A5044514469- Ectopic Pregnancy Diagnosis and Management
- Maternal and fetal healthcare
- Gestational Trophoblastic Disease Studies
- Pregnancy-related medical research
- Pregnancy and preeclampsia studies
- Assisted Reproductive Technology and Twin Pregnancy
- Homicide, Infanticide, and Child Abuse
- Uterine Myomas and Treatments
- Muscle and Compartmental Disorders
- Pelvic and Acetabular Injuries
- Prenatal Screening and Diagnostics
- Gestational Diabetes Research and Management
- Anorectal Disease Treatments and Outcomes
- Pelvic floor disorders treatments
- Bariatric Surgery and Outcomes
- Child and Adolescent Health
- Organ and Tissue Transplantation Research
- Birth, Development, and Health
- Endometriosis Research and Treatment
- Cancer Risks and Factors
- Chronic Kidney Disease and Diabetes
- Ultrasound in Clinical Applications
- Gynecological conditions and treatments
- Statistical Methods in Epidemiology
Wexham Park Hospital
2016-2024
Frimley Park Hospital
2020
Leiden University Medical Center
2018
Charles University
2018
Chelsea and Westminster Hospital
2015
Karolinska Institutet
2014
London North West Healthcare NHS Trust
2014
Northwick Park Hospital
2014
Chelsea and Westminster Hospital NHS Foundation Trust
2012-2013
West Middlesex University Hospital
2010
Objectives To validate recent guidance changes by establishing the performance of cut-off values for embryo crown-rump length and mean gestational sac diameter to diagnose miscarriage with high levels certainty. Secondary aims were examine influence age on interpretation values, determine optimal intervals between scans findings repeat that definitively pregnancy failure. ) Design Prospective multicentre observational trial. Setting Seven hospital based early assessment units in United...
The M6 risk-prediction model was published as part of a two-step protocol using an initial progesterone level ≤ 2 nmol/L to identify probable failing pregnancies (Step 1) followed by the 2). has been shown have good triage performance for stratifying women with pregnancy unknown location (PUL) being at low or high risk harboring ectopic (EP). This study validated in clinical practice evaluating number protocol-related adverse events and how effectively patients were triaged.This prospective...
To validate externally five approaches to predict ectopic pregnancy (EP) in pregnancies of unknown location (PUL): the M6P and M6NP risk models, two-step triage strategy (2ST, which incorporates M6P), M4 model, beta human chorionic gonadotropin ratio cut-offs (BhCG-RC).Secondary analysis a prospective cohort study.Eight UK early assessment units.Women presenting with PUL BhCG >25 IU/l.Women were managed using 2ST protocol: classified as low EP if progesterone ≤2 nmol/l; remaining cases...
Does a logistic regression model and scoring system to predict viability of an intrauterine pregnancy uncertain (PUV) perform as well in independent patient group the original group?The showed good performance on external validation confirming their value for prediction miscarriage/viability PUV patients up 11-14 weeks gestation.Several individual ultrasound demographic factors have been described predictors miscarriage. A simple using basic clinical features, such maternal age, bleeding...
Abstract Objective: To identify the risks of sustaining obstetric anal sphincter injury (OASI) during childbirth. Methods: Data were analysed from 12,612 vaginal deliveries recorded at Northwick Park District General Hospital, London, 1 January 2006 to 30 November 2009. Results: A total 85.6% spontaneous and 14.2% instrument deliveries. The majority (64.5%) sustained some form perineal damage, 3.7% being OASI. Logistic regression analyses revealed risk factors for OASI be Asian ethnicity...
Abstract Introduction There is no global agreement on how to best determine pregnancy of unknown location viability and using biomarkers. Measurements progesterone β human chorionic gonadotropin (βhCG) are still used in clinical practice exclude the possibility a viable intrauterine (VIUP). We evaluate predictive value progesterone, βhCG, βhCG ratio cut‐off levels VIUP women with location. Material methods This was secondary analysis prospective multicenter study data consecutive between...
ABSTRACT Objectives Ectopic pregnancy (EP) is a major high‐risk outcome following of unknown location (PUL) classification. Biochemical markers are used to triage PUL as high vs low risk guide appropriate follow‐up. The M6 model currently the best risk‐prediction model. We aimed update and evaluate whether performance can be improved by including clinical factors. Methods This prospective cohort study recruited consecutive between January 2015 2017 at eight units (Phase 1), with two centers...
In many parts of the developing world, urine protein heat coagulation test is routinely used to screen for proteinuria in pregnancy. The aim this study was determine whether > or =1+ on a standardised reliably detects significant and compare it with dipstick urinary protein. Heat test, 24-hour excretion results 102 women were compared. as sensitive specific =2+ detecting =500 mg/day. however, less than lesser degrees proteinuria.
Aim of this study was to evaluate the performance saline hydrosonography (HSGM) (also known as infusion sonography (SIS)) against transvaginal ultrasound scan (TVS) and hysteroscopy in diagnosis uterine cavity lesions. Diagnostic with biopsy is considered “gold standard” diagnose intrauterine abnormalities. The introduction HSGM has improved diagnostic capability ultrasound. It important establish efficacy safety before it widely recommended for use. This retrospective observational data...
