Editor's highlightsEditor's highlights first appeared in EJOGRB in January 2001, when Professor Jim Thornton took over as editor-in-chief upon the retirement of Professor Tom Eskes. At that time it was part of a Journal section which included opinion, news and lists of forthcoming conferences. The aim was to create a community of readers who would open the printed issue each month and be presented with a Europe-wide perspective on our specialty. Later, when it became clear that the Internet was a more efficient provider of news and conference listings, Editor's highlights evolved into its present form – a column directing readers towards a selection of papers which the editor found especially interesting.
Editor's highlightsGaucher's disease, named after the French doctor who first described it in 1882, is an autosomal recessive disorder which causes lipid accumulation in leukocytes and organs including liver, spleen and brain. About 1% of people in the USA are carriers and the carrier rate among Ashkenazy Jews is about 9%. Manifestations of the disease, such as anaemia, thrombocytopaenia, organomegaly and bone diseases, can be exacerbated by pregnancy, which may also cause new complications. The management of pregnancy is reviewed on page 3 by Ganovsky-Grisaru and colleagues from Israel and Europe.
Editor's highlightsWe were saddened, as this issue of the Journal was being prepared, to hear of the death of our distinguished Editor Emeritus, Professor TKAB Eskes, on 28th March 2011. Tom Eskes was for many years one of the leaders of our specialty in Europe and his influence on this journal was immense, right from the start. He was present at the meetings which led to the foundation of the European Journal of Obstetrics & Gynecology and Reproductive Biology in 1971. He became the Journal's Chief Editor in 1977 and remained in this post for 24 years.
Editor's highlightsMedical trainees today have limited opportunities to experience medicine in other European countries. Undergraduates are allowed a short time away from their own medical school but they often choose to travel outside Europe and experience a different style of medicine. Europe's centres of excellence, besides their rich historical diversity, have much to teach one another about medical science and clinical practice—as they regularly demonstrate in the EJOGRB. We are pleased to see that trainees in our specialty are maintaining international links through the European Network of Trainees in Obstetrics and Gynecology (ENTOG).
Editor's highlightsThis month, as spring approaches, professional meetings resume. In Spain, the World Congress on Women's Mental Health and the European Congress on Osteoporosis and Osteoarthritis take place in Madrid and Valencia respectively. In the USA the Society for Gynecologic Investigation meets in Miami, Florida. In the UK the Confidential Enquiry into Maternal Deaths launches its latest report, Saving Mothers’ Lives 2006–2008, with meetings on consecutive days in three British cities and, for the first time, in Dublin.
Editor's highlightsIn October 2010 the Nobel Prize in Physiology or Medicine was awarded to Professor Robert G Edwards for the development of in vitro fertilization (IVF). This is a fitting – and some would say long overdue – tribute to a man who has changed the lives of millions of people. What is remarkable about his achievement is not so much that he had to contend with vociferous opposition to the idea of “creating life in a test-tube” but that he succeeded without official support or funding. His original research had been on mice but when he applied to the UK Medical Research Council for long-term support for studies on human reproduction, his request was turned down, partly because infertility had a low priority compared to population control.
Editor's highlightsIn our last issue (December 2010) we published a review of the investigation and management of sexual dysfunction, and we mentioned that patients’ confusion about sex often arises from media misinformation. This month, our first review (page 3) develops this theme with regard to the female orgasm. The author, Vincenzo Puppo of Bologna, Italy, begins with a quote from a 2009 EJOGRB paper: “sexual health is a global issue that is vital to overall well-being” and includes a quote from a 1948 textbook: “Exalting vaginal orgasm while decrying clitoris satisfaction is found to beget much frustration.
Editor's highlightsFemale sexual dysfunction seems to be becoming a subject of controversy. Recently it was described as a “new condition” constructed by pharmaceutical companies trying to create a market for drugs of doubtful effectiveness (BMJ 2010; 341: c5050). An accompanying commentary agreed that doctors often prescribe such medication because they feel their therapeutic options are very limited. The commentary also pointed out, however, that definitions of female sexual dysfunction are being revised and that the best available evidence supports a multidisciplinary or biopsychosocial approach to treatment (BMJ 2010; 314: c5336).
