Imperial College London

Professor Tom Bourne

Faculty of MedicineDepartment of Metabolism, Digestion and Reproduction

Chair in Gynaecology
 
 
 
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Contact

 

+44 (0)20 3313 5131t.bourne Website

 
 
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Location

 

Early pregnancy and acute gynaecologyInstitute of Reproductive and Developmental BiologyHammersmith Campus

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Summary

 

Publications

Publication Type
Year
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473 results found

Dall'Asta A, Forlani F, Shah H, Paramasivam G, Yazbek J, Bourne T, Calì G, Lees Cet al., 2021, Evaluation of the Tramline Sign in the Prediction of Placenta Accreta Spectrum and Perioperative Outcomes in Anterior Placenta Previa., Ultraschall Med

PURPOSE:  To evaluate perioperative outcomes and the prognostic role of the tramline sign in a cohort of women with anterior placenta previa. MATERIALS AND METHODS:  Retrospective analysis of 3D ultrasound volumes from women with anterior placenta previa who underwent ultrasound examination beyond 32 weeks. 3D and 3D color volumes were obtained from a sagittal section of the uterus bisecting a partially full bladder and processed using Crystal Vue and Crystal Vue Flow rendering to look for the "tramline sign". "Partial obliteration" was defined as a loss of some or part of the uterine-serosal interface and "full obliteration" as when both interfaces were interrupted. Postnatal ascertainment of placenta accreta spectrum (PAS) was confirmed by findings recorded intraoperatively or on a pathology report. RESULTS:  65 cases were included. The tramline sign was "partially" (17) or "fully" (19) obliterated in 36 cases (55.4 %), and present in 29 (44.6 %). Obliteration was associated with earlier gestational age at delivery (35 + 1 (26 + 3-38 + 3) vs. 36 + 4 (25 + 3-38 + 0) weeks, p = 0.005), greater estimated blood loss (800 (400-11 000) vs. 600 (300-2100) mls, p = 0.003), longer operative time (155 (60-240) vs. 54 (25-80) minutes, p < 0.001), higher rate of hysterectomy (97.2 % vs. 0.0 %, p < 0.001), longer postoperative admission (7 (3-19) vs. 3 (1-5) days, p < 0.001) and a 100 % rate of postnatal diagnosis of PAS. The finding of an "obliterated" tramline sign identified all women that required hysterectomy and all cases of PAS. CONCLUSION:  A "partially or fully obliterated" tramline sign is strongly associated with indicators of operative complexity, the postnatal confirmation of PAS, and the need for peripartum hysterectomy.

Journal article

Christodoulou E, Bobdiwala S, Kyriacou C, Farren J, Mitchell-Jones N, Ayim F, Chohan B, Abughazza O, Guruwadahyarhalli B, Al-Memar M, Guha S, Vathanan V, Gould D, Stalder C, Wynants L, Timmerman D, Bourne T, Van Calster Bet al., 2021, External validation of models to predict the outcome of pregnancies of unknown location: a multicentre cohort study., BJOG: an International Journal of Obstetrics and Gynaecology, Vol: 128, Pages: 552-562, ISSN: 1470-0328

OBJECTIVE: To externally validate five approaches to predict ectopic pregnancy (EP) in pregnancies of unknown location (PUL): the M6P and M6NP risk models, the two-step triage strategy (2ST, which incorporates M6P), the M4 risk model, and beta human chorionic gonadotropin ratio cut-offs (BhCG-RC). DESIGN: Secondary analysis of a prospective cohort study. SETTING: Eight UK early pregnancy assessment units. POPULATION: Women presenting with a PUL and BhCG >25 IU/L. METHODS: Women were managed using the 2ST protocol: PUL were classified as low risk of EP if presenting progesterone ≤2 nmol/L; the remaining cases returned two days later for triage based on M6P. EP risk ≥5% was used to classify PUL as high risk. Missing values were imputed, and predictions for the five approaches were calculated post hoc. We meta-analysed centre-specific results. MAIN OUTCOME MEASURES: Discrimination, calibration and clinical utility (decision curve analysis) for predicting EP. RESULTS: Of 2899 eligible women, the primary analysis excluded 297 (1 0%) women who were lost to follow-up. The area under the ROC curve for EP was 0.89 (95% confidence interval 0.86-0.91) for M6P, 0.88 (0.86-0.90) for 2ST, 0.86 (0.83-0.88) for M6NP, and 0.82 (0.78-0.85) for M4. Sensitivities for EP were 96% (M6P), 94% (2ST), 92% (N6NP), 80% (M4), and 58% (BhCG-RC); false positive rates were 35%, 33%, 39%, 24%, and 13%. M6P and 2ST had the best clinical utility and good overall calibration, with modest variability between centres. CONCLUSIONS: 2ST and M6P performed best to predict and triage PUL.

