Gynaecological morbidity associated with caesarean niche: increasing awareness, prevention and management
Author(s) Brook A.J.; Clarke F.R.; Bhatia K.
Source Obstetrician and Gynaecologist; Apr 2020; vol. 22 (no. 2); p. 122-130
Key content: Caesarean section rates are rising globally; while obstetric consequences are well defined, long-term gynaecological sequelae are frequently overlooked. Caesarean niche results from poor healing of the uterine scar and is being increasingly reported as an important factor in a variety of new gynaecological symptoms reported after caesarean section. Until recently, a lack of high-quality evidence has hampered diagnostic assessment. Recent publications provide a useful consensus for improved diagnosis and guidance on management, with thoughts that caesarean section technique potentially contributes to niche development. Learning objectives: To describe the gynaecological morbidity associated with caesarean niche. To understand theories regarding caesarean niche development, its sonographic assessment for clinical relevance and subsequent management. To reflect on surgical techniques for caesarean section to minimise niche development. Ethical issues: With rising caesarean section rates, caesarean niche is an emerging clinical problem. Should we advise women of the possibility of long-term gynaecological consequences of the caesarean niche?
The cost-effectiveness of progesterone in preventing miscarriages in women with early pregnancy bleeding: an economic evaluation based on the PRISM trial
Author(s) Okeke Ogwulu C.B.; Goranitis I.; Roberts T.E.; Devall A.J.; Gallos I.D. et al.
Source BJOG: An International Journal of Obstetrics and Gynaecology; May 2020; vol. 127 (no. 6); p. 757-767
Objectives: To assess the cost-effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding.
Author(s): Schram C.M.H.
Source: Obstetrician and Gynaecologist; 2018; vol. 20 (no. 2); p. 125-131
Publication Date: 2018
Publication Type(s): Article
Available at The Obstetrician & Gynaecologist - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Key content: Appraisal is a formative and developmental process; annual appraisals are the cornerstones of revalidation. Supporting information for an appraisal should cover the whole scope of work of an obstetrician and gynaecologist, including any educational, managerial or academic work over a 5-year revalidation cycle. The quality of supporting information, including reflection, is more important than the quantity. Supporting information for an appraisal can be found in many day-to-day clinical activities. Learning objectives: To be familiar with the guiding principles of appraisal and revalidation. To appreciate how to provide supporting information that satisfies appraisal and revalidation requirements. To know how to prepare efficiently and effectively for appraisal and revalidation.Copyright © 2018 Royal College of Obstetricians and Gynaecologists
Post coital bleeding (PCB): Time for action by Royal Colleges as standardised pathways and guidance needed. Outcome of a ten year review of PCB referrals to East Lancashire Teaching Hospitals Colposcopy Services
Author(s): Krishnamoorthy U.; Waddington T.; Choudhry S.
Source: BJOG: An International Journal of Obstetrics and Gynaecology; Mar 2018; vol. 125 ; p. 129-130
Publication Date: Mar 2018
Publication Type(s): Conference Abstract
Available at BJOG: An International Journal of Obstetrics and Gynaecology - from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Introduction Post coital bleeding (PCB) consists of spotting or bleeding that occurs during or after sexual intercourse can be alarming for patients as is a cardinal symptom of cervical cancer although mostly due to benign causes. There is ambiguity in management of PCB and paucity of national/college guidance. Given the anxiety it evokes in patients and association with cervical cancer, there is the need for streamlined National pathway. Objectives Review aimed to improve standard of care provided for management of PCB. Objectives were to evaluate current management and extrapolate audit results and evidence from literature guide development and implementation of PCB Care pathway locally.
Author(s): Golash M.; Misfar N.; Bhatia K.
