Pub Date : 2021-01-01DOI: 10.1111/1471-0528.15-16715
T. Khan, E. Leung, C. Fotopoulou
Objective Covid-19 has resulted in significant number of elective surgeries being delayed or cancelled worldwide with an estimated 28 million patients being affected. Previous studies suggest that perioperative Covid-19 infection has significant implications on surgical morbidity with perioperative mortality rates as high as 23.8%. Complication profiles increase with any additional treatment burden such as cytotoxic chemotherapy, radiotherapy or immunotherapy. Design We investigated the impact of the Covid-19 pandemic on gynaecological-cancer surgery in an international prospective multi-centre study. Participating centres entered consecutive patient's data into a customized electronic database for 12 weeks from the first COVID positive patient managed in their hospital between March and June 2020. Patients were eligible for enrolment into the present study if they were planned to undergo surgery for gynaecological cancer during the study duration, regardless of their COVID-19 status and whether they underwent surgery as recommended or not. Those patients who did not undergo their planned surgery were followed up for 12-weeks to observe outcomes. Method 4722 patients with gynecological cancer were recruited across 56 countries from 4 continents. The distribution of sites of origin was: 42% (n = 2024) uterine, 39% (n = 1872) ovarian, 11% (n = 538) cervical and 5.93% (n = 275) vulva-vagina cancer. The majority of the patients entered 73% (n = 3465) were from high-income countries, 26% (n = 1255) from middle income countries and 0.04% (n = 2) from low income countries. 4490 patients underwent surgery with a significant proportion of the patients experiencing change or adaptation of their treatment due to the COVID-19 pandemic. Results The main impact was on surgical timing;1.1% (n = 50) of patients experienced > 12-week delay in surgery, 2% (n = 119) a change in choice of operation, 0.02% (n = 50) change in neo-adjuvant chemotherapy, 2.7% (n = 452) received surgery in alternative hospital. Patients in this study had confirmed resolved COVID-19 prior to surgery in 0.95% (n = 45) of patients with an additional 0.34% (n = 16) with probable resolved COVID-19 infection. Furthermore, a post-operative COVID-19 rate of 2.27% (n = 25) and pulmonary complication rate of 1.8% (n = 20) was found in the initial analysis of the Covidsurg cancer data, analysing outcomes for 1102 gynaecological cancer patients. The overall 30-day mortality rate in this cohort was 1.18% (n = 13) (5). Discussion The largest multi-centre analysis of gynaecological cancer surgery during the Covid-19 pandemic has demonstrated worldwide significant adjustments of timing, indications and radicality of surgery in an effort to reduce COVID-19 related complications and has exposed constraints of the system, even in high income countries.
{"title":"Impact of the COVID pandemic on gynaecological cancer surgery - COVIDSurg gynaecological-cancer results","authors":"T. Khan, E. Leung, C. Fotopoulou","doi":"10.1111/1471-0528.15-16715","DOIUrl":"https://doi.org/10.1111/1471-0528.15-16715","url":null,"abstract":"Objective Covid-19 has resulted in significant number of elective surgeries being delayed or cancelled worldwide with an estimated 28 million patients being affected. Previous studies suggest that perioperative Covid-19 infection has significant implications on surgical morbidity with perioperative mortality rates as high as 23.8%. Complication profiles increase with any additional treatment burden such as cytotoxic chemotherapy, radiotherapy or immunotherapy. Design We investigated the impact of the Covid-19 pandemic on gynaecological-cancer surgery in an international prospective multi-centre study. Participating centres entered consecutive patient's data into a customized electronic database for 12 weeks from the first COVID positive patient managed in their hospital between March and June 2020. Patients were eligible for enrolment into the present study if they were planned to undergo surgery for gynaecological cancer during the study duration, regardless of their COVID-19 status and whether they underwent surgery as recommended or not. Those patients who did not undergo their planned surgery were followed up for 12-weeks to observe outcomes. Method 4722 patients with gynecological cancer were recruited across 56 countries from 4 continents. The distribution of sites of origin was: 42% (n = 2024) uterine, 39% (n = 1872) ovarian, 11% (n = 538) cervical and 5.93% (n = 275) vulva-vagina cancer. The majority of the patients entered 73% (n = 3465) were from high-income countries, 26% (n = 1255) from middle income countries and 0.04% (n = 2) from low income countries. 