TOG Topics List

This post is about the TOG topics list with links starting from 2012 till July 2026. The download links to the 'free access' articles have been provided. All you have to do is to click the specific topic and the article will be open in a new window.

My purpose in sharing it with you all is to give an idea about 'organising your study material' in a way to save your precious time. This is a practical answer to a  frequently asked question, “What are the TOG articles in a specific year?”

You need a subscription to access the articles for which no links are given. After a specific time, the article becomes free to access. The list will make sure that you get all the important articles. Please add to this list whenever a new TOG issue is published.

All the best.

Dr Rubab Khalid

TOG LIST

2026

JULY 2026

• Muscle and the Menopause
• Neurovascular Disorders in Pregnancy
• Management of Azoospermia: A Systematic Approach
• Use of Vaginal Pessaries for Pelvic Organ Prolapse

APRIL 2026

• Lichen Sclerosus for Obstetrician
• Unexplained infertility
• Fibroids and Fertility: Evolution of Practice

JANUARY 2026

• The management of chronic pain in pregnancy
• Assessment of fetal growth in twin pregnancies
• Management of isolated abnormal amniotic fluid volume in pregnancy Summary  Click here
• Elevated HCG levels outside of pregnancy: a screening algorithm

2025

OCTOBER 2025

• Newborn screening and role of genomic testing
• Placenta Acreta Spectrum: Management Update
• Menopause care: alternatives to hormone replacement therapy
• Borderline ovarian tumors

JULY 2025

• Acute liver disorders in 3rd trimester - AFLP, HELLP, Infectious hepatitis
• Applications for cell-free fetal DNA beyond common aneuploidy
• Management of cytomegalovirus infection in pregnancy
• Ovarian torsion: a modern approach to management
• Vulvovaginal cysts: differentiation and management
• Cervical cancer elimination: what, how and WHO?

APRIL 2025

• Non-trophoblastic tumours of the placenta: pathophysiology, diagnosis and management
• Preventing and reducing the morbidity and mortality of preterm birth in singleton pregnancies
• Hirsutism: a guide for the obstetrician and gynaecologist
• Ovarian hyperstimulation syndrome – risk reduction strategies
• Abdominal wall catheters for postoperative analgesia in patients undergoing open gynaecological procedures

JANUARY 2025

• Placenta accreta spectrum: imaging and diagnosis
• Review of global inequalities in management of gynaecological cancer
• COVID-19 in pregnancy
• Perinatal mental health: an overview of pathology,services and the law
• Enhanced recovery revisited
• Performance anxiety: implications for obstetricians and gynaecologists

2024

OCTOBER 2024

• Urethral Carnucles
• Endometriosis as a risk factor for ovarian cancer
• Surgical techniques for ovarian endometriosis
• AI in medicine

JULY 2024

• Use of psychotropic medication in perinatal period
• Gynaecological pathology and ART
• Premature ovarian insufficiency

APRIL 2024

• Sarcoidosis in Pregnancy
• Hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of ovarian cancer
• Heavy menstrual bleeding in adolescence: who to investigate and how to manage it
• What's new in guidance? Urinary incontinence and pelvic organ prolapse (NICE guideline NG 123)
• A proactive safety approach to delivering safer care in obstetrics and gynaecology

JANUARY 2024

• Telemedicine and remote training: the impact on obstetrics and gynaecology training
• Endometriosis and subfertility Summary Click Here
• Diagnosis and management of vulval intraepithelial neoplasia
• Cosmetic Gynaecology

2023

Endometriosis & Subfertility

This blog post is based on points taken from a TOG article which was published in January 2024. This article delves into the pathology, diagnostic approaches, and management strategies for endometriosis-associated subfertility.

To download the original article: Click Here

To access ALL TOGs: Click Here

Introduction

• Prevalence of endometriosis in UK ~10% in reproductive age
• With subfertility 25-50%
• Clinical presentation pelvic pain, subfertility & bowel dysfunction or incidental (during fertility investigations)
• Challenging to manage in context of subfertility as mainstays of management are often long-term hormonal treatments

Pathology of endometriosis-associated infertility

• Endometriosis defined as endometrial tissue, ectopic glands & stroma outside uterus, mostly within pelvis

Anatomical distortion

• Up to 30% women with endometriosis have tubal pathology. Tubal damage may impair egg capture & transport
• Degree of endometriosis corresponds to decline in conception rates. Lower fertility rates even with mild disease

