Correction: Evidence-Based Guideline on Laparoscopy in Pregnancy: Commissioned by the British Society for Gynaecological Endoscopy (BSGE) Endorsed by the Royal College of Obstetricians & Gynaecologists (RCOG).

[This corrects the article on p. 5 in vol. 11, PMID: 31695854.].

Evidence-Based Guideline on Laparoscopy in Pregnancy: Commissioned by the British Society for Gynaecological Endoscopy (BSGE) Endorsed by the Royal College of Obstetricians & Gynaecologists (RCOG).

Laparoscopy is widely utilised to diagnose and treat acute and chronic, gynaecological and general surgical conditions. It has only been in recent years that laparoscopy has become an acceptable surgical alternative to open surgery in pregnancy. To date there is little clinical guidance pertaining to laparoscopic surgery in pregnancy. This is why the BSGE commissioned this guideline. MEDLINE, EMBASE, CINAHL and the Cochrane library were searched up to February 2017 and evidence was collated and graded following the NICE-approved process. The conditions included in this guideline are laparoscopic management of acute appendicitis, acute gall bladder disease and symptomatic benign adnexal tumours in pregnancy. The intended audience for this guideline is obstetricians and gynaecologists in secondary and tertiary care, general surgeons and anaesthetists. However, only laparoscopists who have adequate laparoscopic skills and who perform complex laparoscopic surgery regularly should undertake laparoscopy in pregnant women, since much of the evidence stems from specialised centres.

Laparoscopic salpingectomy and removal of Essure hysteroscopic sterilisation device: a case series.

OBJECTIVES: Tubal sterilisation using Essure is a minimally invasive technique for permanent contraception, with high rates of patient satisfaction. However, some women subsequently choose removal of the inserts, due to side effects such as pelvic pain, abnormal bleeding, dyspareunia or allergic dermatitis. This case series presents the management of eight women who underwent laparoscopic removal of Essure inserts in conjunction with salpingectomy. We describe our surgical technique, its underlying principles and immediate surgical outcomes. METHODS: Eight patients were identified as having undergone removal of Essure inserts, via an electronic search of the surgical procedures database. A retrospective review of case records was undertaken. The primary outcome was safety and feasibility of the laparoscopic salpingectomy approach. Secondary outcome measures included implant fracture rate, operative time, blood loss and length of patient stay. RESULTS: All eight women were able to undergo laparoscopic salpingectomy and removal of the Essure inserts without the need for laparotomy or hysterectomy. There were no incidences of fracture or incomplete removal of the insert. Immediate postoperative recovery was uncomplicated in all eight women; the mean length of stay was 17 h. One patient had a small bowel serosal tear attributed to laparoscopic entry. CONCLUSION: This case series suggests that laparoscopic salpingectomy for removal of Essure inserts is safe and feasible. We acknowledge that the numbers were small. However, consistent use of a laparoscopic approach in these eight patients indicates that this procedure is a feasible and suitable alternative to hysterectomy.

Vasa praevia: a missed diagnosis.

Vasa praevia is an uncommon obstetric complication, which if undiagnosed is associated with a high fetal mortality because of the rapid haemorrhage from tearing of fetal vessels resulting in fetal exsanguinations. Antenatal diagnosis in most cases is not made and therefore prevention of fetal death is not possible. Outcome depends primarily on prenatal diagnosis and caesarean delivery at 36 weeks or even earlier. Advances in ultrasound have led to an improved ability to diagnose this condition. Evaluation of high-risk patients with transvaginal colour flow Doppler ultrasound should be considered and should be included in the protocol for routine obstetrics scan. We report three cases of vasa praevia presenting as ante-partum and intra-partum bleeding. Two of them had associated suspected low-lying placenta. This occurred within 4 years (2002-2006) in a small DGH with a delivery rate of 1,800 per year. The purpose of writing these case reports is to warn others of the need for vigilance antenatally, especially with a low-lying placenta, velamentous insertion of cord, IVF and multiple pregnancy. Colour Doppler should be used to visualise blood vessels in these high-risk cases and elective caesarean section should be performed at 35-36 weeks in cases diagnosed as vasa praevia.

Ante-partum haemorrhage: an update.

Ante-partum haemorrhage is an important cause of maternal and fetal morbidity and mortality, despite modern improvement in obstetric practice and transfusion service. It is defined as any vaginal bleeding from the 20th week of gestation till delivery. The initial management of ante-partum haemorrhage should concentrate on resuscitation and accurate diagnosis. The most important causes are placenta praevia and abruption accounting for more than half the cases. The numbers of cases of placenta praevia and placenta accreta are increasing with the increasing caesarean section rate. In many cases, it is not possible to make a definite diagnosis, despite all the investigations. Development of ultrasound especially transvaginal scan has helped in the definitive diagnosis and management of placenta praevia. Every unit should have a clear protocol for the management of massive haemorrhage, which should be regularly updated and rehearsed.

Premature ovarian failure.

Premature ovarian failure (POF) is gonadal failure before the age of 40 years. Several rare causes have been discovered yet we still fail to identify the cause in many cases. Although it was once thought to be a permanent condition, a substantial number of patients experience spontaneous remissions and even pregnancy. HRT remains the cornerstone of treatment and the only proven method of achieving pregnancy in these patients is by ovum donation. New alternatives to HRT and fertility preservation are under development. Basic understanding of ovarian physiology and pathogenesis of POF is necessary for the development of newer therapies.