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Early pregnancy problems account for a major part of all gynaecological emergencies. Other less common gynaecological emergencies are acute pain, severe vaginal bleeding and collapse, which are covered in detail in other chapters.
All women with early pregnancy and acute gynaecological problems should receive prompt referral to a dedicated early pregnancy unit that provides efficient, evidence-based care with access to appropriate information and counselling. The National Service Framework recommends that all women should have access to an early pregnancy unit, which should be easily available (www.earlypregnancy.org.uk). Ideally, these services should also be directly accessible to GPs.
A report of the National Confidential Enquiry into Patient Outcome and Death in 2007 stated that when a patient with an acute healthcare problem arrives in hospital, he or she requires prompt clinical assessment, appropriate investigations and institution of a clear management plan. There should be an early decision regarding the need to involve all relevant specialties and other required services followed by a timely review by an appropriately trained senior clinician. This should be undertaken in an environment that is best suited to meet the patient's clinical needs. Although there is conflicting opinion on the optimal location for the assessment of emergency admissions, it has been recommended that women presenting with early pregnancy complications should undergo initial assessment in dedicated emergency assessment units. The rationale for the use of emergency assessment units is that they can reduce both the emergency department's workload and hospital length of stay.
Early pregnancy services should be modelled in such a way that they are accessible to deal with all the problems of early pregnancy, such as bleeding and medical conditions such as hyperemesis gravidarum, and also to facilitate routine antenatal care before the 12th week of pregnancy. The National Institute for Health and Care Excellence (NICE) antenatal care guideline recommended that booking with maternity services should take place before 12 weeks of pregnancy. The model of care for all early pregnancy events should be composed around the women's journey. It is important to have local care pathways in place for initial assessment, investigations for contributing causes and focused treatment. All clinical staff must undertake regular, written and documented audited training for the identification and initial management of referral for serious medical and mental health conditions that may affect pregnant women or recently delivered mothers.
The last decade has witnessed striking progress in assisted reproductive technology (ART) and over the past few years the success rate of ART has increased significantly due to the introduction of novcl technologies and improved embryo culture systems. Along with this rapid pace of development comes the need for clinicians to keep abreast.
This book brings fresh insights into the pathophysiology of human reproduction, providing up-to-date and practical information on the clinical and laboratory management of subfertility. Particular emphasis is placed on the clinical appraisal of the current and potential strategies to improve the management of the subfertile couple, as well as the various therapeutic options available for the management of subfertility.
The preparation of this book was driven by a desire to provide a hands-on, practical guide to assisted reproduction that would be accessible to those practising in the field of Assisted Reproduction, those working on the establishment and day-to-day running of an IVF clinic, and those with a more general interest in assisted reproduction. The contributing authors include internationally renowned clinicians and scientists actively involved in the field of reproductive medicine and those who are acknowledged in their own fields.
We are most grateful to all who have made the publication of this book possible.
Fibroids are a frequent finding in women with infertility. Gonadotrophin releasing hormone agonists (GnRH-agonist) will cause both uterine and fibroid shrinkage and a reduction or elimination of menstrual flow. Uterine artery embolization offers an alternative method of treatment that allows conservation of the uterus. Under local anaesthesia and sedation, an 18-gauge needle can deliver heat to a fibroid with localized ablation of a fibroid. Hysteroscopic myomectomy may be considered for women with submucous fibroids less than 3 cm. Uterine septum is the most common congenital abnormality of the female reproductive tract with an incidence of 2-3% in the general population. This chapter discusses hydrosalpinx, endometriosis and ovulation induction, endometriosis and intrauterine insemination, endometriosis and in vitro fertilization, and management of ovarian cyst. It also explains elevated follicle stimulating hormone (FSH), thin endometrium, assisted reproductive techniques, and embryo transfer.
In setting up a new in vitro fertilization (IVF) unit it is necessary to convince others that there is an economical need for one to be established. The two methods for procedure costing for the IVF unit are top-down approach and bottom-up approach. The calculation of likely activity is based on a number of factors that include market research, existing waiting lists, referral base, currently available service in the area and their activity. Assisted conception services fall into three categories: wholly private and independent; state funded units; and part academic-part patient funded units. This chapter describes the clinical and laboratory set-up requirements including quality control, laboratory set-up, entry restriction, air-filtration, laboratory lighting, safety and security, and generator back-up for an IVF unit. The IVF chamber is a controlled environmental chamber which is mobile and is specifically designed to maintain ideal temperature and pH during the handling of gametes and embryos.
This user-friendly, practical guide provides an excellent introduction to good clinical practice in the investigation and treatment of infertility, using the very latest assisted reproductive technologies. There are chapters on clinical assessment of the male and the female, followed by detailed chapters on the full range of clinical procedures that can be put in place to help overcome infertility. In addition, other chapters deal with IVF, GIFT and ZIFT and clinical aspects of PGD, which has an increasingly important role these days. Guidance is given on how to set up and run a successful IVF unit based on the experience of the authors, and for the benefit of those new to the field or responsible for developing an IVF service for their patients. With its clinical focus, this will undoubtedly become an essential introduction to assisted reproduction for doctors, embryologists, and nurses.
Assisted human reproduction continues its worldwide spread as increasing numbers of patients are treated annually, and more clinicians and scientists enter the field each year. Demand for new knowledge remains insatiable whether on the web, in conferences or textbooks. Demand comes from so many quarters, from medical and scientific professionals, teachers, nurses, counsellors, patients and students, each needing information for their own particular ends. Comprehensive texts covering this wide demand are rare, new books mostly being highly specialised to a particular topic or technique.
Good Clinical Practice in Assisted Reproduction offers this comprehensive approach to the clinical aspects of assisted reproduction. It is unusual among the many books covering this field of biomedicine. Setting out to make data available using a simple form of presentation enabling easy searching, data are presented in 20 straightforward but detailed chapters, each debating topics essential to this form of treatment. Stressing clinical care rather than the scientific aspects of human embryology and their application, successive chapters have a simple and attractive style grouping data under sub-headings at regular intervals. Browsing is made easy without any need for constant recourse to indices or other textbooks. Tables are well laid out and direct, diagrams redrawn to a single style giving a highly attractive layout to the book. References are numerous and complete, present full details to chosen articles and offer advanced knowledge to provide data to more advanced readers in the field. Such simple and direct means of projecting its contents make this book attractive to a wide readership searching for an easy-to-read and easily accessible yet responsible text.
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