Endometrioma

• Found in 17-44% 1/3 have bilateral cysts
• Detrimental to ovarian function. Can be a significant cause of dyspareunia
• Recurrence — 30% in 2-5 yrs after surgery 80% in treated ovary, 8% in both & 11% in contralateral ovary
• Endometrioma presence is the marker of more severe disease
• 50% with deep endometriosis (DE) have endometrioma

Ref: TOG

Investigating endometriosis-related subfertility

• Must have a holistic diagnostic workup for subfertility
• Baseline Ultrasound (USS), Ovarian reserve assessment (AMH & AFC), Ovulatory disorders, Tubal patency & Semen analysis
• ESHRE guideline 
• Laparoscopy no longer the gold standard for diagnosis of endometriosis 
• Laparoscopy to be only done if negative imaging ± failed or inappropriate empirical t/m
• Imaging to be done — MRI & USS as first-line for deep endometriosis. Choose an imaging depends on clinical skills & equipment availability

Staging and scoring endometriosis

revised American Society of Reproductive Medicine (rARSM) 

• Originally designed to classify disease extent & relationship with pregnancy rate 
• Most common & easy to use. Does not correlate with pain or subfertility

ENZIAN scoring system

• Descriptive surgical scoring system Applied to peri-operative imaging assessment
• Proven clue in per-operative prediction of laparoscopic operating time
• There is no or very little correlation with patient symptoms & infertility

Endometriosis fertility index (EFI)

• Specific for women where fertility is priority
• 10-point scoring with 5 categories of risk
• Developed to predict pregnancy rates in women with surgically assessed endometriosis attempting non-IVF conception
• High inter-user reproducibility & good at predicting non-IVF pregnancy rates post-surgery & also pregnancy after ART
• EFI can help in shared decision-making about whether to perform surgery

Ref: TOG

Management of endometriosis-related subfertility

• Challenging to balance adequate management of symptoms & desire for fertility 
• MDT approach — gynaecologist, colorectal surgeon, urologist, specialist nurses & fertility specialist 

Ref: TOG

Assisted conception in the context of endometriosis

• Assisted conception offered as first-line t/m as best chance to achieve parenthood

Effect of endometriosis on ART

• minimal/mild no impact on clinical pregnancy or live birth rates
• moderate/severe significantly lowers number of eggs collected & reduces live birth rate by ~1/4
• Reduced number of retrieved oocytes but no effect on clinical pregnancy & live birth rates 

Surgical treatment of endometriosis prior to ART

• Surgical t/m of endometrioma prior to ART — does not improve live birth rate
• Cystectomy
• associated with poorer response to stimulation & greater risk of cycle cancellation as compared to no surgery 
• reduces the risk of recurrence
• Sclerotherapy vs Cystectomy — more oocytes collected & improved live birth rates with sclerotherapy
• Routine removal of endometrioma prior to ART not recommended but considered if pain or to allow access to follicles at egg collection and in DE

Risks of ART in women with endometriosis

• IVF does not increase endometriosis-related pain, nor does IVF increase the risk of recurrence
• Ovarian stimulation has minimal impact of endometrioma size
• Risk of pelvic infection with an endometrioma undergoing egg collection <1% Use antibiotics (good practice)

Full Summary Available on RK4 Courses | MRCOG Part 2 E-Course

https://www.rubabk4courses.com/courses/mrcog-part-2-e-course/

You may also like:

• RK4 Courses MRCOG Part 2/3
• TOG Tuberculosis in Pregnancy 
• GreenTop Guidelines Links
• Module 14: Subfertility

Tuberculosis in Pregnancy

This is a quick summary of the points taken from the TOG article which was published in July 2023. It is an important exam topic so must be covered thoroughly.

