Evaluating the value of intrapartum fetal scalp blood sampling to predict adverse neonatal outcomes: A UK multicentre observational study (2019)

Type of publication:
Journal article

Author(s):
Al Wattar, Bassel H; Lakhiani, Aarti; Sacco, Adalina; Siddharth, Aditi; Bain, Alexandra; Calvia, Alexandra; Kamran, Atiyah; Tiong, Bing; Warwick, Bethan; MacMahon, Caroline; Marcus, Diana; Long, Emma; Coyle, Gillian; Lever, Gillian Elizabeth; Michel, Gina; Gopal, Gomathy; Baig, Hana; Price, Hannah Louise; Badri, Hawra; Stevenson, Helen; Hoyte, Helene; Malik, Humaira; Edwards, Jade; Hartley, Jennifer; Hemers, Jennifer; Tamblyn, Jennifer; Dalton, John Alexander William; Frost, Jonathan; Subba, Kamana; Baxter, Kathryn; Sivakumar, Kavitha; Murphy, Kelly; Papadakis, Konstantinos; Bladon, Laura Rachel; Kasaven, Lorraine; Manning, Louisa; Prior, Mathew; Ghosh, Mausumi; Couch, Melanie; Altunel, Melis; Pearce, Melissa; Cocker, Michael; Stephanou, Michael; Jie, Michelle; Mistry, Minesh; Wahby, Mohammed Osama; Saidi, Nabila Shahid; Ramshaw, Nicola Louise; Tempest, Nicola; Parker, Nina; Tan, Phoebe L; Johnson, Racheal Louise; Harris, Rachel; Tildesley, Rachel; Ram, Ramya; Painuly, Ritu; Cuffolo, Romana; Bugeja, Roberta; Ngadze, Rose; Grainger, Rosie; Gurung, Sabitra; Mak, Sammy; Farrell, Sara; Cowey, Sarah; Neary, Sarah; Quinn, Sarah; Nijjar, Simrit Kaur; Kenyon, Sophie; Lamb, Stephanie; Tracey, Susan; Lee, Tara; Kinsella, Therese; Davidson, Trecia; Corr, Trent; Sampson, Uzo; McQueen, Victoria; *Parry-Smith, William; Castling, Zora; AB-FAB study group

Citation:
European Journal of Obstetrics, Gynecology, and Reproductive Biology; Sep 2019; vol. 240 ; p. 62-67

Abstract:
OBJECTIVE To evaluate the value of fetal scalp blood sampling (FBS) as an adjunct test to cardiotocography, to predict adverse neonatal outcomes. STUDY DESIGN A multicentre service evaluation observational study in forty-four maternity units in the UK. We collected data retrospectively on pregnant women with singleton pregnancy who received FBS in labour using a standardised data collection tool. The primary outcome was prediction of neonatal acidaemia diagnosed as umbilical cord arterial pH < 7.05, the secondary outcomes were the prediction of Apgar scores<7 at 1st and 5th minutes and admission to the neonatal intensive care unit (NICU). We evaluated the correlation between the last FBS blood gas before birth and the umbilical cord blood and adjusted for time intervals. We constructed 2 × 2 tables to calculate the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) and generated receiver operating curves to report on the Area Under the Curve (AUC). RESULTS In total, 1422 samples were included in the analysis; pH values showed no correlation (r = 0.001, p = 0.9) in samples obtained within an hour (n = 314), or within half an hour from birth (n = 115) (r=-0.003, p = 0.9). A suboptimal FBS pH value (<7.25) had a poor sensitivity (22%) and PPV (4.9%) to predict neonatal acidaemia with high specificity (87.3%) and NPV (97.4%). Similar performance was noted to predict Apgar scores <7 at 1st (sensitivity 14.5%, specificity 87.5%, PPV 23.4%, NPV 79.6%) and 5th minute (sensitivity 20.3%, specificity 87.4%, PPV 7.6%, NPV 95.6%), and admission to NICU (sensitivity 20.3%, specificity 87.5%, PPV 13.3%, NPV 92.1%). The AUC for FBS pH to predict neonatal acidaemia was 0.59 (95%CI 0.59-0.68, p = 0.3) with similar performance to predict Apgar scores<7 at 1st minute (AUC 0.55, 95%CI 0.51-0.59, p = 0.004), 5th minute (AUC 0.55, 95%CI 0.48-0.62, p = 0.13), and admission to NICU (AUC 0.58, 95%CI 0.52-0.64, p = 0.002). Forty-one neonates had acidaemia (2.8%, 41/1422) at birth. There was no significant correlation in pH values between the FBS and the umbilical cord blood in this subgroup adjusted for sampling time intervals (r = 0.03, p = 0.83). CONCLUSIONS As an adjunct tool to cardiotocography, FBS offered limited value to predict neonatal acidaemia, low Apgar Scores and admission to NICU.

