Consultant Obstetrician Research Articles

Non-invasive prenatal testing: Assessing the availability and accessibility of information available to the pregnant population within the Republic of Ireland

ObjectiveWhile non-invasive prenatal testing (NIPT) has been widely adopted throughout Europe, Australia, and the USA, population level access to NIPT varies considerably. Ireland has no national screening programme for fetal anomalies, although NIPT is available from out-of-country providers. We aimed to describe the availability of NIPT in Ireland and the quality of information available online from NIPT providers. MethodsInformation available online from NIPT providers in the Republic of Ireland was analysed by examining all healthcare facilities websites and reviewing private health insurance directories. Data on information provided by NIPT providers was collected by two independent researchers from April to May 2023. ResultsFour of the 19 maternity hospitals/units in Ireland had information on NIPT on their websites, with three including an explanation of NIPT, testing accuracy, and associated fees (€380-480). Twenty private clinics led by obstetric consultants advertised NIPT online, of which seventeen clinics included an explanation of NIPT, testing accuracy, and associated fees (€380-€650). Twenty-nine other providers, which included ultrasound clinics, direct-to-consumer laboratory testing, and General Practitioners, advertised NIPT with 18 of these providers including an explanation of NIPT, testing accuracy, and associated fees (€179-€630). ConclusionWhile there is apparent demand for NIPT and it is available in Ireland, there is disparity between providers on the type and quality of information available. Difficulty obtaining accessible information, the associated financial costs and location of providers advertising NIPT are likely to be barriers to accessing NIPT. A national screening programme for aneuploidy should be considered to ensure both equitable access to and reliable information about prenatal screening.

Medical Illustration - A Pictorial Essay Visual Illustration of Obstetric Anal Sphincter Injuries (OASIS) Degrees of Severity, a Picture is Worth a Thousand Words

AbstractObstetric anal sphincter injury affects about 5.7% of primiparous women who deliver vaginally. Perineal injury during childbirth is a common event with important morbidity associated with third-and-fourth degree perineal tears (also referred to as obstetric anal sphincter injuries—OASIS). As there was a lack of consistency in the classification of a partial anal sphincter injury, with up to 33% of consultant obstetricians classifying a complete or partial tear of the EAS as a second-degree tear. We have proposed simple, digital diagrammatic drawings to visually represent all degrees (grades) of OASIS based on the WHO OASIS classification.

A national survey of clinicians’ opinions of rotational vaginal births

IntroductionMalposition of the fetal head, defined as occiput transverse or posterior positions, occurs in approximately 5% of births. At full cervical dilatation, fetal malposition is associated with an increased risk of rotational vaginal birth. There are three different rotational methods: manual rotation, rotational ventouse or rotational (Kielland’s) forceps. In the absence of robust evidence, it is not currently known which of the three methods is most efficacious, and safest for parents and babies. ObjectiveTo gain greater insights into opinions and preferences of rotational birth to explore the acceptability and feasibility of performing a randomised trial comparing different rotational methods. Material and methodsA survey was sent via email to obstetricians from the British Maternal Fetal Medicine Society, as well as expert obstetricians and active academics in ongoing research in the UK. The questions focussed on perceived competence, preferred rotational method, location (theatre or labour room), willingness to recruit to an RCT, and its outcome measures. Closed questions were followed by the option of free text to allow further comments. The free text answers underwent thematic analysis. Results252 consultant obstetricians responded. The majority stated they were competent in performing manual rotation (88.1%). Half felt proficient using Kielland’s rotational forceps (54.4%). Most obstetricians felt skilled in rotational ventouse (76.2%). Manual rotation was the preferred first rotational method of choice in cases of both occiput transverse and posterior positions. The decision for which rotational method to attempt first was considered case-dependent by many. Two thirds of obstetricians would usually conduct rotational births in theatre (67.9%). Over half (52%) do not routinely use intrapartum ultrasound. Most (62.7%) would be willing to recruit to a randomised controlled trial comparing manual versus instrumental rotation. Over half (57.2%) would be willing to recruit to the same RCT if they were the most senior doctor competent in rotational vaginal birth supervising a junior. ConclusionThere is a wide range of practice in conducting rotational vaginal births in the UK. An RCT to investigate the impact of different rotational methods on outcome would be both feasible and desirable, especially in research-active hospitals.

