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Eriksson LSE, Epstein E, Testa AC, et 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
Foo L, Johnson S, Marriott L, et 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.
Coomarasamy A, Devall AJ, Brosens JJ, et 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
Bielen D, Tomassetti C, Van Schoubroeck D, et 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
Van Calster B, Valentin L, Froyman W, et 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
Kyriacou C, Kim SH, Bobdiwala S, et al., 2020, The assessment of microRNA expression in pregnancies classified as a pregnancy of unknown location, Publisher: WILEY, Pages: E63-E63, ISSN: 1470-0328
Grewal K, Al-Memar M, Fourie H, et 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
Bourne T, Kyriacou C, Coomarasamy A, et 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
Bourne T, Leonardi M, Kyriacou C, et 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
Al-Memar M, Vaulet T, Fourie H, et 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.
Farren J, Jalmbrant M, Falconieri N, et 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
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Grewal K, Lee YS, Smith A, et al., 2020, Euploid Miscarriage is Associated with <i>Lactobacillus</i> 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
Luijken K, Wynants L, van Smeden M, et 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.
Kyriacou C, Kim SH, Bobdiwala S, et 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
Ibeto L, Antonopoulos A, Grassi P, et 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
Al-Memar M, Bobdiwala S, Fourie H, et al., 2020, The association between vaginal bacterial composition and miscarriage: a nested case-control study, BJOG: an International Journal of Obstetrics and Gynaecology, Vol: 127, Pages: 264-274, ISSN: 1470-0328
OBJECTIVE: To characterise vaginal bacterial composition in early pregnancy and investigate its relationship with first and second trimester miscarriages. DESIGN: Nested case-control study. SETTING: Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London. POPULATION: 161 pregnancies; 64 resulting in first trimester miscarriage, 14 in second trimester miscarriage and 83 term pregnancies. METHODS: Prospective profiling and comparison of vaginal bacteria composition using 16S rRNA gene-based metataxonomics from 5 weeks gestation in pregnancies ending in miscarriage or uncomplicated term deliveries matched for age, gestation and body-mass index. MAIN OUTCOME MEASURES: Relative vaginal bacteria abundance, diversity and richness. Pregnancy outcomes defined as first or second trimester miscarriage, or uncomplicated term delivery. RESULTS: First trimester miscarriage associated with reduced prevalence of Lactobacillus spp.-dominated vaginal microbiota classified using hierarchical clustering analysis (65.6% vs. 87·7%; P=0·005), higher alpha diversity (mean Inverse Simpson Index 2.5 (95% confidence interval 1.8-3.0) vs. 1.5 (1.3-1.7), P=0·003) and higher richness 25.1 (18.5-31.7) vs. 16.7 (13.4-20), P=0·017), compared to viable pregnancies. This was independent of vaginal bleeding and observable before first trimester miscarriage diagnosis (P=0·015). Incomplete/complete miscarriage associated with higher proportions of Lactobacillus spp.-deplete communities compared to missed miscarriage. Early pregnancy vaginal bacterial stability was similar between miscarriage and term pregnancies. CONCLUSIONS: These findings associate the bacterial component of vaginal microbiota with first trimester miscarriage and indicate suboptimal community composition is established in early pregnancy. While further studies are required to elucidate the mechanism, vaginal bacterial composition may represent a modifiable risk factor fo
Bobdiwala S, Christodoulou E, Farren J, et al., 2020, Triaging women with pregnancy of unknown location using two‐step protocol including M6 model: clinical implementation study, Ultrasound in Obstetrics and Gynecology, Vol: 55, Pages: 105-114, ISSN: 0960-7692
INTRODUCTION: The M6 risk prediction model has been shown to have good triage performance for stratifying women with a PUL as being at low or high-risk of harboring an ectopic pregnancy. There is evidence that M6 has better overall test performance than the hCG ratio (serum hCG at 48 hours/hCG at presentation) and older models such as the M4 model. M6 was published as part of a two-step protocol using an initial progesterone ≤2nmol/l to identify likely failing pregnancies (step 1), followed by M6 (step 2). This study validated the triage performance of this protocol in clinical practice by evaluating (1) the number of protocol-related adverse events and (2) how patients are effectively triaged. METHODS: This was a prospective multi-centre interventional study of 3272 women with a PUL carried out between January 2015 and January 2017 in four district general hospitals and four university teaching hospitals in the United Kingdom. We defined the final pregnancy outcome as: a failed PUL (FPUL), an intrauterine pregnancy (IUP) or an ectopic pregnancy (EP) (including persistent PUL (PPUL)). FPUL and IUP were grouped as low-risk and EP and PPUL as high-risk PUL. Patients had a serum progesterone and hCG level at 0 hours and repeat hCG at 48 hours. In seven centres, if the initial progesterone was ≤2nmol/l, patients were discharged with a follow-up urine pregnancy test in two weeks to confirm a negative result. If the progesterone was >2nmol/l or had not been taken, a 48 hour hCG level was taken and results entered into the M6 model. Patients were managed according to their predicted outcome: those classified with pregnancies likely to resolve (FPUL) were advised to perform a urine pregnancy test in two weeks and those with a likely IUP were invited for a scan a week later. When a women with a PUL was classified as high-risk (i.e. those with a risk of EP ≥ 5%) were reviewed clinically within 48 hours. One centre used a progesterone cut-off ≤10nmol/l an
