Spotlight on… maternal medicine

Abstract

When I was asked to do a review of the coverage of maternal medicine in TOG I was unsure what I would find. Have we covered the breadth of the subject? Have we concentrated in the obvious areas? Are the articles all written by leaders in their field or by trainees hoping to get a foothold on their climb towards academic achievement? The first article on maternal medicine appeared in TOG volume 1 1999 (TOG 1999;1:29–32). Written by one of the founders of maternal medicine in the UK, John Davison, it was an educational article on chronic renal disease in pregnancy. Whilst the field has moved on in the last 16 years, this well written article is an excellent introduction to the subject. The first article on hypertension in pregnancy was published in 2003 (TOG's 5th year). Written by Glanville and Walker (TOG 2003;5:149–154) this remains an authoritative description of HELLP, its pathogenesis and management (albeit they did not know about the beneficial affects of magnesium for the premature baby). Over the years there have been another five articles on hypertension and, taken as a whole, these give a comprehensive guide on the pathophysiology and management of hypertension in pregnancy and the puerperium. One of the most recent was a scholarly and comprehensive discussion on the use of aspirin (and calcium) in the prevention of pre-eclampsia (TOG 2014;16:245–250). As we have improved the care of pregnant women, cardiac disease has risen to be the commonest cause of maternal death. The importance of this is reflected in an article by Wuntaakal et al. (TOG 2013;15:247–255) on myocardial infarction in pregnancy and a pair of articles by Gelson et al. (TOG 2007;9:15–20 and TOG 2007;9:83–87) on acquired and congenital heart disease. This pair of articles elegantly describes the complex multidisciplinary care these women require and the excellent results that can be achieved. Sepsis has featured heavily in maternal mortality statistics in recent years with a peak in deaths from Group A Streptococcus in the 2006–8 triennium and sepsis accounting for 1 in 4 of all maternal deaths in the 2009–2012 report (MBBRACE 2014). This area has been covered with articles on appendicitis (TOG 2015;17:105–110), genital tract sepsis (TOG 2012;14:106–114) and Group A Streptococcus (TOG 2012;14:9–16). Through this series of articles, TOG has taken a lead in ensuring that clinicians are informed and may help in the campaign to control sepsis. Of all the UKOSS updates published over the years, the most influential was in 2011 during the H1N1 season. Marian Knight's short article (TOG 2011;13:63) on AH1N1 influenza in pregnancy brought home to many the dangers of influenza in pregnancy, the possible role of timely anti-viral treatment and the importance of the influenza vaccine. Then there are the less serious but common conditions that bother all obstetricians such as headache in pregnancy and asthma in pregnancy. Revell and Morrish (TOG 2014;16:179–184) describe how to differentiate between common and serious causes of headaches in pregnancy with a helpful discussion of ‘red flag’ symptoms. Goldie and Brightling (TOG 2013;15:241–245) bring us up-to-date with treatments of asthma, how to reduce the risk of exacerbation and the role of modern treatments, such as montelukasts. Mental health disorders are not ignored with articles on anorexia nervosa (TOG 2012;14:179–187), postnatal affective disorders (TOG 2008;10:231–235) and maternal depression (TOG 2008;10:151–155). This is just a taste of the over 30 articles on maternal disease in pregnancy that have appeared in TOG in the last 15 years. I recommend them to all obstetricians, GPs with an interest in improving maternal health and our midwifery colleagues. Along with the regular updates from UKOSS, summaries of RCOG Green-top Guidelines, and release of key messages from MBBRACE (released online in TOG on the day of the release of the data in December 2014 [TOG 2015;17: 72–73]), TOG is leading the way in helping obstetricians across the world improve maternal outcomes. A virtual issue of all TOG articles on maternal medicine is available at http://onlinetog.org.