MIDWIFERY CARE FOR W O M E N PLANNING VAGINAL BIRTH AFTER CAESAREAN: A SURVEY OF O N TA R I O MIDWIFERY PRACTICES

Due to new evidence, the safety of vaginal birth after Caesarean (VBAC) si again generating controversy ni maternity care. Asurvey of midwifery practices was undertaken ot determine midwifery practice patterns and the factors that influence their care of women with aprior Caesarean birth. Atwo-part questionnaire, pertaining to practice characteristics and VBAC care, was mailed to al 40 Ontario midwifery practices. Data from closed-ended questions were analysed using SPSS, while open-ended responses were examined for common themes. A survey response rate of 92.5% was obtained. While 73% of practices that responded reported that they wil not accept women with more than one lower segment Caesarean birth into care, 65% indicated that they wil attend home births for women with one prior Caesarean birth. For practices that do not atend women with aprior Caesarean birth at home, prohibitive hospital policies (64%) and lack of obstetrical support (86%) were the most frequently reported reasons. Concern about increased risk and lack of experience were also identified. Variations ni practice patterns do not appear ot be related to geographic practice characteristics. The survey has identified some of the factors that influence how Ontario midwives care for women with a prior Caesarean birth. Hospital policies and support from consultant obstetricians appear to have a greater impact on midwifery care for women with prior Cacsarean birth than midwives' perception of increased risk or lack of experience.

Current opinion on large-scale prospective myomectomy databases toward evidence-based preconception and antenatal counselling utilising a standardised myomectomy operation note.

No large-scale databases exist of pregnancy outcomes and rate of uterine rupture for women after myomectomy, resulting in inconsistent antenatal counselling and decision-making regarding mode and timing of delivery. Standardising information collected at myomectomy may facilitate data collection, informing prenatal/ antenatal counselling. To determine clinician opinions regarding standardisation of myomectomy operation notes to allow comprehensive data input into a prospective database of pregnancy outcomes, toward an evidence-based approach to decision making regarding timing and mode of delivery in subsequent pregnancies. A google forms survey was emailed to all consultant (attending-level) obstetricians and gynaecologists across 25 hospitals in London, Kent, Surrey, and Sussex (UK) between March and May 2022. To enhance response rates, two further email reminders were sent alongside in-person reminders from selected local unit representatives. Senior clinician opinion for characteristics necessary to collect at time of surgery to develop a widescale database of post myomectomy pregnancy outcomes. 209/475 (44%) responses received; 95% (198/209) agreed with standardising operation notes. Criteria selected for inclusion included cavity breach (98%, 194/198), location (98%, 194/198), number of fibroids removed (93%, 185/198) and number of uterine incisions (96%, 190/198). Gynaecologists support standardising myomectomy operation notes to inform the development of prospective large-scale databases of pregnancy outcomes after myomectomy. Acquisition of clinician opinions on the development and content of a standardised myomectomy operation note to aid the development of a pregnancy-outcome database for women after myomectomy.

Implementation of aspirin use during pregnancy in community midwifery-led care in the Netherlands: A pilot survey.

