House_of_Lords

Consultant gynae - ambulatory, fertility, abortion care and women's health. This is also our family account...
@lord-doctor.bsky.social

[House_of_Lords @Jon_Tania]

@sandydoc79 @HysteroscopyA @clarky_on @TheBSGE @RCHTWeCare Pretty standard for miscarriage & TOP now, and overwhelming majority of patients say they'd choose it again (far more than medical management). Block gives good post-op pain relief too so usually home within 10 mins.

Agree re. Entonox - there is evidence of no effect on pain

[House_of_Lords @Jon_Tania]

@HysteroscopyA @sandydoc79 @clarky_on @TheBSGE @RCHTWeCare [2/2]

So extremely useful, and used widely, in uterine evacuation where patients often dread the thought of a paracervical block (injections to cause nerve block). They really shouldn't need it after that as the block should provide good pain relief

[House_of_Lords @Jon_Tania]

@HysteroscopyA @sandydoc79 @clarky_on @TheBSGE @RCHTWeCare We have Penthrox available for all gynae procedures (e.g. IUD fits, colposcopy, hysteroscopy) but rarely needed as aim should be not to cause significant pain in first place.

It is a game changer where anxiety is an issue; it is both analgesic and anxiolytic. [1/2]

[House_of_Lords @Jon_Tania]

@KevinDTweets On the contrary, proud and genuinely honoured to have supported Nicola. The green ID icon is a link through to all affiliations and declarations of interest - like any quality academic journal, @bmj_latest would not permit publication without a full DoI

[Phoebe Davis @phoebe_ivy]

NEW: UK police guidance suggests officers search homes for abortion drugs and check phones for menstrual tracking apps after unexpected pregnancy loss

@ObserverUK

https://t.co/Gegr8nr54e

[House_of_Lords @Jon_Tania]

@HysteroscopyA @TheBSGE @EjogElsevier @ChelwestFT @MFT_SaintMarys @DrGailBusby The definitions are interchangeable, but "anaesthetist led sedation" is usually abbreviated to GA. The anaesthetist can give more / less / no propofol and/or midazolam, they can keep you drowsy not asleep. But deep sedation & light GA are the same thing

[House_of_Lords @Jon_Tania]

@HysteroscopyA @TheBSGE @EjogElsevier May be better to say "similar to that at dentist" but found in the younger cohort a lot had never had dental work. Point is gynae should not be different from other unpleasant but tolerable procedures

[House_of_Lords @Jon_Tania]

@HysteroscopyA @TheBSGE @EjogElsevier

[House_of_Lords @Jon_Tania]

@HysteroscopyA @TheBSGE @EjogElsevier I'll try to grab some screenshots of slides but am at BSGE so a bit constrained

[Right to Equality @Right2Equality]

Check out this petition calling for the decriminalisation of abortion: https://t.co/5HFeUSYNnW

Please sign and share widely!

[House_of_Lords @Jon_Tania]

@BSACP @stellacreasy @ToniaAntoniazzi @jessphillips @VictoriaAtkins @liz_sugg @alexbrewer @Jess4Lowestoft Thank you so much to all those supporting us

[House_of_Lords @Jon_Tania]

@Dhammikax Sadly been done in UK, and used in court, for a while. Also not appreciated that taking forensic blood still needs patient consent in most situations

[House_of_Lords @Jon_Tania]

@SEL23040118 @HysteroscopyA @ElaineFalkner @SedateUk @DrMartinLees @RCHTWeCare @DrGailBusby @RCObsGyn I do believe you can only keep quality high by continual monitoring & benchmarking. Reducing variations in quality is something the NHS has never been good at, we can only strive to do our best at a local level

[House_of_Lords @Jon_Tania]

@SEL23040118 @HysteroscopyA @ElaineFalkner @SedateUk @DrMartinLees @RCHTWeCare @DrGailBusby @RCObsGyn Thankfully they are very rare - as said before we offer OPH because it's preferred by patients & clinically better, not for cost-saving or convenience.

Where it happens we investigate like any other incident / complaint. Once we stopped a locum until retraining

[House_of_Lords @Jon_Tania]

@HysteroscopyA @RCObsGyn @RCHTWeCare @doctorhelgi Sorry for confusion:
1) Was referring to MVA not OPH (previous Tweet said no LA had been given for MVA which isn't the norm)

2) Sedation converts OPH to needing recovery - nothing wrong with that, just it's then no longer an OPH

[House_of_Lords @Jon_Tania]

@HysteroscopyA @ElaineFalkner @SedateUk @DrMartinLees Certainly hope not, would not be acceptable practice. At RCOG we teach full paracervical block on twice-yearly the skills workshop but in some situations topical cream, gel or Penthrox also useful. Need a range of options to suit what patient wants & needs (yes, incl. GA)

[House_of_Lords @Jon_Tania]

@ElaineFalkner Happy to send policy & training guide if DM email, though these more for procedures that always need LA like use of tenaculum, MVA, cervical Bx etc.

[House_of_Lords @Jon_Tania]

@ElaineFalkner Expectation should be hysteroscopy & targeted biopsy pain <5/10; IUD fitting 4-7; paracervical block (PCB) 4-5. Topical LA makes injection & tenaculum less sharp, so offer it in advance where these may be needed. PCB routine where pain would be >5 (eg MVAs, Cx dilation)