JAMA Clinical Reviews

Planned caesarean birth on maternal request needs balanced antenatal counselling, not headline rate comparisons. Document goals, pelvic floor risk factors and intended family size, then discuss vaginal birth morbidity, operative risk, future pregnancy risk and timing after 39 weeks.

Patients taking semaglutide or tirzepatide still need structured lifestyle support. The practical emphasis is diet quality, protein, hydration, gastrointestinal adverse effects and resistance exercise, especially when appetite changes, fatigue or treatment discontinuation make weight regain more likely.

Progressive limb weakness, slurred speech, dysphagia, fasciculations or weight loss needs examination for both upper and lower motor neurone signs. Open this when ALS is on the problem list and early neurology referral, genetic counselling, nutrition, communication and respiratory planning need structure.

Normal liver blood tests do not exclude chronic hepatitis B. Open it for screening language: surface antigen, surface antibody and core antibody help separate current infection, immunity and previous exposure, with pregnancy and immunosuppression adding specific risks.

Heart failure with left bundle branch block is not only a medicines problem. Review the ECG beside the ejection fraction, then consider electrophysiology referral when dyssynchrony or high-burden right ventricular pacing could be driving symptoms.

A brief question about pregnancy plans can change medication review, contraception, glucose control and referral before risk is carried into pregnancy. This is a clear primary care listen for pre-gestational diabetes, chronic hypertension, obesity, teratogenic medicines and the basics people forget when the clinic is busy.

Postmenopausal bleeding is the entry point here, but the useful move is knowing when ultrasound stops being enough. Persistent bleeding, fibroids, and a distorted cavity all push this towards biopsy, and the episode keeps staging and referral tied to what happens next.

The trigger is a child with headache, dizziness or balance change after sport, especially when symptoms declare themselves within 24 hours. Open this for a concise bedside review of red flags, oculomotor checks, gait testing and why return-to-play decisions need more than a symptom checklist.

The clue is fatigue with craving ice, restless legs, heavy menstrual bleeding, pregnancy, or prior bariatric surgery, even before anaemia appears. Start here because the episode turns iron deficiency into a usable plan: ferritin first, fasting transferrin saturation when ferritin misleads, then low-frequency oral or early intravenous iron.

An abnormal shoulder MRI after 40 is often a trap, not a diagnosis. The teaching point is interpretation: match rotator cuff or labral findings to history and examination, and reserve MRI for questions that change management rather than escalating because the report looks dramatic.