Editor’s highlightsWhen we last wrote about the Millennium Development Goals (MDGs) we mentioned MDG5, which is about improving maternal health. There are, however, seven other goals with targets just as challenging as the 75% reduction in maternal mortality asked by MDG5. The aim of MDG3 is to “promote gender equality and empower women” and its target is the elimination of gender disparity in all levels of education by 2015. In June of this year, publication of the Millennium Development Goals Report revealed a mixed picture of success and slow progress across the various MDGs.
Editor's highlightsThe specialty of obstetrics and gynaecology is of public interest. Every day newspapers carry articles about women's health, such as stories of a safe delivery in unusual circumstances or a bad experience for which a hospital or doctor is being blamed. In general, obstetricians are wary of talking to the media, but medical journals are less shy. Researchers like it when their papers attract attention and many universities seek publicity for their staff. Some journals issue regular press releases highlighting papers which the editor thinks are interesting.
Editor's highlightsAs the summer fades, and with it the memory of an excellent European performance in football's World Cup, many countries are facing a winter of economic austerity. Our specialty may not be first in line for cuts to funding – governments want people to keep having babies – but we cannot escape some of the effects of budget reductions. These bring risks. Staff in many public services are already thinly spread and overworked. If this process goes too far in the maternity services, it begins to threaten the low maternal and perinatal mortality rates that much of Europe takes for granted.
Editor's highlightsAugust is holiday time in most of Europe, so except for colleagues who take their laptops with them, most readers will be a little late in catching up with this issue of the Journal. Gynaecological urologists may be even later, as the Joint Annual Meeting of the International Continence Society and the International Urogynaecological Association is being held in Toronto on 23–27 August. These two societies hold a joint meeting every five or six years. In 2011 each comes to Europe (one to Glasgow and the other to Lisbon) and in 2012 their venues will be Beijing and Brisbane.
Editor's highlightsIn these pages we often comment on global issues of women's health and we have drawn attention to the apparent lack of progress towards Millennium Development Goal 5 – a 75% reduction in maternal mortality rates (MMR) by year 2015. Recently new estimates were publicised suggesting that progress is better than expected, but rather than causing widespread pleasure they were criticised for being over-optimistic. A damaging row over figures was avoided, but only just. Although numerical targets are useful for focussing attention it is important to remember that the countries with the greatest problems are those in which the data are least reliable.
Editor's highlightsEach European country has its own professional association of obstetricians and gynaecologists, looking after the interests of women and specialists in that country. Language barriers often make interaction difficult but many of these organisations are becoming more international in outlook. The French College of Gynaecologists and Obstetricians, for example, recently published one of its guidelines, translated into English, in this Journal and we shall be publishing another one, on stress urinary incontinence, next month.
Editor's HighlightsIn a few days’ time the 21st European Congress of Obstetrics and Gynaecology will open in Antwerp. We expect it to be a great success and we are particularly pleased by the close co-operation between EBCOG and its affiliated subspecialty societies, whose logos form a colourful footnote to the http://www.ebcog2010.be webpage. In the past the problem for our specialty in Europe has been poor communication between national societies but our future challenge will be to avoid fragmentation into subspecialty groupings.
Editor's highlightsNext month there will be two important European meetings within 100 km of each other. On 5–8 May the EBCOG Congress will be held in Antwerp, Belgium, and we hope that many readers, encouraged by our comments in last month's issue, are planning to attend. Shortly after that, on 19–22 May, the European Society of Contraception and Reproductive Health will hold its eleventh Congress in The Hague, The Netherlands. The Congress's theme, Culture, Communication, Contraception, reflects its focus on diversity, and its co-presidents point out that preventive strategies must increasingly “take into account the specific cultural, sub-cultural, economic, ethnic and religious characteristics of subpopulations within the European community.” This is an important message.
