Recent Submissions

  • A woman with hip pain and teeth in the pelvis.

    Malik, Adnan Ather; Yosief, Lydia Salem; Mahdi, Dana; Butt, Umar; Luckiewicz, Andrzej; Malik, Amman; Cassidy, Aaron; Malik, Amina; Kader, Nardeen; Merchant, Fraser; et al. (Wiley, 2021-08-05)
    No abstract available.
  • At any cost : a paradigm shift in the culture of caesarean section rate monitoring in the United Kingdom

    Redjepova, Oguljemal; Bilagi, Ashwini; Redjepova, Oguljemal; Bilagi, Ashwini; Obstetrics and Gynaecology; Medical and Dental; Sandwell and West Birmingham NHS Trust (Taylor and Francis Group, 2024-04-09)
    Recent reviews into maternity safety in the United Kingdom (UK) have led to a paradigm shift in culture and policy around caesarean section (CS) rate monitoring. CS rates in the UK have risen considerably over the last few decades and, in this time, there has been national effort at the level of government to kerb such rises due to concerns about the associated morbidity, and the medicalisation of birth. However, recent findings from two landmark reviews raise concerns that the pursuit of low CS rates may have caused harm to patients in some instances, and this has led the UK government to recommend cessation of the use of total CS rates as performance metric for maternity services. Instead, it is proposed that such data be collected with use of the Robson classification. Ongoing appraisal of maternity safety will be required to evaluate the effect of these changes in future.
  • Training for intrapartum sonography using optical ultrasound simulation

    Clark, Anna E; Patel, Neysa; Kovalenko, Mariya; Hanidu, Arwa; Usman, Sana; Lees, Christoph; Usman, Sana; Obstetrics and Gynaecology; Medical and Dental; Imperial College Healthcare NHS Trust; Imperial College London; Sandwell and West Birmingham NHS Trust; KU Leuven (Elsevier, 2024-03)
    No abstract available
  • A Systematic Review of the Effect of Type, Pressure, and Temperature of the Distension Medium on Pain During Office Hysteroscopy.

    De Silva, Prathiba M; Stevenson, Helen; Smith, Paul P; Justin Clark, T; Stevenson, Helen; Obstetrics and Gynaecology; Medical and Dental; University of Birmingham; Birmingham Women's and Children's NHS Foundation Trust; Sandwell and West Birmingham NHS Trust (Elsevier, 2021-01-11)
    Objective: To identify the optimal distension medium type, pressure, and temperature to minimize pain during office hysteroscopy. Data sources: MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from inception to January 29, 2020. Methods of study selection: We included randomized controlled trials in which women undergoing office hysteroscopy were randomized to either a distension medium type, pressure, or temperature against a suitable control, where pain was an outcome. Data regarding feasibility, visualization, complications, and satisfaction were also collected. Tabulation, integration, and results: The literature search returned 847 studies, of which 18 were included for systematic review and 17 for meta-analysis. There was no significant difference in intraprocedural pain when comparing the use of normal saline against carbon dioxide (standardized mean difference [SMD], -0.12; 95% confidence interval [CI], -0.36 to 0.13). Subgroup analysis of high-quality studies revealed a statistically significant reduction in postprocedural pain with normal saline (SMD, -0.65; 95% CI, -1.14 to -0.16). Side effects were less frequent (Peto odds ratio, 0.29; 95% CI, 0.20-0.40) and patient satisfaction was higher (SMD, 1.39; 95% CI, 0.51-2.28) with normal saline compared with carbon dioxide. Pressures of ≤40 mm Hg reduced intraprocedural pain (SMD, -0.67; 95% CI, -1.09 to -0.26) at the expense of a higher proportion of unsatisfactory views (81%-89% at ≤40 mm Hg vs 95%-99% at ≥50 mm Hg). Postprocedural pain was reduced with lower filling pressures. Warming saline did not reduce intraprocedural pain (SMD, 0.59; 95% CI, -0.14 to 1.33). Conclusion: Normal saline, instilled at the lowest pressure to acquire a satisfactory view, should be used for uterine distension during office hysteroscopy to minimize pain.
  • Use of anticoagulants to improve pregnancy outcomes in couples positive for M2 haplotype : a systematic review

