Turner syndrome through the lens of a gynaecologist.

Turner syndrome is a rare condition affecting 1 in 2500 female births and yet is the most common sex chromosome abnormality in women. Described as a cradle-to-grave condition, it requires life-long multidisciplinary management. Accelerated atresia of the primordial follicular pool leads to premature ovarian insufficiency, which is an almost inevitable feature of Turner syndrome, especially in 45XO karyotype. Many patients will have had their diagnosis made in childhood and require paediatric endocrinology management especially for induction of puberty. At the age of 18, patients may then be transitioned to an adult service. Continuation of multidisciplinary care for these women requires input from specialist services in menopause care, reproductive medicine and high-risk pregnancy, cardiology, endocrinology, bone health and psychosocial care. A gynaecologist may take on the mantle of lead clinician especially during the perceived reproductive years of a Turner syndrome patient's life, hinging together management input from other disciplines. This review attempts to summarise an overview of the involvement of such a multidisciplinary team in the management of a single but complex condition, through the lens of a gynaecologist.

Serous ovarian carcinoma in pregnancy.

The diagnosis of ovarian carcinoma in pregnancy is rare (incidence of 0.018-0.073/1000 pregnancies). Its rarity is reflected by a paucity of cases reported in the literature. The present report concerns a case of advanced serous ovarian carcinoma in a full-term pregnancy. This was an incidental finding discovered during an emergency caesarean section for presumed fetal distress. The majority of ovarian carcinomas diagnosed in pregnancy present at early stages, are associated with a good prognosis and are non-epithelial type tumours. Advanced epithelial ovarian carcinoma diagnosed in pregnancy however is associated with a poor prognosis. Case reporting should certainly contain detailed information on clinicopathological variables and treatment regimens. Longer-term maternal and neonatal outcomes are more difficult to substantiate in case reporting. The authors therefore feel that data centralisation would be beneficial in identifying optimal management strategies in these rare tumours and in other malignant tumours diagnosed and treated during pregnancy.

Outpatient hysteroscopy: an observational study of patient acceptability.

OBJECTIVE: To assess the patient acceptability of outpatient hysteroscopy when Prilocaine is used as analgesia and to determine if our practice of using Prilocaine only if indicated by pain is appropriate. MATERIAL AND METHODS: Prospective observational study of 100 consecutive patients undergoing outpatient hysteroscopy. RESULTS: One hundred consecutive women attending for outpatient hysteroscopy, completed questionnaires after the procedure, indicating the level of pain experienced on an analogue scale. Prilocaine hydrochloride (40 mg/ml) had been administered as an intracervical block only if a patient experienced pain or if cervical dilatation was required. Patients expressed significantly more pain during hysteroscopy than after hysteroscopy whether Prilocaine was used or not. The median pain score was significantly higher in the group that required local anesthetic. There was a greater desire to have the procedure done under general anesthesia when Prilocaine was used than when it was not used. CONCLUSION: Pain is a determining factor in patient acceptability of outpatient hysteroscopy and is a likely reason for some women to opt to have a hysteroscopy under general anesthesia. The practice of administering Prilocaine only if needed is inappropriate. Future studies should now aim to determine the optimal drug, dose, and timing of administration of analgesia in pre-selected women who are likely to experience pain and hence benefit from analgesia.