Editor's highlightsWith the approach of Easter, it is time for a reminder that March 30 is the deadline for the registration of authors presenting at the European Congress of Obstetrics and Gynaecology in Antwerp, Belgium, at the beginning of May. The congress website, www.ebcog2010.be , gives details of the meeting and includes some fascinating background information. We already knew that Antwerp has beautiful buildings and a rich cultural history but we were unaware that this inland city is Europe's second-largest international shipping port, or that the Flanders Concert and Congress Centre (the venue for the congress) is situated in Antwerp's world-famous zoo.
Editor's highlightsNext month, International Women's Day on 8th March will be an opportunity to raise awareness of women's health issues around the world. The continuing high rate of maternal mortality is one of most pressing of these and it is encouraging to see an international coalition, the White Ribbon Alliance (WRA), working hard to draw attention to this preventable cause of death. WRA, launched in 1999 and supported by influential women including Sarah Brown, wife of the UK Prime Minister, has members in 143 countries and national alliances in 15, including Burkina Faso, Nepal and Yemen.
Editor's highlightsIn recent years this Journal has had two Co-Editors-in-Chief, working together in an enjoyable and harmonious relationship. We have divided the work equally and month by month we have alternated in writing the “Editors’ Highlights”. The last article of 2009 was written by Wolfgang Künzel and as usual contained an excellent mixture of clinical wisdom, scientific analysis and a “European View”. What it did not mention was that it would be Wolfgang's last “Editors’ Highlights”, because December 2009 marked his departure from the post of Editor-in-Chief.
Editors’ highlightsThe aim of this Journal is to publish review articles regularly every month and we are happy to continue to do so in the last issue of 2009. The first article deals with the role of myo-inositol in human reproduction and the second is a systematic review of the accuracy of C-reactive protein determination in predicting chorioamnionitis.
Editors’ highlightsWith summer gone and Christmas still to come, November is a month of long dark nights in Europe. These are good for academic work and discussion, and in some countries this is a busy time for local and regional meetings. In London the Academic Association of Obstetrics and Gynaecology (AAOG) is about to hold its fourth annual meeting. It evolved from an older organisation, the Association of Professors of Obstetrics and Gynaecology, with the purpose of being a voice for academics in our specialty in the British Isles.
Editors’ highlightsIn previous issues we have had the pleasure of offering reviews about a wide variety of subjects and this month we are happy to continue with five reviews ranging from the methodology of systematic reviews to COX-2 expression in ovarian malignancies. On page 121, Knox and colleagues from Birmingham, UK, memorably describe systematic reviews of fetal medicine as “a tool for translation of research findings from a few expert centres to a wider health care specialty”. They identified 84 reviews which met their inclusion criteria – over half being in the field of fetal pathology.
Editors’ highlightsIn January we mentioned that we were looking forward to the 19th FIGO World Congress of Gynecology and Obstetrics in Cape Town, South Africa. Now, with the Congress only a few weeks away, the size of the undertaking is clear. The organisers are expecting more than 6000 delegates and the scientific programme (available at www.figo2009.org.za ) is 86 pages long, with a list of topics ranging from molecular biology to orgasmic dysfunction. Without an early breakthrough in human cloning it will be impossible to attend all the simultaneous sessions.
Editors’ highlightsPostpartum haemorrhage (PPH) causes about 20% of maternal deaths in developing countries but the picture is very different in the developed world. For example, in the “Perinatal Data Base 2004 Hesse” PPH was only 1.1% and material death was not evident. If drugs are available and applied early enough in the postpartum period, and if specific causes of PPH (e.g. retention of placental tissue, coagulation disorders, uterine myomas and others) are managed appropriately, maternal death can be prevented in most cases.
Editors’ highlightsAlthough this issue looks no different from last month's, there has been a major change behind the scenes. Until now the Journal's editorial structure has been based on geography, with Regional Receiving Editors for Mediterranean countries, Scandinavian countries, and so on. This was appropriate for a journal covering a continent which, although small in terms of land mass, has a rich variety of languages, cultures and indeed styles of medical practice. In the past, local contact was essential and new research was presented at regional or national meetings which covered all branches of our specialty.