    Khattak, Hajra; Aleem Husain, Syed; Baker, Deborah; Greer, Ian; Husain, Syed Aleem; Obstetrics and Gynaecology; Medical and Dental; University of Birmingham; Sandwell and West Birmingham NHS Trust; IHG Pharmaco Ltd; Queen's University Belfast (Elsevier, 2024-02-21)
    Background: Placental mediated pregnancy complications (PMPC) are common, often recurring, and pose a significant health risk to mother and fetus. Evidence suggests that the hypercoagulable state associated with many PMPC, could reflect reduced expression of Annexin 5 (ANXA5), a naturally occurring anticoagulant protein in placental tissue. The ANXA5 M2 haplotype is a genetic variant, which results in reduced expression of ANXA5 protein. M2 haplotype carrier couples may therefore be at increased risk of PMPC. Evidence regarding the effectiveness of anticoagulation to prevent PMPC is inconsistent. Furthermore, studies have not selected or stratified for M2 haplotype carriers, in whom there is a predisposition to hypercoagulability, to assess the effectiveness of anticoagulation, which may vary from those without the M2 haplotype. Objectives and rationale: The aim of this study was to systematically review the current evidence to assess whether anticoagulant treatment improves pregnancy outcomes in couples positive for M2 haplotype. Search methods: The review was registered on PROSPERO (CRD42022343943). A comprehensive literature search was performed using MEDLINE, Embase and Cochrane collaboration databases from inception to January 2023. Two reviewers assessed the articles for eligibility and extracted the data simultaneously. Primary outcome was successful pregnancy and live birth. Secondary outcomes included PMPC (implantation failure, miscarriage, pre-eclampsia, preterm birth and fetal growth restriction). Outcomes: From a pool of 410 references, 10 were selected for full text review, of which three studies (a post hoc analysis of a randomised controlled trial, cohort study and a case report) were included in this review. Included studies comprised of 223 individuals, 129 of whom who received anticoagulation treatment after testing positive for M2 haplotype. The studies collectively showed an improvement in pregnancy outcomes in M2 haplotype positive individuals however, given the heterogeneity of studies, it was not possible to conduct a meta-analysis and draw firm conclusions. Wider implications: Current evidence is limited, such that the value of screening couples for the M2 haplotype to select or stratify for treatment with prophylactic anticoagulation remains unknown. Thus, further studies including well designed, large, multi-centre randomised controlled trials are required to assess whether anticoagulation treatment will be effective in improving pregnancy outcomes in M2 haplotype couples.
  • Covariate analysis query: Hospital surgical volume-outcome relationship in caesarean hysterectomy for placenta accreta spectrum.

    Redjepova, Oguljemal; Lowe-Zinola, Jack; Griffin, Christopher; Redjepova, Oguljemal; Obstetrics & Gynaecology; Medical and Dental; Sandwell and West Birmingham NHS Trust; University Hospitals Birmingham NHS Trust; Notre Dame Medical School (Wiley, 2022-01-07)
    No abstract available
  • Caesarean section operation is not associated with myometrial hypertrophy-a prospective cohort study.

    Ewies, Ayman A. A.; Qadri, Shahin; Awasthi, Rachna; Zanetto, Ulisses; Ewies, Ayman AA; Gynaecology; Medical and Dental; Sandwell and West Birmingham NHS Trust; University of Birmingham; The Royal Wolverhampton NHS Trust (Taylor and Francis Group, 2022-06-10)
    Maternity statistics of England in 2020 showed rise in Caesarean Section (CS) rate to 31%. Some studies correlated adverse gynaecological symptoms e.g. menstrual irregularities and pelvic pain to 'niche' formation at CS scar site. Niche formation was speculated to cause myometrial hypertrophy aggravating these symptoms. This was a prospective comparative histological study including 52 consecutive benign hysterectomy specimens which were categorised into 2 groups: (i) specimens with CS scar (n = 22), (ii) specimens with no CS scar (n = 30). Median (IQ range) uteri weight was 97.2grms (43.5-226) and 91.7grms (35.7-201.7) in study and control groups, respectively (p = .991). Mean (±SD) thickness of anterior myometrial wall was 18.7 mm (±3.6) and 19.4 mm (±4.5) in study and control groups, respectively (p = .58). Mean (±SD) thickness of posterior myometrial wall was 19.1 mm (±3.7) and 18.7 mm (±3.9) in study and control groups, respectively (p = .78). The assumption that CS scar causes myometrial hypertrophy was not demonstrated in this study.IMPACT STATEMENTWhat is already known on this subject? Maternity statistics world-wide show a continuous rise in the rate of Caesarean Section (CS) operation. The CS scar is assumed to be related to adverse clinical gynaecological symptoms such as intermenstrual bleeding, dysmenorrhoea, dyspareunia and chronic pelvic pain; however, the mechanism of this association is not clear. Further, little is known about the effects of CS scar on uterine wall morphology and function.What do the results of this study add? This study was the first prospective series in the literature to compare the uteri with scar with those without in respect of weight and myometrial wall thickness. It was not able to demonstrate the association between having CS scar and myometrial hypertrophy which was hypothesised to be the cause of adverse gynaecological symptoms. However, the microscopic examination of the CS scar revealed adenomyosis, haemorrhage and/or chronic inflammation in most cases.What are the implications of these findings for clinical practice and/or future research? The clinical implication of the histological changes shown in the CS scar requires large comparative clinical studies.
  • Aspirin use in pregnancy : where are we and what next?

    Man, Rebecca; Hodgetts, Victoria; Morris, R. Katie; Man, Rebecca; Obstetrics and Gynaecology; Medical and Dental; Sandwell and West Birmingham NHS Trust; University of Birmingham (Elsevier, 2023-01-14)
    Aspirin is currently recommended from 12 weeks gestation until the birth of the baby for women with one high, or two moderate risk factors for pre-eclampsia, to reduce the risk of developing the condition. There is evidence to suggest aspirin use in pregnancy potentially reduces the risk of preterm birth and small for gestational age or fetal growth restricted babies. For women with recurrent pregnancy loss associated with anti-phospholipid syndrome, aspirin is recommended in combination with heparin. In this review, we discuss the history of aspirin use and its application to improving pregnancy outcomes. We also highlight the current evidence surrounding aspirin use in pregnancy and explore avenues for further research.
  • Serum Albumin as a Predictor of Survival after Interval Debulking Surgery for Advanced Ovarian Cancer (AOC): A Retrospective Study.