Link to full-text [no password required – author manuscript]

Perivascular epitheloid cell tumor and mesonephric adenocarcinoma of the uterine cervix: an unknown co-existence (2019)

Type of publication:
Journal article

Author(s):
*Dimitrios Papoutsis, *Banchhita Sahu, *Joanna Kelly, Angeliki Antonakou

Citation:
Oxford Medical Case Reports, Volume 2019, Issue 1, January 2019

Abstract:
A 67-year-old woman with post-menopausal bleeding and a suspicious endocervical mass was referred to gynaecology outpatients’ for diagnosis and management. Cervical punch biopsies taken showed a benign cervical perivascular epithelioid cell tumour (PEComa), with MRI imaging and PET-CT scan indicating a 3–4 cm endocervical tumour with malignant features. The patient underwent radical hysterectomy with lymph node dissection and the surgical specimen histopathology demonstrated a residual benign PEComa and a stage IIB mesonephric adenocarcinoma (MNA) of the cervix. There is no disease recurrence 12 months after surgery. Cervical PEComas are extremely rare tumours of mesenchymal origin deriving from the perivascular epithelioid cells with only 14 cases described so far. Cervical MNAs are rare tumours originating from the remnants of the mesonephric duct of Wolff with only 40 cases reported. Our case adds to the existing literature and highlights the challenges with regard to preoperative diagnosis, treatment and prognosis.

Link to full-text [open access – no password required]

Altmetrics:

Obstetric and gynaecology trainees’ knowledge of paediatric and adolescent gynaecology services in the UK: A national qualitative thematic analysis (2019)

Type of publication:
Journal article

Author(s):
*Ritchie, J K; *Sahu, B; Wood, P L

Citation:
European Journal of Obstetrics, Gynecology, and Reproductive Biology; Apr 2019; vol. 235 ; p. 30-35

Abstract:
BACKGROUND: The British Society of Paediatric and Adolescent Gynaecology (BritSPAG) was created in 2000 with specific aims to include raising the profile of paediatric and adolescent gynaecology (PAG) within the United Kingdom (UK). The Society has since developed a set of clinical standards for all acute hospitals providing gynaecological services to enable successful provision of paediatric and adolescent gynaecology care.AIMSTo determine the depth of knowledge that obstetric and gynaecology trainees have with regards to the PAG services provided at their Hospital, reflecting how widely PAG services have had an impact on trainees.METHOD: The national survey was distributed to all deaneries in the UK for circulation to all their trainees via e mail during Nov 2017-March 2018.RESULTS: 28% of the trainees said there was a PAG clinic at their hospital, 46.9% did not have a clinic and 24.7% were unsure. 41.6% of the respondents were aware of BritSPAG, however only 10.4% were aware of the BritSPAG clinical standards for service planning with regards to PAG clinics. Nearly half were aware of the PAG specialist centre for their region but only 6.5% were aware of the BritSPAG UK map of services. A large majority (93.24%) didn’t believe that trainees in O&G received adequate exposure to PAG in their training.CONCLUSION: This study represents the largest and first national survey to seek obstetric and gynaecology trainees’ thoughts on the provision of PAG training in the UK today. Given that only 28% of trainees answering said that they were aware of a PAG clinic at their hospital, this indicates not only that many hospitals did not have a dedicated PAG clinic but more worryingly five of the trainees were not aware of the existence of a confirmed PAG clinic at their hospital, and therefore are potentially losing out on training opportunities. Disappointingly the results of our survey reveal that trainees in Obstetrics and Gynaecology still have very little experience or exposure to PAG during their training despite there being opportunities to do so.

Acute appendicitis secondary to endometriosis of the appendix: A case series (2019)

Type of publication:
Conference abstract

Author(s):
Argyriou O.; Wall M.; Johnson M.; Sutton P.A.; *Tamvakeras P.