Journal article

Banerjee J, Mullins E, Townson J, Playle R, Shaw C, Kirby N, Munnery K, Bourne T, Teoh TG, Dhanjal M, Poon L, Wright A, Lees Cet al., 2021, Pregnancy and Neonatal Outcomes in COVID-19: Study protocol for a global registry of women with suspected or confirmed SARS-CoV-2 infection in pregnancy and their neonates, understanding natural history to guide treatment and prevention, BMJ Open, Vol: 11, Pages: 1-6, ISSN: 2044-6055

Introduction: Previous novel coronavirus pandemics, Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), observed an association of infection in pregnancy with pre-term delivery, stillbirth and increased maternal mortality. Coronavirus disease2019(COVID-19), caused by SARS-CoV-2 infection, is the largest pandemic in living memory. Rapid accrual of robust case data on women in pregnancy and their babies affected by suspectedCOVID-19or confirmed SARS-CoV-2 infection will inform clinical management and preventative strategies in the current pandemic and future outbreaks. Methods and analysis: The Pregnancy And Neonatal outcomes in COVID-19 (PAN-COVID) registry is an observational study collecting focussed data on outcomes of pregnant mothers who have had suspected COVID-19 in pregnancy or confirmed SARS-CoV-2 infection and their neonatesvia a web-portal. Amongst the women recruited to the PAN-COVID registry, the study will evaluate the incidence of:1. Miscarriage and pregnancy loss2. FGR and stillbirth 3. Pre-term delivery 4. Vertical transmission(suspected or confirmed) and early-onset neonatal SARS-CoV-2 infection Data will be centre based and collected on individual women and their babies. Verbal consent will be obtained, to reduce face-to-face contact in the pandemic whilst allowing identifiable data collection for linkage. Statistical analysis of the data will be carried out on a pseudonymised dataset by the study statistician. Regular reports will be distributed to collaborators on the study research questions. Ethics and dissemination: This study has received research ethics approval in the UK. For international centres, evidence of appropriate local approval will be required to participate, prior to entry of data to the database. The reports will be published regularly. The outputs of the study will be regularly disseminated to 4participants and collaborators on the study

Journal article

Van den Bosch T, Verbakel JY, Valentin L, Wynants L, De Cock B, Pascual MA, Leone FPG, Sladkevicius P, Alcazar JL, Votino A, Fruscio R, Lanzani C, Van Holsbeke C, Rossi A, Jokubkiene L, Kudla M, Jakab A, Domali E, Epstein E, Van Pachterbeke C, Bourne T, Van Calster B, Timmerman Det al., 2021, Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 57, Pages: 164-172, ISSN: 0960-7692

Journal article

Moro F, Verdecchia V, Romeo P, Ciccarone F, Zannoni GF, Valentin L, Timmerman D, Bourne T, Froyman W, Scambia G, Testa ACet al., 2021, Ultrasound, macroscopic and histological features of malignant ovarian tumors, INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER, Vol: 31, Pages: 150-151, ISSN: 1048-891X

Journal article

Murugesu S, Galazis N, Jones B, Chan M, Bracewell-Milnes T, Ahmed-Salim Y, Grewal K, Timmerman D, Yazbek J, Bourne T, Saso Set al., 2020, Evaluating the use of Telemedicine in Gynaecological Practice: A Systematic Review, BMJ Open, Vol: 10, ISSN: 2044-6055

Objectives The aim of this systematic review is to examine the use of telemedicine in the delivery and teaching of gynaecological clinical practice. To our knowledge, no other systematic review has assessed this broad topic.Design Systematic review of all studies investigating the use of telemedicine in the provision of gynaecological care and education. The search for eligible studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and focused on three online databases: PubMed, Science Direct and SciFinder.Eligibility criteria Only studies within gynaecology were considered for this review. Studies covering only obstetrics and with minimal information on gynaecology, or clinical medicine in general were excluded. All English language, peer-reviewed human studies were included. Relevant studies published up to the date of final submission of this review were considered with no restrictions to the publication year.Data extractions and synthesis Data extracted included author details, year of publication and country of the study, study aim, sample size, methodology, sample characteristics, outcome measures and a summary of findings. Data extraction and qualitative assessment were performed by the first author and crossed checked by the second author. Quality assessment for each study was assessed using the Newcastle-Ottawa scale.Results A literature search carried out in August 2020 yielded 313 records published between 1992 and 2018. Following a rigorous selection process, only 39 studies were included for this review published between 2000 and 2018. Of these, 19 assessed gynaecological clinical practice, eight assessed gynaecological education, one both, and 11 investigated the feasibility of telemedicine within gynaecological practice. 19 studies were classified as good, 12 fair and eight poor using the Newcastle-Ottawa scale. Telecolposcopy and abortion care were two areas where telemedicine was found to be effective in p

Journal article

Bourne T, Bilardo CMK, 2020, ISUOG virtual world congress on ultrasound in obstetrics and gynecology, 16-18 October 2020: presentations and awards, Ultrasound in Obstetrics and Gynecology, Vol: 56, Pages: 958-960, ISSN: 0960-7692

