434 results found
Saso D, Jones B, Chawla M, et al., 2019, Management of borderline ovarian tumours in a London University Hospital: long-term follow up and overall survival, Publisher: WILEY, Pages: 92-92, ISSN: 1470-0328
Bobdiwala S, Saso S, Verbakel JY, et al., 2019, Diagnostic protocols for the management of pregnancy of unknown location (PUL): a systematic review and meta-analysis, Publisher: WILEY, Pages: 17-17, ISSN: 1470-0328
Saso S, Al-Memar M, Jones B, et al., 2019, Performing ultrasonography in patients awaiting uterine transplantation: the UK cohort, Publisher: WILEY, Pages: 127-127, ISSN: 1470-0328
Bourne T, 2019, Prediction of first-trimester viability using clinical, ultrasound and biomarker information, Publisher: WILEY, Pages: 26-27, ISSN: 1470-0328
Lokugamage A, Swordy A, Bourne T, et al., 2019, Footprints of birth: qualitative analysis of an innovative educational intervention highlighting women's voices to improve empathy and reflective practice in maternity care, Publisher: WILEY, Pages: 46-46, ISSN: 1470-0328
Bobdiwala S, Kyriacou C, Christodoulou E, et al., 2019, Evaluating cutoff values for progesterone, single hCG and hCG ratio to define pregnancy viability and location in women with a pregnancy of unknown location (PUL), Publisher: WILEY, Pages: 24-25, ISSN: 1470-0328
Al-Memar M, Vaulet T, Nikolic G, et al., 2019, Pain and bleeding in the first trimester and long-term pregnancy outcomes: a prospective cohort study, Publisher: WILEY, Pages: 18-18, ISSN: 1470-0328
Grewal K, Lee Y, Smith A, et al., 2019, Lactobacillus-deplete vaginal microbiota composition is associated with chromosomally normal miscarriage, Publisher: WILEY, Pages: 29-29, ISSN: 1470-0328
Bourne T, Shah H, Falconieri N, et al., 2019, Investigating burnout, wellbeing and defensive medical practice among obstetricians and gynaecologists in the United Kingdom, RCOG World Congress 2019, Publisher: WILEY, Pages: 121-122, ISSN: 1470-0328
Bobdiwala S, Christodoulou E, Farren J, et al., 2019, A multicentre trial on the performance of a two-step triage protocol based on initial serum progesterone and serial hCG used to manage pregnancies of unknown location (PUL), Publisher: WILEY, Pages: 15-16, ISSN: 1470-0328
Landolfo C, Froyman W, Testa AC, et al., 2019, Imaging in gynaecological disease: clinical and ultrasound features of immature teratomas of the ovary, Publisher: WILEY, Pages: 115-115, ISSN: 1470-0328
Al-Memar M, Vaulet T, Fourie H, et al., 2019, Intrauterine haematomas in the first trimester and association with adverse pregnancy outcomes, Publisher: WILEY, Pages: 18-19, ISSN: 1470-0328
Jordans IPM, de Leeuw RL, Stegwee SI, et al., 2019, Niche definition and guidance for detailed niche evaluation, Acta Obstetricia et Gynecologica Scandinavica, ISSN: 1600-0412
With interest we read the correspondence of Bamberg et al.1 and Scioscia et al.2 about the randomized controlled trial of the first authors concerning the uterine niche after caesarean section (CS).3 They state that at the time of the trial it was not established which technique should be used in the evaluation of a caesarean scar or niche in daily practice and future research. Both authors underline the need for a uniform evaluation of the CS scar establishing an internationally accepted definition of a niche. In their study a niche was defined as an anechogenic area at the site of the uterine scar with a depth of at least 1 mm.