Aspirin nowadays is widely used in pregnancy, but implementation among gynecologists took nearly four decades. For a complete insight in the implementation of aspirin, community midwives are to be involved. Community midwives do not have authority to prescribe aspirin and have to refer to a general practitioner or consultant obstetrician for a prescription. The study was an online, national pilot survey about the implementation of aspirin use during pregnancy among independently practicing community midwives consisting of 29 items with five categories: background, advising, prescribing, possible indications, and clinical practice. Forty-seven community midwives completed the survey between April and May 2021. All respondents had experience on advising aspirin use in pregnancy. History of preterm pre-eclampsia or HELLP syndrome was identified as a risk factor for developing utero-placental complications by 97.9% of the community midwives. Moderate risk factors in women with otherwise low-risk pregnancy were identified by >75% of the participants. Practical issues in prescribing aspirin were experienced by one-third of the respondents. Suggestions were made to obtain authority for community midwives to prescribe aspirin and improve collaboration with consultant obstetricians and general practitioners. Community midwives seem to be adequate in identifying risk factors for developing utero-placental complications in women with otherwise low-risk pregnancy. Practical issues for prescribing aspirin occur often. Obtaining authority for community midwives to prescribe aspirin after education should be considered and consulting a consultant obstetrician should become more accessible to overcome the practical issues. Further educating community midwives and general practitioners might improve implementation rates and perinatal outcomes.

How COVID-19 pandemic affected clinical exposure of final year medical students: A comparison study of portfolio assessments

Background and Objective COVID-19 restrictions had a major impact on the academic sector globally. The aim of this study was to compare the clinical exposure of final year medical students at the professorial unit of Obstetrics and Gynaecology of Colombo South Teaching Hospital during the COVID-19 pandemic with those who attended clinical training prior to the pandemic. Methods Systematic sampling of 66 medical students belonging to two clinical groups, who had completed their professorial Obstetrics and Gynaecology appointment during the pandemic, was done, using their student portfolios recording the clinical skills and procedures performed during the appointment. The pre-COVID-19 data were gathered from a previous study carried out in the same unit in 2018. Results Most students managed to complete both the Gynaecological and the Obstetrics Mini–Clinical Evaluation Exercise (62.1% and 56.1% respectively) but, compared to the pre-pandemic era, a higher percentage presented only one case or none. All students completed the Objective Structured Assessment of Technical Skills in episiotomy suturing (100%) and a majority (90.9%) performed artificial rupture of membranes (ARM). However, only 36.4% had the opportunity to perform a PAP smear independently. Majority (95.1%) of the cases were presented to the registrars attached to the unit while only a minority was evaluated by a consultant (3.8%). The Obstetric and Gynaecological clinical procedures and skill acquisition showed slightly lower percentages than in the pre-COVID-19 period with the means and the medians lying in between the 1st and 2nd quartiles of the distribution. Conclusion On average, there was a slight decrease in the clinical exposure to procedures and skills during the COVID-19 outbreak compared to the non-COVID-19 period. Additionally, the opportunity of the medical students to be supervised by a consultant Obstetrician and Gynaecologist reduced drastically during the pandemic.

Successful Pregnancy Outcome in end-stage Renal Disease (ESRD) Patient : A Case Report

Pregnancy in women with chronic kidney disease (CKD) has always been considered as a challenging event both for the mother and the fetus . Outcomes of pregnancy in patients with End stage renal disease ( ESRD ) have long been considered to be extremely poor and challenges are harder in ESRD patients undergoing maintenance hemodialysis( MHD) . The cases of successful full term pregnancy occurring in an ESRD patient are still very few in whole world even after the evolutionary improvement of medical care. Development of well established multidisciplinary center make it possible to bring a successful pregnancy outcome among ESRD patients who are on going MHD. Patients with CKD are usually amenorrheic and fertility is markedly reduced . Women with chronic kidney disease, who get pregnant have poor pregnancy outcome in term of fetus and mother. Here we report a case of 34 years old lady, mother of two children , housewife presented in Bangladesh Specialized Hospital with a diagnosis 3 rd G 29 weeks of pregnancy with ESRD (on maintenance hemodialysis) with Hypertension. She was treated conservatively with joint consultation with Consultant Obstetrician, Nephrologist and Pediatrician. Her elective Lower uterine segment Cesarean section (LUCS) was done at her 35 weeks of pregnancy due to fetal distress with previous history of 2 LUCS. Both the mother and baby were healthy while discharge from hospital. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 162-164

