Publications
355 results found
Regan L, 2018, Miscarriage: What Every Woman Needs to Know, ISBN: 9781409175681
This book gives up-to-date information on the many causes of miscarriage and the latest treatments available.
Lord J, Regan L, Kasliwal A, et al., 2018, Early medical abortion: best practice now lawful in Scotland and Wales but not available to women in England, BMJ SEXUAL & REPRODUCTIVE HEALTH, Vol: 44, Pages: 155-158, ISSN: 2515-1991
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- Citations: 8
Jha S, Regan L, 2018, Termination of pregnancy (abortion), Medicolegal Issues in Obstetrics and Gynaecology, Editors: Jha, Ferriman, Publisher: Springer, Pages: 313-316, ISBN: 9783319786834
Abortion is the spontaneous or induced termination of pregnancy. Abortion in England, Scotland and Wales is regulated by the Abortion Act 1967. All abortions other than those performed as an emergency require approval by two registered medical practitioners and must be performed in facilities registered for this purpose. Prior to proceeding with an abortion it is imperative that an intrauterine pregnancy be confirmed to avoid missing an ectopic pregnancy. Women should be informed that there is a small risk of failure to end the pregnancy and a risk of further intervention after the initial treatment. For pregnancy less than 14 weeks either a surgical or medical abortion is a feasible option whereas after 14 weeks, a medical termination would be advisable.
Gillespie A, Taheri M, Sullivan M, et al., 2018, The impact of fibroids on the rate of first trimester miscarriage in the recurrent miscarriage population, RCOG Congress 2018, Publisher: WILEY, Pages: 41-41, ISSN: 1470-0328
DiMarco A, Christakis I, Constantinides V, et al., 2018, Undiagnosed Primary Hyperparathyroidism and Recurrent Miscarriage: The First Prospective Pilot Study., World Journal of Surgery, Vol: 42, Pages: 639-645, ISSN: 1432-2323
BACKGROUND: Primary hyperparathyroidism (pHPT) in pregnancy is reported to be associated with significant maternal and foetal complications and an up to threefold increase in the risk of miscarriage. However, the true incidence of pHPT in pregnancy, complete and miscarried, is unknown and there are no data on the prevalence of undiagnosed pHPT in recurrent miscarriage (RM) (≥3 consecutive miscarriages under 24-week gestation). This is the first prospective study aiming to establish the prevalence of undiagnosed pHPT in RM. METHODS: Following UK National ethics committee approval, women who had experienced 3 or more consecutive miscarriages were recruited from a nationwide RM clinic. Serum corrected calcium, phosphate, PTH and vitamin D were evaluated. Patients with raised serum calcium and/or PTH were recalled for confirmatory tests. Power calculations suggested that a minimum of 272 patients were required to demonstrate a clinically significant incidence of pHPT. RESULTS: Three hundred women were recruited, median age 35 years (range 19-42). Eleven patients had incomplete data, leaving 289 patients suitable for analysis; 50/289 patients (17%) with abnormal tests were recalled. The prevalence of vitamin D deficiency (<25 nmol/l) and insufficiency (25-75 nmol/l) was 8.7 and 67.8%, respectively. One patient was diagnosed with pHPT (0.34%) and underwent successful parathyroidectomy. CONCLUSIONS: The prevalence of undiagnosed pHPT (0.34%) in RM in this study appears to be many times greater than the 0.05% expected in this age group. The findings of this pilot study merit follow-up with a larger-scale study. Routine serum calcium estimation is not currently undertaken in RM and should be considered.