Journal article

Landolfo C, Achten ETL, Ceusters J, Baert T, Froyman W, Heremans R, Vanderstichele A, Thirion G, Van Hoylandt A, Claes S, Oosterlynck J, Van Rompuy AS, Schols D, Billen J, Van Calster B, Bourne T, Van Gorp T, Vergote I, Timmerman D, Coosemans Aet al., 2020, Assessment of protein biomarkers for preoperative differential diagnosis between benign and malignant ovarian tumors, GYNECOLOGIC ONCOLOGY, Vol: 159, Pages: 811-819, ISSN: 0090-8258

Journal article

Coomarasamy A, Devall AJ, Brosens JJ, Quenby S, Stephenson MD, Sierra S, Christiansen OB, Small R, Brewin J, Roberts TE, Dhillon-Smith R, Harb H, Noordali H, Papadopoulou A, Eapen A, Prior M, Di Renzo GC, Hinshaw K, Mol BW, Lumsden MA, Khalaf Y, Shennan A, Goddijn M, van Wely M, Al-Memar M, Bennett P, Bourne T, Rai R, Regan L, Gallos IDet al., 2020, Micronized vaginal progesterone to prevent miscarriage: a critical evaluation of randomized evidence, Obstetrical and Gynecological Survey, Vol: 75, Pages: 743-744, ISSN: 0029-7828

Historically, a lack of methodologically strong and generalizable studies has limited policy makers from recommending the use of progesterone supplementation to improve outcomes in women at high risk of miscarriage. The PROMISE and PRISM trials were carried out to rectify this and generate robust evidence on the role of progesterone supplementation to prevent miscarriage.

Journal article

Moro F, Buonsenso D, Van der Merwe J, Bourne T, Deprest J, Froyman W, Inchingolo R, Smargiassi A, Mascilini F, Moruzzi MC, Ciccarone F, Landolfo C, Lanzone A, Scambia G, Timmerman D, Testa ACet al., 2020, A Prospective International Lung Ultrasound Analysis Study in Tertiary Maternity Wards During the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic, JOURNAL OF ULTRASOUND IN MEDICINE, ISSN: 0278-4297

Journal article

Kasaven LS, Saso S, Barcroft J, Yazbek J, Joash K, Stalder C, Nagi JB, Smith JR, Lees C, Bourne T, Jones BPet al., 2020, Authors' reply Re: Implications for the future of Obstetrics and Gynaecology following the COVID-19 pandemic: a commentary, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 128, Pages: 616-617, ISSN: 1470-0328

Journal article

Mitchell-Jones N, Lawson K, Bobdiwala S, Farren J, Bottomley C, Tobias A, Bourne Tet al., 2020, The association between hyperemesis gravidarum and psychological symptoms, psychosocial outcomes and infant bonding: a two point prospective case control multi-centre survey study in an inner city setting, BMJ Open, Vol: 10, Pages: 1-12, ISSN: 2044-6055

ObjectivesTo assess if there is any association between hyperemesis gravidarum (HG), psychological morbidity and infant bonding and to quantify any psychosocial consequences of HG DesignTwo-point prospective case control, multi-centre survey study with antenatal and postnatal data collection SettingThree London hospitalsParticipantsPregnant women at ≤ 12 completed weeks gestation recruited consecutively over two years. Women with HG were recruited at the time of admission; controls recruited from a low risk antenatal clinic. 106 women were recruited to the cases group and 108 to the control. Response rates at antenatal data collection were 87% and 85% in the cases and control groups respectively. Postnatally, the response rate was 90% in both groups. Primary and secondary outcome measuresPrimary outcomes were; psychological morbidity in the antenatal and postnatal periods, infant bonding in the postnatal period and psychosocial implications of HG. Secondary outcomes were the effects of severity and longevity of HG and assessment of correlation between EPDS scores and maternal-to-infant bonding scores. ResultsAntenatally, 49% of cases had probable depression compared to 6% of controls (OR 14.4 (5.29,39.44). Postnatally, 29% of cases had probable depression versus 7% of controls (OR 5.2(1.65,17.21). There was no direct association between HG and infant bonding. 53% of women in the HG group reported needing four or more weeks of sick leave compared to 2% in the control group (OR 60.5 (95% CI 8.4;2535.6)). ConclusionsLong lasting psychological morbidity associated with HG was evident. Significantly more women in the cases group sought help for mental health symptoms in the antenatal period, however very few were diagnosed with or treated for depression in pregnancy or referred to specialist perinatal mental health services. HG did not directly affect infant bonding. Women in the cases group required long periods off work, highlighting the socioeconomic impact of HG.