Predictors of Failed Trial of Labour After Previous one Caesarean Section

OBJECTIVE To look for failed trail of labour after one caesarean section and predicting factors associated with failed labour
 STUDY DESIGN Comparative Cross-sectional Study
 SETTING AND DURATION OF STUDY Gynaecology and Obstetrics department Pak Emirates Military Hospital Rawalpindi.
 From May 2021 to October 2021.
 METHODS A prospective study was conducted on the women who were booked cases in our department for antenatal checkups and labour. Those women with history of one caesarean section were recruited for the analysis. They underwent labour in our department and those with failed labour were diagnosed and managed by consultant obstetrician. Relevant clinical factors associated with failed labour among women with one previous caesarean section included in our study.
 RESULTS A total of 380 women who underwent labour in our hospital with one previous caesarean section were recruited. Mean age of the women included in the study was 34.435±7.361 years. 162 (42.6%) had successful trial of labour while in 218 (57.4%) women trail of labour could not succeed. Statistical analysis revealed that gestation age more than 40 weeks, poor Bishop score (<5) at admission and requirement of labour augmentation (with oxytocin) were found statistically significantly associated with failed trial of labour in our study participants (p-value<0.05).
 CONCLUSION Failed trial of labour was a common clinical condition in women with one previous caesarean section. Women with gestation age more than 40 weeks, poor bishop score at admission and requiring labour augmentation were more at risk of having failed trial in our study participants. 
 
 

Immediate and longer-term impacts of fetal surveillance education on workforce knowledge and cognitive skills.

Background: Following the development of the Royal Australian College of Obstetricians and Gynaecologists Intrapartum Fetal Surveillance Guideline in 2003, an education program was developed to support guideline implementation and clinical practice. It was intended that improved clinician knowledge, particularly of cardiotocography, would reduce rates of intrapartum fetal morbidity and mortality. The program contains a multiple-choice assessment, designed to assess fetal surveillance knowledge and the application of that knowledge. We used the results of this assessment over time to evaluate the impact of the education program on clinicians' fetal surveillance knowledge and interpretive skills, in the immediate and longer-term. Methods: We undertook a retrospective analysis of the assessment results for all participants in the Fetal Surveillance Education Program, between 2004 and 2018. Classical Test Theory and Rasch Item Response Theory analysis were used to evaluate the statistical reliability and quality of the assessment, and the measurement invariance or stability of the assessments over time. Clinicians' assessment scores were then reviewed by craft group and previous exposure to the program. Results: The results from 64,430, broadly similar assessments, showed that participation in the education program was associated with an immediate improvement in clinician performance in the assessment. Performance improvement was sustained for up to 18 months following participation in the program and recurrent participation was associated with progressive improvements. These trends were observed for all craft groups (consultant obstetricians, doctors in training, general practitioners, midwives, student midwives). Conclusions: These findings suggest that the Fetal Surveillance Education Program has improved clinician knowledge and the associated cognitive skills over time. The stable difficulty of the assessment tool means any improvement in clinician's results, with ongoing exposure to the program, can be reliably assessed and demonstrated. Importantly this holds true for all craft groups involved in intrapartum care and the interpretation of cardiotocography.

Cervical cerclage technique: what do experts actually achieve?

