'The London Women's Clinic, 115 Harley Street, London Wl, 2Academic Department ... more 'The London Women's Clinic, 115 Harley Street, London Wl, 2Academic Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, University of London and 3Department of Reproductive Endocrinology, University College London Medical School, ...
Acta Obstetricia et Gynecologica Scandinavica, 1994
Pregnancy in a rudimentary uterine horn is rare and is usually associated with fetal death and se... more Pregnancy in a rudimentary uterine horn is rare and is usually associated with fetal death and serious maternal morbidity or mortality. A case is presented of such a pregnancy associated with a high maternal serum alpha feto-protein presenting as an acute emergency at 29 weeks' gestation resulting in fetal salvage.
American Journal of Obstetrics and Gynecology, Sep 1, 1996
Our purpose was to study the hemodynamic changes in the uterine and intraovarian vessels during t... more Our purpose was to study the hemodynamic changes in the uterine and intraovarian vessels during the normal menstrual cycle and to relate the vascular changes to hormonal index values. Seven women who had bilateral tubal patency, a normal pelvis on laparoscopy, and regular ovulatory cycles underwent serial transvaginal ultrasonography on menstrual cycle day 2, daily from estimated day of ovulation-6, hourly from estimated day of ovulation-2, or when the mean follicular diameter was > 16 mm (whichever was earlier) until 6 hours after follicular rupture and once 7 days after follicular rupture. At each scan uterine and intraovarian blood flow was assessed with transvaginal color Doppler ultrasonography and serum concentrations of follicle-stimulating hormone, luteinizing hormone, estradiol, and progesterone assessed by fluoroimmunoassay. In one case there was evidence of a luteinized unruptured follicle and the patient was therefore excluded from analysis. In the other six women there was spontaneous ovulation at a mean of 39 hours after the onset of the luteinizing hormone surge. On the side with the dominant follicle, follicular and ovarian stromal peak systolic blood flow velocity rose significantly during the menstrual cycle with no significant change in pulsatility index. The changes in blood flow velocity correlated significantly with changes in serum follicle-stimulating hormone, luteinizing hormone and progesterone concentrations. There were no significant changes in either blood flow velocity or pulsatility index in the contralateral ovary. Uterine artery time-averaged maximum velocity on the side of the developing ovarian follicle increased during the menstrual cycle with no significant change in the contralateral vessel. Uterine artery pulsatility index on the side of the developing follicle declined during the midluteal phase and was significantly lower than on the contralateral side. The changes in time-averaged maximum velocity correlated with the changes in serum estradiol and progesterone concentrations. The vascular changes in the wall of the dominant ovarian follicle and ovarian stroma during the menstrual cycle are consistent with activity of angiogenic-like factors. The decline in uterine artery resistance during the midluteal phase may reflect optimal vascularity for implantation of the blastocyst.
In this study we assessed the variability of measuring uterine artery pulsatility index by colour... more In this study we assessed the variability of measuring uterine artery pulsatility index by colour Doppler ultrasound using different ultrasound transducers (abdominal 3 MHz, abdominal 5 MHz, endovaginal 5 MHz with and without a full bladder). We then assessed the intra-observer coefficient of variation for the different transducers and interobserver variability for two observers using the endovaginal probe. The intercycle variability and effects of a full bladder on uterine artery blood flow were also assessed. The uterine vessels were most easily identified using the endovaginal transducer. The most reproducible results were obtained using the endovaginal probe. The coefficients of variation obtained for the vaginal route were intra-observer 4.1%, interobserver 11.8% and intercycle 16.5%. The blood flow indices were significantly different between the endovaginal and both transabdominal 5 and 3 MHz probes (P = 0.0027 and 0.0005 respectively). There was no significant effect of a full bladder on pulsatility index. This study suggests that transvaginal colour Doppler ultrasound is reproducible and the results obtained from clinical use would be reliable.