Journal article

Farren J, Jalmbrant M, Falconieri N, Mitchell-Jones N, Bobdiwala S, Al-Memar M, Tapp S, Van Calster B, Wynants L, Timmerman D, Bourne Tet al., 2020, Differences in post-traumatic stress, anxiety and depression following miscarriage and ectopic pregnancy between women and their partners: a multicenter prospective cohort study, Ultrasound in Obstetrics and Gynecology, ISSN: 0960-7692

OBJECTIVES: To investigate and compare post-traumatic stress, depression and anxiety in women and their partners over a 9-month period following miscarriage or ectopic pregnancy. METHODS: This was a prospective cohort study. Consecutive women and partners were approached in the early pregnancy units of three hospitals in central London. One, three and nine months after early pregnancy loss, recruits were emailed links to surveys containing the Hospital Anxiety and Depression Scale (HADS) and Post-traumatic Diagnostic Scale (PDS). The proportion of participants meeting screening criteria for moderate/severe anxiety or depression and post-traumatic stress (PTS) was assessed. Mixed-effects logistic regression was used to analyse differences between women and their partners and the evolution over time. RESULTS: 386 partners were approached after the woman in whom the loss had been diagnosed consented to participate. 192 couples were recruited. All partners were male. Response rates were 57%, 45% and 38% for partners, and 76%, 68% and 57% for women, at month 1, 3 and 9 respectively. For partners, 7% met the criteria for PTS at month 1, 8% at month 3 and 4% at month 9, compared to 34%, 26% and 21%, respectively, of women. Partners also experienced lower rates of moderate/severe anxiety (6% vs 30% at month 1, 9% vs 25% at month 3, 6% vs 22% at month 9) and depression (2% vs 10% at month 1, 5% vs 8% at month 3, 1% vs 7% at month 9). The odds ratios for morbidity in partners vs women after 1 month was 0.02 (95% CI, 0.004-0.12) for post-traumatic stress, 0.05 (95% CI, 0.01-0.19) for moderate/severe anxiety and 0.15 (95% CI, 0.02-0.96) for moderate/severe depression. Morbidity for each outcome decreased modestly over time, without strong evidence of a different evolution for women and their partners. CONCLUSIONS: Partners experience far lower levels of post-traumatic stress, anxiety and depression than women after early pregnancy loss. This article is protected by copyright. A

Journal article

Kasaven LS, Saso S, Barcroft J, Yazbek J, Joash K, Stalder C, Ben Nagi J, Richard Smith JR, Lees C, Bourne T, Jones BPet al., 2020, Implications for the future of obstetrics and gynaecology following the COVID-19 pandemic: a commentary., BJOG: an International Journal of Obstetrics and Gynaecology, Vol: 127, Pages: 1318-1323, ISSN: 1470-0328

In March 2020, the World Health Organization (WHO) declared COVID-19 a global pandemic. At the time of writing, more than 261,184 cases of COVID-19 have been confirmed in the UK resulting in over 36,914 directly attributable deaths.1 The National Health Service (NHS) has been confronted with the unprecedented task of dealing with the enormity of the resultant morbidity and mortality. In addition, the workforce has been depleted as a direct consequence of the disease, in most cases temporarily, but in some tragic cases permanently.

Journal article

Eriksson LSE, Epstein E, Testa AC, Fischerova D, Valentin L, Sladkevicius P, Franchi D, Frühauf F, Fruscio R, Haak LA, Opolskiene G, Mascilini F, Alcazar JL, Van Holsbeke C, Chiappa V, Bourne T, Lindqvist PG, Van Calster B, Timmerman D, Verbakel JY, Van den Bosch T, Wynants Let al., 2020, An ultrasound-based risk model to predict lymph node metastases before surgery in women with endometrial cancer: a model development study., Ultrasound in Obstetrics and Gynecology, Vol: 56, Pages: 443-452, ISSN: 0960-7692

OBJECTIVES: To develop a pre-operative risk model using endometrial biopsy results, clinical and ultrasound variables to predict the individual risk of lymph node metastases in women with endometrial cancer. METHODS: A mixed effects logistic regression model was developed on 1501 prospectively included women with endometrial cancer subjected to transvaginal ultrasound examination before surgery. Missing data, including missing lymph node status, was imputed. Discrimination, calibration and clinical utility were evaluated using leave-center-out cross-validation. The predictive performance was compared with risk classification from endometrial biopsy alone (high-risk = endometrioid cancer grade 3/non-endometrioid cancer) or combined endometrial biopsy and ultrasound (high-risk = endometrioid cancer grade 3/non-endometrioid cancer/deep myometrial invasion/cervical stromal invasion/extrauterine spread). RESULTS: Lymphadenectomy was performed in 691 women, of which 127 had lymph node metastases. The model included the predictors age, duration of abnormal bleeding, endometrial biopsy result, tumor extension and tumor size according to ultrasound and "undefined tumor with an unmeasurable endometrium". The model's AUC was 0.73 (95% CI 0.68 to 0.78), calibration slope 1.06 (95% CI 0.79 to 1.34) and calibration intercept 0.06 (95% CI 0.15 to 0.27). Using risk thresholds for lymph node metastases 5% vs. 20% the model had sensitivity 98% vs. 48% and specificity 11% vs. 80%. The model had higher sensitivity and specificity than high-risk according to endometrial biopsy alone (50% vs. 35% and 80% vs. 77%) or combined endometrial biopsy and ultrasound (80% vs. 75% and 53% vs. 52%). The model's clinical utility was higher than that of endometrial biopsy alone or combined endometrial biopsy and ultrasound at any given risk threshold. CONCLUSIONS: Based on endometrial biopsy results, clinical and ultrasound characteristics, the individual risk of lymph node metastases in wo