Andreotti RF, Timmerman D, Strachowski LM, et al., 2020, O-RADS US risk stratification and management system: A consensus guideline from the ACR ovarian-adnexal reporting and data system committee., Radiology, Vol: 294, Pages: 168-185, ISSN: 0033-8419
The Ovarian-Adnexal Reporting and Data System (O-RADS) US risk stratification and management system is designed to provide consistent interpretations, to decrease or eliminate ambiguity in US reports resulting in a higher probability of accuracy in assigning risk of malignancy to ovarian and other adnexal masses, and to provide a management recommendation for each risk category. It was developed by an international multidisciplinary committee sponsored by the American College of Radiology and applies the standardized reporting tool for US based on the 2018 published lexicon of the O-RADS US working group. For risk stratification, the O-RADS US system recommends six categories (O-RADS 0-5), incorporating the range of normal to high risk of malignancy. This unique system represents a collaboration between the pattern-based approach commonly used in North America and the widely used, European-based, algorithmic-style International Ovarian Tumor Analysis (IOTA) Assessment of Different Neoplasias in the Adnexa model system, a risk prediction model that has undergone successful prospective and external validation. The pattern approach relies on a subgroup of the most predictive descriptors in the lexicon based on a retrospective review of evidence prospectively obtained in the IOTA phase 1-3 prospective studies and other supporting studies that assist in differentiating management schemes in a variety of almost certainly benign lesions. With O-RADS US working group consensus, guidelines for management in the different risk categories are proposed. Both systems have been stratified to reach the same risk categories and management strategies regardless of which is initially used. At this time, O-RADS US is the only lexicon and classification system that encompasses all risk categories with their associated management schemes.
Bourne T, Shah H, Falconieri N, et al., 2019, Burnout, well-being and defensive medical practice among obstetricians and gynaecologists in the UK: cross-sectional survey study, BMJ Open, Vol: 9, ISSN: 2044-6055
Objectives: To determine the prevalence of burnout in doctors practising obstetrics and gynaecology, and assess the association with defensive medical practice and self-reported wellbeing.Design: Nationwide online cross-sectional survey study; December 2017-March 2018. Setting: Hospitals in the United KingdomParticipants: 5661 practising Obstetrics and Gynaecology consultants, specialty and associate specialist doctors and trainees registered with the Royal College of Obstetricians and Gynaecologists Primary and Secondary Outcome Measures: Prevalence of burnout using the Maslach Burnout Inventory and defensive medical practice (avoiding cases or procedures, overprescribing, over-referral) using a 12-item questionnaire. The odds ratios of burnout with defensive medical practice and self-reported wellbeing.Results: 3102/5661 doctors (55%) completed the survey. 3073/3102 (99%) met the inclusion criteria (1462 consultants, 1357 trainees and 254 specialty and associate specialist doctors). 1116/3073 (36%) doctors met the burnout criteria, with levels highest amongst trainees (580/1357 [43%]). 258/1116 (23%) doctors with burnout reported increased defensive practice compared to 142/1957 (7%) without (adjusted odds ratio 4.35, 95% CI 3.46 to 5.49). Odds ratios of burnout with wellbeing items varied between 1.38 and 6.37, and were highest for anxiety (3.59, 95% CI 3.07 to 4.21), depression (4.05, 95% CI 3.26 to 5.04), and suicidal thoughts (6.37, 95% CI 95% CI 3.95 to 10.7). In multivariable logistic regression, being of younger age, white or ‘other’ ethnicity, and graduating with a medical degree from the UK or Ireland had the strongest associations with burnout.Conclusions: High levels of burnout were observed in obstetricians and gynaecologists and particularly amongst trainees. Burnout was associated with both increased defensive medical practice and worse doctor wellbeing. These findings have implications for the wellbeing and retention of doctors as well a
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, Vol: 54, Pages: 530-537, 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
Jordans IPM, de Leeuw RL, Stegwee SI, et al., 2019, Niche definition and guidance for detailed niche evaluation, Acta Obstetricia et Gynecologica Scandinavica, Vol: 98, Pages: 1351-1352, 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.