Regan L, Glasier A, 2017, The British 1967 Abortion Act-still fit for purpose?, LANCET, Vol: 390, Pages: 1936-1937, ISSN: 0140-6736
Schreiber K, Breen K, Cohen H, et al., 2017, HYdroxychloroquine to Improve Pregnancy Outcome in Women with AnTIphospholipid Antibodies (HYPATIA) Protocol: A Multinational Randomized Controlled Trial of Hydroxychloroquine versus Placebo in Addition to Standard Treatment in Pregnant Women with Antiphospholipid Syndrome or Antibodies, SEMINARS IN THROMBOSIS AND HEMOSTASIS, Vol: 43, Pages: 562-571, ISSN: 0094-6176
Prior M, Bagness C, Brewin J, et al., 2017, Priorities for research in miscarriage: a priority setting partnership between people affected by miscarriage and professionals following the James Lind Alliance methodology, BMJ Open, Vol: 7, ISSN: 2044-6055
Objectives To identify and prioritise important research questions for miscarriage.Design A priority setting partnership using prospective surveys and consensus meetings following methods advocated by the James Lind Alliance.Setting UK.Participants Women and those affected by miscarriage working alongside healthcare professionals.Results In the initial survey, 1093 participants (932 women who have experienced miscarriage, 8 partners, 17 family members, friends or colleagues, 104 healthcare professionals and eight charitable organisations) submitted 3279 questions. A review of existing literature identified a further 64. Non-questions were removed, and the remaining questions were categorised and summarised into 58 questions. In an interim electronic survey, 2122 respondents chose their top 10 priorities from the 58 summary questions. The 25 highest ranked in the survey were prioritised at a final face-to-face workshop. In summary, the top 10 priorities were ranked as follows: research into preventative treatment, emotional aspects in general, investigation, relevance of pre-existing medical conditions, emotional support as a treatment, importance of lifestyle factors, importance of genetic and chromosomal causes, preconception tests, investigation after different numbers of miscarriage and male causal factors.Conclusions These results should be the focus of future miscarriage research. Presently, studies are being conducted to address the top priority; however, many other priorities, especially psychological and emotional support, are less well researched areas. We hope our results will encourage both researchers and funders to focus on these priorities.
Solanky N, Leon L, Maurer C, et al., 2017, A new biological and clinical resource for research into pregnancy complications: The Baby Biobank, 27th Mammalian Genetics and Development Workshop of the Genetics-Society, Publisher: CAMBRIDGE UNIV PRESS, ISSN: 0016-6723
Regan L, 2017, INTEGRATING HUMAN RIGHTS AND WOMEN'S HEALTH. COMPETENCIES FOR PRACTICE, 23rd Congress of the World Association of Sexual Health, Publisher: WILEY, Pages: E221-E222, ISSN: 1743-6095
Sarodey G, Regan L, Rai R, 2017, Audit on psychological assessment of couple in a tertiary care recurrent miscarriage unit in the United Kingdom, RCOG World Congress 2017, Publisher: WILEY, Pages: 11-11, ISSN: 1470-0328
Hopkinson NS, Dacre J, Regan L, et al., 2017, The need for a new Tobacco Control Plan: an issue of justice, British Medical Journal, Vol: 356, ISSN: 1468-5833
jayasena C, abbara A, comninos A, et al., 2016, Novel circulating placental markers prokineticin-1, soluble fms-like tyrosine kinase-1, soluble endoglin and placental growth factor and risk of late miscarriage, Human Reproduction, Vol: 31, Pages: 2681-2688, ISSN: 0268-1161
STUDY QUESTION Are novel circulating placental markers prokineticin-1 (PK-1), soluble fms-like tyrosine kinase-1 (sFlt-1), soluble endoglin (sEng) and placental growth factor (PlGF) associated with late miscarriage in asymptomatic first trimester pregnant women?SUMMARY ANSWER Increased serum sFlt-1 or PlGF, but not sEng or PK-1, were significantly associated with reduced miscarriage risk after adjustment for age, BMI, gestational age, smoking and blood pressure.WHAT IS KNOWN ALREADY Abnormal placental development is observed in two-thirds of miscarriages. Identifying women at high risk of late miscarriage could help diagnose potentially treatable causes of miscarriage such as infection, thrombosis or immunological disease. Recently, the circulating placental markers PK-1, sFlt-1, sEng and PlGF have been