Journal of Obstetrics and Gynaecology, Apr 15, 2020
Intravenous leiomyomatosis (IVL) is a rare uterine smooth muscle tumour. It is difficult to diagn... more Intravenous leiomyomatosis (IVL) is a rare uterine smooth muscle tumour. It is difficult to diagnose clinically with most cases confirmed by the pathology report. IVL is significant due to its pote...
Hellenic Journal of Obstetrics and Gynecology, 2021
Objective: To evaluate the effectivity of laparoscopic ovarian drilling procedures at the East Su... more Objective: To evaluate the effectivity of laparoscopic ovarian drilling procedures at the East Sussex Healthcare Trust, UK, over the past decade on sub-fertile women with polycystic ovary syndrome, regardless of clomiphene resistance. Design: Retrospective case note review of LOD procedures Methods: Study 1: Evaluating a systematic literature review investigating ovulation and pregnancy rates following LOD. Study 2: An audit of 58 women with LOD treated for ovulation induction at the ESHT fertility clinic between 2005-2014. Main outcome measures: Ovulation, pregnancy, live birth, miscarriage rates; tubal patency; associated pathologies; previous treatments compared with Cochrane Review 2012. Results: Study 1: From the literature review, 71% achieved ovulation, whereas the pregnancy, live birth and miscarriage rates were 25-51%, 24-44% and 4-9% respectively. Study 2: Of the 58 patients studied, ovulation rate was 69%, pregnancy rate was 39.4% and live birth rate was 30.3%. The miscar...
JBUMDC 2015; 5(2): 65-68 Page-65 ABSTRACT: Objective: To assess the outcome of pregnancies concei... more JBUMDC 2015; 5(2): 65-68 Page-65 ABSTRACT: Objective: To assess the outcome of pregnancies conceived by in vitro fertilization. Materials and Methods: A retrospective study utilizing case notes of 110 cases of in vitro fertilization (IVF) delivered in East Sussex Hospital Trust (ESHT)was carried out from 2010 to 2011 in two district general hospitals, Eastbourne and Conquest hospital that come under ESHT. All cases with IVF during these two years were included. Demographic details, predisposing risk factors, body mass index, causes of infertility, antenatal care, onset of labour, mode of delivery and details of baby were collected and analysed. Results: Infertility was female related in 46% and male related in 38%. In females tubal factor was the main cause. 18% had pre-existing medical conditions, polycystic ovaries being the commonest. 75% had singleton pregnancy and 25% twin’s .Nearly 6% had antepartum haemorrhage, twins having higher (11%) rates compared to singleton pregnancy (...
general hospital with severe crampy lower abdominal pains. No abnormality was detected, her pregn... more general hospital with severe crampy lower abdominal pains. No abnormality was detected, her pregnancy test was negative and the pain was relieved by intramuscular opioid. She re-presented the following day with the same pain which was relieved when heavy vaginal bleeding ensued. Pelvic ultrasound had not been performed but on gynaecological review, the clinical impression was of cervical stenosis presenting with uterine pain and eventually relieved by the spontaneous release of the haematometra. Examination under anaesthesia (EUA), hysteroscopy and dilatation of the cervix was carried out to prevent a recurrence of such symptoms with the next period and prevent further cervical dystocia in pregnancy. However, EUA revealed a shortened cervix consistent with previous surgery and the cervix dilated up to 10 Hegar with ease. Hysteroscopy showed a normal uterine cavity.
