MRCOG Part 3

An analysis, led by Arri Coomarasamy, Professor of Gynaecology at the University of Birmingham and the Director of the Tommy’s National Centre for Miscarriage Research, published in a series of 3 articles in the Lancet has shown that Black women are at a high risk of miscarriage. It is not yet known if this is due to differences in biology, social circumstances, lifestyle factors, or other reasons. Professor Coomarasamy and his team are calling for further research, and discuss what can be done to reduce the risk of miscarriage in Black women. Find out more at https://www.thelancet.com/series/misc... [...]

Bleeding at and after caesarean section kills mothers, particularly in low resource countries. This presentation addresses the epidemiology, diagnosis and management of PPH at CS. The presentation was made at the Jhpiego PPH CoP Virtual Annual Meeting on the 23rd July 2020. The presenters are Arri Coomarasamy and John Varallo, and the chair is Augustino Hellar.

Bowel injury during gynaecological operation: an essential lesson of the MRCOG exam. What are the risk factors? What are the complications? How should you diagnose and manage a small and large bowel injury? When should you use primary repair, resection and repair or a stoma? What post-operative care is needed? Find out the answers to this this and other questions in this video. Visit www.acecourses.co.uk for MRCOG resources.This video is based on the best-selling O&G book: https://www.amazon.co.uk/Gynecologic-...​. All royalties from this book go to the Charity Ammalife to support healthcare providers in low-income countries.

Contraception after pregnancy in 10 questions and answers: an Essential MRCOG lesson by ACE Courses (www.acecourses.co.uk). Find the answers to many questions around the use of contraception just after child birth, including: when does a women need emergency contraception after childbirth? which emergency contraceptives are safe after childbirth in breastfeeding women? what regular contraceptions are available to breastfeeding women? can combined oral contraceptives be used in breastfeeding women? When can you use copper IUD after childbirth? Can DMPA be used after childbirth?

The Fetal Medicine Foundation webinar, organised by the legend Professor Kypros Nicolaides, was attended by over 7000 delegates from 154 countries. In this lecture, you can hear Professor Arri Coomarasamy discuss the role of progesterone hormone for the prevention miscarriages. What is evidence for effectiveness and safety? What does the totality of evidence, summarised in a meta-analysis show? Which progesterone, what dose, what regimen? This video has the answers! It also covers the two landmark trials on the subject, the PROMISE and PRISM trials, both of which were published in the New England Journal of Medicine. [...]

An MRCOG lesson on hereditary gynaecological cancers (BRCA1, BRCA2, RAD51C, RAD51D, BRIP1, Lynch syndrome, Bowden syndrome and Peutz-Jeghers syndrome). An essential lesson for MRCOG.

The PRISM trial is the largest ever randomised trial in miscarriage prevention; it recruited more than 4000 women from 48 hospitals in the UK. It evaluated the effects of progesterone hormone in women with early pregnancy bleeding. Overall, there was a 3% increase in live birth rate with progesterone, compared with placebo, but the finding was associated with some statistical uncertainty (RR 1.03, 95% CI 1.00 to 1.07, p = 0.08). However, a clear benefit was found for women with the dual risk factors of early pregnancy bleeding and a history of (any number of) previous miscarriages (RR = 1.09, [...]

An MRCOG lesson on RCTs: Part B. In part A (please watch that video also!), we learnt about the quality features of an RCT. In this video, we learn about the common statistics we use in the reporting of RCTs. These include: Risk, Relative risk (or Risk Ratio, RR); Absolute risk difference (ARD); and Number Needed to Treat (NNT). We also look at what a Confidence Interval (CI) means. The statistics are illustrated with a simple numerical example. Enjoy!

An MRCOG lesson on RCTs. A randomised trial is the best design for assessing the effectiveness of a treatment. In this video we look at the 6 methodological features that are important for the quality of an RCT: randomisation; concealment; blinding; ITT; good follow-up rate and comparability of care provided. In Part B, we will look at the statistics of RCTs!

How do you manage a patient with diabetes who needs to have an operation? What pre-operative assessments will you do? How will you deal with oral hypoglycaemic medicines or insulin on the day of the operation? How will you manage peri-operative hyperglycaemia or hypoglycaemia? The answers can be found in this short MRCOG video.