Al-Memar M, Vaulet T, Fourie H, et al., 2019, The impact of early pregnancy events on long-term pregnancy outcomes: a prospective cohort study, Ultrasound in Obstetrics and Gynecology, ISSN: 0960-7692
OBJECTIVES: To prospectively assess the impact of pelvic pain, vaginal bleeding and nausea and vomiting in the first trimester of pregnancy on long-term pregnancy outcomes. METHODS: Prospective observational cohort study at Queen Charlotte's & Chelsea Hospital, London, UK, from March 2014-2016. Consecutive women with confirmed intrauterine pregnancies between 5-14 weeks gestation were recruited. Serial ultrasound scans were performed in the first trimester. Participants completed validated symptom scores for vaginal bleeding, pelvic pain, and nausea and vomiting. The key symptom of interest was any pelvic pain and/or vaginal bleeding. Pregnancies were followed up until the final outcome was known. Antenatal, delivery, and neonatal outcomes were obtained from hospital records. We calculated adjusted odds ratios (aOR) using logistic regression with correction for maternal age. RESULTS: We recruited 1003 women. After excluding first trimester miscarriages (N=99), terminations (N=20), lost to follow up (N=32) and withdrawals (N=5), 847 pregnancies were analysed. Adverse antenatal complications were observed in 166/645 (26%) women with pain and/or bleeding, and in 30/181 (17%) women without (aOR=1.79, 95% CI=1.17-2.76). Neonatal complications were observed in 66/635 (10%) women with and 11/176 (6%) women without pain and/or bleeding (aOR=1.73, 95% CI=0.89-3.36). Delivery complications were observed in 402/615 (65%) women with and 110/174 (63%) women without pain and/or bleeding (aOR=1.16, 95% CI=0.81-1.65). For 18 of 20 individual antenatal complications, incidence was higher among women with pain and/or bleeding, despite the overall incidences being low. Nausea and vomiting in pregnancy showed little association with adverse pregnancy outcomes. CONCLUSIONS: Our study suggests that there is an increased incidence of antenatal complications in women with pelvic pain and/or vaginal bleeding in the first trimester. This should be considered when advising women attending
Andreotti RF, Timmerman D, Benacerraf BR, et al., 2019, Ovarian-Adnexal Reporting Lexicon for Ultrasound: A White Paper of the ACR Ovarian-Adnexal Reporting and Data System Committee (vol 15, pg 1415, 2018), JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY, Vol: 16, Pages: 403-406, ISSN: 1546-1440
Al-Memar M, Vaulet T, Fourie H, et al., 2019, Impact of Intrauterine Haematoma on Pregnancy Outcomes., 66th Annual Scientific Meeting of the Society-for-Reproductive-Investigation (SRI), Publisher: SAGE PUBLICATIONS INC, Pages: 378A-378A, ISSN: 1933-7191
Froyman W, Landolfo C, De Cock B, et al., 2019, Risk of complications in patients with conservatively managed ovarian tumours (IOTA5): a 2-year interim analysis of a multicentre, prospective, cohort study, Lancet Oncology, ISSN: 1470-2045
BACKGROUND: Ovarian tumours are usually surgically removed because of the presumed risk of complications. Few large prospective studies on long-term follow-up of adnexal masses exist. We aimed to estimate the cumulative incidence of cyst complications and malignancy during the first 2 years of follow-up after adnexal masses have been classified as benign by use of ultrasonography. METHODS: In the international, prospective, cohort International Ovarian Tumor Analysis Phase 5 (IOTA5) study, patients aged 18 years or older with at least one adnexal mass who had been selected for surgery or conservative management after ultrasound assessment were recruited consecutively from 36 cancer and non-cancer centres in 14 countries. Follow-up of patients managed conservatively is ongoing at present. In this 2-year interim analysis, we analysed patients who were selected for conservative management of an adnexal mass judged to be benign on ultrasound on the basis of subjective assessment of ultrasound images. Conservative management included ultrasound and clinical follow-up at intervals of 3 months and 6 months, and then every 12 months thereafter. The main outcomes of this 2-year interim analysis were cumulative incidence of spontaneous resolution of the mass, torsion or cyst rupture, or borderline or invasive malignancy confirmed surgically in patients with a newly diagnosed adnexal mass. IOTA5 is registered with ClinicalTrials.gov, number NCT01698632, and the central Ethics Committee and the Belgian Federal Agency for Medicines and Health Products, number S51375/B32220095331, and is ongoing. FINDINGS: Between Jan 1, 2012, and March 1, 2015, 8519 patients were recruited to IOTA5. 3144 (37%) patients selected for conservative management were eligible for inclusion in our analysis, of whom 221 (7%) had no follow-up data and 336 (11%) were operated on before a planned follow-up scan was done. Of 2587 (82%) patients with follow-up data, 668 (26%) had a mass that was already in fo