Galjaard S, Ameye L, Lees CC, et al., 2019, Sex differences in fetal growth and immediate birth outcomes in a low-risk Caucasian population, Biology of Sex Differences, Vol: 10, ISSN: 2042-6410
BackgroundAccording to the WHO Multicentre Growth Reference Study Group recommendations, boys and girls have different growth trajectories after birth. Our aim was to develop gender-specific fetal growth curves in a low-risk population and to compare immediate birth outcomes.MethodsFirst, second, and third trimester fetal ultrasound examinations were conducted between 2002 and 2012. The data was selected using the following criteria: routine examinations in uncomplicated singleton pregnancies, Caucasian ethnicity, and confirmation of gestational age by a crown-rump length (CRL) measurement in the first trimester. Generalized Additive Model for Location, Scale and Shape (GAMLSS) was used to align the time frames of the longitudinal fetal measurements, corresponding with the methods of the postnatal growth curves of the WHO MGRS Group.ResultsA total of 27,680 complete scans were selected from the astraia© ultrasound database representing 12,368 pregnancies. Gender-specific fetal growth curves for biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) were derived. The HC and BPD were significantly larger in boys compared to girls from 20 weeks of gestation onwards (p < 0.001) equating to a 3-day difference at 20–24 weeks. Boys were significantly heavier, longer, and had greater head circumference than girls (p < 0.001) at birth. The Apgar score at 1 min (p = 0.01) and arterial cord pH (p < 0.001) were lower in boys.ConclusionsThese longitudinal fetal growth curves for the first time allow integration with neonatal and pediatric WHO gender-specific growth curves. Boys exceed head growth halfway of the pregnancy, and immediate birth outcomes are worse in boys than girls. Gender difference in intrauterine growth is sufficiently distinct to have a clinically important effect on fetal weight estimation but also on the second trimester d
Martínez-Más J, Bueno-Crespo A, Khazendar S, et al., 2019, Evaluation of machine learning methods with Fourier Transform features for classifying ovarian tumors based on ultrasound images, PLoS ONE, Vol: 14, Pages: 1-14, ISSN: 1932-6203
IntroductionOvarian tumors are the most common diagnostic challenge for gynecologists and ultrasound examination has become the main technique for assessment of ovarian pathology and for preoperative distinction between malignant and benign ovarian tumors. However, ultrasonography is highly examiner-dependent and there may be an important variability between two different specialists when examining the same case. The objective of this work is the evaluation of different well-known Machine Learning (ML) systems to perform the automatic categorization of ovarian tumors from ultrasound images.MethodsWe have used a real patient database whose input features have been extracted from 348 images, from the IOTA tumor images database, holding together with the class labels of the images. For each patient case and ultrasound image, its input features have been previously extracted using Fourier descriptors computed on the Region Of Interest (ROI). Then, four ML techniques are considered for performing the classification stage: K-Nearest Neighbors (KNN), Linear Discriminant (LD), Support Vector Machine (SVM) and Extreme Learning Machine (ELM).ResultsAccording to our obtained results, the KNN classifier provides inaccurate predictions (less than 60% of accuracy) independently of the size of the local approximation, whereas the classifiers based on LD, SVM and ELM are robust in this biomedical classification (more than 85% of accuracy).ConclusionsML methods can be efficiently used for developing the classification stage in computer-aided diagnosis systems of ovarian tumor from ultrasound images. These approaches are able to provide automatic classification with a high rate of accuracy. Future work should aim at enhancing the classifier design using ensemble techniques. Another ongoing work is to exploit different kind of features extracted from ultrasound images.
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