Cervical cerclage is a recognised intervention in the management of women who are at risk of preterm birth and mid-trimester loss. The mechanism of action of cerclage is unclear and the technique has been poorly researched. We aimed to evaluate cerclage technique amongst experienced obstetricians, using a cerclage simulator we previously developed and evaluated. This prospective experimental simulation and observational study used identical simulators for 28 Consultant Obstetricians who were asked to perform their normal cerclage. Suture type, height, knot site and free thread length were recorded. Using computerised tomography, depth of bite and tension (by reduction in area of cervix) were calculated. Fifty-two cervical cerclages were completed (Mersilene tape n=20, monofilament suture n=32). Mean suture height was 33mm (SD 7.7mm) and was greater with monofilament suture than Mersilene tape and was associated with smaller needle size. Mean depth of bite and mean reduction of starting area did not differ by suture type. Seven procedures showed one or more suture bites that had entered the cervical canal once or more. In the first study of cerclage technique by experienced obstetricians using simulator and CT imaging we demonstrate wide variation in technique; this may affect the efficacy of the procedure. Further work should include establishing optimal technique and a consensus agreed for training and clinical practice.

VNOTES (vaginal Natural Orifice Transluminal Endoscopic Surgery): is this the future of gynaecological surgery?

The Obstetrician & GynaecologistEarly View Commentary vNOTES (vaginal Natural Orifice Transluminal Endoscopic Surgery): is this the future of gynaecological surgery? Wai Yoong MD FRCOG, Corresponding Author Wai Yoong MD FRCOG [email protected] orcid.org/0000-0001-7286-5968 Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UKCorrespondence: Wai Yoong. Email: [email protected]Search for more papers by this authorVictoria Sampson MRCOG, Victoria Sampson MRCOG Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UKSearch for more papers by this authorLusekelo Mwenechanya MBBS, Lusekelo Mwenechanya MBBS Specialist Trainee, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UKSearch for more papers by this authorJan Baekelandt MD PhD, Jan Baekelandt MD PhD orcid.org/0000-0002-8344-8622 Gynaecological Oncologist, Department of Gynaecology, Imelda Hospital, Bonheiden, BelgiumSearch for more papers by this author Wai Yoong MD FRCOG, Corresponding Author Wai Yoong MD FRCOG [email protected] orcid.org/0000-0001-7286-5968 Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UKCorrespondence: Wai Yoong. Email: [email protected]Search for more papers by this authorVictoria Sampson MRCOG, Victoria Sampson MRCOG Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UKSearch for more papers by this authorLusekelo Mwenechanya MBBS, Lusekelo Mwenechanya MBBS Specialist Trainee, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, UKSearch for more papers by this authorJan Baekelandt MD PhD, Jan Baekelandt MD PhD orcid.org/0000-0002-8344-8622 Gynaecological Oncologist, Department of Gynaecology, Imelda Hospital, Bonheiden, BelgiumSearch for more papers by this author First published: 20 February 2023 https://doi.org/10.1111/tog.12860Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Towards a clinical consensus on the management of pregnancy and birth after laparoscopic and open myomectomy: A survey of obstetricians and gynaecologists

ObjectivesThe primary aim was to assess if a clinical consensus regarding the management of pregnancy post myomectomy existed amongst consultant obstetricians and gynaecologists. Secondary objectives were to evaluate factors which influence the clinician’s decision making in this group of women. Study designElectronic survey sent to all consultants working in the North Central and East London deanery, Kent Surrey and Sussex deanery and Imperial NHS Trust to assess opinions on mode of birth post myomectomy, intervals advised to pregnancy post myomectomy, factors influencing the management of delivery in the scarred uterus post myomectomy, opinions on induction of labour and questions relating to operative notes. Results209 consultant responses received between 07/03/2022–07/05/2022 (44% response rate); 77% (161/209) practicing obstetricians and gynaecologists, 10% (21/109) pure gynaecologists and 13% (27/209) pure obstetricians.The majority would support a vaginal birth after open myomectomy (75%) and laparoscopic myomectomy (79%). No consensus was found as to the optimal time interval between myomectomy and pregnancy. Higher frequency of performing myomectomy and a greater level of experience were significantly associated with a shorter interval to pregnancy advised.The most important operative factors influencing decision to support trial of labour post myomectomy were breach of uterine cavity; location of fibroids removed and number of incisions on the uterus. 77% believe women should be given a choice regarding mode of delivery post myomectomy in a similar way to previous LSCS. 82.8% would support enrolment of patients into a prospective trial to investigate delivery post myomectomy. ConclusionsWe present a comprehensive survey of clinician opinions on pregnancy post myomectomy demonstrating that the majority of consultant obstetricians and gynaecologists sampled would support vaginal birth post myomectomy; counselling patients in a similar way to VBAC; a standardised myomectomy operation note and enrolment of patients in a future prospective trial. Wide variation in opinion regarding interval to pregnancy post myomectomy has been highlighted. We believe this information will facilitate counselling discussions and empower women with subsequent pregnancies after myomectomy to make an informed decision on mode of birth post myomectomy.