Craciunas L, Gallos I, Chu J, et al., 2019, Conventional and modern markers of endometrial receptivity: a systematic review and meta-analysis, Human Reproduction Update, ISSN: 1355-4786
BACKGROUND: Early reproductive failure is the most common complication of pregnancy with only 30% of conceptions reaching live birth. Establishing a successful pregnancy depends upon implantation, a complex process involving interactions between the endometrium and the blastocyst. It is estimated that embryos account for one-third of implantation failures, while suboptimal endometrial receptivity and altered embryo-endometrial dialogue are responsible for the remaining two-thirds. Endometrial receptivity has been the focus of extensive research for over 80 years, leading to an indepth understanding of the processes associated with embryo-endometrial cross-talk and implantation. However, little progress has been achieved to translate this understanding into clinically meaningful prognostic tests and treatments for suboptimal endometrial receptivity. OBJECTIVE AND RATIONALE: The objective of this systematic review was to examine the evidence from observational studies supporting the use of endometrial receptivity markers as prognostic factors for pregnancy outcome in women wishing to conceive, in order to aid clinicians in choosing the most useful marker in clinical practice and for informing further research. SEARCH METHODS: The review protocol was registered with PROSPERO (CRD42017077891). MEDLINE and Embase were searched for observational studies published from inception until 26 February 2018. We included studies that measured potential markers of endometrial receptivity prior to pregnancy attempts and reported the subsequent pregnancy outcomes. We performed association and accuracy analyses using clinical pregnancy as an outcome to reflect the presence of receptive endometrium. The Newcastle-Ottawa scale for observational studies was employed to assess the quality of the included studies. OUTCOMES: We included 163 studies (88 834 women) of moderate overall quality in the narrative synthesis, out of which 96 were included in the meta-analyses. Studies reported on
Jordans IPM, de Leeuw RA, Stegwee SI, et al., 2019, Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 53, Pages: 107-+, ISSN: 0960-7692
Brown RG, Al-Memar M, Marchesi JR, et al., 2018, Establishment of vaginal microbiota composition in early pregnancy and its association with subsequent preterm prelabour rupture of the fetal membranes, Translational Research, ISSN: 1931-5244
Vaginal bacterial community composition influences pregnancy outcome. Preterm prelabor rupture of the fetal membranes (PPROM), which precedes 30% of all spontaneous preterm births, is associated with high vaginal bacterial diversity prior to rupture. The point at which vaginal bacterial diversity is established before PPROM is unknown. In this study, we use metataxonomics to longitudinally characterize the vaginal bacterial composition from as early as 6 weeks of gestation in women at high (n = 38) and low (n = 22) risk of preterm birth who subsequently experience PPROM and in women delivering at term without complications (n = 36). Reduced Lactobacillus spp. abundance and high diversity was observed prior to PPROM in 20% and 26% of women at low and high risk of preterm births respectively, but in only 3% of women who delivered at term. PPROM was associated with instability of bacterial community structure during pregnancy and a shift toward higher diversity predominately occurring during the second trimester. This was characterized by increased relative abundance of potentially pathogenic species including Prevotella, Peptoniphilus, Streptococcus, and Dialister. This study identifies reduced Lactobacillus spp. abundance and increasing vaginal bacterial diversity as an early risk factor for PPROM and highlights the need for interventional studies designed to assess the impact of modifying vaginal bacterial composition for the prevention of preterm birth.