identified; however, it is not known if circulating levels of these markers are associated with late miscarriage.STUDY DESIGN, SIZE, DURATION A single-centre observational cohort study with prospectively collected data was carried out at a tertiary care centre 2010–2012, in 993 asymptomatic pregnant women. Plasma PK-1, and serum sEng, sFlt-1 and PlGF were measured once in each patient during the antenatal booking visit, and pregnancy outcome was monitored prospectively. Less than 1% of patients were lost to follow-up. Multiples of median (MOM) levels were calculated to adjust for gestational age.PARTICIPANTS/MATERIALS, SETTING, METHODS Nine-hundred and ninety-three asymptomatic pregnant women attending antenatal clinic for a routine booking antenatal appointment were recruited to the study, of whom 12 were lost to follow-up and excluded from analysis. Of the cohort, 50 of the remaining 981 women suffered late miscarriage.MAIN RESULTS AND THE ROLE OF CHANCE Gestation-adjusted sEng, sFlt-1 and PlGF levels were 11% (P < 0.01), 36% (P < 0.001) and 30% (P < 0.001), respectively, lower in women who later suffered miscarriage compared with unaffected pregnanc
Leon LJ, Solanky N, Stalman SE, et al., 2016, A new biological and clinical resource for research into pregnancy complications: The Baby Bio Bank, Placenta, Vol: 46, Pages: 31-37, ISSN: 1532-3102
About 20% of pregnancies are affected by some form of complication. Research has shown that anomalies in implantation, development, and growth of the fetus; ineffective nutrient exchange between mother and fetus due to placental dysfunction; and maternal problems such as hypertension or infection during pregnancy can all lead to adverse pregnancy outcomes. However, the molecular aetiology of such events remains poorly understood. Fetal growth restriction (FGR), recurrent miscarriage (RM), preterm birth (PTB), and pre-eclampsia (PE) are the most common pregnancy complications encountered in the UK and these outcomes can result in an array of morbidities in both mother and baby, and in the most severe cases in mortality. We need to know more about normal pregnancy and where the important triggers are for failure. This prompted us to collect a large set of biological samples with matching clinical data from over 2500 normal and abnormal pregnancies, for use in research into these conditions. This paper outlines the nature of these sample sets and their availability to academia and industry, with the intention that their widespread use in research will make significant contributions to the improvement of maternal and fetal health worldwide (http://www.ucl.ac.uk/tapb/sample-and-data-collections-at-ucl/biobanks-ucl/baby-biobank).
Karmarkar R, Fernando R, Regan L, et al., 2016, Urethral sphincter volume and urodynamic diagnoses, Publisher: Wiley, Pages: S213-S214, ISSN: 1520-6777
Karmarkar R, Fernando R, Regan L, et al., 2016, Is the urethra more mobile in women with stress urinary incontinence?, Publisher: Wiley, Pages: S368-S369, ISSN: 1520-6777
Regan L, Nelson-Piercy C, 2016, Women's Health, Kumar and Clark's Clinical Medicine, Editors: Kumar, Kumar, Publisher: Elsevier Health Sciences, ISBN: 9780702066009
It still remains the "gold standard", thorough guide to clinical medicine its forefathers were.’ BMA Medical Book Awards judges. New to this edition: 2 new chapters: Global Health and Women’s Health. 25 new authors.
Schreiber K, Breen K, Sciascia S, et al., 2016, Proposed trial: HYPATIA - a prospective randomised controlled trial of hydroxychoroquine vs. placebo during pregnancy in women with antiphospholipid antibodies, Publisher: Wiley, Pages: 163-163, ISSN: 1538-7933
Coomarasamy A, Williams H, Truchanowicz E, et al., 2016, PROMISE: first-trimester progesterone therapy in women with a history of unexplained recurrent miscarriages - a randomised, double-blind, placebo-controlled, international multicentre trial and economic evaluation, Health Technology Assessment, Vol: 20, Pages: 1-94, ISSN: 1366-5278
Lewis G, Jauniaux E, Morroni C, et al., 2016, Improving Global Maternal Health: challenges and opportunities, Obstetrics: Normal and Problem Pregnancies E-Book, Publisher: Elsevier Health Sciences, ISBN: 9780323392174
Take advantage of the collective wisdom of global experts in the field, including two new editors— Drs. Vincenzo Berghella and William Grobman -- and nearly 30 new contributors.