Journal article

Foo L, Johnson S, Marriott L, Bourne T, Bennett P, Lees Cet al., 2020, Peri-implantation urinary hormone monitoring distinguishes between types of first-trimester spontaneous pregnancy loss, Paediatric and Perinatal Epidemiology, Vol: 34, Pages: 495-503, ISSN: 0269-5022

BackgroundLutenising hormone (LH) and human chorionic gonadotropin (hCG) hormone are useful biochemical markers to indicate ovulation and embryonic implantation, respectively. We explored “point‐of‐care” LH and hCG testing using a digital home‐testing device in a cohort trying to conceive.ObjectiveTo determine conception and spontaneous pregnancy loss rates, and to assess whether trends in LH‐hCG interval which are known to be associated with pregnancy viability could be identified with point‐of‐care testing.MethodsWe recruited healthy women aged 18‐44 planning a pregnancy. Participants used a home monitor to track LH and hCG levels for 12 menstrual cycles or until pregnancy was conceived. Pregnancy outcomes (viable, clinical miscarriage, or biochemical pregnancy loss) were recorded. Monitor data were analysed by a statistician blinded to pregnancy outcome.ResultsFrom 387 recruits, there were 290 pregnancies with known outcomes within study timeline. Adequate monitor data for analysis were available for 150 conceptive cycles. Overall spontaneous first‐trimester pregnancy loss rate was 30% with clinically recognised miscarriage rate of 17%. The difference to LH‐hCG interval median had wider spread for biochemical losses (0.5‐8.5 days) compared with clinical miscarriage (0‐5 days) and viable pregnancies (0‐6 days). Fixed effect hCG profile change distinguished between pregnancy outcomes from as early as day‐2 post‐hCG rise from baseline.ConclusionThe risk of first‐trimester spontaneous pregnancy loss in our prospective cohort is comparable to studies utilising daily urinary hCG collection and laboratory assays. A wider LH‐hCG interval range is associated with biochemical pregnancy loss and may relate to late or early implantation. Although early hCG changes discriminate between pregnancies that will miscarry from viable pregnancies, this point‐of‐care testing model is not sufficiently developed to be predictive.

Journal article

Bielen D, Tomassetti C, Van Schoubroeck D, Vanbeckevoort D, De Wever L, Vanden Bosch T, D'Hooghe T, Bourne T, D'hoore A, Wolthuis A, Van Cleynenbreughel B, Meuleman C, Timmerman Det al., 2020, The IDEAL study: MRI for suspected deep endometriosis assessment prior to laparoscopy is equally reliable as radiological imaging as a complement to transvaginal ultrasonography, Ultrasound in Obstetrics and Gynecology, Vol: 56, Pages: 255-266, ISSN: 0960-7692

OBJECTIVES: this prospective observational study compared the value of magnetic resonance imaging (MRI) complementary to transvaginal ultrasonography (TV-US) to our standard preoperative assessment of patients with endometriosis referred for surgery in a tertiary care academic center. Based on the extent to which endometriosis affects reproductive organs, bowel, ureters, bladder or other abdominal organs, the surgery will be carried out by gynecologists only or by a multidisciplinary team involving abdominal surgeons and/or urologists. METHODS: In 74 women with clinically suspected deep endometriosis (DE) the standard preoperative imaging, i.e. an expert transvaginal ultrasonography (TV-US), complemented by an intravenous urography (IVU) for the evaluation of the ureters, and a double contrast barium enema (DCBE) for the evaluation of the rectum, sigmoid and caecum was compared with an expert TV-US complemented by a 'one-stop' abdominal and pelvic magnetic resonance imaging (MRI). The findings of the laparoscopy were the reference standard to provide an answer to the question if a 'one-stop' abdominal/pelvic MRI is equally reliable as our standard radiological imaging as a complement to transvaginal ultrasonography for preoperative triaging of patients with suspected urological and intestinal involvement by DE in tertiary care centers. RESULTS: The standard preoperative imaging as well as the combined findings of the TV-US and the MRI allowed a correct stratification for a monodisciplinary approach by gynecologists or a multidisciplinary approach in 90.5% of the patients. Both TV-US and DCBE underestimated the severity of the rectal involvement in 2.7%, whereas TV-US and/or DCBE overestimated it in 6.8% of the patients. CONCLUSIONS: In conclusion, complementary to an expert transvaginal ultrasound (TV-US) a 'one-stop' magnetic resonance imaging (MRI) predicts the intra-operative findings equally well as the standard radiological imaging (IVU and DCBE) in patients re

Journal article

Coomarasamy A, Devall AJ, Brosens JJ, Quenby S, Stephenson MD, Sierra S, Christiansen OB, Small R, Brewin J, Roberts TE, Dhillon-Smith R, Harb H, Noordali H, Papadopoulou A, Eapen A, Prior M, Di Renzo GC, Hinshaw K, Mol BW, Lumsden MA, Khalaf Y, Shennan A, Goddijn M, van Wely M, Al-Memar M, Bennett P, Bourne T, Rai R, Regan L, Gallos IDet al., 2020, Micronized vaginal progesterone to prevent miscarriage: a critical evaluation of randomized evidence, American Journal of Obstetrics and Gynecology, Vol: 223, Pages: 167-176, ISSN: 0002-9378