Source: Journal of Minimally Invasive Gynecology; 2017; vol. 24 (no. 7)
Publication Date: 2017
Publication Type(s): Conference Abstract
Abstract:Study Objective: To describe the learning curve and outcomes of Minitouch endometrial ablation cases done by 12 gynaecologists. Design: Electronic discharge summaries and last outpatient clinic letters were analysed of patients who have completed 4-month follow up. Setting: Day case setting of a general hospital within a National Health Service trust. Patients: Patients treated with Minitouch endometrial ablation between January and December 2016. Intervention: Minitouch endometrial ablation procedures. Measurements and Main Results: 48 Minitouch endometrial ablation cases were performed. Four patients are awaiting 4-month follow up. Electronic discharge summaries and last outpatient clinic letters for the remaining 44 patients were analysed. All cases were done in a day case setting by 12 gynaecologists, resulting in an average 3.7 cases per operator. Patients' average age was 42.9 (range 28-53) and their indications were: 39/44 menorrhagia, 2/44 irregular bleeding, and 3/44 metromenorrhagia. Fibroids measuring 9-46 mm were identified during pre-op ultrasound in 15/44 (34.1%) patients, included 11 intramural, 4 sub-mucosal, and 2 sub-serosal. One or more pharmacological treatments had previously failed in 30/44 (68.2%) patients. All patients had normal cavities with an average sounding length of 8.9 cm (range 7-14 cm). 4/44 patients (9.1%) had a history of 1-2 LSCS. Successful resolution of symptoms (amenorrhea, spotting or lighter periods) at 4-months was identified in 36/44 (82%) patients. One of these patients is not completely satisfied and is scheduled for second review. Another is being treated with Esmya. No adverse event was reported. Of the remaining 8/44(18%) patients with persistent symptoms, one patient is under wait and watch, five are receiving pharmacological treatment, one underwent rollerball ablation, and one total laparoscopic hysterectomy. Conclusion: The learning curve for our large team of gynaecologists with varying experience levels was short and consistent as demonstrated by excellent safety and effectiveness outcomes. Minitouch has enabled us to introduce outpatient endometrial ablation service for the first time in our trust.
Comparing hospital and telephone follow-up for patients treated for stage-I endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial
Author(s): Beaver K.; Williamson S.; Sutton C.; Hollingworth W.; Gardner A.; Allton B.; Ghani R.; Abdel-Aty M.; Walker B.; Willett M.; Blackwood K.; Burns S.; Curwen D.; Keating P.; Murray S.; Wood N.; Martin-Hirsch P.; Tomlinson A.
Source: BJOG: An International Journal of Obstetrics and Gynaecology; Jan 2017; vol. 124 (no. 1); p. 150-160
Publication Date: Jan 2017
Publication Type(s): Journal: Article
Available in full text at BJOG: An International Journal of Obstetrics and Gynaecology - from John Wiley and Sons
Abstract:Objective: To evaluate the effectiveness of nurse-led telephone follow-up (TFU) for patients with stage-I endometrial cancer. Design: Multicentre, randomised, non-inferiority trial. Setting: Five centres in the North West of England. Sample: A cohort of 259 women treated for stage-I endometrial cancer attending hospital outpatient clinics for routine follow-up. Methods: Participants were randomly allocated to receive traditional hospital based follow-up (HFU) or nurse-led TFU. Main outcome measures: Primary outcomes were psychological morbidity (State Trait Anxiety Inventory, STAI-S) and patient satisfaction with the information provided. Secondary outcomes included patient satisfaction with service, quality of life, and time to detection of recurrence. Results: The STAI-S scores post-randomisation were similar between groups [mean (SD): TFU 33.0 (11.0); HFU 35.5 (13.0)]. The estimated between-group difference in STAI-S was 0.7 (95% confidence interval, 95% CI -1.9 to 3.3); the confidence interval lies above the non-inferiority limit (-3.5), indicating the non-inferiority of TFU. There was no significant difference between groups in reported satisfaction with information (odds ratio, OR 0.9; 95% CI 0.4-2.1; P = 0.83). Women in the HFU group were more likely to report being kept waiting for their appointment (P = 0.001), that they did not need any information (P = 0.003), and were less likely to report that the nurse knew about their particular case and situation (P = 0.005). Conclusions: The TFU provides an effective alternative to HFU for patients with stage-I endometrial cancer, with no reported physical or psychological detriment. Patient satisfaction with information was high, with similar levels between groups. Tweetable abstract: ENDCAT trial shows effectiveness of nurse-led telephone follow-up for patients with stage-I endometrial cancer. Copyright © 2016 Royal College of Obstetricians and Gynaecologists
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