Coomarasamy A, Williams H, Truchanowicz E, et al., 2015, A randomized trial of progesterone in women with recurrent miscarriages, New England Journal of Medicine, Vol: 373, Pages: 2141-2148, ISSN: 1533-4406
BackgroundProgesterone is essential for the maintenance of pregnancy. However, whether progesterone supplementation in the first trimester of pregnancy would increase the rate of live births among women with a history of unexplained recurrent miscarriages is uncertain.MethodsWe conducted a multicenter, double-blind, placebo-controlled, randomized trial to investigate whether treatment with progesterone would increase the rates of live births and newborn survival among women with unexplained recurrent miscarriage. We randomly assigned women with recurrent miscarriages to receive twice-daily vaginal suppositories containing either 400 mg of micronized progesterone or matched placebo from a time soon after a positive urinary pregnancy test (and no later than 6 weeks of gestation) through 12 weeks of gestation. The primary outcome was live birth after 24 weeks of gestation.ResultsA total of 1568 women were assessed for eligibility, and 836 of these women who conceived naturally within 1 year and remained willing to participate in the trial were randomly assigned to receive either progesterone (404 women) or placebo (432 women). The follow-up rate for the primary outcome was 98.8% (826 of 836 women). In an intention-to-treat analysis, the rate of live births was 65.8% (262 of 398 women) in the progesterone group and 63.3% (271 of 428 women) in the placebo group (relative rate, 1.04; 95% confidence interval [CI], 0.94 to 1.15; rate difference, 2.5 percentage points; 95% CI, −4.0 to 9.0). There were no significant between-group differences in the rate of adverse events.ConclusionsProgesterone therapy in the first trimester of pregnancy did not result in a significantly higher rate of live births among women with a history of unexplained recurrent miscarriages. (Funded by the United Kingdom National Institute of Health Research; PROMISE Current Controlled Trials number, ISRCTN92644181. opens in new tab.)
Donaldson B, Jain P, Holder BS, et al., 2015, What determines uptake of pertussis vaccine in pregnancy? A cross sectional survey in an ethnically diverse population of pregnant women in London, Vaccine, Vol: 33, Pages: 5822-5828, ISSN: 1873-2518
Demetriou C, Abu-amero S, White S, et al., 2015, Investigation of the Annexin A5 M2 haplotype in 500 white European couples who have experienced recurrent spontaneous abortion, Reproductive Biomedicine Online, Vol: 31, Pages: 681-688, ISSN: 1472-6491
Annexin A5 is a placental anti-coagulant protein that contains four nucleotide substitutions (M2 haplotype) in its promoter. This haplotype is a risk factor for recurrent spontaneous abortion (RSA). The influence of the M2 haplotype in the gestational timing of spontaneous abortions, paternal risk and relationships with known risk factors were investigated. European couples (n = 500) who had experienced three or more consecutive spontaneous abortions, and two fertile control groups, were selected for this study. The allele frequency of M2 was significantly higher among patients who had experienced early RSA than among controls (P = 0.002). No difference was found between controls and patients who had undergone late spontaneous abortions. No difference was found between patients who had experienced RSA who had a live birth or no live births, or between patients who were positive or negative for known risk factors. Male and female partners in each group had similar allele frequencies of M2. The M2 haplotype is a risk factor for early spontaneous abortions, before the 12th week of gestation, and confers about the same relative risk to carriers of both sexes. Having one or more M2 allele(s) in combination with other risk factors further increases the RSA risk.