Editors’ highlightsDeath rates of mothers and fetuses during pregnancy, labor and the puerperium have always been strong indicators of the functioning of a health care system. Maternal death, once the most important indicator, is no longer the focus of attention as antepartum and intrapartum fetal death and neonatal death play an increasing role. Perinatal mortality (PNM) has fallen strikingly during the last decades, reaching 0.5–1.0% today in European countries, due to reorganization of hospital care by establishing neonatal intensive care units and improvement of obstetrical services.
Editors’ highlightsThe stillbirth rate attracts less attention in European countries than the perinatal mortality rate (PMR), which also includes neonatal deaths. Nevertheless the stillbirth rate may be the better guide to the quality of maternity care. We focus on the PMR because adverse events in pregnancy may lead to death after delivery as well as to stillbirth but the PMR may give us false reassurance about how well we are doing. In the UK in recent years there has been a slow but steady fall in the PMR which has been due entirely to a reduction in neonatal deaths, largely as a result of improving paediatric care of preterm babies.
Editors’ highlightsSix months ago, in the Editors’ Highlights of our October 2008 issue, we described the “Maternal and neonatal health – obstetric fistula” project in Northern Nigeria. It is supported by The Rotary Foundation, the Aventis Foundation, the Bundesministerium für Zusammenarbeit und Entwicklung and Rotary Clubs from Nigeria, Germany and Austria. We pointed out that this project, which uses a benchmarking model in 10 hospitals in Kaduna and Kano, is designed to reduce the high maternal and fetal mortality in that area.
Editors’ highlightsWe are writing this “Editors’ highlights” column on what is an historic day – a global “highlight” indeed. By the time we finish writing, Barack Obama will have been inaugurated as the 44th President of the USA and the first president of African-American descent. There are people in America whose great-grandparents were bought and sold as slaves, and for them the impact of this event must be overwhelming, but the rest of us across the world can share the feeling of inspiration. Sadly, it was Europeans who introduced slavery into the Americas, and during the period of British colonisation, cities such as Glasgow, Liverpool and Bristol prospered greatly due in large part to the transatlantic slave trade.
Editors’ highlightsThe European Perinatal Health Report from the EURO PERISTAT project was released in December 2008, showing for the first time comparable data on maternal and infant health across Europe. It is the most comprehensive report on the subject to date and takes a new approach to health reporting. Instead of comparing single indicators like infant mortality in European countries, it paints a fuller picture by presenting data about mortality, low-birth-weight and preterm birth alongside data about health care and other factors that affect the outcome of pregnancy.
Editors’ highlightsAt the start of a new year we all like to look forward and already some forthcoming events in our specialty are creating a sense of anticipation. The nineteenth FIGO World Congress of Gynecology and Obstetrics will be held in Cape Town in October ( www.figo.org/meetings_congress_world.asp ). This city, at the meeting-point of two oceans and overlooked by its famous mountain, is a beautiful setting, and South Africa, ever since its first democratic elections in 1994, has been an inspiring country for the rest of the world.
Editors’ highlightsLike most journals in our specialty, EJOGRB appears every month. Our “Editors’ Highlights” is therefore prepared a few weeks ahead, and today as we write there is a flurry of concern in the media that taking antibiotics during pregnancy may increase the risk of cerebral palsy. This was the result of a press conference in London prior to on-line publication in The Lancet of a paper reporting 7-year follow up of the ORACLE study, a randomised trial of antibiotics to treat premature labour. Among the women who had had intact membranes, the incidence of subsequent reported cerebral palsy in the children was 1.7% in the control (no antibiotics) group but 3.3% in the group which had received erythromycin.
