Obstetrics and Gynaecology Forum - Volume 23, Issue 4, 2013
Volume 23, Issue 4, 2013
Author Zephne M. Van der SpuySource: Obstetrics and Gynaecology Forum 23 (2013)More Less
Author Athol KentSource: Obstetrics and Gynaecology Forum 23, pp 7 –10 (2013)More Less
The medical profession has been waiting for a decade to be invigorated by the sequencing of the human genome, arguably the greatest scientific project ever. The technology has been spectacular but the results of the project have yielded more unexpected results than definitive answers - many about the very nature of our human genome and our microbiome. While a few direct benefits have become apparent, the anticipated torrent of clinical applications has not yet materialised. The vast numbers of naturally occurring mutations (or polymorphisms) has surprised scientists and sifting through the variations to pinpoint meaningful and irrelevant aberrations is a daunting task. Understanding the association of sequence abnormalities, both single and multiple, with pathology will allow the prediction of the risk of developing a disorder but it is already clear that risk and manifestation are not easily calculated. The presence of a mutation does not mean a resulting condition will inevitably appear. The interpretation of sequencing is still in its infancy, as are the rules, guidelines and recommendations regarding what information about a genome is released, to whom and what a genomic sequencing laboratory's present and future obligations are. Genome sequencing is a new science, much younger than assisted reproduction, and developments in the clinical, moral, ethical, legal and commercial aspects of gene sequencing have to be addressed by doctors. It is our obligation to join that debate.
Source: Obstetrics and Gynaecology Forum 23, pp 14 –19 (2013)More Less
Author Dennis A. DaveySource: Obstetrics and Gynaecology Forum 23, pp 21 –24 (2013)More Less
The Women's Health Initiative randomised controlled trials that were mainly of relatively older postmenopausal women, reported that menopausal hormone therapy (MHT) has adverse consequences including an increased risk of breast cancer, coronary heart disease (CHD), venous thromboembolism (VTE) and stroke. Further investigation has shown that in healthy younger women, during the "window of opportunity" from the menopause to the age of about 60 years, MHT is not harmful and apart from the relief of menopausal symptoms may be of significant benefit in reducing the incidence of CHD, osteoporosis and possibly of Alzheimer's disease.
Source: Obstetrics and Gynaecology Forum 23, pp 27 –31 (2013)More Less
There has been constant debate regarding the conceptualising, aetiology and management of female sexual pain. It is a condition which is highly prevalent and distressing for patients, yet is often underdiagnosed and undertreated and proves challenging to health care providers. Traditionally, female sexual pain disorder was divided into two categories, dyspareunia and vaginismus. Most recently, these categories have been combined with a new definition 'genito-pelvic pain/penetration disorder' as described later in this manuscript. Sexual pain disorders often have a biological, psychosexual and functional component. Attention should be focussed on the predisposing, precipitating and maintaining factors of the condition. Diagnosis requires careful history taking and examination and treatment should be individualised and may require a multidisciplinary approach.
Author Graham R. HowarthSource: Obstetrics and Gynaecology Forum 23, pp 33 –36 (2013)More Less
In the absence of effective intervention indemnity will become unaffordable to obstetricians. Unindemnified obstetricians would be poorly advised to continue practising; a case could not only leave them financially ruined but a deserving patient may be inadequately compensated. As indemnity becomes more expensive there will be a progressive decrease in the number of practitioners who can afford it and a stage will be reached when it is unaffordable. Private patients will however continue to fall pregnant and require delivering. As no private facilities are available they will be forced across to the state sector not only increasing the workload of busy state facilities but also increasing the state's litigation risk and medico-legal liability burden.
Genital warts in young Australians five years into national human papillomavirus vaccination programme : national surveillance data : product newsSource: Obstetrics and Gynaecology Forum 23 (2013)More Less