Rai R, Regan L, 2015, Pregnancy Morbidity Associated with Thrombophilias: Recurrent Miscarriage, Disorders of Thrombosis and Hemostasis in Pregnancy A Guide to Management, Editors: Cohen, O'Brien, Publisher: Springer, Pages: 125-137, ISBN: 9783319151205
In this second edition of Disorders of Thrombosis and Hemostasis in Pregnancy - A Guide to Management the content has been thoroughly updated, with a particular focus on strengthening the management sections to ensure that advice on ...
Schreiber K, Sciascia S, Breen K, et al., 2015, Proposed trial: hypatia - a prospective randomised controlled trial of hydroxychoroquine versus placebo during pregnancy in women with antiphospholipid antibodies, XXV Congress of the International Society on Thrombosis and Haemostasis, Publisher: Wiley, Pages: 281-281, ISSN: 1538-7836
Regan L, 2015, Domestic violence, Publisher: WILEY-BLACKWELL, Pages: 384-385, ISSN: 1470-0328
Regan L, 2015, Human rights and women's health in the 21st century, Publisher: WILEY-BLACKWELL, Pages: 377-378, ISSN: 1470-0328
Moore GE, Ishida M, Demetriou C, et al., 2015, The role and interaction of imprinted genes in human fetal growth, Philosophical Transactions of the Royal Society B: Biological Sciences, Vol: 370, Pages: 1-12, ISSN: 0962-8436
Identifying the genetic input for fetal growth will help to understand common, serious complications of pregnancy such as fetal growth restriction. Genomic imprinting is an epigenetic process that silences one parental allele, resulting in monoallelic expression. Imprinted genes are important in mammalian fetal growth and development. Evidence has emerged showing that genes that are paternally expressed promote fetal growth, whereas maternally expressed genes suppress growth. We have assessed whether the expression levels of key imprinted genes correlate with fetal growth parameters during pregnancy, either early in gestation, using chorionic villus samples (CVS), or in term placenta. We have found that the expression of paternally expressing insulin-like growth factor 2 (IGF2), its receptor IGF2R, and the IGF2/IGF1R ratio in CVS tissues significantly correlate with crown–rump length and birthweight, whereas term placenta expression shows no correlation. For the maternally expressing pleckstrin homology-like domain family A, member 2 (PHLDA2), there is no correlation early in pregnancy in CVS but a highly significant negative relationship in term placenta. Analysis of the control of imprinted expression of PHLDA2 gave rise to a maternally and compounded grand-maternally controlled genetic effect with a birthweight increase of 93/155 g, respectively, when one copy of the PHLDA2 promoter variant is inherited. Expression of the growth factor receptor-bound protein 10 (GRB10) in term placenta is significantly negatively correlated with head circumference. Analysis of the paternally expressing delta-like 1 homologue (DLK1) shows that the paternal transmission of type 1 diabetes protective G allele of rs941576 single nucleotide polymorphism (SNP) results in significantly reduced birth weight (−132 g). In conclusion, we have found that the expression of key imprinted genes show a strong correlation with fetal growth and that for both genetic and genomics data a
Aghajanova L, Mahadevan S, Altmaee S, et al., 2015, No evidence for mutations in <i>NLRP7</i>, <i>NLRP2</i> or <i>KHDC3L</i> in women with unexplained recurrent pregnancy loss or infertility, HUMAN REPRODUCTION, Vol: 30, Pages: 232-238, ISSN: 0268-1161
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Hameed A, Malik S, Regan L, 2014, Debate: should progesterone supplements be used in recurrent pregnancy loss?, Recurrent Pregnancy Loss Causes, Controversies, and Treatment, Second Edition, Editors: Carp, Publisher: CRC Press, Pages: 93-96, ISBN: 9781482216141
This second edition presents new material on the latest controversies, featuring opinions from both sides of ongoing debates.
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