Editors’ HighlightsAlthough Editors’ Highlights usually focuses on the needs of European readers we are very pleased that, through the Internet, this Journal has a worldwide readership with a high proportion of electronic readers in North America. Transatlantic professional links are rather haphazard, however, and it is good to see that this month they are being strengthened by a gathering of obstetricians and gynaecologists from the UK, Canada and the USA. The seventh international scientific meeting of the Royal College of Obstetricians and Gynaecologists has been organised in conjunction with the Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynaecologists.
Editor's highlightsWhat is new?Review: Ovarian carcinoma is generally revealed too late, at a time when management is restricted to reducing the size of the tumour by operative treatment followed by chemotherapy. Only a small number of patients are diagnosed during the very early development of the tumour, usually during an abdominal or vaginal ultrasound examination within the framework of a routine check. Thus about 20% of ovarian cancer patients are diagnosed while the disease is limited to one or both ovaries.
Editors’ highlightsJuly is the month when most people look forward to holidays but it is a stressful time for medical students facing important examinations. Assessing clinical skills has never been easy and methods of doing so have changed. In the past students were watched examining real patients and the result might depend on whether the case was simple or difficult. Today many schools are trying to make assessment objective by using rubber models of the abdomen and pelvis, but these are expensive and the techniques of examining them are different from those required in practice.
Editors’ HighlightsMay 9th is “Europe Day”. On that date in 1950 the French foreign minister, Robert Schuman, called for the creation of a supranational institution to manage the combined coal and steel industries of France and Germany. His purpose, in the aftermath of World War II, was to make another war “not merely unthinkable but materially impossible” and he crystallised this into a practical proposal. Thirty-five years later European leaders recognised the Schuman declaration as the beginning of the European Union (EU) and decided to mark the date, though admittedly this celebration has not yet captured public imagination across the continent.
Editors’ highlightsGermany is presently fighting for a change in the law on stem cell research. On Thursday February 14, the discussion in the Bundestag, the German parliament, addressed one of science's most sensitive issues. Pressure is growing for an easing of restrictions that local scientists complain prevent them from keeping up with global advances. The Bundestag sees the stem cell question as one which carries historic overtones of the Nazis’ genetic experiments linked to the creation of a “master race”. Six years ago a law was passed banning the production of embryonic cells from pre-existing stem cell lines.
Editors’ highlightsFor doctors, the ability to move between countries is one of the attractions of a career in medicine. Patients too are now becoming more mobile. Intercontinental air travel means that obstetricians may see women who have had their early antenatal care thousands of miles away. Humanitarian crises, particularly in Africa, are bringing asylum-seekers to Europe and presenting the medical services with new challenges. Within Europe, economic migration from East to West has increased markedly in recent years and clinicians face increasing problems in communicating with patients.
Editors’ HighlightsThe February Editors’ Highlights is an excellent opportunity to make you aware of the 20th European Congress of Obstetrics and Gynaecology that will take place on 4–8 March 2008 in Lisbon, Portugal. It is the former EAGO congress now organized by the European Board and College of Obstetrics and Gynaecology (EBCOG). Professor Dunlop, the congress president and President of EBCOG and of the Union Européenne des Médecins Spécialistes (UEMS) Section of O & G, says: “The Congress will bring you up to date information about all aspects of obstetrics and gynaecology.
Editors’ highlightsAssisted reproduction techniques (ART) are available in 28 European countries and are being used to treat increasing numbers of patients. In 2003, the most recent year for which pan-European figures are available, there were 365,103 treatment cycles with ART, 132,932 of which involved IVF and 162,149 involved ICSI. Over 46% of women undergoing IVF were aged over 34 and 12% were over 40. The risks of pregnancy are increased by ART. Risk to the baby has been reduced in some countries by limiting the number of embryos replaced but in eastern Europe more than 10% of ART cycles involved replacement of four or more embryos and in Greece the figure was 30%.
Editors’ highlightsThe 4th and 5th Millennium Development Goals (MDG), proclaimed in 2000 by the United Nations, aim at reducing child mortality by two thirds and eliminating two thirds of maternal mortality by the target date of 2015. At a global conference, “Women deliver”, held from 18th to 20th October 2007 in London, however, health politicians, international non-governmental organisations (NGOs) and professional bodies had to confess that these goals are still far away from being reality.
