Introduction

The health of women is fundamental to the health of our communities, and so deserves a special place in medical school curricula. Despite this, there are moves in some postgraduate medical courses—in Australia and elsewhere—to reduce or even eliminate formal terms in obstetrics, gynaecology and women’s health. We believe that all doctors should be confident and competent in providing high-quality healthcare and advice to the women they care for. For these reasons, we have developed the third edition of this book to address the core curriculum for medical courses in Australia, New Zealand and the United Kingdom. The book also has been tailored for doctors-in-training at the resident level as well as trainees in general practice and other women’s-health-focused speciality streams. We have aimed to cover, in broad terms, the entire syllabus for medical students and the commonest and most important obstetric and gynaecological conditions likely to be encountered by busy junior hospital doctors, as well as those in general practice and primary care.

Since the last edition—published now over eight years ago—there have been a number of important advances in our knowledge of conditions, in management approaches and indeed in new technologies brought to bear in our care. As examples, next generation genetic sequencing has led to major advances not only in fetal screening and diagnosis, but also in pre-pregnancy carrier screening options for women and couples and cancer genetics. Indeed, new understanding of the genesis of ovarian cancer has led to a paradigm shift in risk reduction options for women at increased heritable risk. We have updated this edition to include all of these new medical options, and to put them into context for women in their own social situations. We are also delighted to welcome our new co-author, Dr Kiarna Brown, who brings a wealth of clinical experience from her home city of Darwin in northern Australia.

In this new edition we have striven to make the cases as inclusive as possible. We have actively worked to include issues relating to migrant and refugee women, and women who have English as a second language. We have included cases of Indigenous women to ensure there is an awareness of the extra complexities that can arise for certain population groups. We acknowledge the importance of doctors being culturally safe and we wish for healthcare workers to have some confidence in providing culturally respectful clinical care. We have sought to put women’s healthcare in the context of the broad social determinants of health and to consider issues relating to transgender patients and to avoid heteronormative stereotypes where possible.

Our approach in this book is based on the problem-based learning (PBL) scenarios with which most recently graduated doctors will be familiar. PBLs introduce students to typical clinical situations and focus on the key elements of history-taking and on relevant examination approaches, then guide the reader through decision-making about the most useful investigations. Using these techniques, students are guided through treatment and management of common and important conditions and complications.

Our approach of questioning the reader as each of the cases progress will, hopefully, encourage exploration of management options based on the current evidence. In addition to the purely clinical aspects of each case, the emotional, social and psychological aspects of management of the individual woman—and her family—are examined. In each case, we list additional resources to further illuminate the principles and evidence underpinning management.

Each of the cases histories commences with a description of the clinical situation and follows the woman as the case progresses. Along the way important points in clinical examination and diagnosis, as well as complications, investigations and managements, are integrated into the text as a conversation with the reader. Essential points are highlighted in boxes, and ‘clinical pearls’ are attached in the hope that these points will stay with the reader in years to come.

In the chapters dealing with obstetrics and gynaecology we address the reader as a house or resident medical officer charged with direct care of the patient in a busy hospital setting. We also, at times, include tips for junior doctors facing women’s health problems in the outer urban or rural setting, since facilities for care and the advice of senior practitioners may be more limited in those surroundings. Importantly, care pathways vary considerably across countries. In the section dealing with ambulant women’s health issues, we address the reader as a general practitioner in an urban or non-urban setting, women’s health clinic, or family planning service. Where conditions initially seen in general practice later are referred for care in more specialised services we continue to follow the patient through the journey.

In preparing this new edition we have had invaluable help and guidance from our colleagues including Professor Michael Peek of the Australian National University, and Dr Darren Russell, director of the Cairns Sexual Health Clinic, who kindly provided Case 25. We hope that you find the latest edition of this book a valuable and accessible resource in providing care to the women whose health underpins our communities.