Early and late pregnancy outcomes in women treated with cold-coagulation versus LLETZ cervical treatment for cervical intraepithelial neoplasia; a retrospective cohort study (2018)

Type of publication:
Journal article

Author(s):
*Papoutsis, Dimitrios; *Underwood, Martyn; *Parry-Smith, William; *Panikkar, Jane

Citation:
Archives of gynecology and obstetrics; Apr 2018; Vol.297(4):1015-1025

Abstract:
PURPOSE To compare the pregnancy outcomes between women who were treated with cold-coagulation versus large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia. METHODS This was a retrospective cohort study of women who had a single cervical treatment between 2010 and 2011. We identified those women who had a singleton pregnancy subsequent to their cervical treatment until September 2017. Women with previous cervical treatment, previous miscarriage or preterm delivery were excluded. RESULTSWe identified 86 women with a pregnancy after LLETZ treatment and 75 women after cold coagulation. Those who had LLETZ when compared to cold coagulation miscarried more often in the first trimester (33.7 vs 17.3%; p = 0.01) than in the second trimester. In women with LLETZ this effect of increased early miscarriage was shown to be prolonged and to persist up to 17 months after excision. Women with LLETZ when compared to cold coagulation had higher spontaneous preterm birth rates (8.9 vs 6.7%) even though the difference was non significant, with the earliest spontaneous preterm birth occurring at 32 weeks and 34 weeks, respectively. CONCLUSION We found that women who received LLETZ treatment when compared to cold coagulation had higher spontaneous preterm birth rates in their subsequent pregnancy and miscarried more frequently in the first trimester, and demonstrated an increased early miscarriage risk that persisted for more than a year after excisional treatment.

Does gestational weight gain of more than 12 kg in women increase the risk of a cesarean section delivery, gestational diabetes and pregnancy induced hypertension? A retrospective case series (2017)

Type of publication:
Journal article

Author(s):
Antonakou A.; *Papoutsis D.; Kechagia A.

Citation:
Clinical and Experimental Obstetrics and Gynecology; 2017; vol. 44 (no. 4); p. 540-544

Abstract:
Purpose: The purpose of this study was to investigate whether the gestational weight gain of more than 12 kg represented a risk factor for an increased rate of cesarean section (CS) delivery, gestational diabetes, and pregnancy-induced hypertension (PIH). Materials and Methods: This was a retrospective case series study performed in a Greek National Health Service hospital and included women having given birth to singleton pregnancies between 2004-2009. Cases with multiple pregnancies, stillbirths, and congenital fetal abnormalities were excluded. Results: 600 eligible women were included in the study. Gestational weight increase correlated positively and was higher in women with a CS delivery, gestational diabetes, and PIH. The prepregnancy body mass index was identified as a predictor of gestational diabetes. The weight gain of less than 12 kg during pregnancy provided a protective effect against CS delivery by reducing the likelihood of this by 85%. Conclusion: The present authors have shown that the increased body weight gain during pregnancy of more than 12 kg is associated with increased rates of CS delivery, gestational diabetes, and hypertensive disorders in pregnancy.

An unusual cause of fetomaternal distress at term: uterine vessel rupture in pregnancy (2015)

Type of publication:
Journal article

Author(s):
Calcott G.A., Gaber M., Freedman J., Patni S.

Citation:
BMJ Case Reports, August 2015, vol./is. 2015

Abstract:
This report describes a case of spontaneous bleeding from uterine vessels presenting as hyperstimulation and fetomaternal distress at term. A 40-week primigravid woman underwent an emergency caesarean section for fetal distress, which unexpectedly revealed a spontaneous haemoperitoneum. Clinical assessment and investigations postoperatively gave a diagnosis of a rightsided uterine artery aneurysm that, it was believed, had ruptured, causing the haemoperitoneum. This was successfully treated postnatally using interventional radiological techniques leading to expeditious maternal recovery and discharge home.

Link to full-text: http://casereports.bmj.com/content/2015/bcr-2014-209004.full.pdf

Thrombolysis for stroke in pregnancy at 39 weeks gestation with a subsequent normal delivery (2015)

Type of publication:
Journal article

Author(s):
*Ritchie J., *Lokman M., *Panikkar J.

Citation:
BMJ Case Reports, August 2015, vol./is. 2015

Abstract:
Stroke during pregnancy is fortunately a rare event, however, it can have severe consequences, with 9.5% of all maternal deaths being related to stroke. The most common presentation is an ischaemic stroke. There has been much debate as to the correct treatment for such cases’ and whether thrombolysis can be used safely in pregnancy. Our case describes a 28-year-old woman with a previous normal vaginal delivery presenting in her third trimester with a sudden onset of dense left hemiparesis. She was successfully treated with alteplase, an intravenous recombinant tissue-type plasminogen activator, and made a full recovery after normal delivery of a healthy infant. This case report highlights one of the first documented successful outcomes from thrombolysis for this condition in the UK and may help inform future management of these women.

