Obstetrics and Gynaecology

High-grade vaginal intraepithelial neoplasia (VAIN2/3): comparison of clinical outcomes between treated and untreated patients in an observational cohort study (2015)

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Type of publication:
Conference abstract

Author(s):
*Pandey B., *Papoutsis D., *Guttikonda S., *Ritchie J., *Reed N., *Panikkar J., *Blundell S.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, April 2015, vol./is. 122/(149)

Abstract:
Introduction We aimed to compare the clinical outcomes between treated and untreated patients with high-grade vaginal intraepithelial neoplasia (VAIN2/3) in our colposcopy unit. Methods The clinical records of all patients diagnosed with VAIN and vaginal cancer over the time period of 1981-2012 were retrieved and reviewed. The primary outcome was to identify the progression of treated versus untreated patients with VAIN2/3 to vaginal cancer and to compare persistent VAIN disease in both subgroups. The secondary outcome was to identify any associations between particular demographic features of treated/ untreated VAIN2/3 patients with their clinical outcome. Results During the time period of this observational cohort study 36 patients of which 11 patients with VAIN1, 19 with VAIN2/3 disease and 6 with vaginal cancer were identified. In those with VAIN2/3 (n = 19) the diagnosis was made in a younger age in the subgroup of treated patients (n = 8) versus the untreated patients (n = 11) (47 +/- 7.1 versus 54.3 +/- 11.5 years old). Nulliparity and smoking status were similar between the two cohorts. The median follow-up for the untreated women was 7 years (range 1-22 years). In the treated VAIN2/3 group, median time from diagnosis to treatment was 4 years (range 0.2-7 years), and median follow-up after treatment was 7 years (range 0.5-18 years). Treatment methods were ablation (n = 4), excision of lesion (n = 2) and vaginectomy (n = 2). There were no cases of treated VAIN2/3 patients (0%) that progressed to vaginal cancer, whereas n = 3 cases of untreated VAIN2/3 patients (21.4%) progressed to vaginal cancer. Following initial VAIN2/3 diagnosis, 8/11 cases of untreated VAIN2/3 (72.7%) had persistent disease as identified in follow-up cytology/colposcopy/vaginal biopsies. In the treated VAIN2/3 patients, 5/5 cases (100%) had persistent disease post-diagnosis but after treatment this decreased to 2/7 cases (28.5%). Conclusion Treated VAIN2/3 patients were of younger age but of similar smoking status and parity in comparison to untreated patients. Three cases of untreated VAIN2/3 progressed to vaginal cancer, whereas there were no such cases of patients receiving treatment for VAIN2/3. The VAIN2/3 patients who received treatment had a higher rate of persistent VAIN disease at followup post-diagnosis (100% versus 72.7%), but after treatment this rate fell down to 28.5%. Further studies are needed to conclude whether treatment of VAIN2/3 disease reduces the rate of VAIN disease persistence and affects the progression to vaginal cancer.

Link to full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201504001-00343&LSLINK=80&D=ovft

Teenage pregnancy: incidence and outcomes in a rural Shropshire district general hospital trust (2015)

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Type of publication:
Conference abstract

Author(s):
*Moores K.L., Ritchie J., *Calcott G., *Underwood M. , *Oates S.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, April 2015, vol./is. 122/(319)

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. The review sought to determine outcomes of teenage pregnancy (2013-2014) and compare rates of teenage pregnancy (2008-2013) 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, was conducted. Data sources included the MEDWAY Hospital Database. Recorded pregnancy outcomes were classified into two categories: outcomes in mothers aged 19 years or younger at time of delivery and outcomes in all mothers 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 6 years were compared to recorded rates in 1996. Results The rate of teenage pregnancy has continued to reduce; especially in those aged <16 years. Over 90% of teenage mothers had a vaginal delivery and were half as likely to require caesarean delivery (RR 0.49; 95% CI 0.33-0.75). Low rates of instrumental deliveries were seen in each category; no failed instrumental deliveries occurred among teenage mothers. Teenage mothers were not at a statistically significant increased risk of preterm delivery; however, mean term birthweights were lower among teenage mothers; 3302 g compared with 3464 g in the total population; and mean Apgar scores were the same in both groups. No difference was seen in rates of severe perineal trauma; however, more than 60% of teenage mothers had an intact perineum. Furthermore, teenage mothers had significantly lower rates of postpartum haemorrhage (RR 0.66, 95% CI 0.48-0.90). Conclusion Thus, one may suggest a lower risk of harm to teenage parturients and their babies compared with the local population, contrary to current general beliefs.