A Midwife Of My Own: Public Support For Implementation Of Midwifery Continuity Of Carer

Many service users and charities feel that implementing midwifery continuity of carer (MCoC), with linked consultant obstetricians in place, is a high priority for the NHS. A community of interest network has been set up for individuals and organisations representing women, parents, interest groups and communities who share this goal. We understand the current pressures on maternity services and want to support action to find solutions to those barriers that pose a challenge to implementation. Here, we introduce the network, our perspective on MCoC and the support we offer.

Validation of a novel birth simulator for impacted fetal head at cesarean section: An observational simulation study.

Impacted fetal head (IFH) is a challenging complication of cesarean section (CS) associated with significant morbidity. Training opportunities for IFH have been reported as inconsistent and inadequate. This study assessed the validity of a novel birth simulator for IFH at cesarean section. Obstetricians and midwives collaborated with model-making company, Limbs & Things (UK), to modify the original PROMPT Flex® simulator and develop a new "Enhanced CS Module" for IFH at cesarean section. Changes included addition of a retractable uterus and restricted pelvic inlet, and the fetal mannequin was modified to allow accurate limb articulation and flexion at the waist. Obstetricians and midwives from three maternity units in Southwest England were individually recorded, each undertaking three simulated scenarios of IFH at cesarean section. Obstetricians were asked to deliver the fetal head and midwives, to perform a vaginal push-up. Participants completed a questionnaire on realism (face validity) and usefulness for training (content validity) with five-point Likert scale responses. Construct validity was assessed by testing an a priori hypothesis that "experts" (consultant obstetricians with >7 years' experience) would be more likely to achieve delivery than "novices" (registrars with <7 years' experience). Performance variables were compared between groups using Chi-square and Mann-Whitney U-tests. In all, 105 simulated scenarios were undertaken by 35 obstetricians and midwives. A range of techniques were employed to deliver the IFH including change of hand, vaginal disimpaction and reverse breech extraction. Overall, 86% (30/35) described the model as fairly (4)/very realistic (5) (median=4, interquartile range [IQR]=4-5). The model was considered fairly (4)/very useful (5) for training by 97% (34/35; median=5; IQR=5-5). Experts delivered the fetal head in all simulations (36/36) and novices delivered the head in 76.9% (30/39) (p=0.002). Experts delivered the fetal head 58% quicker than novices (median=66.8s, IQR=53-86 vs median=104 s, IQR=67.7-137). This novel birth trainer realistically simulates IFH at cesarean section and allows rehearsal of all disimpaction techniques. It was reported to be very useful for training and distinguishes between novice and expert obstetricians. Techniques for IFH are difficult to learn experientially. Simulation is likely to provide an effective and safe form of training.

Transport of Peripartum Patients for Medical Management: Predictors of Any Intervention During Transport.