    Dai, Dairui; Balega, Janos; Sundar, Sudha; Kehoe, Sean; Elattar, Ahmed; Phillips, Andrew; Singh, Kavita; Balega, Janos; Sundar, Sudha; Kehoe, Sean; et al. (Taylor and Francis Group, 2020-10-06)
    Objective: To investigate the impact of serum albumin (at diagnosis and pre-operatively) on survival in patients undergoing cytoreductive surgery for advanced ovarian cancer(AOC) and whether improvement in albumin achieved following neoadjuvant chemotherapy (NACT) affects overall survival (OS). Methods: Outcomes of 441 patients who underwent cytoreduction for AOC were reviewed. Albumin was recorded at diagnosis and pre-operatively. Further analysis was performed if patients were hypoalbuminaemic at diagnosis.Analysis was stratified according to whether the patientreceived primary debulking surgery (PDS) or interval debulking surgery (IDS) and if their albumin was corrected. Results: 308 patients had a serum albumin level at diagnosis and 400 patients had a pre-operative albumin available for analysis. For patients with an albumin at diagnosis ≤ 35g/L and ≥36 g/L, median OS was 31.5 (95% CI 23.5-39.5) and 50.4 (95% CI 38.9-61.9) months respectively (P = 0.003). Followingmultivariate analysis (MVA), albumin at diagnosis remained statistically significant as an independent marker for survival, even after adjusting for cytoreductive outcome, stage and grade(p = 0.04, Hazard ratio 1.38, 95% CI 1.01-1.89).Hypoalbuminaemic patients at diagnosis achieved complete cytoreduction in 53% of cases.For PDS patients, median OS was 19.7 months (95% CI 11.5-27.9). For IDS patients, median OS was 27.9 months (n = 1).IDS patients with a corrected albumin had a median OS of 42.9 months (95% CI 31.5-54.3) (p > 0.05). Conclusion: Hypoalbuminaemia at diagnosis is a poor prognostic factor in AOC. Normalization of serum albumin after NACT is a potential predictor of survival.
  • SARS-2 COVID-19-induced immunity response, a new prognostic marker for the pregnant population correlates inversely with neonatal Apgar score.

    Marwah, M; Shokr, H; Demitry, A; Wang, K; Ahmad, S; Marwah, S; Wandroo, F; Demitry, A; Marwah, S; Wandroo, Farooq; et al. (Springer, 2022-03-05)
    Background: The COVID-19 infection has impacted pregnancy outcomes; however, few studies have assessed the association between haematological parameters and virus-related pregnancy and neonatal outcomes. We hypothesised differences in routine haematology indices in pregnant and non-pregnant COVID-19 patients as well as COVID-19-negative pregnant subjects and observed neonatal outcomes in all pregnant populations. Further, we tested if pattern identification in the COVID-19 pregnant population would facilitate prediction of neonates with a poor Apgar score. Methods: We tested our hypothesis in 327 patients (111 COVID-19-positive pregnant females, 169 COVID-19-negative pregnant females and 47 COVID-19-positive non-pregnant females) in whom standard routine laboratory indices were collected on admission. Results: Pregnant COVID-19-positive patients exhibited higher WBC, neutrophil, monocyte counts as well as neutrophil/lymphocyte and neutrophil/eosinophil ratio compared to non-pregnant COVID-19-positive patients (p = 0.00001, p = 0.0023, p = 0.00002, p = 0.0402, p = 0.0161, p = 0.0352, respectively). Preterm delivery was more prevalent in COVID-19-positive pregnant patients accompanied with a significantly lower birth weight (2894.37 (± 67.50) g compared with 3194.16 (± 50.61) g, p = 0.02) in COVID-19-negative pregnant patients. The COVID-19-Induced Immunity Response (CIIR) was defined as (WBC × neutrophil) / eosinophil; Apgar scores were significantly and inversely correlated with the CIIR index (r =-0.162). Interpretation: Pregnancy appears to give rise to an increased immune response to COVID-19 which appears to protect the mother, however may give rise to complications during labour as well as neonatal concerns. CIIR is a simple metric that predicts neonatal distress to aid clinicians in determining the prognosis of COVID-19 and help provide early intensive intervention to reduce complications.
  • Association between combined oral hormonal contraceptives and depression: Could diet play a role?

    Lowe-Zinola, Jack; Redjepova, Oguljemal; Griffin, Christopher; Lowe-Zinola, Jack; Redjepova, Oguljemal; Doctors; Obstetrics & Gynaecology; Medical and Dental; University Hospitals Birmingham NHS Trust; Sandwell and West Birmingham NHS Trust; Notre Dame Medical School (Wiley, 2022-02-28)
    No abstract available