Gynaecology, obstetrics and reproductive endocrinology: a website guide

Introduction
Suppose you want to find a good website about gynaecology and/or obstetrics and you try the search engine Google, you will get 1,060,000 hits for gynaecology and 1,260,000 for obstetrics. Both give as the first link www.obgyn.net, ‘the Universe of Women’s Health’. This website was launched in 1996 and survived the 2001 shakeout of the medical health portals, most probably because of its active community of doctors and consumers who visit the site approximately one million times a month.

OBGYN.net originated from an email list for gynaecologists from all over the world who exchanged ideas about daily practice concerns. The list is still there in the professional forum, OBGYN-L, at forums.obgyn.net/ob-gyn-l. There are three main sections in English for medical professionals, patients and industry, and divisions in Spanish, Portuguese, German and Dutch. Separate sections are provided for professionals and patients, which can be accessed by both. This site has many subsections, each devoted to a gynaecological subspecialty.

“Many websites in the field of obstetrics and gynaecology have their roots in OBGYN.net.”

Many websites in the field of obstetrics and gynaecology have their roots in OBGYN.net, such as the website of the International Federation of Gynecology and Obstetrics (FIGO) (www.figo.org), where useful information can be found about FIGO’s 102 member societies, of which about 30 have a link to their own
website, including the Netherlands Society of Obstetrics and Gynaecology (www.nvog.nl) and the American College of Obstetricians and Gynecologists (www.acog.org). In common with most professional organisations, the pages also include a calendar of meetings and conferences.

Of course you can always start with the website of your national society, especially if you prefer to read information in your native language if it is not English. However, if you prefer to have a wider choice, look at www.medbioworld.com and click on Associations by Specialty.

Clinical guidelines
The website of the UK’s Royal College of Obstetricians and Gynaecologists (www.rcog.org.uk/mainpages.asp?SectionID=5) contains clinical evidence based guidelines and standards for medical audit and good clinical practice. Crucially, individual recommendations have been graded according to the level of evidence on which they are based, using a scheme endorsed by the National Health Service Executive in the UK. Also, the Society of Obstetricians and Gynaecologists of Canada has a rich content of clinical practice guidelines on its website (sogc.medical.org/SOGnet/sogc_docs/common/guide/library_e.shtml).

An exciting new site is offered by the Geneva Foundation for Medical Education and Research. This is a non-profit organisation established in 2002. It is supported by the Department of Health of the Canton of Geneva, the Faculty of Medicine, Geneva University and the Geneva Medical Association, and works in
close collaboration with the WHO. As well as the English version (www.gfmer.ch/Guidelines/Obstetrics_gynecology_guidelines.php?langue=English), there are also versions in Spanish, French, Italian and German.

This article is restricted to an overview of the English language gynaecology and obstetrics websites, calling at the different subspecialties/special interests but excluding contraception, climacterium and menopause, and endometriosis, which are more extensively discussed elsewhere in this issue.

GynaecologyMinimally invasive surgery
The OBGYN.net section www.obgyn.net/hysteroscopy/hysteroscopy.asp covers hysteroscopy, laparoscopy and hydrolaparoscopy, and collaborates with the American Association of Gynecologic Laparoscopists (AAGL) and the International Society for Gynecologic Endoscopy (ISGE). Images can be found on the ISGE site at isge.org/resource.html. There are plans to build a large catalogue of images, which has been under construction for some time. The AAGL (www.aagl.org) appears to be more active in this field. Its publications can be accessed free of charge to members.

Highly focused on hysteroscopy is the Brazilian website www.histeroscopia.med.br/hysteroscopy.htm. It contains a great deal of information as well as images (www.histeroscopia.med.br/images.htm). For those who want to surf independently, the links pages at www.obgyn.net/gynlap/home.htm are a tremendous starting point for accessing clinical information about laparoscopy.

There is also a lot of information about endoscopy on non-gynaecology websites such as www.sls.org/index.html. Using the page with links to related sites it is possible to make a round trip back to gynaecology.