Citation:
Colorectal Disease; 2019; vol. 21, S2, p. 36-37

Abstract:
Purpose: To review the clinical presentation, laboratory results, imaging and operative findings of patients subsequently found to have histological evidence of endometriosis of the appendix in a District General Hospital (DGH) between 2016-2018. Method(s): Ten histological reports containing the search term “endometriosis of the appendix” were identified. Four were excluded as planned gynaecological resections for known endometriosis. The case notes, laboratory and imaging reports of six patients were reviewed. Result(s): In three patients, a 72-h or less history of right iliac fossa (RIF) pain was present (24-h or less in two), whereas on two occasions there was a 3-week history of intermittent RIF pain. Three patients reported nausea and vomiting and two were pyrexial. No history of diarrhoea was reported. Inflammatory markers (white cell count-WCC, C-reactive protein-CRP) were raised on three occasions. In five patients, available imaging (CT/USS) was suggestive of an inflammatory process in the right iliac fossa, with principle diagnosis being acute appendicitis, and in one the diagnosis was solely clinical. In all six cases, acute appendicitis was found intraoperatively. The Alvarado score ranged from 4-7. Conclusion(s): Endometriosis of the appendix may present to surgical teams as acute appendicitis. Surgeons should be aware that a longer history of intermittent RIF pain and normal inflammatory markers does not exclude appendicitis secondary to endometriosis. An appendicectomy should be performed, as the aetiology does not appear to otherwise affect the natural history of this condition.

Link to full-text [no password required]

Transanal endoscopic microsurgery for early rectal cancer-can it be done safely with good outcomes at a in a UK district general hospital (2019)

Type of publication:
Conference abstract

Author(s):
*Vidyasankar V.; *Chakrabarthy A.; *McCloud J.; *Clarke R.

Citation:
Colorectal Disease; Sep 2019; vol. 21, S3, p. 54

Abstract:
Aim: Randomised controlled trials have demonstrated advantages of Transanal endoscopic microsurgery (TEMS) for early rectal cancer resections. The aim of our study was to assess the safety and outcome of TEMS for early rectal cancer at a U.K district general hospital. Method(s): Between July 2011 to January 2017, 27 patients, 13 men and 14 women, Mean age 77 years, underwent TEMS. Mean lesion diameter was 49 mm. Patient selection was based on multidisciplinary decision. Follow up included colonoscopy, MRI and CT according to standard protocol. Patients were admitted for overnight observation and discharged the following day. Result(s): Mean operative time was 60 minutes. Average hospital stay was 24 hours. One patient (3.7%) had bleeding, three (11%) developed perforation, which were identified and repaired immediately. Two (7.4%) developed pyrexia, One patient (3.7%) developed minor stricture. One (3.7%) developed a recto-vaginal fistula. R0 resection was achieved in 81% and R1 resection was achieved in 19% of cancer cases. One patient (3.7%) developed local recurrence. No mortality. Conclusion(s): Our study demonstrates that TEMS for early rectal cancer can be safely performed in selected patients at a district general hospital, with outcomes comparable with international data.

Link to full-text [no password required]

Childbirth-related pelvic floor trauma in women at-risk: A survey of the current obstetric management of short stature primigravid women (2019)

Type of publication:
Conference abstract

Author(s):
*Rachaneni S.; Freeman R.

Citation:
International Urogynecology Journal; September 2019; vol. 30 (no. 1 Supplement)

Abstract:
Objective: To assess the antenatal and intrapartum management of short statured primigravid women in relation to the awareness of the increased risk of long-term pelvic floor morbidity from childbirth, by Obstetricians and Gynaecologists in the UK. Method(s):We carried out a questionnaire survey with 15 questions about the antenatal and intrapartum management of short statured primigravid women with a clinically large fetus, their timing and mode of delivery and discussion with the women about their risk of long-term pelvic floor morbidity following spontaneous and instrumental vaginal deliveries, their choice of instruments and episiotomy. Result(s): The survey was completed by 424 Members and Fellows of Royal College of Obstetricians and Gynaecologists (UK). We created a scenario of a short stature primigravid woman who presented with a clinically large baby around 38 weeks gestation. Sixty five percent of the responders stated that they would scan for estimated fetal weight, 48% would offer induction of labo-r at 40 weeks gestation and 13% would offer an elective caesarean section at 39-40 weeks. Only 59% of the responders said that would discuss the risks of obstructed labo-r, shoulder dystocia, instrumental delivery and Obstetric anal sphincter injury. Seventy percent of the responders said they would not discuss the long term risks of urinary, fecal incontinence and prolapse during antenatal or intrapartum management. For intrapartum management with failure to progress in the second stage of labo-r, 69% would attempt a rotational instrumental delivery, and only 5% would offer an emergency caesarean section. Manual rotation followed by ‘straight’ forceps application (59%) was the most frequent rotational delivery offered followed by Ventouse (40%) and Keillands forceps rotation. Thirty four percent stated that do not routinely perform an episiotomy in this scenario. The choice of instrument was not based on the long-term risk of pelvic floor dysfunction in 73% of the responses. Conclusion(s): The survey reveals a poor level of counselling of primigravid women of short stature who are known to be at higher risk of long-term pelvic floor trauma and consequent incontinence and prolapse.