Background When obstetricpatients present to a hospital without obstetric consultants for medical care, they are often transferred for a higher level of care. Factors associated with patientcare during transport between hospitals are unknown. Our study investigated factors associated with care intensity. Methods We retrospectively reviewed charts from peripartum adult patientswho were transported to our academic quaternary center between January 1, 2012, and April 19, 2020. We excluded patients transported for gynecologic or fetus-related complications. We defined any transport interventions as any ventilator management, any titration of continuous infusions, and any continuation or initiation of medication during transport. Results We included 126 patients, and the mean age (SD) was 29 (7) years. There were 87 (695) antepartum patients, with nine (7%) requiring mechanical ventilation. Of the patients, 98 (78%) received at least one intervention during transport. Transport time (OR: 1.03, 95% CI: 1.001-1.06, P = 0.040), preeclampsia (OR: 3.8, 95% CI: 1.1-12.7, P = 0.030), and any obstetric hemorrhage (OR: 8.3, 95% CI: 1.03-68, P = 0.047), either antepartum or postpartum, were associated with higher likelihood of receiving any intervention. Conclusions Peripartum patients often received interventions during transport. Preeclampsia and hemorrhage were associated with the likelihood of interventions. Transport clinicians should be prepared when transporting these patients. Further studies are needed to confirm our observations.

The efficiency of using maternal markers in early detection and management of congenital anomalies in Majmaah city, KSA

Nowadays the serum analytic investigations have become the first step, noninvasive, detecting method of choice of foetal abnormalities specially for at-risk patients.This study volenteers were Saudi pregnant women in King Khalid General Hospital (KKGH) at Majmaah city, Riyadh, Saudi Arabia.The study intended to judge and evaluate using the concentrations of Beta Human Chorionic Gonadotropin (βHCG) in serum as efficient maternal markers for early detection as well as management of foetal abnormalities and pregnancy complications.A total of 201 serum samples were studied. 101 sera of pregnant women were taken in the first trimester, while the other 100 non-pregnant females were acted as control volenteers. The sensitive Enzyme immunoassay (ELISA) method was applied for quantitative scoring of beta HCG levels. Pregnant women were followed up by a consultant obstetrician till delivery. Trisomy 21 and blighted ovum disorders were selected as cases of interest.Serum βHCG concentrations multiple of median (MoM) for the mothers of affected babies compared with the healthy ones. Defrences were significant as p: value showed 0.001 for each appraisal.Non-pregnant serum beta HCG (2.1 IU/ml) compared with only three weeks of gestation (576 IU/ml) for early detection of pregnancy. Upon comparison a significant high level of β HCG was recorded for the three weeks gestation with (p,value:0.001) which clearly indicates the existence of pregnancy.The use of β HCG could be the method of choice for early detection of pregnancy. This will save the embryo life during the first trimester of gestation especially in the radiology departments.

Quality of surgical management of placenta accreta spectrum in a tertiary center in Sri Lanka: baseline study for quality improvement project: problems and solutions

IntroductionPlacenta accreta spectrum (PAS) is associated with a multitude of maternal and fetal complications. Events related to its management have resulted in significant psychological morbidity, with lifelong consequences which warrant continuous support to cope with their lives. The objective of the study is to highlight the importance of multidisciplinary holistic care and explore room for improvement in the provision of care for women with PAS.MethodsOur study was conducted on deliveries complicated with PAS from January 2019 to June 2021. 27 women were diagnosed with PAS during this period and received treatment. Impact of life event scale- revised (IES-R) and short form health survey-36(SF-36) questionnaires were administered to assess the impact of PAS on their lives. In depth interviews were conducted with the women. A multidisciplinary team meeting was later conducted to formulate a comprehensive care plan for women with PAS.ResultsThe response rate was 96.2%. Mean age of the sample is 34.1 years (SD 4.3). Interval to current pregnancy varies from 0.6 years to 10 years with mean of 4.6 years. Mean gestational age of diagnosis of PAS was 25.4(SD 6.7) weeks. The care bundle provided for women with PAS was evaluated in all cases.Surgery was conducted electively in 82% of patients. Blood transfusions were noted in 85%. Mean pre-operative stay was 9.5 days (SD 8.3) and mean post-operative stay was 8.8 days (SD 8). Total hospital stay ranged from 6 to 48 days (mean 19.5 days, SD 11.4).IES-R scores were significant in 4/26 patients. There was no correlation with the interval from the surgery with any of the subscales or with the total scores. The lapsed time after the surgery had a significant correlation with physical functioning and pain domains of the SF-36 questionnaire.Description of the experience, loss of femininity with loss of the uterus, concerns and fears about the future and measures to improve the quality of care were the themes identified and described.A multidisciplinary team meeting, consisting of consultant obstetricians performing surgery for PAS, anesthetists, hematologist, transfusion medicine specialist, urologist, physiotherapist, nutritionist and nursing officers from ICU and wards, was held and their contributions helped to map out a definitive care plan.ConclusionsPAS is associated with long term physical and psychological morbidity. Continuous support through quarterly clinic visits and telephone conversations may alleviate the psychological trauma. However, some physical disabilities may be lifelong and life changing. Importance of reducing primary caesarean section and promoting trial of labour after caesarean delivery should be promoted among patients and caregivers.