Urogynaecology
The American Urogynecologic Society’s website (www.augs.org) is better than that of the International Urogynecological Association (www.iuga.info). However, the latter earns its place because it links to its high-quality International Urogynecology Journal and Pelvic Floor Dysfunction of which the full text of many papers is available free of charge.

The youngest OBGYN.net section www.obgyn.net/urogyn/urogyn.asp contains original papers, congress videos and links (www.obgyn.net/urogyn/links/mp_links.htm). It is fair to say that the links are very US-oriented. Among them is the general urology site of the American Urological Association, www.auanet.org.

For urinary incontinence the International Continence Society has a site with a good links page (www.continet.org). Patients who suffer from incontinence are in general very embarrassed and it is essential for them to be able to obtain useful information from the Web in a confidential way. They can find this information from the American Urological Association at www.urologyhealth.org. [The sites for children about bedwetting, such as Wetbuster (www.wetbuster.com) and Bedwetting Kids (www.cambridgekids.com.au/forkids.htm) are very touching, although slightly off the topic of urogynaecology].

Oncology
Oncology of the female breast is not discussed in this issue, although in some countries it is within the expertise of the gynaecological oncologist. Instead, we refer readers to general oncology sites. For oncology of the female reproductive organs, FIGO staging is very widely accepted but is rather hard to find on the FIGO website (www.figo.org/default.asp?id=32). 

The Society of Gynecologic Oncologists (SGO) (www.sgo.org) is a non-profit international organisation made up of obstetricians and gynaecologists specialising in gynaecological oncology. Abstracts of past SGO conferences can be found at www.sgo.org/meetings. The National Cancer Institute in the US has a comprehensive site with general information on cancer (www.nci.nih.gov), where location-specific information can be obtained by clicking on an alphabetical list of all cancers (www.nci.nih.gov/cancerinfo/types) or selecting Gynecologic on this page. An interesting overview of ongoing clinical trials worldwide, subdivided by tumour location, is available at www.cancer.gov/clinicaltrials/finding, while excellent results can be obtained from performing a search on a gynaecological oncology topic using www.cancer.gov/search/search_cancertopics.aspx and selecting Gynecologic Cancers.

The University of Pennsylvania site features tutorials on all gynaecological cancer locations. OncoLink (www.oncolink.upenn.edu) was founded in 1994 by Penn cancer specialists. Its mission is to help cancer patients, their families, health care professionals and the general public obtain accurate cancer-related information free of charge. The home page of the International Gynecologic Cancer Society (www.igcs.org) links to its International Journal of Gynecological Cancer (www.blackwellpublishing.com/journal.asp?ref=1048-891X), with the five most accessed articles available free of charge.

The American Society for Colposcopy and Cervical Pathology website (www.asccp.org) offers patient information and educational material on cervical pathology for professionals, online continuing medical education and consensus guidelines.

Obstetrics
Perinatology/maternal-fetal medicine As a starting point in perinatology the best choice is www.perinatology.com. Perinatology.com is an educational resource for perinatologists, referring physicians and genetic counsellors. Information on the site has been written by perinatologists and genetic counselors of the San Gabriel Valley Perinatal Medical Group.

“As a starting point in perinatology the best choice is www.perinatology.com.”

The OBGYN.net pregnancy and birth section (www.obgyn.net/pb/pb.asp) is not very systematic but links to interesting papers and other sites such as OBLINK (oblink.com) with a focus on preterm labour. The WHO (www.who.int/health_topics/obstetrics/en) is highly respected, not just in developing countries, for its information on maternal and fetal health, given in English, Spanish and French. There are a number of regional perinatology organisations that have their own websites. The Society for Maternal-Fetal Medicine, formerly the Society of Perinatal Obstetricians, has a site at www.smfm.org, which provides a number of resources for research, employment/careers in the USA, meetings and especially the annual meeting of the society itself. It also provides access to the society’s newsletter.

Twin-to-twin transfusion syndrome
There are several websites available on particular topics of interest in perinatology, for example twin-to-twin transfusion syndrome. The website www.fetalmd.com/ttts.htm provides the details of various treatment options such as serial amniocentesis and laser photocoagulation.