Progesterone is essential for the maintenance of pregnancy. Several small trials have suggested that progesterone supplementation may reduce the risk of miscarriage in women with recurrent or threatened miscarriage. Cochrane Reviews summarized the evidence and found that the trials were small with substantial methodologic weaknesses. Since then, the effects of first-trimester use of vaginal micronized progesterone have been evaluated in 2 large, high-quality, multicenter placebo-controlled trials, one targeting women with unexplained recurrent miscarriages (the PROMISE [PROgesterone in recurrent MIScarriagE] trial) and the other targeting women with early pregnancy bleeding (the PRISM [PRogesterone In Spontaneous Miscarriage] trial). The PROMISE trial studied 836 women from 45 hospitals in the United Kingdom and the Netherlands and found a 3% greater live birth rate with progesterone but with substantial statistical uncertainty. The PRISM trial studied 4153 women from 48 hospitals in the United Kingdom and found a 3% greater live birth rate with progesterone, but with a P value of .08. A key finding, first observed in the PROMISE trial, and then replicated in the PRISM trial, was that treatment with vaginal micronized progesterone 400 mg twice daily was associated with increasing live birth rates according to the number of previous miscarriages. Prespecified PRISM trial subgroup analysis in women with the dual risk factors of previous miscarriage(s) and current pregnancy bleeding fulfilled all 11 conditions for credible subgroup analysis. For the subgroup of women with a history of 1 or more miscarriage(s) and current pregnancy bleeding, the live birth rate was 75% (689/914) with progesterone vs 70% (619/886) with placebo (rate difference 5%; risk ratio, 1.09, 95% confidence interval, 1.03-1.15; P=.003). The benefit was greater for the subgroup of women with 3 or more previous miscarriages and current pregnancy bleeding; live birth rate was 72% (98/137) with progest

Journal article

Van Calster B, Valentin L, Froyman W, Landolfo C, Ceusters J, Testa AC, Wynants L, Sladkevicius P, Van Holsbeke C, Domali E, Fruscio R, Epstein E, Franchi D, Kudla MJ, Chiappa V, Alcazar JL, Leone FPG, Buonomo F, Coccia ME, Guerriero S, Deo N, Jokubkiene L, Savelli L, Fischerova D, Czekierdowski A, Kaijser J, Coosemans A, Scambia G, Vergote I, Bourne T, Timmerman Det al., 2020, Validation of models to diagnose ovarian cancer in patients managed surgically or conservatively: multicentre cohort study, BMJ: British Medical Journal, Vol: 370, Pages: 1-12, ISSN: 0959-535X

Objective To evaluate the performance of diagnostic prediction models for ovarian malignancy in all patients with an ovarian mass managed surgically or conservatively.Design Multicentre cohort study.Setting 36 oncology referral centres (tertiary centres with a specific gynaecological oncology unit) or other types of centre.Participants Consecutive adult patients presenting with an adnexal mass between January 2012 and March 2015 and managed by surgery or follow-up.Main outcome measures Overall and centre specific discrimination, calibration, and clinical utility of six prediction models for ovarian malignancy (risk of malignancy index (RMI), logistic regression model 2 (LR2), simple rules, simple rules risk model (SRRisk), assessment of different neoplasias in the adnexa (ADNEX) with or without CA125). ADNEX allows the risk of malignancy to be subdivided into risks of a borderline, stage I primary, stage II-IV primary, or secondary metastatic malignancy. The outcome was based on histology if patients underwent surgery, or on results of clinical and ultrasound follow-up at 12 (±2) months. Multiple imputation was used when outcome based on follow-up was uncertain.Results The primary analysis included 17 centres that met strict quality criteria for surgical and follow-up data (5717 of all 8519 patients). 812 patients (14%) had a mass that was already in follow-up at study recruitment, therefore 4905 patients were included in the statistical analysis. The outcome was benign in 3441 (70%) patients and malignant in 978 (20%). Uncertain outcomes (486, 10%) were most often explained by limited follow-up information. The overall area under the receiver operating characteristic curve was highest for ADNEX with CA125 (0.94, 95% confidence interval 0.92 to 0.96), ADNEX without CA125 (0.94, 0.91 to 0.95) and SRRisk (0.94, 0.91 to 0.95), and lowest for RMI (0.89, 0.85 to 0.92). Calibration varied among centres for all models, however the ADNEX models and SRRisk were the be

Journal article

Kyriacou C, Kim SH, Bobdiwala S, Bennett P, Bourne T, Terzidou Vet al., 2020, The assessment of microRNA expression in pregnancies classified as a pregnancy of unknown location, Publisher: WILEY, Pages: E63-E63, ISSN: 1470-0328