To download the original article: Click Here

To Access All TOGs: Click Here

To Join RK4 MRCOG Courses: Click Here

Introduction

• Tuberculosis (TB) is one of the leading infectious causes of overall mortality
• Highest disease burden in low-resource countries 
• >2/3 cases in Africa and Southeast Asia
• Co-infection of TB & HIV in reproductive years is significant
• In UK — increasing due to immigration 
• Can have adverse effects on mother & fetus

Epidemiology

• Global incidence - 1990-2020 — 9.9 million with 1.3 million deaths worldwide 
• Major contributors to the resurging global TB epidemic — Poverty, HIV Coinfection, Drug resistance
• In 2020 UK had 4700 cases = 6.9 per 100 000
• Risk of new migrant women having active TB highest in first 5 years of migration
• Exact worldwide TB prevalence in pregnancy - Uncertain & depends on area
• Low-prevalence countries 0.06-0.25%
• High-prevalence countries 
• 0.07-0.5% (in HIV negative)
• 0.7-11% (in HIV-positive) 

Pathophysiology

• Causative organism — Mycobacterium tuberculosis (non-spore-forming, aerobic & non-motile bacteria)
• Primarily airborne infection
• Can also occur through ingestion of unpasteurised milk or direct implantation
• TB particles range from 1-5 microns in size, carried to terminal alveoli and multiply there
• Alveolar macrophages ingest & destroy most of the particles, but few survive and continue to multiply
• A granuloma is formed by macrophages around the bacilli
• Usually, the immune system clears the infection, but if it fails, it remains dormant without clinical manifestations or may cause symptoms.
• ~10% immunocompromised with latent TB will develop reactivation of TB
• ~10% healthy acquire infection during their life
• Most common form of clinical TB — Pulmonary disease
• 20% active TB can present as extrapulmonary TB with cervical nodes being most common site (31%). 
• Other sites are CNS, spinal cord, abdomen, pericardium (more common in immunocompromised & HIV-positive)

Outcomes of primary TB infection 

1. Latent TB
2. Primary TB (within 2 years)
3. Secondary TB

Clinical Presentation 

• Suspect TB if h/o exposure to patients with chronic cough or recent visits to endemic areas
• Symptoms except for Fever same as non-pregnant — weight loss, night sweats, chills, appetite loss, tiredness & weakness
• Latent disease will be asymptomatic & non-infectious but can have reactivation
• Four-symptom screening for TB suggested by WHO 

Adrenal Disease and Pregnancy

This blogpost is about the Adrenal Disease and Pregnancy. The points have been taken from a TOG article which was published in October 2021. The article covers this topic quite comprehensively. It is recommended to read the original article for complete understanding of this important exam topic. I hope you find this post helpful. 

To download the original article: Click Here

To access ALL TOGs List: Click Here

www.rubabk4courses.com

Introduction

• Adrenal disease in pregnancy is rare
• Challenging to diagnose
• Associated with ↑ adverse outcomes for both mother & fetus
• Timely diagnosis & MDT involvement are essential to manage these high risk pregnancies

Major Adrenal Disorders

• Primary Adrenocortical Insufficiency (Addisons’s Disease)
• Cushing’s Syndrome
• Primary Aldosteronism (PA)
• Congenital Hyperplasia (CAH)
• Pheochromocytoma & Paraganglioma (PPGL)

Primary Adrenocortical Insufficiency (Addisons’s Disease)

Adrenal insufficiency (AI) classified → primary, secondary & tertiary

Primary Insufficiency in Pregnancy

• Uncommon 1 in 3000 to 5.5 in 100 000 pregnancies
• Results due to adrenocortical disease
• Both Glucocorticoid (GC) & Mineralocorticoid (MC) deficiency 
• 70-90% due to autoimmune atrophy of adrenal gland

Secondary Insufficiency  associated with ACTH secretion disorders mainly cortisol deficiency 

Tertiary Insufficiency  associated with CRH secretion disorders mainly cortisol deficiency 

Cortisol during pregnancy 

• ↑ Levels Both free & total cortisol
• Peaks at 26th weeks
• Diurnal rhythmic variation is maintained

Ref: TOG

Diagnosis

• Females with Primary AI → lower fertility rates
• Most diagnosed before pregnancy & are already on GC & MC
• Challenging to diagnose for the 1st time in pregnancy as overlap of physiological symptoms of pregnancy 
• Highly Suggestive Features → hyperpigmentation on mucous membranes, extensor surfaces & non exposed regions

Short Synacthen stimulation Test

• Non-pregnant → diagnosis likely if morning cortisol <140 nmol/L along with ↑ ACTH
• Pregnant → this cut-off not reliable as most women have values >555 nmol/L in 2nd /3rd tri
• Offer treatment if indeterminate SST & retest after delivery

Salivary free cortisol 

In pregnancy → consistent, generalisable & rationale measure of adrenal function