The UK Twin-to-Twin Transfusion Syndrome Association has a site at www.twin2twin.org, which contains a description of research on birth and babies (including fetal medicine, obstetrics and neonatology).

Fetal monitoring
Again we start at a links page of OBGYN.net in the Fetal Monitoring section at www.obgyn.net/FM/prof.htm. This page provides a number of links to other sites relevant to perinatology, such as guidelines and protocols, research, journals and professional societies. The sites are given a one- to five-star rating (although the criteria used for rating are quite subjective). For midwives and junior doctors who find interpretation of cardiotocography (CTG) difficult, the site at www.wmpi.net/ctg/index.ctg.htm provides a CTG tutor to help the user acquire a good basic knowledge and understanding of the subject. More general information about fetal monitoring (CTG, fetal pulse oximetry and STAN electrocardiogram) can be found at www.obgyn.net/fm/fm.asp.

Midwifery resources
The American College of Nurse-Midwives (www.acnm.org) is an organisation of professional midwives in the USA. This site contains a wealth of professional information and educational material. Additional midwife practitioner resources can be found at www.obgyn.net/pb/links/mp_midwife.htm. The debate between doctors and midwives about the best way to deliver care continues in cyberspace. The ideal site should give a balanced view of the risks versus the benefits of home and hospital delivery. Midwives tend to use the principles of evidence based medicine, as is evident from reading the journal Midwifery.

Perinatal audit
There are a number of UK-based sites on perinatology, two of which are highlighted below. The West Midlands Perinatal Institute (www.wmpi.net) provides information about the Institute’s activities and information for those involved in the provision of perinatal care. Information on its activities regarding the West Midlands Congenital Anomaly Register, ultrasound and fetal growth is also given. This website also provides links to other useful sites such as that of the Confidential Enquiry into Maternal and Child Health (CEMACH) (www.cemach.org.uk). CEMACH provides information about its history, organisation and role. The most recent annual reports are available for downloading, which many health care professionals will find useful.

Reproductive endocrinology
Ever tried to search for ‘fertility’ using the search engine Google? In October 2003 a search produced 2,770,000 hits. Many commercial sites also offer their services to couples who are having difficulty conceiving.

For some years Ferti.Net was the top infertility site (www.ferti.net), first launched in 1996. The content is arranged in a magazine format and changes every month. There is a very active Journal Club in Reproductive Medicine. The character of the site is mainly European and it has a clear link to the European Society of Human Reproduction and Embryology (ESHRE) (www.eshre.com). The ESHRE site has grown and improved, holding annual conferences, which today are the best available in the field.

Another useful pharmaceutical industry-based infertility website is fercenter.com, featuring interviews and conference reports.

OBGYN.net has a fertility section at www.obgyn.net/infertility/infertility.asp. Using the links it is clear that many sites are advertising in vitro fertilisation (IVF), such as Marc Perloe’s IVF.com (www.ivf.com). The information these sites provide is adequate for consumers. Less commercial is www.asrm.com, the more neutral site of the American Society for Reproductive Medicine. It has a section (requiring a password) for members as well as an open section including many FAQs (frequently asked questions) for lay people. Its well-respected journal Fertility and Sterility can be accessed at www.fertstert.org/current. Its European counterparts are www.eshre.com with the journal Human Reproduction (humrep.oupjournals.org) and the site of the British Fertility Society (www.britishfertilitysociety.org.uk). For the general public there is also the Resolve website belonging to the National Infertility Association (www.resolve.org), or more specific sites on individual topics such as endometriosis (www.endometriosiszone.org/), including Endometriosis Zone, described elsewhere in this issue.

Conclusion
Citing website addresses in a published article carries certain risks. Firstly, the site can have disappeared or changed dramatically the moment the paper is published. The second problem is presented by the often very lengthy addresses which can be difficult to type correctly into an Internet browser. Consequently the
author would very much appreciate any comment on the quality of the quoted sites, broken links or changed addresses to vdslikke@knmg.nl.

The text of this complete issue of Gynaecology Forum is available at www.obgyn.net/medforum2003.asp.