Transvaginal ultrasound and MRI show high levels of accuracy for the non-invasive diagnosis of adenomyosis.

We undertook a retrospective analysis of the prevalence of obstetric cholestasis in the population of the South Birmingham area in the various ethnic subgroups. A diagnosis of intrahepatic cholestasis of pregnancy was made on the basis of symptoms of generalised pruritus along with biochemical evidence of the condition, after ruling out other liver diseases. We found an overall prevalence of 0.7%, with an occurrence in the white population of 0.62%, compared to that in the Asians of Pakistani origin of 1.46%. In the Asians of Indian origin it was found to be 1.24%. The prevalence of obstetric cholestasis was significantly higher in the Pakistani and Indian subgroups compared to the whites.

No abstract

Key content:• The process of health technology assessment (HTA) is demonstrated using two examples: a systematic review and a clinical trial.• The HTA of anti-D prophylaxis for Rh-negative pregnant women was undertaken to inform a decision on whether to introduce this intervention universally.• Using statistical methods to pool the results, it was calculated that the number needed to treat with antenatal anti-D prophylaxis to avoid one case of sensitisation was 278.• The EVALUATE trial was designed to investigate differences in complication rates between laparoscopic and abdominal hysterectomy and between laparoscopic and vaginal hysterectomy.• The laparoscopic procedure has a higher mean cost per quality-adjusted life year (QALY), but it scores significantly higher on all the quality of life questionnaires. Ultimately, it will be the willingness of the National Health Service to pay the extra cost per additional QALY that will decide whether it is adopted into routine practice. Learning objectives:• To understand, through examples, the practical application of the process of HTA in everyday clinical practice.• To appreciate the incorporation of clinical and economic evaluations into assessment of effectiveness.• To understand the quality criteria for assessing primary studies in a systematic review. Ethical issues:• It is no longer sufficient to consider only the clinical effectiveness of a technology. HTA should include an economic evaluation to determine value for money.• Systematic reviews provide evidence of effectiveness, although implementation of a technology will depend on its relative importance to policy decision makers.• Researchers need to be transparent in any shortcomings in the design or conduct of their trials and reviews.

No abstract