Conference paper

Bobdiwala S, Harvey R, Abdallah Y, Al-Memar M, Fisher R, Stalder C, Timmerman D, Bourne Tet al., 2020, The potential use of urinary hCG measurements in the management of pregnancies of unknown location, HUMAN FERTILITY, ISSN: 1464-7273

Journal article

Grewal K, Al-Memar M, Fourie H, Stalder C, Timmerman D, Bourne Tet al., 2020, The natural history of pregnancy-related enhanced myometrial vascularity following miscarriage, Ultrasound in Obstetrics and Gynecology, Vol: 55, Pages: 676-682, ISSN: 0960-7692

OBJECTIVES: Our primary aim was to report the incidence of enhanced myometrial vascularity (EMV) in consecutive women following first trimester miscarriage who attended our early pregnancy assessment unit. We further aimed to evaluate the clinical presentation, and complications associated with the condition. METHODS: A prospective cohort study conducted in a London teaching hospital between June 2015 and June 2018. Consecutive patients with an observation of EMV by transvaginal ultrasonography (TVS) were included. The diagnosis was made following the subjective identification of EMV using color Doppler ultrasonography and a peak systolic velocity (PSV) ≥20cm/sec within the collection of vessels. Women were followed up with repeat scans every 14 days. Management was expectant unless intervention was indicated because of excessive or prolonged bleeding, the persistent presence of retained tissue in the endometrial cavity or patient choice. The final clinical outcome was recorded. Time to resolution was defined as the date of EMV detection until resolution was observed. The time to cessation of symptoms was also documented. RESULTS: Forty patients were diagnosed with EMV during the study period following miscarriage and included in the study. There were 2627 first trimester losses in the department during this study period, hence the incidence of EMV following miscarriage was 1.52%. All cases were associated with ultrasound evidence of retained products of conception (RPOC) at presentation (mean dimensions 22x20x20mm). Thirty-one patients initially opted for expectant management, of which 18 were successful, five were lost to follow up and eight subsequently had surgical evacuation due to patient wishes. No expectantly managed case required emergency intervention. Nine patients chose surgical evacuation as primary treatment. No strong correlation was seen between PSV and blood loss at surgery (PSV range 20-148cm/sec, median 47 cm/sec). The estimated blood lo

Journal article

Bourne T, Leonardi M, Kyriacou C, Al-Memar M, Landolfo C, Cibula D, Condous G, Metzger U, Fischerova D, Timmerman D, van den Bosch Tet al., 2020, ISUOG consensus statement on rationalization of gynecological ultrasound services in context of SARS-CoV-2., Ultrasound in Obstetrics and Gynecology, ISSN: 0960-7692

Journal article

Bourne T, Kyriacou C, Coomarasamy A, Al-Memar M, Leonardi M, Kirk E, Landolfo C, Blanchette-Porter M, Small R, Condous G, Timmerman Det al., 2020, ISUOG Consensus Statement on rationalization of early-pregnancy care and provision of ultrasonography in context of SARS-CoV-2., Ultrasound in Obstetrics and Gynecology, ISSN: 0960-7692

Journal article

Al-Memar M, Vaulet T, Fourie H, Bobdiwala S, Farren J, Saso S, Bracewell-Milnes T, De Moor B, Sur S, Stalder C, Bennett P, Timmerman D, Bourne Tet al., 2020, Intrauterine haematomas in the first trimester and pregnancy complications, Ultrasound in Obstetrics and Gynecology, Vol: 55, Pages: 536-545, ISSN: 0960-7692

OBJECTIVES: The role of intrauterine haematoma on pregnancy outcomes remains uncertain. Some studies report an association with miscarriage, whilst others refute this. The impact on long-term outcomes is not known. We aimed to assess if intrauterine haematomas detected using ultrasonography in the first trimester are associated with adverse pregnancy outcomes. METHODS: A prospective observational cohort study at Queen Charlotte's & Chelsea Hospital, London, was conducted between March 2014 and March 2016. Participants with intrauterine pregnancies were recruited and underwent serial ultrasound scans in the first trimester. Clinical symptoms, including pelvic pain and vaginal bleeding were recorded using validated symptom scores at each visit. The presence, location and size of any intrauterine haematoma seen on ultrasonography was noted. Pregnancy outcomes were obtained from hospital records. RESULTS: Of 1003 recruited participants, 268 had an intrauterine haematoma (27%). The presence of intrauterine haematoma in the first trimester was associated with preterm birth (OR 1.94; 95% CI 1.07-3.53). No association was found with miscarriage (OR 0.916; 95% CI 0.571-1.471). This was irrespective of the absolute size of the haematoma or the presence or absence of vaginal bleeding and pelvic pain. A retroplacental haematoma was associated with an increase in overall antenatal complications (P = 0.0395). CONCLUSIONS: Our data demonstrates no association between the presence of intrauterine haematoma in the first trimester and first trimester miscarriage. However, a relationship with preterm birth independent of the presence of symptoms of pain and bleeding is evident. These women should be counseled about their increased risk of preterm birth and possibly be offered increased surveillance during their pregnancies. This article is protected by copyright. All rights reserved.

