Permanent URI for this collection
Browse
Recent Submissions
Publication International expert consensus statement on physiological interpretation of cardiotocograph (CTG) : first revision (2024)(Elsevier, 2024-10-02) Chandraharan, Edwin; Pereira, Susana; Ghi, Tullio; Perez-Bonfils, Anna Gracia; Fieni, Stefania; Jia, Yan-Ju; Griffiths, Katherine; Sukumaran, Suganya; Ingram, Caron; Reeves, Katharine; Bolten, Mareike; Loser, Katrine; Carreras, Elena; Suy, Anna; Garcia-Ruiz, Itziar; Galli, Letizia; Zaima, Ahmed; Global Academy of Medical Education & Training, London; Barts Health NHS Trust, London; University of Parma, Italy; Germans Trias i Pujol, Barcelona, Spain; George Eliot Hospital NHS Trust, Nuneaton; et al.; Obstetrics and Gynaecology; Medical and Dental; Sukumaran, SuganyaThe first international consensus guideline on physiological interpretation of cardiotocograph (CTG) produced by 44 CTG experts from 14 countries was published in 2018. This guideline ensured a paradigm shift from classifying CTG by arbitrarily grouping certain features of the fetal heart rate into different "categories", and then, randomly combining them to arrive at an overall classification of CTG traces into "Normal, Suspicious and Pathological" (or Category I, II and III) to a classification which is based on the understanding of fetal pathophysiology. The guideline recommended the recognition of different types of fetal hypoxia, and the determination of features of fetal compensatory responses as well as decompensation to ongoing hypoxic stress on the CTG trace. Since its first publication in 2018, there have been several scientific publications relating physiological interpretation of CTG, especially relating to features indicative of autonomic instability due to hypoxic stress (i.e., the ZigZag pattern), and of fetal inflammation. Moreover, emerging evidence has suggested improvement in maternal and perinatal outcomes in maternity units which had implemented physiological interpretation of CTG. Therefore, the guideline on Physiological Interpretation of CTG has been revised to incorporate new scientific evidence, and the interpretation table has been expanded to include features of chorioamnionitis and relative utero-placental insufficiency of labour (RUPI-L). Keywords: Cardiotocograph (CTG); Chorioamnionitis; Fetal heart rate cycling; How is THIS Fetus?; Relative utero-placental insufficiency of labour (RUP-L); Suggestive of Fetal Inflammation (SOFI); ZigZag Pattern.Publication How long should patients stay in hospital after minimally invasive hysterectomy?(Elsevier, 2023-09) Ellabany, Rania Hassanein Mohamed; Barakat, Anas; Osborn, Rosie; Polymeros, Konstantinos; George Eliot Hospital NHS Trust, Nuneaton; University Hospitals of Leicester NHS Trust; University of Leicester; Northampton General Hospital; Obstetrics and Gynaecology; Medical and Dental; Ellabany, Rania Hassanein MohamedPoster abstract #985 of the European Society of Gynaecological Oncology (ESGO) 2023 Congress, September 28-October 1 2023, Istanbul, Türkiye.Publication Disseminated trophoblastic peritoneal implants after surgical treatment of ectopic pregnancy : an extremely rare case highly relevant to trainees. ‘Who could have correctly diagnosed it?’(Wiley, 2016-12-04) Tan, A.; Naik, A.; Sohail, I.; Matts, S.; Wahab, M.; George Eliot Hospital, Nuneaton; Obstetrics and Gynaecology; Medical and Dental; Tan, A.; Naik, A.; Sohail, I.; Matts, S.; Wahab, M.Presentation abstract 0138 of the RCOG National Trainees Conference (NTC) 2016, 5-6 December 2016, Newcastle, UK.Publication The overuse of high vaginal swabs in the gynaecology outpatient department(Wiley, 2017-03-17) Ali, F.; Wahab, M.; George Eliot Hospital, Nuneaton; Gynaecology; Medical and Dental; Ali, F.; Wahab, M.Poster presentation EP064 in Category E: Poster Presentations: General Gynaecology (including Menstrual Disorders/ Fibroids/ Endometriosis/ Psychosomatic) from the RCOG World Congress 2017, 20–22 March 2017, CTICC Cape Town, South