 2018, a PPH care bundle termed the Obstetric Bleeding Strategy (OBS) was implemented as a quality improvement project across all Welsh maternity units and improvements in maternal outcomes were observed. The OBS PPH care bundle incorporates assessment of bleeding risk, real-time cumulative quantification of blood loss, escalation of multiprofessional care including more senior staff at defined volumes of blood loss and point-of-care testing of coagulation at 1 L blood loss (or earlier if clinical concern) with targeted blood product transfusion in cases of haemostatic impairment. The Obstetric Bleeding Study UK (OBS UK) will evaluate this intervention in a larger number of maternity units across the UK. METHODS AND ANALYSIS: OBS UK is a stepped wedge cluster randomised trial designed to test the effectiveness of the OBS intervention compared with usual care on clinical and psychological PPH outcomes after childbirth, evaluate its cost-effectiveness and perform a process evaluation. The study will be capturing data from over 270 000 women and birthing people giving birth in the care of 36 participating maternity units during the 30-month study period. All maternity units will undertake a control period (lasting 3-18 months) during which usual PPH care will be provided, followed by a 9-month implementation period during which the OBS PPH care bundle will be introduced using quality improvement methods and then an OBS UK intervention period (lasting 3-18 months) during which OBS PPH care will be delivered.The primary outcome is the number of women receiving allogeneic red blood cell transfusion for PPH per 1000 maternities. Secondary outcomes are informed by the core PPH outcome set, psychological and cost-effectiveness measures for women and their partners and a mixed methods process evaluation exploring how the intervention was deployed and possible improvements to inform wider implementation. ETHICS AND DISSEMINATION: OBS UK will establish whether (and how) the OBS UK PPH care bundle improves outcomes and experiences of women and their partners. Published results will provide evidence to inform PPH maternity care across the UK and internationally. Dissemination of the findings will be made available to members of the public and participants. TRIAL REGISTRATION NUMBER: ISRCTN17679951

DOI: 10.1136/bmjopen-2026-118723

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A systematic review of clinical outcome reporting in randomised controlled trials evaluating remote obstetric antenatal monitoring (2026)

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Type of publication:

Conference abstract

Author(s):

Le Vance J.; Man R.; *Adeoye A.; Amaranathan S.; Massey S.; Gurney L.; Morton V.H.; Morris R.K.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BMFMS Abstracts 2026. Leeds United Kingdom. 133(Supplement 1) (pp S29), 2026. Date of Publication: 01 Aug 2026.

Abstract:

Objective: Technological innovations in remote antenatal care have expanded rapidly, aiming to shift aspects of care outside the hospital setting. However, current research objectively heralds variable outcome reporting, currently limiting meaningful comparison. This review systematically examined the heterogeneity of outcome reporting in remote obstetric monitoring trials and determined the need for a core outcome set (COS). Method(s): Five databases were searched from January 2015 to November 2025. Randomised controlled trials (RCTs), RCT protocols and randomised pilot studies evaluating any remote antenatal monitoring device with an appropriate comparator were included. Outcomes and their timing were extracted verbatim by two reviewers. Duplicate and similarly worded outcomes were removed, and outcome variability was assessed by the number of unique outcomes reported. Outcomes were categorised into domains. Result(s): Forty studies were included: 24 (60%) RCTs, 10 (25%) RCT protocols and 6 (15%) pilot RCTs. Blood pressure (17, 42.5%) and blood glucose monitoring (16, 40.0%) were the most frequently used technologies, with 19 studies (47.5%) employing multiple monitoring devices. Across all studies, 1,004 verbatim outcomes were reported, of which 11% (113) were primary outcomes. No single outcome was reported in all studies. After de-duplication, 361 unique outcomes remained, grouped into 73 domains. Glycaemic monitoring demonstrated the greatest definitional variation, with 29 distinct definitions. When stratified by measurement time-points, outcomes increased to 1,210, with fewer than 6% assessed beyond three months postpartum. Conclusion(s): This review demonstrated the current variability in consistent outcome reporting for remote antenatal monitoring trials. A COS is recommended for standardising outcome reporting.

DOI: 10.1111/1471-0528.70283

Robotic hysterectomy: an umbrella review and regional access in the Midlands, UK - Is there inequity? (2026)

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Type of publication:

Journal article

Author(s):

Saoudi, Tareq Al; Kanani, Trisha; McGill, Shaun; Isherwood, John; Fan, Frankie; Brown, Luke; Williams, Philippa; Sahare, Pankhuri; Sisodia, Shilpa; McVicar, Kathryn; Lacey, Patricia; Elleray, Rebecca; *Cheetham, Mark; Habiba, Marwan; Orrock, Emma; Wilson, Robert; Dennison, Ashley.

Citation:

European Journal of Obstetrics, Gynecology, & Reproductive Biology. 321:115041, 2026 Feb 28.

Abstract:

STUDY OBJECTIVE: To review current evidence on robotic-assisted hysterectomy (RAH) and assess hysterectomy practices across the Midlands, UK, with a focus on the availability of robotic procedures, geographical variations in the incidence of uterine cancer, and service provision.

DESIGN: An umbrella review conducted in accordance with the PRISMA guidelines combined with a descriptive regional data analysis.

SETTING: Midlands, UK.

PATIENTS: Women undergoing hysterectomy for uterine cancer between 2019 and 2023, based on national and regional datasets.

INTERVENTION: Comparison of RAH with open and laparoscopic approaches, and assessment of access to robotic surgery across integrated care boards (ICBs) in the Midlands.

MEASUREMENTS AND MAIN RESULTS: The final analysis included 12 systematic reviews. Compared with open hysterectomy, RAH was associated with reduced blood loss, lower transfusion rate, shorter hospital stay, and lower complication rates, while benefits over laparoscopic hysterectomy were less consistent. Descriptive regional analysis demonstrated substantial variation in uterine cancer incidence and hysterectomy rates across ICBs in the Midlands. Visual comparison suggested that areas with a higher
incidence of uterine cancer did not align consistently with higher rates of RAH, and access to robotic surgery varied across the region, with some ICBs having no local provision.

CONCLUSION: The continued expansion of RAH in the UK highlights the need for coordinated governance and service planning. Observed regional variation supports the development of clear referral pathways, standardized patient selection criteria, and regional oversight to guide equitable and effective integration of robotic surgery, particularly in areas with limited local provision.

DOI: 10.1016/j.ejogrb.2026.115041

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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