Editorial

Happy New Year! I hope. I say this because this editorial is written months before publication and I am yet to experience the outcome of planned industrial action and hope that it can be resolved to the satisfaction of our junior doctors. Most doctors dislike politics so I hope that this issue will be informative and interesting and more in keeping with what we like, which is caring for our patients. We start with an Editor's Pick by Mohamed Abdel-Fattah, introducing key past papers in TOG on urogynaecology. Editor's Pick articles are linked to Virtual Issues that collate special interest and subspecialist reviews and can be found on the TOG page on Wiley Online Library (onlinetog.org), under the ‘FIND ISSUES’ panel (http://bit.ly/Virtual-Issues). Don't forget you can also access these and all other TOG articles using the TOG app! Issa and colleagues then tackle a clinical dilemma: is it endometriosis or irritable bowel syndrome? Or both? They outline the differences and similarities between these two conditions, explain the concept of visceral hypersensitivity and guide the reader through management. If we are to avoid women moving back and forth between gynaecology and gastroenterology, we need to develop a closer working relationship with our specialist colleagues. For those who are not urogynaecologists and if the default for the management of uterine prolapse is hysterectomy, there seems to be a bewildering array of alternative methods ‘out there’. With increasing demand for conservative measures, Jefferis and colleagues summarise the options and evidence for non-hysterectomy approaches. They add caution to the use of mesh, especially for a transvaginal approach. Consensus for management of uterine prolapse, however, is unlikely to be achieved until there is more robust evidence and training is more widely available. We are naturally cautious about any drug used in pregnancy but there is a balance of risk that must be taken into account for the mother and the fetus. Soh and Mackillop consider biologics, which are a range of drugs commonly used to treat young women with rheumatic diseases and other immune-mediated conditions, such as Crohn's disease and idiopathic thrombocytopenic purpura. Case vignettes are used to help understand these drugs and the ‘Take Home Messages’ table can be shared with medical colleagues treating these conditions. Younas and colleagues present the increasing range of treatment options for women for whom fibroids impact on health and fertility. Already there have been changes since conception of this paper. In November 2014, the Food and Drug Administration (FDA) in the USA issued a statement warning against ‘power’ morcellation in the laparoscopic management of fibroids because of the risk of disseminating occult malignancy (sarcoma or carcinoma), this is in addition to benign abdominal myomatosis from lost fragments during morcellation. Many international specialist medical societies have released recommendations that the reader should consider and are available online. There are new and safer methods for laparoscopic fibroid extraction emerging mainly using a variety of morcellation bags; watch this space! Also the scope and licence for ulipristal acetate in the management of women affected by fibroids has changed. Greater is the use for symptom management, but still uncertain is the value or safety in women wishing to preserve fertility. Before joining the throng of new prescribers, gynaecologists are reminded to understand this emerging drug of choice and its potential interactions. Suggested reading includes the TOG review of selective progesterone receptors (TOG 2014;16:46–50) or a suitable formulary. The article by Milburn and colleagues on liver masses in pregnancy fits the mandate of TOG, describing the management of a rare but potentially dangerous condition, serving as valuable CPD and a resource for the next time such a woman attends for maternity care. Described are the special considerations for pregnancy, the range of lesions and management strategies and we are asked to consider hepatic bleeding in pregnant women with epigastric pain and hypovolaemic shock. I remember the Tips and Techniques article by Relph and colleagues going through editing with sage words from the reviewers recalling their own experience of failed hysteroscopy; I am sure you will recall your own experiences when reading it too. The article by White and colleagues enlightens the reader on how laparoscopic surgical skills are acquired and retained. We are aware that time pressures for junior doctors limit exposure to live training opportunities. The need to develop better models of training was highlighted by the RCOG Working Party Report Tomorrow's Specialist. Education theory is complex but here it is condensed with a focus on laparoscopic surgery and is summarised with a 12 bullet point ‘aide-memoire’ on the strategies to optimise simulation training. Professor Marian Knight gives us an update of the recently published MBRRACE-UK report, highlighting that maternal death rates have decreased but thrombosis and thromboembolism remain the commonest direct causes of death. We are made aware of the importance of recognising mental health and complex social issues as contributing factors in the 12 months following childbirth and multiple comorbidities as indirect causes of maternal death. Professor Drife brings a smile to my face with his “And finally…”. In this issue he attempts to write MCQs, not quite TOG CPD standard yet but then he has written a book. You will note a gynaecological bias to this issue. In addition to commissioned reviews we rely on submitted reviews, more commonly these seem to cover gynaecological topics. Come on you obstetricians, ethicists and educationalists, let's hear from you! Editorial board Mark Roberts MD MRCOG Royal Victoria Infirmary, Newcastle Upon Tyne Mohamed Abdel-Fattah FRCOG University of Aberdeen, Aberdeen Philippa Corson MRCOG North Middlesex Hospital, London (Trainee Representative) Kate Harding FRCOG (CPD Editor) Guy's and St Thomas' NHS Foundation Trust, London Stuart Jack MRCOG Royal Infirmary, Edinburgh Euan Kevelighan FRCOG (CPD Editor) Singleton Hospital, Swansea Justin Konje FMCOG (Nig) FWACS MRCOG University of Leicester, Leicester (Lead CPD Editor) Kate Langford MA MD MBA FRCOG Guy's and St Thomas' NHS Foundation Trust, London Jo Morrison BM BCh MA MRCOG DPhil (Oxon) Musgrove Park Hospital, Taunton David Parkin MD FRCOG (CPD Editor) Aberdeen Royal Infirmary, Aberdeen Nicola Mullin MFFP FRCOG Countess of Chester Hospital NHS Foundation Trust, Chester Surabhi Nanda MRCOG Liverpool Women's NHS Foundation Trust, Liverpool Thomas Tang MD MRCOG Regional Fertility Centre, Royal Maternity Hospital, Belfast Ephia Yasmin MRCOG University College London Hospitals NHS Foundation Trust, London International advisory board Ben CP Chan FRCOG Hong Kong Maternal & Fetal Medicine Clinic Ki-Hong Chang MD PhD Ajou University School of Medicine, Korea Amr El-Shalakany MSc MD FRCOG Ain Shams University Maternity Hospital, Cairo, Egypt Kristen A Matteson MD MPH Brown Medical School, Providence, USA Henry Murray MRCOG Australia Dimitrios Koleskas MRCOG Euroclinic, Athens, Greece N Rajamaheswari MD DGO MCh (Urology) Director, Urogynaecology Research Center Pvt Ltd, India Duru Shah MD FCPS FICS FICOG DGO DFP FICMCH Jaslok Hospital, Sir Hurkinsondas Hospital and Breach Candy Research Centers, India David Shaker FRCSEd FRCOG FRANZCOG University of Queensland, Rockhampton Base Hospital and Mater Private Hospital, Australia Dirk Timmerman MD PhD University Hospitals Leuven, Belgium