Editorial

Jo Morrison I write this editorial with a sense of both eagerness and trepidation, as the new Editor-in-Chief-elect for TOG, aware that I have taken on a big responsibility and have even bigger shoes to fill (albeit of relatively small feet!). I am indebted to Kate Harding, the current Editor-in-Chief (EiC) for her help, encouragement and sage advice over the years. She has led TOG and her team through extremely difficult times, but hands over TOG in a great position, and I hope that I am able to continue her legacy with the help of the editorial team and board. I am extremely grateful that she will continue in an emeritus role, so will remain my ‘phone a friend’. In the meantime, we aim to appoint a new Deputy EiC, with a more obstetric or generalist focus to their clinical work. Reading through the reviews in this edition of TOG has brought me a certain amount of déjà vu, since some of these topics, including HIV testing in pregnancy and management of the term breech, were ‘hot topics’ when I was revising for the MRCOG. I hope that several of the reviews in this edition will be useful to those now going through their exams. It's interesting to reflect how much knowledge we now take for granted, and how management of HIV, especially, has been completely transformed. I write this on the 31st anniversary of Freddie Mercury's death. It is sad to remember how many we lost from this disease before the introduction of antiretroviral therapy made it a chronic condition with excellent prognosis and gave us the ability to prevent horizontal and vertical transmission. However, in order to do this, we need to identify those in vulnerable groups with the disease, who may have minimal healthcare access. HIV testing is addressed by Keating et al. Whereas opt-out testing is now routine in UK obstetric care, we have not universally adopted testing for those with CIN, for which HIV is a treatable risk factor. Having met opposition to the introduction of routine HIV testing for those with high grade or persistent CIN, this article will hopefully help to convince those who have not yet adopted the British Association of Sexual Health and HIV (BASHH), British HIV Association (BHIVA) and British Infection Association (BIA) recommendations. The review on term breech presentation by P Timmons et al. discusses how much things have changed since the publication of the Term Breech trial1 and notes that, as breech delivery is now a vanishing skill, it would not be possible to repeat this pivotal study. However, this has implications for maternal safety, and the options for management of women with breech presentation are discussed in this comprehensive review. Timmons et al. summarise the management of women with valvular heart disease in pregnancy and discuss the importance of prenatal counselling. Reilly et al. discuss the implications of fetal placental mosaicism, which affects 2–3% of pregnancies, and how this can affect the interpretation of non-invasive prenatal testing (NIPT) and chorionic villus sampling. They describe how care is required in selecting the optimal invasive test and how to avoid over-interpretation of abnormal results. Nambiar et al. outline the evidence around venous thromboembolism (VTE) and gynaecological surgery. One very useful section is their discussion of hormone replacement therapy (HRT) and surgery, which does not significantly increase the risk of VTE, and they note that the Society of Obstetricians and Gynaecologists of Canada (SOGC) do not recommend cessation of HRT before surgery. I shall be sharing this excellent article with our pre-operative assessment team, since I get asked about this frequently! Bartholin's cysts are very common, affecting 2% of women. Bati-Paracha and Sharma discuss management, including outpatient management with Word or Jacobi ring catheters, avoiding general anaesthetic and surgery for many. Bartholin's duct and gland cancers are very rare, but it is important to consider the biopsy of solid or irregular lesions; British Gynaecological Cancer Society Guidelines 2 advise against excision of suspicious lesions without histology, since this may compromise future care. Goswami et al.'s important review addresses the causes and management of premenstrual dysphoric disorder. This is an important topic which affects 3–8% of women and can be ‘a chronic, debilitating disorder with severe emotional and physical symptoms and functional impairment’. I hope that this article will help to increase general awareness and be useful to those in both primary and secondary care, so that women can be helped and not feel dismissed. Writing the January TOG editorial is set to be my new Advent tradition for a while, to be completed before the rest of the holiday season preparations. As my neighbour has just turned on their Christmas lights, hopefully, I will have completed this before the TOG editorial team put me on Santa's naughty list! Given the events of the past year, I'm sure many of us will be wishing for peace, health, happiness and action on climate change for 2023.

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