May J, Duncan C, Mol B, et al., 2018, A multi-centre, double-blind, placebo-controlled, randomised trial of combination methotrexate and gefitinib versus methotrexate alone to treat tubal ectopic pregnancies (GEM3): Trial protocol, Trials, Vol: 19, ISSN: 1745-6215
BackgroundTubal ectopic pregnancy (tEP) is the most common life-threatening condition in gynaecology. Treatment options include surgery and medical management. Stable women with tEPs with pre-treatment serum human chorionic gonadotrophin (hCG) levels < 1000 IU/L respond well to outpatient medical treatment with intramuscular methotrexate. However, tEPs with hCG > 1000 IU/L can take significant time to resolve with methotrexate and require multiple outpatient monitoring visits. In pre-clinical studies, we found that tEP implantation sites express high levels of epidermal growth factor receptor. In early-phase trials, we found that combination therapy with gefitinib, an orally active epidermal growth factor receptor antagonist, and methotrexate resolved tEPs without the need for surgery in over 70% of cases, did not cause significant toxicities, and was well tolerated. We describe the protocol of a randomised trial to assess the efficacy of combination gefitinib and methotrexate, versus methotrexate alone, in reducing the need for surgical intervention for tEPs.Methods and analysisWe propose to undertake a multi-centre, double-blind, placebo-controlled, randomised trial (around 70 sites across the UK) and recruit 328 women with tEPs (with pre-treatment serum hCG of 1000–5000 IU/L). Women will be randomised in a 1:1 ratio by a secure online system to receive a single dose of intramuscular methotrexate (50 mg/m2) and either oral gefitinib or matched placebo (250 mg) daily for 7 days. Participants and healthcare providers will remain blinded to treatment allocation throughout the trial. The primary outcome is the need for surgical intervention for tEP. Secondary outcomes are the need for further methotrexate treatment, time to resolution of the tEP (serum hCG ≤ 15 IU/L), number of hospital visits associated with treatment (until resolution or scheduled/emergency surgery), and the return of menses by 3 months after resolution. We will a
Epstein E, Fischerova D, Valentin L, et al., 2018, Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus nomenclature: prospective multicenter study (vol 51, pg 818, 2018), ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 52, Pages: 684-684, ISSN: 0960-7692
Andreotti RF, Timmerman D, Benacerraf BR, et al., 2018, Ovarian-Adnexal Reporting Lexicon for Ultrasound: A White Paper of the ACR Ovarian-Adnexal Reporting and Data System Committee, JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY, Vol: 15, Pages: 1415-1429, ISSN: 1546-1440
BACKGROUNDEarly pregnancy loss (EPL) is a common event, with scope for long-term personal and societal impact. There are three decades worth of published evidence of profound psychological sequelae in a significant proportion of women. However, the wide variety of outcomes, screening instruments, assessment timings and geographical locations makes it challenging to form a coherent picture of the morbidity within the whole group and its subgroups.OBJECTIVE AND RATIONALEThis review aims to investigate three questions. (1) What is the evidence for depression, anxiety and post-traumatic stress disorder (PTSD) following a miscarriage or an ectopic pregnancy in women and/or their partners? (2) What is the intensity and duration of these conditions, and how do they compare to those without losses? (3) Which patients have been found to be at highest risk of psychopathology? Answers to these questions are salient not only in day-to-day clinical interactions with those experiencing EPL, whose psychological needs may not be prioritized, but should also form the basis for tailoring healthcare policy in terms of screening for and treating the associated psychological morbidity.SEARCH METHODSThe following databases were searched, from the start of each database up to July 2017: MEDLINE (Ovid interface, 1948 onwards), Embase classic + Embase (Ovid interface, 1947 onwards), and PsychINFO (Ovid interface, 1806 onwards). Search strategies were developed using medical subject headings (MeSH). The concepts of psychological morbidity (anxiety, depression or PTSD) and pregnancy loss (miscarriage or ectopic pregnancy) were first expanded with the Boolean operator ‘or’, then linked together using ‘and’.Included studies were of prospective cohort design, including women or men following EPL (with the majority to have experienced losses before 24 weeks gestation), and reporting standardized psychometric measures for anxiety, depression and post-traumatic stress disord
Dall'Asta A, Shah H, Masini G, et al., 2018, Evaluation of the tramline sign for abnormally invasive placenta using three-dimensional ultrasound and Crystal Vue rendering technology, Ultrasound in Obstetrics and Gynecology, Vol: 52, Pages: 403-404, ISSN: 0960-7692
Prenatal diagnosis of abnormally invasive placenta (AIP) and accurate characterization of its variants can contribute to reducing maternal morbidity and mortality by allowing optimal management in terms of timing and planning of delivery (1,2).