Link to full-text: http://casereports.bmj.com/content/2015/bcr-2015-209563.full.pdf

Postpartum posterior reversible encephalopathy syndrome (PRES) in a twin pregnancy complicated by preeclampsia-eclampsia: Case report (2014)

Type of publication:
Journal article

Author(s):
*Papoutsis D., *El-Attabi N., *Sizer A.

Citation:
Clinical and Experimental Obstetrics and Gynecology, 2014, vol./is. 41/3(351-353), 0390-6663 (2014)

Abstract:
This is the second case in literature of posterior reversible encephalopathy syndrome (PRES) in a twin pregnancy complicated by preeclampsia-eclampsia. A 27-year-old primigravida with dichorionic diamniotic twin pregnancy was admitted at 36 weeks of gestation for induction of labour due to preeclampsia. On the second day postpartum, the patient developed severe hypertension, visual symptoms, confusion, headache, and eclamptic fits. Head computed tomography (CT) showed hypodense basal ganglia lesions. The patient was treated in the intensive treatment unit with hydralazine and labetalol infusions and anticonvulsants. Five days later, there was complete clinical improvement and follow-up magnetic resonance imaging (MRI) was normal. The patient was discharged 11 days post-delivery. Diagnosis of PRES is based on the presence of clinical features of acute neurologic compromise, abnormal neuroimaging findings, and complete reversibility of findings after prompt treatment. Early recognition and proper treatment result in complete reversibility of this condition.

Link to more details or full-text:

Teenage pregnancy rates and outcomes in a district general hospital NHS Trust in rural Shropshire (2014)

Type of publication:
Conference abstract

Author(s):
*Ritchie J., *Moores K., *Oates S.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, November 2014, vol./is. 121/(19-20), 1470-0328 (November 2014)

Abstract:
Introduction: The UK has the highest rate of teenage pregnancy across Western Europe however; the rate has been reducing, and is currently at its lowest since 1969. Perceptions exist of worse outcomes in teenage pregnancies among healthcare professionals and the public alike. We aim to determine outcomes of teenage pregnancy (2013- 2014) and compare rates of teenage pregnancy (2008-2013) and at Shrewsbury and Telford Hospitals (SaTH) NHS Trust and compare with local population outcomes. Methods: A 12-month retrospective review of teenage pregnancy outcomes and comparison with outcomes of all deliveries at SaTH between April 2013 and March 2014; a total of 4916 deliveries. Data sources included the MEDWAY Hospital Database. Recorded pregnancy outcomes classified into two categories: outcomes in mothers’ aged 19 years or younger at time of delivery and outcomes in all mothers’ in who delivered at SaTH in the study period. Parameters assessed included mode of delivery; blood loss; perineal trauma; birthweight; Apgar scores. Teenage pregnancy rates over the last six years were compared to recorded rates in 1996. Results: The rate of teenage pregnancy has continued to reduce, especially those under 16 years. Over 90% of teenage mothers’ had vaginal delivery; only 3% had elective and 5% had emergency caesarean deliveries. Low rates of instrumental deliveries were seen in each category; however, no failed instrumental deliveries occurred among teenage mothers’. Babies born over 37 weeks of gestation was lower among teenage mothers’ however mean birthweights were similar and mean Apgar scores were the same in both groups. Severe perineal trauma was much lower among teenage mothers’; more than half had no perineal trauma. Furthermore, teenage mothers’ had much lower rates of post-partum haemorrhage. Thus, one may suggest a lower risk of harm to teenage parturients and their babies compared with the general local population.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201411006-00055&LSLINK=80&D=ovft

 

A rare obstetric emergency: acute uterine torsion in a 32-week pregnancy (2014)

Type of publication:
Journal article

Author(s):
*Moores KL, *Wood MG, *Foon RP

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Uterine torsion is rare in pregnancy and the cause in most cases is unknown. It is associated with fetal compromise, with perinatal mortality reported to be around 12%. Our case describes an acute torsion, presenting in pregnancy with severe abdominal pain and vomiting with a viable 32-week gestation. Emergency caesarean section was performed and the 180degree uterine torsion was diagnosed intraoperatively. Posterior hysterotomy was required for delivery prior to detorsion of the uterus. This report describes that prompt recognition and intraoperative vigilance can achieve a successful maternal and fetal outcome in this rare and difficult obstetric scenario.

Link to more details or full-text: http://casereports.bmj.com/content/2014/bcr-2013-202974.abstract