• Jason Waugh


It seems that 2013 is already racing by and here we are in April already! Tax returns, revalidation in full swing and the conference season up and running. Mark your diaries for the RCOG congress in June and I may see many of you there. Feedback is always welcome and I'm always happy for a chat if you think there are ways we can improve the journal and its CPD function.

So what does TOG have in store for you this quarter? It's again a diverse range of reviews with, I hope, something for all.

We start off with a very comprehensive review of sickle cell disease and β-thalassaemia major in pregnancy from Asma Eissa and Susan Tuck on page 71. Obstetric medicine articles are always challenging for authors as the subject matter can be vast, however this review is concise, informative, and easy to read and provides a useful update to all obstetricians (and the odd gynaecologist). This is also a very timely review as commissioning of obstetric services becomes more topical and obstetric networks evolve to deal with rare medical disorders in pregnancy. Just how many sickle cell pregnancies should you see to retain the skills to manage some of the subtle complications that can arise?

On page 79, Mark Kilby's team have reviewed the data on chromosomal microarray in prenatal diagnosis. Don't be put off by the acronyms, as this is a comprehensive review of where we are currently with this technology and includes a useful discussion surrounding the ethics of testing and reporting these tests. The mere possibility of whole genome testing on non-invasive samples is sometimes hard to imagine but this paper makes the concept seem that much closer to reality.

Wrapping up obstetrics is a review from Pippa Kyle and co authors discussing the value of obstetric surveillance systems in the NHS, on page 85. It would be easy to forget the huge amount of data that are collected and collated in relation to maternity across the UK. This review reminds us of the importance of participation in compiling registry data and of the huge gains that can be made from collaborative data collection when diseases and complications are rare. Again, this is one of those articles where you thought you knew it all until you've read it; and then you realise how much more there is out there that you could be contributing to.

So to gynaecology. On page 91, Nitish Narvekar and Yalanadu Suresh have reviewed the role of surgery in assisted conception. This article covers the current evidence around surgical techniques prior to IVF aimed at optimising outcome. Covering everything from salpingectomy to myomectomy and both hysteroscopic and laporoscopic methods, no procedure is left uncovered. Whilst this is not my clinical area of practice, I was surprised by the relatively small amount of evidence in this area and the degree to which expert opinion still dictates management. The future looks ripe for multiple grant applications and more reviews for this topic.

For both the reproductive medicine specialist and the general gynaecologist we have a review from Thomas Tang and colleagues on the management of recurrent miscarriage (page 99). Again, this is not my area of practice but it is such a common condition that I found the review to be a really interesting read.

The last of our reviews for this issue is from Professor Anne Garden and colleagues on the management of menstrual disorders in adolescents with learning and physical disabilities (page 106). I cannot recommend this review highly enough. The insights it gave me into the complex issues raised for this small but significant population of young women challenged my approach to this and other areas of practice for those with disabilities.

I am delighted to see two clinical governance papers included in this issue. The first is on the ethical and medico-legal issues surrounding surrogacy from Celia Burrell and Hannah O’Connor on page 113. Whilst some of us might have to consider introducing a discussion on surrogacy into a consultation more often than others, there are an increasing number of women for whom this will represent either a solution to problems of subfertility or a means of avoiding substantial medical risk associated with pregnancy. This article gives the reader a concise summary of the background and then a clear presentation of the ethical and medico-legal issues that might ensue. Better still, it comes with its own proforma (Box 2 of paper) to guide management in cases of surrogate pregnancy with really useful basic reminders of the key issues and milestones to be recorded. This was without doubt one of the most useful articles I have ever read in TOG and I cannot recommend it highly enough.

The second clinical governance article is from Paul Moran and colleagues (page 120) on the new database within the British Society of Urogynaecology which compliments nicely the UK Obstetric Surveillance Systems (UKOSS) review. This is clearly of interest to urogynaecologists who may or may not already be aware of the system. This article also gives an interesting insight into the development of such a resource and may inspire others to consider such initiatives within their own specialties.

And, as usual, there's more: letters, website and book reviews, an update from UKOSS, and CPD galore. If we've not covered your niche in this issue then think of submitting an abstract on the subjects that you think need to be covered. The new publishing team and the board can now review abstracts very quickly and we are continually looking to commission new reviews. I hope you enjoy this issue!


Editorial board

Jason Waugh MRCOG

Royal Victoria Infirmary, Newcastle Upon Tyne

Mohamed Abdel-Fattah MRCOG

University of Aberdeen, Aberdeen

Jo Anthony MA FRCOG

Northampton General Hospital NHS Trust

(Chair of the RCOG Revalidation Committee)

Kate Harding FRCOG

Guy's and St Thomas' NHS Foundation Trust, London

Justin Konje FMCOG (Nig) FWACS MRCOG

University of Leicester, Leicester (CPD Editor)

Kate Langford MA MD FRCOG

Guy's and St Thomas' NHS Foundation Trust, London

David Parkin MD FRCOG

Aberdeen Royal Infirmary, Aberdeen

Mark Roberts MD MRCOG

Royal Victoria Infirmary, Newcastle Upon Tyne

Thomas Tang MD MRCOG

Regional Fertility Centre, Royal Maternity Hospital, Belfast

International advisory board


Private practice and Queen Mary Hospital, Hong Kong

Ki-Hong Chang MD PhD

Ajou University School of Medicine, Korea


Mercy Hospital for Women, Melbourne, Australia

Amr El-Shalakany MSc MD FRCOG

Ain Shams University Maternity Hospital, Cairo, Egypt

Henry Murray MRCOG


Dimitrios Koleskas MRCOG

Euroclinic, Athens, Greece


Jaslok Hospital, Sir Hurkinsondas Hospital and Breach Candy Research Centers, India


University of Queensland, Rockhampton Base Hospital and Mater Private Hospital, Australia


John Hunter Hospital, New South Wales, Australia

Dirk Timmerman MD PhD

University Hospitals Leuven, Belgium