Bobdiwala S, Saso S, Verbakel JY, et al., 2018, Diagnostic protocols for the management of pregnancy of unknown location: a systematic review and meta-analysis, BJOG: An International Journal of Obstetrics and Gynaecology, ISSN: 1470-0328
BACKGROUND: There is no international consensus on how to manage women with a pregnancy of unknown location (PUL). OBJECTIVES: To present a systematic quantitative review summarising the evidence related to management protocols for PUL. SEARCH STRATEGY: MEDLINE, COCHRANE and DARE databases were searched from 01/01/1984 to 31/01/2017. The primary outcome was accurate risk prediction of women initially diagnosed with a PUL having an ectopic pregnancy (high risk) as opposed to either a failed PUL or intrauterine pregnancy ((low risk). SELECTION CRITERIA: All studies written in the English language, that were not case reports or series that assessed women classified as having a PUL at initial ultrasound. DATA COLLECTION AND ANALYSIS: Forty-three studies were included. QUADAS-2 criteria were used to assess the risk of bias. We used a novel linear mixed effects model and constructed summary receiver operating characteristic (SROC) curves for the thresholds of interest. MAIN RESULTS: There was a high risk of differential verification bias in most studies. Meta-analyses of accuracy were performed on (i) single hCG cut-off levels, (ii) hCG ratio (hCG at 48 hours / initial hCG), (iii) single progesterone cut-off levels and (iv) the 'M4 model' (a logistic regression model based on the initial hCG and hCG ratio). For predicting an ectopic pregnancy, the AUCs (95% CI) for these four management protocols were: (i) 0.42 (0.00-0.99), (ii) 0.69 (0.57-0.78), (iii) 0.69 (0.54-0.81) and (iv) 0.87 (0.83-0.91), respectively. CONCLUSIONS: The M4 model was the best available method for predicting a final outcome of ectopic pregnancy. Developing and validating risk prediction models may optimise the management of PUL. This article is protected by copyright. All rights reserved.
Saso S, Tziraki M, Clancy NT, et al., 2018, Use of Laser Speckle Contrast Analysis during pelvic surgery in a uterine transplantation model, Future Science OA, Vol: 4, Pages: FSO324-FSO324, ISSN: 2056-5623
Aim: Uterine transplantation (UTx) is proposed for treatment of uterine factor infertility. Our aim was to assess whether Endoscopic Laser Speckle Contrast Analysis (eLASCA) could evaluate pelvic blood flow at anastomotic sites required for sheep and rabbit UTx. Results/methodology: eLASCA detected blood flow in rabbit UTx #7 and #9. In sheep UTx #2, #3 and #5, the results allowed us to conclude that blood flow was present in the uterine graft following transplantation; and post-UTx, the animal had heart and respiratory rates, and oxygen saturation compatible with a normal hemodynamic status. Conclusion: These preliminary results establish the potential of Laser Speckle Contrast Analysis as noncontact and real-time tool for observation of spatially-resolved blood flow from which other parameters can be derived.
Landolfo C, Valentin L, Franchi D, et al., 2018, Differences in the ultrasound features of papillations in unilocular-solid adnexal cysts: a retrospective international multicenter study, Ultrasound in Obstetrics and Gynecology, Vol: 52, Pages: 269-278, ISSN: 0960-7692
OBJECTIVES: The aim is to determine if there are any ultrasound features of papillations or of the cyst wall that can discriminate between benign and malignant unilocular-solid cysts with papillations but no other solid components. METHODS: Patients with an adnexal lesion described at ultrasonography as unilocular-solid with papillations but no other solid components were identified from the International Ovarian Tumor Analysis (IOTA) database derived from seven ultrasound centers. All had undergone transvaginal ultrasonography between 1999 and 2012 by an experienced examiner following the IOTA research protocol. Information on four ultrasound features of papillations had been collected prospectively. Information on a further seven ultrasound features was collected retrospectively from electronic or paper ultrasound images of good quality. The histological diagnosis of the surgically removed adnexal lesion was the gold standard. RESULTS: Of 204 masses included, 131 (64%) were benign, 42 (20.5%) were borderline tumors, 31 (15%) primary invasive and one (0.5%) was a metastasis. Multivariate logistic regression analysis showed the following ultrasound features to be independently associated with malignancy: the height of the largest papillation, blood flow in papillations, papillation confluence or papillation dissemination, and shadows behind papillations. Shadows decreased the odds of malignancy, the other features increased them. CONCLUSION: We have identified ultrasound features that can help discriminate between benign and malignant unilocular-solid cysts with papillations but no other solid components. Our results need to be confirmed in prospective studies.