Link to full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201504001-00718&LSLINK=80&D=ovft

Success rate of cold coagulation for the treatment of cervical intraepithelial neoplasia: a retrospective analysis of a series of cases (2015)

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Type of publication:
Journal article

Author(s):
*Parry-Smith W, *Underwood M , De Bellis-Ayres S, *Bangs L, Redman CW, *Panikkar J.

Citation:
Journal of Lower Genital Tract Disease, January 2015, vol./is. 19/1(17-21), 1089-2591;1526-0976 (13 Jan 2015)

Abstract:
OBJECTIVE: To establish the cure rate at 1 year of patients who have undergone cold coagulation for the treatment of cervical intraepithelial neoplasia (CIN).DESIGN: Retrospective review of data for all patients at Shrewsbury and Telford NHS Trust who had undergone cold coagulation as part of their treatment for CIN between 2001 and 2011. Follow-up data up to December 2012 were analyzed. SETTING: Colposcopy Department, Shrewsbury and Telford NHS Trust, United Kingdom.POPULATION: Women undergoing cold coagulation for the treatment of CIN between 2001 and 2011, with cytologic follow-up until December 2012. METHODS: Patients were identified using a local colposcopy database. Data were obtained via the local histopathology reporting systems. Statistical analyses were performed using Stata/IC 10.1 software. MAIN OUTCOME MEASURES: Posttreatment cytology and whether subsequent treatment was required, with histology results. RESULTS: Data on 557 patients were collected and analyzed. Pre-cold coagulation treatment histologic findings were CIN 1 in 156 patients (28.01%), CIN 2 in 260 patients (46.68%), and CIN 3 in 141 patients (25.31%). The median length of time between cold coagulation treatment and first follow-up smear, used to calculate cure rates at around 1 year, was 406 days (interquartile range 123 days, range 169-3,116 days). The cure rate after cold coagulation was 95.7% at around 1 year. CONCLUSIONS: Cold coagulation has a cure rate comparable to that of excisional treatments such as large loop excision of the transformation zone and should be considered more widely in patients undergoing primary treatment for CIN, where there is no suspicion of invasive disease on history, examination and cytologic results.

 

The first case of thrombolysis for stroke in pregnancy in the UK (2014)

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Type of publication:
Conference abstract

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

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, November 2014, vol./is. 121/(7), 1470-0328 (November 2014)

Abstract:
Case: A healthy 28-year-old Caucasian woman presented to the Royal Shrewsbury Hospital (RSH) in her second pregnancy at 39 weeks of gestation with a sudden onset of dense left hemiparesis. This woman had no preceding risk factors. An urgent CT scan showed no acute changes suggesting a diagnosis of ischaemic stroke. Through discussion between the stroke specialist and consultant obstetrician, it was decided for thrombolysis which was performed in the emergency department prior to transfer to a larger hospital with stroke facilities. We wished to discover how many other women had undergone thrombolysis for stoke in pregnancy and the associated risks. We conducted a literature review concentrating on stroke and pregnancy including known risk factors and thrombolyis in pregnancy. We have found no other documented case of thromboylsis being used for stroke in pregnancy in the UK. Additionally there are many case reports not from the UK that demonstrate good maternal and fetal outcomes after thromobolysis. Conclusion: Our case appears to be the first reported case of thrombolysis for stroke in pregnancy in the UK. All post investigations have so far come back as normal, which is unusual as most other cases have had known risk factors for stroke. Our patient has recovered well post thrombolysis, which demonstrates the importance of dealing with stroke in pregnancy efficiently to allow thrombolysis to be achieved quickly. Although the risks and benefits need to be weighed up on an individual basis, our case and the relevant literature show that thrombolyiss can be safely used in pregnancy with good maternal and fetal outcomes.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201411006-00021&LSLINK=80&D=ovft

 

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

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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