The management of PUL often lacks uniformity and a clear evidence-base. We previously published on two-step triage protocol based the presenting serum progesterone (step 1) hCG ratio two days later 2) to select at high-risk ectopic pregnancy (EP). This study assessed this protocol's performance complications when used in clinical practice. A multicentre prospective cohort was performed 1734 consecutive across seven UK hospitals. Patients had level 0 hours repeat 48 hours. If ≤2, patients...
Deep venous thrombosis (DVT) and pulmonary embolism (PE) are rare life-threatening complications caused by compression of inferior vena cava (IVC) pelvic veins large leiomyoma the uterus. We report a 54-year-old woman presented to Accident Emergency (A & E) department with complaints left leg swelling, pain shortness breath. She had history heavy menstrual bleeding treated oral progesterone. Her examination revealed tachypnea 24-week size abdominopelvic mass. Imaging investigations...
Women with pregnancies of uncertain viability (PUV) have been shown to benefit psychologically from information about the likelihood miscarriage1. a PUL are also likely value such information. A better understanding relationship between baseline progesterone and positive outcomes will enable counselling in this period uncertainty. This was prospective, observational study. All seven UK hospitals were managed according risk prediction models. Baseline compared final outcome at 11–14 weeks...
Heavy bleeding may indicate that miscarriage is likely to occur and scores have shown value in prediction models for pregnancies of uncertain viability (PUV). Their predicting outcome PUL, however, has not been robustly analysed. We assessed whether could be used counsel women the likelihood viability/ ectopic pregnancy (EP) prior serum hormone results. This was a prospective, observational study. All PUL across seven hospitals were managed according risk models. A modified pictorial score...
<h3>Objective</h3> To analyze the risk factors associated with and outcome of macrosomic babies (birth weight more than 4500 g). <h3>Methods</h3> Retrospective review records 44 delivered between January September 2009 at West Middlesex University Hospital, Isleworth. <h3>Results</h3> 1.47% were macrosomic. Mean birth was 4676 g (range from to 5220 Increased body mass index (BMI) not macrosomia (84% born mothers BMI less 30). None had either gestational or established diabetes. preterm. 91%...
Conventional evacuation of retained products conception (RPOC) is a blind technique which may not remove focal RPOC and associated with perforation adhesion risks. Ultrasound (USS) guided (ERPC) commonly used alternative but we hypothesised that for tissue following miscarriage, termination pregnancy (TOP) or delivery hysteroscopic removal under direct visualisation was an effective safe allows intraoperative confirmation empty uterus. For 15 months women small well-defined intrauterine...
The management of PUL often lacks uniformity and a clear evidence-base. We previously published two-step triage protocol based on the presenting serum progesterone (step 1) M6 model, logistic regression model initial hCG ratio two days later 2) to select at high-risk ectopic pregnancy (EP). This study assessed this protocols' performance complications when used in clinical practice. A multicentre prospective cohort was performed 3272 consecutive across eight UK hospitals. Patients had level...
Measurements of serum hormones are used to indicate the likely location and viability a pregnancy when it cannot be visualised with ultrasound in some cases decide on Methotrexate treatment. We aimed define performance single measurements hCG, progesterone hCG ratio (hCG 48hrs/hCG 0hrs) for diagnosing location. This was prospective multi-centre cohort study 3272 women PUL. Eight patients met exclusion criteria, 367 had initial ≤25 IU/L 297 were lost follow-up, leaving 2600 analysis. Serum...
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To externally validate the performance of M6 risk model, and two step triage system (2ST) to identify pregnancies unknown location (PUL) at high ectopic pregnancy. Step 1 triages patients as low if presenting progesterone (if available) is ≤2 nmol/L, else a 2 classification or by calculated. requires 48-hour hCG level, but can be calculated with (M6p) without (M6np) progesterone. When predicts > 5% pregnancy, PUL classified risk. We used data from an interventional study in 3272 consecutive...
Risk prediction models utilising hCG and progesterone are effective tools to manage PUL pending a final diagnosis by TVUS. The M6 model uses progesterone, the ratio (hCG 48 hours/hCG 0 hours). Although often measured in clinical practice, there limited data regarding use of measurements beyond hours. We assessed effectiveness risk stratification at 96 hours using time taken confirm ectopic pregnancy This was secondary analysis 3977 prospective cases 8 UK hospitals between January 2015 August...
Risk prediction models are effective tools to triage pregnancy of unknown location (PUL). The M6 model uses progesterone, hCG and the ratio (hCG 48hours/hCG 0hours) as part a two-step protocol. Step one questions whether progesterone is ≤ 2nmol/L. If so, advises urine test in 2 weeks likely failing. We analysed various cut-off levels order compare them step threshold. This was secondary analysis 4408 prospective PUL cases at 8 UK hospitals between January 2015 March 2020. outcomes were...