Epstein E, Fischerova D, Valentin L, et al., 2018, Ultrasound characteristics of endometrial cancer as defined by the International Endometrial Tumor Analysis (IETA) consensus nomenclature - A prospective multicenter study, Ultrasound in Obstetrics and Gynecology, Vol: 51, Pages: 818-828, ISSN: 0960-7692
OBJECTIVES: To describe the sonographic features of endometrial cancer in relation to stage, grade, and histological type using the International Endometrial Tumor Analysis (IETA) terminology. METHODS: Prospective multicenter study on 1714 women with endometrial cancer undergoing a standardized transvaginal grayscale and Doppler ultrasound examination by an experienced ultrasound examiner using a high-end ultrasound system. Clinical and sonographic data were entered into a web-based protocol. We assessed how strongly sonographic characteristics, according to IETA, were associated to outcome at hysterectomy, i.e. tumor stage, grade, and histological type. RESULTS: After excluding 176 women (no or delayed hysterectomy, final diagnosis other than endometrial cancer, or incomplete data), 1538 women were included in our statistical analysis. Median age was 65 years (range 27-98), and median BMI 28.4 (range 16-67), 1378 (89.7%) women were postmenopausal, and 1296 (84.2%) reported abnormal vaginal bleeding. Grayscale and color Doppler features varied according to grade and stage. High-risk tumors (stage 1A, grade 3 or non-endometrioid or ≥ stage 1B) were less likely to have regular endometrial myometrial border (difference of -23%, 95% CI -27 to -18%), whilst they were larger (mean endometrial thickness; difference of +9 mm, 95% CI +8 to +11 mm), more frequently had non-uniform echogenicity (difference of +10%, 95% CI +5 to +15%), a multiple, multifocal vessel pattern (difference of +21%, 95% CI +16 to +26%), and a moderate or high color score (difference of +22%, 95% CI +18 to +27%), than low-risk tumors. CONCLUSION: Grayscale and color Doppler ultrasound features are associated with grade and stage, and differ between high and low risk endometrial cancer.
Van den Bosch T, de Bruijn AM, de Leeuw RA, et al., 2018, A sonographic classification and reporting system for diagnosing adenomyosis, Ultrasound in Obstetrics and Gynecology, ISSN: 0960-7692
OBJECTIVE: To develop a uniform classification and standardized reporting system of ultrasound findings of adenomyosis using the Morphological Uterus Sonographic Assessment (MUSA) criteria. METHOD: The opinion presented in this manuscript was built based on a thorough discussion among all authors, including a Delphi procedure. Selected images and videos of typical cases of the different morphological variations of adenomyosis were used in the debates. RESULTS: A classification and reporting system of different types of adenomyosis based on ultrasound was agreed upon including (1) identification of adenomyosis based on MUSA criteria, (2) disease location (anterior, posterior, left lateral, right lateral, fundal), (3) classification of the lesions as focal or diffuse, (4) presence or absence of intralesional cysts, (5) myometrial layer involvement (junctional zone, myometrium, serosal involvement), (6) disease extent (< 25%, 25-50%, > 50% of uterine volume affected by adenomyosis) and (7) lesion size. CONCLUSIONS: We proposes a uniform classification and reporting system of different types of adenomyosis based on ultrasound. The clinical relevance of this approach needs to be evaluated in further studies. This article is protected by copyright. All rights reserved.
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