Africa.Publication ‘INVENT’ – a collaborative regional multicentre service evaluation and audit of multiple pregnancies : preliminary results from three centres(Wiley, 2019-06-12) Miti, C.; Gomindes, N.; Self, A.; Hurst, P.; Khan, T.; Northwick Park Hospital, London; New Cross Hospital, Wolverhampton; South Warwickshire University NHS Foundation Trust; George Eliot Hospital, Nuneaton; Obstetrics and Gynaecology; MROG West Midlands Collaborative; Medical and Dental; Hurst, P.; Khan, T.Poster abstract 2600 from the 2019 World Congress of the Royal College of Obstretriscians and Gynaecologists, RCOG 2019. London, United Kingdom.Publication Audit: the rise of inductions of labour – are they all indicated?(Wiley, 2021-06-06) Maida, S.; Granshaw, L.; Brobbey, P.; Navaneetham, N.; George Eliot Hospital, Nuneaton; Obstetrics and Gynaecology; Medical and Dental; Maida, S.; Granshaw, L.; Brobbey, P.; Navaneetham, N.Abstract 1112 from the RCOG Virtual World Congress 2021.Publication Ornithine transcarbamylase deficiency – a case well managed through proper planning and multidisciplinary approach(Wiley, 2021-05) Azeem, Z; Jaleel, S; George Eliot Hospital NHS Trust; Medical and Dental; Azeem, Z; Jaleel, SFrom the virtual Annual Scientific Meeting of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) "A Vision for the Future", 15-18 February 2021.Publication Mode of delivery following incomplete resection of large third ventricular colloid cyst(Wiley, 2021-06) Erinle, B.; Farrag, A.; Tsang, K.; Dasgupta, K.; Wahab, M.; George Eliot Hospital NHS Trust, Nuneaton; University Hospital Coventry and Warwickshire; Imperial College Healthcare NHS Trust, London; Anaesthetics; Obstetrics and Gynaecology; Medical and Dental; Erinle, B.; Dasgupta, K.; Wahab, M.; Farrag, AAbstract 917 of the Royal College of Obstetricians & Gynaecologists Virtual World Congress 2021.Publication SUSAC Syndrome- An under reported and misdiagnosed condition that needs greater awareness for adequate management(Wiley, 2021-02-15) Jaleel, Shazia; Azeem, Zahra; George Eliot Hospital NHS Trust; Opthalmology; Obs & Gynae; Medical and Dental; Azeem, Zahra; Jaleel, ShaziaBackground: SUSAC Syndrome is an autoimmune mediated vasculopathy that affects the very small blood vessels in the brain, retina and cochlea. Case report: We report a case of 32 year old para 2 who was a known case of SUSAC syndrome diagnosed in her second pregnancy at 28 weeks of gestation after an episode of coma and fainting. She was transferred to tertiary care with abnormal cognitive function and MRI scan that showed evidence of active vasculopathy. Her symptoms were severe headaches with flashing of lights, tinnitus and joint pains. She had multidisciplinary care with neuroinflammatory team. An emergency ceasarian section was performed at term due to fetal compromise. She had uneventful postnatal course . Discussion: Susac Syndrome affects women more than men usually between 20-40 years. It is difficult to diagnose the condition because of other overlapping symptoms therefore the true prevalence is unknown Headache is an important but often under-appreciated symptom which frequently has a migraines character and may precede other symptoms. Conclusion: A high degree of suspicion is needed to diagnose and treat women presenting in pregnancy. Women will need careful monitoring and neuro inflammatory input for better outcome.Publication Quantitative histomorphometric analysis of gonadal steroid receptor distribution in the normal human endometrium through the menstrual cycle(Springer Nature, 2005-06) Taylor, Anthony H.; Guzail, Muna; Wahab, May; Thompson, John R; Al-Azzawi, Farook; University of Leicester; Leicester Royal Infirmary; George Eliot Hospital, Nuneaton; Obstetrics and Gynaecology; Medical and Dental; Wahab, MayThe aim of this study was to test the hypothesis that the distribution of oestrogen receptor beta (ERbeta) and androgen receptor (AR) are related to cell proliferation or correlated with the expression of