Editors’ highlightsEurope's boundaries are hard to define. Greenland, to the west, has left the European Union but is still part of the kingdom of Denmark. On the southern Mediterranean coast, African and European cultures mingle. Eastwards, Turkey is working towards membership of the European Union. To the north-east, Russia has been a European power since the time of Peter the Great and today the World Health Organisation's Europe office is responsible for all the former Soviet republics up to the Chinese border.
Editors’ highlightsIn 1826 a group of German professors with advanced ideas founded the “Common German Journal of Obstetrics” (Gemeinsame deutsche Zeitschrift für Geburtskunde) under the editorship of W.H. Busch of Marburg, L. Mende of Göttingen and F.A. Ritgen of Giessen. The editors wanted the content of the new journal to comprise obstetrics in the broadest sense. Similar activities also started in other European countries. At this time maternal mortality was elevated and infant mortality was incredibly high. Information and discussion about normal and pathologic situations during delivery were the first steps in improving the quality of obstetrical services.
Editors’ highlightsSeptember is always busy with conferences—too busy, perhaps. This month an international infertility meeting in Barcelona overlaps with the World Congress on IVF in Montreal, and the Asian and Oceanic Congress of Obstetrics and Gynaecology in Tokyo is followed immediately by the German Congress of Endometriosis in Berlin. Next month the World Congress on Ultrasound in Obstetrics and Gynaecology in Florence will overlap with the Congress of the European Society of Gynecology in Paris. Choice is enjoyable but environmentalists may worry about our specialty's carbon footprint.
Editors’ highlightsThe meetings of the Heads of States in Heiligendamm and in Brussels in June 2007 have undoubtedly demonstrated that the European Community should speak with one voice. To strengthen Europe for the future, finance and manpower on research have to be focussed on selected projects if it is to compete in the global market with the steadily growing regions of Asia and Africa. This is true not only for global business but also for science in many fields including health issues. The creation of Euroscience is a promising step in the right direction.
Editor's highlightsThis year the European Community's “Erasmus” programme is 20 years old. It is named after Desiderius Erasmus, an illegitimate boy from Rotterdam who studied in Paris, Louvain, Cambridge, Venice and Basel and became Europe's leading scholar of the 16th century. Five hundred years later, European academics are much less mobile, partly because we no longer speak to one another in Latin. Nevertheless, despite language barriers, it is possible for students – even medical students – to undertake parts of their courses in different countries.
Editors’ highlightsWe are looking forward to the British International Congress of Obstetrics and Gynaecology in July in London—not in the city centre but in Docklands, a historic area that has recently been transformed. When London's Royal Victoria Dock opened in 1855 it was at the forefront of technology, designed specifically for steamships, and by 1921 the “Royal” docks were the largest in the world. Today they form a backdrop to the City Airport and ExCeL, London's largest conference and exhibition centre, which will host the Congress and later be one of the venues for the 2012 Olympics.
Editor's highlightsInternational Women's Day (IWD) is being celebrated on March 8th this year, as indeed it is every year. We suspect that this annual event has escaped the notice of many obstetricians and gynaecologists, though those using the Internet on that date may wonder why Google has changed its logo to include the female symbol. IWD was first observed in 1909 in the United States as part of a campaign by the Socialist Party of America against poor working conditions for women. The day was adopted by socialists across the world, notably by Soviet Russia, and it remains an official holiday in many countries of the former USSR.
Editors’ highlightsAt the start of a new year it is hard to resist the temptation to look backward and forward, like the Italian deity Janus who gave his name to January. In 2007 this Journal will be 36 years old. It was conceived by the Societies of Obstetrics and Gynaecology of the Netherlands and Northern Belgium and its first editorial in 1971 invited contributions from further field. This month we have papers from a dozen countries, half of them outside Europe, and our founders – some of whom are still active in research – must be delighted with this success.