Improved implementation of aspirin in pregnancy among Dutch gynecologists: Surveys in 2016 and 2021.

To evaluate the implementation of low-dose aspirin in pregnancy for the prevention of utero-placental complications among gynecologists in the Netherlands between 2016 and 2021. In this timeframe, a national guideline about aspirin in pregnancy was introduced by the Dutch Society of Obstetrics and Gynecology. A national online survey among Dutch gynecologists and residents was performed. An online questionnaire was distributed among the members of the Dutch Society of Obstetrics and Gynecology in April 2016 and April 2021. Main outcome measure was the proportion of gynecologists indicating prescription of aspirin in pregnancy for high and moderate risk indications. In 2016, 133 respondents completed the survey, and in 2021 231. For all indications mentioned in the guideline there was an increase in prescribing aspirin in 2021 in comparison to 2016. More specifically, the percentage of gynecologists prescribing aspirin for a history of preeclampsia before 34 weeks, between 34 and 37 weeks and at term increased from respectively 94% to 100%, 39% to 98%, and 15% to 97%. Consultant obstetricians and respondents working in an university hospital did not more often indicate the prescription of aspirin for tertiary care indications in 2021. Future use of a prediction model was suggested in the narrative comments. Implementation of aspirin in pregnancy among Dutch gynecologists substantially improved after a five year timeframe in which the national guideline on aspirin during pregnancy was introduced and trials confirming the effect of aspirin were published.

Timing of delivery in antenatal fetal hydronephrosis: a snap shot social media survery of obstetric and fetal medicine practice.

To identify when obstetricians would deliver a fetus with antenatal hydronephrosis and normal liquor. Designed as snap-shot survey. Setting: Survey Monkey link. Population/sample were obstetrics and fetal medicine consultants who received the survey link via closed professional forums on the North West Coast Maternity Clinical Network, Facebook, and publicly on Twitter. Survey link publicised as above, obstetric consultants were asked at what gestation would they deliver a fetus with antenatal hydronephrosis and normal liquor; and what criteria would they use to make that decision. Main outcome measures were number of years in practice, gestation at delivery, anteroposterior diameter (APD) of renal pelvis. A total of 44/102 respondents (43%) would deliver prior to 40weeks (median no. of years as consultant 10 years [IQR 5-17]) vs. those who would not (median years as consultant 5.5 [IQR 3-12]). Re APD threshold of delivery: 17 indicated delivery if the APD were 20mm, 10 if it were 21-30mm and 16 if it were >30mm. Re gestation at which they would deliver: 13 indicated 37-38weeks, 13 indicated 38-39weeks and 17 indicated 39-40weeks. Reasons selected for delivery before term were obstetric anxiety n=2, maternal request n=2, maternal anxiety n=2 and concern about fatal renal damage/renal damage n=34. A surprising number of respondents would consider early delivery of a fetus with hydronephrosis and normal liquor despite the lack of evidence of benefit. The evidence supporting term delivery means that early term delivery is only indicated for obstetric reasons in this scenario.