• Jason Waugh


Greetings again from the Editorial Board and welcome to the October issue. For the second year in a row I find myself writing an editorial for October while on holiday in the baking sun! The internal review of TOG is going well and we have some exciting ideas for development of the journal, and the membership and TOG surveys have provided a fascinating insight into our diverse readership across the globe. I'll report our conclusions in early 2014 and outline plans to develop TOG further for this decade and beyond.

I've always been impressed by speakers who insert dramatic images of their holiday travels into their lectures to either link sections of their talk or just to allow a break from the clinical content. It's not quite the same, but I will punctuate this editorial with details of where I have had the pleasure of selecting and proofing the articles for this issue.

With regard to gynaecology, we have a diverse collection of clinical reviews all read while camping at 2500 metres in the French Alps. Even gynaecology reads better while watching the sun rise over Mont Blanc. It's always good to be able to start with a review from outside the UK and Wendy Vitek and Jared Robins, based in the USA, deliver a clear and concise review of in vitro maturation (IVM; page 215). They debate the merits of this technique versus the lower pregnancy rates achieved and remind us of the need for long-term follow-up data on the offspring born following IVM cycles.

Jonathan Lippiatt and colleagues from the ‘slightly closer to home’ Cardiff University School of Medicine have written on non-cervical human papillomavirus (HPV)-related disease (page 221). This is another of those articles where, as an obstetrician (with no current gynaecology practice), I found the content fascinating, as the possible role of HPV in malignancy distant to the cervix is explored and the merits of HPV vaccination are discussed in the context of future research objectives as well as clinical applications.

Then we have an article for all and a CPD delight from Fevzi Shakir and Yasser Diab on the perforated uterus (page 256). While some may read this and feel that it offers little for the experienced gynaecologist, I personally feel that this review gathers together what published evidence there is on the subject and presents it in such a clear format that the reader cannot but benefit from reading the article. I don't think there are many readers of TOG who won't have experienced this complication at some point in their career and for those who haven't maybe this will reduce the possibility of it happening to them.

Finally in the gynaecology reviews we have an update on squamous vulval cancer, from Claire Bailey and David Luesley in Birmingham (page 227). HPV appears again in discussions on aetiology and the authors are to be congratulated on presenting data on a complex disease in such a clear and digestible format. Useful tips on biopsy technique are appreciated and again important reference is made to the psychosexual consequences of vulvar surgery and the role of reconstructive surgery in the management of these women.

Moving on, we have an education piece from K Suzanne Jackson, Kevin Hayes and Kim Hinshaw on the relevance of non-technical skills (NTS) in obstetrics and gynaecology (read while lunching on the banks of the Ardèche river; page 269). This is an area of postgraduate training that will affect all trainers and familiarising oneself with the NTS required for obstetrics and gynaecology and the methods of assessing them is an essential starting point to being able to use these tools and provide appropriate feedback to trainees. Having had some involvement in the pilots for some of the assessment tools for NTS I can vouch for the importance of training the trainers in this regard as the work involved in delivering the assessments comprehensively is sometimes quite challenging.

More great reviews and another great sunset: this one camped on a cliff-ledge 600 metres up the side of a river gorge. The obstetrics reviews are all very relevant to any practising obstetrician despite all having an obstetric medicine flavour. Firstly, skin eruptions specific to pregnancy are reviewed by Ajaya Maharajan and colleagues (page 233). With everything covered from physiological changes to dermatoses of pregnancy, this will serve as a useful reminder to all of how to work through a differential diagnosis, instigate treatment and when to refer for further dermatology support. We've had quite a bit of feedback from trainees that some TOG articles might better serve their needs and I'm sure that this one will provide ‘other means’ for some difficult-to-obtain log-book signatures and be a useful reference text for those miniCEX opportunities when they arise.

The same trainee benefits will also accompany the review on myocardial infarction and pregnancy from Rekha Wuntakal and colleagues (page 247). Myocardial infarction is a rare but life-threatening medical condition during pregnancy and most of us will thankfully never see it. As such, it is from articles like this that awareness is raised and potentially lives are saved as most cases will present to local units and will need to be recognised early to reduce morbidity and mortality.

Finally we have a review on asthma in pregnancy from Michelle Goldie and Chris Brightling in Leicester (page 241). This very common medical condition is often mismanaged in pregnancy by either obstetricians or in primary care. Treatment is safe and different treatment modalities are discussed with reference to other published national guidelines on asthma management. This is an area of clinical practice where often women with asthma have their first contact with secondary care and an assessment of asthma control is always worthwhile as many women will reduce all and any medications that they take in pregnancy and the consequences of this can be significant.

So there we have it: great reviews read in great locations. I'm sure they will be just as valuable and read just as well wherever you are in October.


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


Kate Harding FRCOG

Guy's and St Thomas' NHS Foundation

Trust, London

Euan Kevelighan FRCOG

Singleton Hospital, Swansea

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

Nicola Mullin MFFP FRCOG

Countess of Chester Hospital NHS

Foundation Trust, Chester

Mark Roberts MD MRCOG

Royal Victoria Infirmary,

Newcastle Upon Tyne

Thomas Tang MD MRCOG

Regional Fertility Centre, Royal Maternity

Hospital, Belfast

International advisory board


Hong Kong Maternal & Fetal Medicine Clinic

Ki-Hong Chang MD PhD

Ajou University School of Medicine, Korea


Mercy Hospital for Women, Melbourne,


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,



John Hunter Hospital, New South Wales


Dirk Timmerman MD PhD

University Hospitals Leuven, Belgium