Multiple endocrine neoplasia type 1 (MEN 1) is a rare inherited disorder caused by mutations in the tumour suppressor gene MEN 1. It is characterised by a predisposition towards the development of parathyroid, anterior pituitary and entero-pancreatic tumours. Clinically, MEN 1 is defined following development of two out of these three tumours. There have been no published cases of the management of MEN 1 in pregnancy. We report the first case of a 31-year-old primigravida with a confirmed diagnosis of MEN 1 prior to conception. Due to the rare nature of MEN 1, there are no guidelines on how such women should be managed. The main issues were to assess and manage potential complications, such as hypercalcaemia, diabetes mellitus and the symptoms from a pituitary tumour as well the issues around a gastrinoma and monitor fetal well-being. A Caesarean section was performed at 35 weeks gestation for a growth-restricted fetus with raised umbilical artery Dopplers. The neonate was treated with intravenous calcium secondary to hypocalcaemia. The patient and neonate recovered well. We have demonstrated successful management of a woman with MEN 1 who completed her pregnancy with few complications and a healthy neonate. It is vital for such women to be managed in the context of a multidisciplinary team setting to optimise maternal and fetal outcomes.

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The majority of the women in the UK who deliver a baby vaginally sustain perineal trauma that requires suturing. GPs are frequently consulted by women regarding perineal health after delivery, either with specific concerns or opportunistically at the 6–8 week routine postnatal check. The aim of this article is to explore the common presentations and underlying pathologies of postpartum perineal problems, their management in primary care and when to refer. We also aim to emphasise the need for a holistic approach and to consider where perineal problems fit into the broader picture of postnatal health.

of bias as they considered options for apical prolapse repair. Whether there is one best apical prolapse surgery and if so, which one, is an enduring controversy in urogynecology. Both transvaginal native tissue repairs and laparoscopic mesh colpopexy with or without robotic assistance are considered standard of care. Complications associated with transvaginal mesh have contributed significantly to patients' hesitation to consider sacrocolpopexy with mesh, as they understandably conflate the 2 mesh methods and often have difficulty separating what they have learned about the history of transvaginal mesh devices from what they could expect with sacrocolpopexy.Ultimately, what is most useful are better quality data about the tradeoffs between durability and complications associated with mesh. Patients often seem to prioritize a choice of procedure that will help them avoid reoperation after prolapse surgery. This analysis provides more data to support that the reoperation rate for the 2 procedures