The data in our study should throw more light on the current thinking of the obstetrical problems facing teenage mothers, in which some of our results support and others refute several long held beliefs about the risks in teenage pregnancy. Early booking, adequate antenatal care and delivery by trained people should improve the obstetric and perinatal outcome in teenage pregnancies, which is still an unresolved problem inspite of various government programmes in developing countries.

Key content The risk factors for metabolic syndrome include central obesity, hypertension, atherogenic dyslipidaemia and insulin resistance. Metabolic syndrome affects 33% of women with polycystic ovary syndrome (PCOS) and has been less well researched than other features such as infertility, anovulation and hirsutism. Consequences of metabolic syndrome include cardiovascular disease, type II diabetes, cancer, sleep apnoea and psychological problems. Cardiometabolic risk screening involves obtaining data on smoking history, weight, body mass index, waist circumference, blood pressure, lipid profile, and taking an oral glucose tolerance test. Management of metabolic syndrome should focus on risk factors and individual components. Lifestyle modification is the only recommended intervention at present. Learning objectives To know the pathogenesis and consequences of metabolic syndrome in women with PCOS. To understand the diagnostic criteria and screening procedures for metabolic syndrome. To learn how to manage metabolic syndrome in women with PCOS. Ethical issues Potential preventive long‐term medication raises two issues: duration of therapy and unwarranted adverse effects. Advocating bariatric surgery without availability of robust evidence in PCOS women.

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Key content:• As women are presenting to early pregnancy assessment units at increasingly earlier gestations and are having earlier scans, the incidence of pregnancy of unknown location (PUL) is increasing.• Although the vast majority will be failing PULs or intrauterine pregnancies, a small subset will be ectopic pregnancies; it is the detection of women in this group that poses the greatest challenge.• Conservative management of PUL results in lower rates of unnecessary intervention, as the condition often resolves spontaneously; the difficulty is in determining which ones will not. Learning objectives:• To learn about the definition and clinical outcomes.• To appreciate the role of biochemical tests and ultrasound in the assessment of women with PUL.• To learn about conservative, medical and surgical management options. Ethical issues:• Is destroying a viable intrauterine pregnancy an acceptable cost for treating all ectopic pregnancies, given the limitations of diagnosis in PUL?Keywords ectopic pregnancy / human chorionic gonadotrophin (hCG) / intrauterine pregnancy / progesteronePlease cite this article as: Sagili H, Mohamed K. Pregnancy of unknown location: an evidence-based approach to management .

Key content • Miscarriage has traditionally been treated by surgical evacuation, on the assumption that any retained tissue increases the risk of infection and haemorrhage. • Over the last decade, effective non‐surgical alternatives have been advocated to minimise unnecessary surgical intervention while maintaining low rates of morbidity and mortality. • Improved access to early pregnancy assessment units and greater awareness among women has led to increasing demand for more conservative management of miscarriage. Learning objectives • To learn about the use of appropriate miscarriage terminology. • To learn about the advantages and disadvantages of expectant, medical and surgical management. • To understand that women's choice is paramount in planning treatment. Ethical issues • Guidance on the sensitive disposal of fetal remains is essential. Please cite this article as: Sagili H, Divers M. Modern management of miscarriage. The Obstetrician & Gynaecologist 2007;9:102–108.

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