1998. Activated protein C sensitivity, protein C, protein S and coagulation in normal pregnancy. ... more 1998. Activated protein C sensitivity, protein C, protein S and coagulation in normal pregnancy. Thrombosis and Haemostasis 79:1166 – 1170. Conard J, Horellou MH, Van Dreden P, Lecompte T, Samama M. 1990. Thrombosis and pregnancy in congenital deficiencies of antithrombin III, Protein S or Protein S: study of 78 women. Thrombosis and Haemostasis 63:319 – 320. Department of Health and Social Services. 1996. Report on Confidential Enquiry into Maternal Deaths in the United Kingdom. London: HMSO. Department of Health and Social Services. 1999. Report on Confidential Enquiry into Maternal Deaths in the United Kingdom. London: HMSO. Einhaupl KM, Villringer A, Meister W, Mehraein S, Garner C, Pellkofer M et al. 1991. Heparin treatment in sinus venous thrombosis. Lancet 338:597 – 600. Gerszten PC, Welch WC, Spearman MP, Jungreis CA, Redner RL. 1997. Isolated deep cerebral venous thrombosis treated by direct endovascular thrombolysis. Surgical Neurology 48:261 – 266. Greer I, Hunt BJ. 2005. Low molecular weight heparin in pregnancy: current issues. British Journal of Haematology 128:593 – 601. Kassam SH, Hadi HA, Fadel HE, Sims W, Jay WM. 1983. Benign intracranial hypertension in pregnancy: current diagnostic and therapeutic approach. Obstetrics and Gynecology Survey 38:314 – 321. Lechner K, Kyrle PA. 1995. Antithrombin III concentrates – are they clinically useful? Thrombosis Haemostasis 73:340 – 348. Paternoster DM, Stella A, Simioni P, Girolami A, Plebani M. 1996. Fibronectin and antithrombin as markers of pre-eclampsia in pregnancy. European Journal of Obstetrics, Gynecology and Reproductive Biology 70:33 – 39. Preston FE, Rosendaal FR, Walker ID, Briet E, Berntorp E, Conard J et al. 1996. Increased fetal loss in women with heritable thrombophilia. Lancet 348:913 – 916. RCOG. 2001. Why Mothers Die 1997 – 1999. The Confidential Enquiry into Maternal Deaths in the United Kingdom. London: HMSO. Turkewitz LJ, Jacobs AK, Bidwell JK. 1991. Atypical MRI findings of venous sinus thrombosis in pregnancy: clinical significance relating to episodic vascular headache. Headache 31:240 – 243.
'The London Women's Clinic, 115 Harley Street, London Wl, 2Academic Department ... more 'The London Women's Clinic, 115 Harley Street, London Wl, 2Academic Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, University of London and 3Department of Reproductive Endocrinology, University College London Medical School, ...
Acta Obstetricia et Gynecologica Scandinavica, 1994
Pregnancy in a rudimentary uterine horn is rare and is usually associated with fetal death and se... more Pregnancy in a rudimentary uterine horn is rare and is usually associated with fetal death and serious maternal morbidity or mortality. A case is presented of such a pregnancy associated with a high maternal serum alpha feto-protein presenting as an acute emergency at 29 weeks' gestation resulting in fetal salvage.
American Journal of Obstetrics and Gynecology, Sep 1, 1996
Our purpose was to study the hemodynamic changes in the uterine and intraovarian vessels during t... more Our purpose was to study the hemodynamic changes in the uterine and intraovarian vessels during the normal menstrual cycle and to relate the vascular changes to hormonal index values. Seven women who had bilateral tubal patency, a normal pelvis on laparoscopy, and regular ovulatory cycles underwent serial transvaginal ultrasonography on menstrual cycle day 2, daily from estimated day of ovulation-6, hourly from estimated day of ovulation-2, or when the mean follicular diameter was > 16 mm (whichever was earlier) until 6 hours after follicular rupture and once 7 days after follicular rupture. At each scan uterine and intraovarian blood flow was assessed with transvaginal color Doppler ultrasonography and serum concentrations of follicle-stimulating hormone, luteinizing hormone, estradiol, and progesterone assessed by fluoroimmunoassay. In one case there was evidence of a luteinized unruptured follicle and the patient was therefore excluded from analysis. In the other six women there was spontaneous ovulation at a mean of 39 hours after the onset of the luteinizing hormone surge. On the side with the dominant follicle, follicular and ovarian stromal peak systolic blood flow velocity rose significantly during the menstrual cycle with no significant change in pulsatility index. The changes in blood flow velocity correlated significantly with changes in serum follicle-stimulating hormone, luteinizing hormone and progesterone concentrations. There were no significant changes in either blood flow velocity or pulsatility index in the contralateral ovary. Uterine artery time-averaged maximum velocity on the side of the developing ovarian follicle increased during the menstrual cycle with no significant change in the contralateral vessel. Uterine artery pulsatility index on the side of the developing follicle declined during the midluteal phase and was significantly lower than on the contralateral side. The changes in time-averaged maximum velocity correlated with the changes in serum estradiol and progesterone concentrations. The vascular changes in the wall of the dominant ovarian follicle and ovarian stroma during the menstrual cycle are consistent with activity of angiogenic-like factors. The decline in uterine artery resistance during the midluteal phase may reflect optimal vascularity for implantation of the blastocyst.