progesterone receptor (PR) or oestrogen receptor alpha (ERalpha) in the normal human endometrium. Immunohistochemical distribution of immunoreactive ERbeta in well-characterised menstrual cycle biopsy samples was lowest in proliferative endometrial glands, highest in early secretory phase glands and maintained at approximately 20% throughout the rest of the menstrual cycle and was closely correlated with stromal AR and stromal ERbeta expression. Stromal ERbeta was not significantly altered until the menstrual phase of the cycle and was not correlated with the expression of any other antigen in the stroma or endometrial glands except stromal AR. By contrast, glandular AR immunoreactivity was below 5% early in the cycle, increased during the secretory phase and showed strong expression just before menstruation. PR and Ki-67 expression showed strong positive correlations, indicating that PR may be a potent regulator of endometrial proliferation. These data suggest that glandular ERbeta expression is closely associated with a functional secretory role whereas glandular ERalpha and PR are associated with proliferation; glandular AR expression may be the switch required for menstruation.Publication Current state of hormone replacement therapy : the case for using trimegestone(SAGE Publications, 2006-07) Wahab, May; Al-Azzawi, Farook; George Eliot Hospital; Obstetrics & Gynaecology; Medical and Dental; Wahab, MayEstrogen deficiency has a negative impact on the quality of life of postmenopausal women and is associated with vasomotor symptoms, insomnia and emotional lability. Other manifestations of estrogen deficiency include dry skin, dry vagina and dyspareunia, in addition to bone loss. Estrogen replacement effectively reverses these changes. The only indication for the administration of a progestogen is to protect the postmenopausal uterus against the potential development of endometrial hyperplasia and carcinoma.Publication Trimegestone differentially modulates the expression of matrix metalloproteinases in the endometrial stromal cell(Oxford University Press, 2006-03) Wahab, M; Taylor, A. H.; Pringle, J. H.; Thompson, J; Al-Azzawi, F; George Eliot Hospital; University of Leicester; University Hospitals of Leicester; Obstetrics and Gynaecology; Medical and Dental; Wahab, M.Matrix metalloproteinases (MMP) are considered to be of critical importance in the initiation of menstruation where MMP protein levels are reciprocally modulated by the actions of the gonadal steroid hormones, estradiol (E(2)) and progesterone (P4), with P4 being considered the principal suppressor of endometrial MMP expression. Trimegestone (T) is a novel progestagen that tightly controls menstruation timing and duration through mechanisms that might involve MMP suppression. Endometrial stromal cells treated with 10(-6) M E(2), P4 or T in the presence and absence of 10(-6)M RU486 showed that both T and P4 suppressed the expression of MMP-1 and MMP-3 transcripts and secreted protein, whereas MMP-9 was not produced in culture. The suppressive effect of T or P4 on MMP-1 and MMP-3 transcript levels was enhanced in the presence of E(2) and attenuated in the presence of RU486, although MMP-1 proteins were unaffected by the presence of RU486, which alone acted as a partial progesterone agonist in these cultures. Immunohistochemistry with MMP-1, MMP-3 and MMP-9-specific antibodies performed on endometrial biopsies obtained from non-treated, LH-dated, normally cycling women and endometrial biopsies obtained from postmenopausal women treated with T-based HRT showed that immunoreactive MMP-1 and MMP-3 was higher in the menstrual phase, whilst MMP-9 expression was higher in the late luteal phase (P = 0.03) and T significantly inhibited the presence of MMP-9(+) cells. These data suggest that T acts in a similar manner to P4, but causes subtle differences in expression patterns of MMPs that may explain the different clinical effect that this progestagen has on endometrial behaviour compared to P4.