Role of flavonoids in the management of acutely symptomatic haemorrhoids: A systematic review and meta-analysis of randomized, controlled trials (2019)

Type of publication:
Conference abstract

Author(s):
*Rehman S.; Miles W.; Sains P.; Sajid M.

Citation:
British Journal of Surgery; Sep 2019; vol. 106, S5, p. 110

Abstract:
Aims: The objective of this article is to assess the role of role of flavonoids in the management of acutely
symptomatic haemorrhoids.
Method(s): The data retrieved from the published randomized, controlled trials (RCT) regarding the role of flavonoids in the management of acutely symptomatic haemorrhoids was analysed using the principles of metaanalysis. The summated outcome of dichotomous variables was expressed in odds ratio (OR).
Result(s): Ten RCTs on 1478 patients comparing the surgical outcomes in patients having clinically and endoscopically diagnosed acute symptomatic haemorrhoids after using flavonoids versus placebo preparation were analysed. In the random effects model analysis using the statistical software Review Manager 5.3, the symptomatic relief (OR, 0.48; 95% CI, 0.16, 1.3928; z = 1.36; P = 0.18), satisfaction on pain relief (OR, 0.30; 95% CI, 0.08, 1.07; z = 1.86; P = 0.06), recurrence (OR, 0.48; 95% CI, 0.14, 1.63; z = 1.17; P = 0.24) and complications rate (OR, 1.31; 95% CI, 0.49, 3.54; z = 0.54; P = 0.59) were statistically similar in both groups. However, symptomatic haemorrhoidal bleeding control rate was higher in flavonoids group (OR, 0.33; 95% CI, 0.13, 0.84; z = 2.33; P = 0.02).
Conclusion(s): Use of flavonoids to treat symptomatic acute haemorrhoids failed to demonstrate better effectiveness over traditional placebo remedies except better bleeding control.

Link to full-text [NHS OpenAthens account required]

Is it Necessary to do Colonoscopy after Appendicectomy in Patients Over the Age of 50 Years? (2019)

Type of publication:
Conference abstract

Author(s):
*Chakrabarty A.; *Vardhrajan V.; *Cheetham M

Citation:
British Journal of Surgery; Sep 2019; vol. 106 S5; p. 70

Abstract:
Aim: In the United Kingdom 1 in 13 people are affected by appendicitis. The commonest age group is between
10 to 20 years. Appendicitis is relatively uncommon in adults over 50 years. There is a belief that appendicitis
may be precipitated or mimicked by colorectal cancer and hence some surgeons recommend that patients over the age of 50 should undergo a post-operative colonoscopy.
Method(s): We identified patients over the age of 50 years who had appendicectomies in our hospital between
2013 and 2017 usingHES data. Detailed data was collected for all the patients from radiology and endoscopy
data bases. We calculated the cost of post-operative colonoscopy to the health system using PBR tariff.
Result(s): 396 patients aged over 50 underwent emergency appendicectomy during the study period. Of these
284 (72%) had had pre-operative C T scans. 88 (22%) out of the 396 patients underwent a colonoscopy within 3 months of their appendicectomy. Of these 88 patients, 62 had pre-operative CT scans. No cancers were found on post-operative colonoscopy. The cost of performing post-operative colonoscopy in this cohort was 35, 464.
Conclusion(s): In an era of liberal preoperative CT scanning for patients over 50 with right iliac fossa pain, it is
not necessary to perform a colonoscopy after appendicectomy. We recommend that for patients who have a
preoperative CT scan, a post-operative colonoscopy is only needed if there are specific imaging abnormalities.

Link to full-text [NHS OpenAthens account required]