In this study we assessed the variability of measuring uterine artery pulsatility index by colour... more In this study we assessed the variability of measuring uterine artery pulsatility index by colour Doppler ultrasound using different ultrasound transducers (abdominal 3 MHz, abdominal 5 MHz, endovaginal 5 MHz with and without a full bladder). We then assessed the intra-observer coefficient of variation for the different transducers and interobserver variability for two observers using the endovaginal probe. The intercycle variability and effects of a full bladder on uterine artery blood flow were also assessed. The uterine vessels were most easily identified using the endovaginal transducer. The most reproducible results were obtained using the endovaginal probe. The coefficients of variation obtained for the vaginal route were intra-observer 4.1%, interobserver 11.8% and intercycle 16.5%. The blood flow indices were significantly different between the endovaginal and both transabdominal 5 and 3 MHz probes (P = 0.0027 and 0.0005 respectively). There was no significant effect of a full bladder on pulsatility index. This study suggests that transvaginal colour Doppler ultrasound is reproducible and the results obtained from clinical use would be reliable.
Journal of Obstetrics and Gynaecology, Apr 15, 2020
Intravenous leiomyomatosis (IVL) is a rare uterine smooth muscle tumour. It is difficult to diagn... more Intravenous leiomyomatosis (IVL) is a rare uterine smooth muscle tumour. It is difficult to diagnose clinically with most cases confirmed by the pathology report. IVL is significant due to its pote...
Hellenic Journal of Obstetrics and Gynecology, 2021
Objective: To evaluate the effectivity of laparoscopic ovarian drilling procedures at the East Su... more Objective: To evaluate the effectivity of laparoscopic ovarian drilling procedures at the East Sussex Healthcare Trust, UK, over the past decade on sub-fertile women with polycystic ovary syndrome, regardless of clomiphene resistance. Design: Retrospective case note review of LOD procedures Methods: Study 1: Evaluating a systematic literature review investigating ovulation and pregnancy rates following LOD. Study 2: An audit of 58 women with LOD treated for ovulation induction at the ESHT fertility clinic between 2005-2014. Main outcome measures: Ovulation, pregnancy, live birth, miscarriage rates; tubal patency; associated pathologies; previous treatments compared with Cochrane Review 2012. Results: Study 1: From the literature review, 71% achieved ovulation, whereas the pregnancy, live birth and miscarriage rates were 25-51%, 24-44% and 4-9% respectively. Study 2: Of the 58 patients studied, ovulation rate was 69%, pregnancy rate was 39.4% and live birth rate was 30.3%. The miscar...