Journal article

Farren J, Jalmbrant M, Falconieri N, Mitchell-Jones N, Bobdiwala S, Al-Memar M, Tapp S, Van Calster B, Wynants L, Timmerman D, Bourne Tet al., 2020, Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study, AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, Vol: 222, ISSN: 0002-9378

Journal article

Grewal K, Lee YS, Smith A, Al-Memar M, Bourne T, MacIntyre DA, Bennett Pet al., 2020, Euploid Miscarriage is Associated with Lactobacillus spp. Deplete Vaginal Microbial Composition and Local Inflammation., 67th Annual Scientific Meeting of the Society-for-Reproductive-Investigation (SRI), Publisher: SPRINGER HEIDELBERG, Pages: 65A-65A, ISSN: 1933-7191

Conference paper

Kyriacou C, Kim SH, Bobdiwala S, Bennett P, Bourne T, Terzidou Vet al., 2020, MicroRNA Expression in Pregnancy of Unknown Location (PUL)., 67th Annual Scientific Meeting of the Society-for-Reproductive-Investigation (SRI), Publisher: SPRINGER HEIDELBERG, Pages: 99A-99A, ISSN: 1933-7191

Conference paper

Luijken K, Wynants L, van Smeden M, Van Calster B, Steyerberg EW, Groenwold RHH, Collaborators, Timmerman D, Bourne T, Ukaegbu Cet al., 2020, Changing predictor measurement procedures affected the performance of prediction models in clinical examples, Journal of Clinical Epidemiology, Vol: 119, Pages: 7-18, ISSN: 0895-4356

OBJECTIVE: To quantify the impact of predictor measurement heterogeneity on prediction model performance. Predictor measurement heterogeneity refers to variation in the measurement of predictor(s) between the derivation of a prediction model and its validation or application. It arises, for instance, when predictors are measured using different measurement instruments or protocols. STUDY DESIGN AND SETTING: We examined effects of various scenarios of predictor measurement heterogeneity in real-world clinical examples using previously developed prediction models for diagnosis of ovarian cancer, mutation carriers for Lynch syndrome, and intrauterine pregnancy. RESULTS: Changing the measurement procedure of a predictor influenced the performance at validation of the prediction models in nine clinical examples. Notably, it induced model miscalibration. The calibration intercept at validation ranged from -0.70 to 1.43 (0 for good calibration), while the calibration slope ranged from 0.50 to 1.67 (1 for good calibration). The difference in c-statistic and scaled Brier score between derivation and validation ranged from -0.08 to +0.08 and from -0.40 to +0.16, respectively. CONCLUSION: This study illustrates that predictor measurement heterogeneity can influence the performance of a prediction model substantially, underlining that predictor measurements used in research settings should resemble clinical practice. Specification of measurement heterogeneity can help researchers explaining discrepancies in predictive performance between derivation and validation setting.

Journal article

Ibeto L, Antonopoulos A, Grassi P, Pang P-C, Panico M, Bobdiwala S, Al-Memar M, Davis P, Davis M, Norman Taylor J, Almeida P, Johnson MR, Harvey R, Bourne T, Seckl M, Clark G, Haslam SM, Dell Aet al., 2020, Insights into the hyperglycosylation of human chorionic gonadotropin revealed by glycomics analysis, PLoS One, Vol: 15, ISSN: 1932-6203

Human chorionic gonadotropin (hCG) is a glycoprotein hormone that is essential for the maintenance of pregnancy. Glycosylation of hCG is known to be essential for its biological activity. "Hyperglycosylated" variants secreted during early pregnancy have been proposed to be involved in initial implantation of the embryo and as a potential diagnostic marker for gestational diseases. However, what constitutes "hyperglycosylation" is not yet fully understood. In this study, we perform comparative N-glycomic analysis of hCG expressed in the same individuals during early and late pregnancy to help provide new insights into hCG function, reveal new targets for diagnostics and clarify the identity of hyperglycosylated hCG. hCG was isolated in urine collected from women at 7 weeks and 20 weeks' gestation. hCG was also isolated in urine from women diagnosed with gestational trophoblastic disease (GTD). We used glycomics methodologies including matrix assisted laser desorption/ionisation-time of flight (MALDI-TOF) mass spectrometry (MS) and MS/MS methods to characterise the N-glycans associated with hCG purified from the individual samples. The structures identified on the early pregnancy (EP-hCG) and late pregnancy (LP-hCG) samples corresponded to mono-, bi-, tri-, and tetra-antennary N-glycans. A novel finding was the presence of substantial amounts of bisected type N-glycans in pregnancy hCG samples, which were present at much lower levels in GTD samples. A second novel observation was the presence of abundant LewisX antigens on the bisected N-glycans. GTD-hCG had fewer glycoforms which constituted a subset of those found in normal pregnancy. When compared to EP-hCG, GTD-hCG samples had decreased signals for tri- and tetra-antennary N-glycans. In terms of terminal epitopes, GTD-hCG had increased signals for sialylated structures, while LewisX antigens were of very minor abundance. hCG carries the same N-glycans throughout pregnancy but in different propo

Journal article

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