JBUMDC 2015; 5(2): 65-68 Page-65 ABSTRACT: Objective: To assess the outcome of pregnancies concei... more JBUMDC 2015; 5(2): 65-68 Page-65 ABSTRACT: Objective: To assess the outcome of pregnancies conceived by in vitro fertilization. Materials and Methods: A retrospective study utilizing case notes of 110 cases of in vitro fertilization (IVF) delivered in East Sussex Hospital Trust (ESHT)was carried out from 2010 to 2011 in two district general hospitals, Eastbourne and Conquest hospital that come under ESHT. All cases with IVF during these two years were included. Demographic details, predisposing risk factors, body mass index, causes of infertility, antenatal care, onset of labour, mode of delivery and details of baby were collected and analysed. Results: Infertility was female related in 46% and male related in 38%. In females tubal factor was the main cause. 18% had pre-existing medical conditions, polycystic ovaries being the commonest. 75% had singleton pregnancy and 25% twin’s .Nearly 6% had antepartum haemorrhage, twins having higher (11%) rates compared to singleton pregnancy (...
general hospital with severe crampy lower abdominal pains. No abnormality was detected, her pregn... more general hospital with severe crampy lower abdominal pains. No abnormality was detected, her pregnancy test was negative and the pain was relieved by intramuscular opioid. She re-presented the following day with the same pain which was relieved when heavy vaginal bleeding ensued. Pelvic ultrasound had not been performed but on gynaecological review, the clinical impression was of cervical stenosis presenting with uterine pain and eventually relieved by the spontaneous release of the haematometra. Examination under anaesthesia (EUA), hysteroscopy and dilatation of the cervix was carried out to prevent a recurrence of such symptoms with the next period and prevent further cervical dystocia in pregnancy. However, EUA revealed a shortened cervix consistent with previous surgery and the cervix dilated up to 10 Hegar with ease. Hysteroscopy showed a normal uterine cavity.
1998. Activated protein C sensitivity, protein C, protein S and coagulation in normal pregnancy. ... more 1998. Activated protein C sensitivity, protein C, protein S and coagulation in normal pregnancy. Thrombosis and Haemostasis 79:1166 – 1170. Conard J, Horellou MH, Van Dreden P, Lecompte T, Samama M. 1990. Thrombosis and pregnancy in congenital deficiencies of antithrombin III, Protein S or Protein S: study of 78 women. Thrombosis and Haemostasis 63:319 – 320. Department of Health and Social Services. 1996. Report on Confidential Enquiry into Maternal Deaths in the United Kingdom. London: HMSO. Department of Health and Social Services. 1999. Report on Confidential Enquiry into Maternal Deaths in the United Kingdom. London: HMSO. Einhaupl KM, Villringer A, Meister W, Mehraein S, Garner C, Pellkofer M et al. 1991. Heparin treatment in sinus venous thrombosis. Lancet 338:597 – 600. Gerszten PC, Welch WC, Spearman MP, Jungreis CA, Redner RL. 1997. Isolated deep cerebral venous thrombosis treated by direct endovascular thrombolysis. Surgical Neurology 48:261 – 266. Greer I, Hunt BJ. 2005. Low molecular weight heparin in pregnancy: current issues. British Journal of Haematology 128:593 – 601. Kassam SH, Hadi HA, Fadel HE, Sims W, Jay WM. 1983. Benign intracranial hypertension in pregnancy: current diagnostic and therapeutic approach. Obstetrics and Gynecology Survey 38:314 – 321. Lechner K, Kyrle PA. 1995. Antithrombin III concentrates – are they clinically useful? Thrombosis Haemostasis 73:340 – 348. Paternoster DM, Stella A, Simioni P, Girolami A, Plebani M. 1996. Fibronectin and antithrombin as markers of pre-eclampsia in pregnancy. European Journal of Obstetrics, Gynecology and Reproductive Biology 70:33 – 39. Preston FE, Rosendaal FR, Walker ID, Briet E, Berntorp E, Conard J et al. 1996. Increased fetal loss in women with heritable thrombophilia. Lancet 348:913 – 916. RCOG. 2001. Why Mothers Die 1997 – 1999. The Confidential Enquiry into Maternal Deaths in the United Kingdom. London: HMSO. Turkewitz LJ, Jacobs AK, Bidwell JK. 1991. Atypical MRI findings of venous sinus thrombosis in pregnancy: clinical significance relating to episodic vascular headache. Headache 31:240 – 243.
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