4490 patients underwent surgery with a significant proportion of the patients experiencing change or adaptation of their treatment due to the COVID-19 pandemic. Results The main impact was on surgical timing;1.1% (n = 50) of patients experienced > 12-week delay in surgery, 2% (n = 119) a change in choice of operation, 0.02% (n = 50) change in neo-adjuvant chemotherapy, 2.7% (n = 452) received surgery in alternative hospital. Patients in this study had confirmed resolved COVID-19 prior to surgery in 0.95% (n = 45) of patients with an additional 0.34% (n = 16) with probable resolved COVID-19 infection. Furthermore, a post-operative COVID-19 rate of 2.27% (n = 25) and pulmonary complication rate of 1.8% (n = 20) was found in the initial analysis of the Covidsurg cancer data, analysing outcomes for 1102 gynaecological cancer patients. The overall 30-day mortality rate in this cohort was 1.18% (n = 13) (5). Discussion The largest multi-centre analysis of gynaecological cancer surgery during the Covid-19 pandemic has demonstrated worldwide significant adjustments of timing, indications and radicality of surgery in an effort to reduce COVID-19 related complications and has exposed constraints of the system, even in high income countries.","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"128 1","pages":"212-212"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62694257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.22541/au.160157465.51991460
J. Duckers, D. Schlueter, Rhiannon Phillips, R. Cosgriff, O. Esan, Shantini Parajothy, Denitza Williams, R. Norman, David Taylor Robinson, S. Carr
This is a rapidly expanding area of interest as the landscape of CF care is changing dramatically, particularly in the era of CFTR modulation. Clinical teams caring for people living with CF are increasingly being asked about pregnancy and potential risks to mothers and their babies. As the authors highlight data on pregnancy in CF historically has mainly been small case series from single sites carried out before CFTR modulators were widely available. The guidelines referenced are somewhat dated as the authors allude to.
{"title":"Re: The outcome of pregnancy in women with cystic fibrosis: a UK population based descriptive study. (First comment on BJOG-20-0094.R1)","authors":"J. Duckers, D. Schlueter, Rhiannon Phillips, R. Cosgriff, O. Esan, Shantini Parajothy, Denitza Williams, R. Norman, David Taylor Robinson, S. Carr","doi":"10.22541/au.160157465.51991460","DOIUrl":"https://doi.org/10.22541/au.160157465.51991460","url":null,"abstract":"This is a rapidly expanding area of interest as the landscape of CF care is changing dramatically, particularly in the era of CFTR modulation. Clinical teams caring for people living with CF are increasingly being asked about pregnancy and potential risks to mothers and their babies. As the authors highlight data on pregnancy in CF historically has mainly been small case series from single sites carried out before CFTR modulators were widely available. The guidelines referenced are somewhat dated as the authors allude to.","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48791277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Treat the patient, not the disease","authors":"Chloe E. Barr, E. Crosbie","doi":"10.2307/3906373","DOIUrl":"https://doi.org/10.2307/3906373","url":null,"abstract":"","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2307/3906373","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45451747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Summer Williams, G. Bruxner, E. Ballard, A. Kothari
Background: The decision of whether to prescribe antidepressants (AD) and anxiolytics (AX) to pregnant women is complex, with serious potential ramifications. Clinicians’ perception of the risk of teratogenicity significantly influences their prescribing decisions and in turn impacts maternal decision making. Our study sought to discern differences in perceived risk between Obstetricians and Gynaecologists (O&Gs) and General Practitioners (GPs) when prescribing these medications in pregnancy. Furthermore, we investigated factors impacting perception, clinicians’ willingness to prescribe and their approach to provision of patient information. Methods: This study was conducted via a nation-wide online SurveyMonkey extended to Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) database-derived affiliates: GP diplomates, fellows and trainees (5409 survey invitations: 545 respondents). Descriptive statistics were used to present responses for clinicians overall and separately for GPs and O&Gs. Results: GPs reported higher rates of being aware of up-to-date medication prescription recommendations (57.6%) compared with O&Gs (44.2%). GPs also reported higher rates of training adequacy in psychotropic prescription (56.1% versus 29.0%). There was evidence to suggest GPs level of confidence in knowledge base, initiation and prescription of antidepressants and anxiolytics was higher than those of O&Gs. The mean perception of patient non-compliance was similar between clinician groups (approximately 35%), but GPs perceived the extent of patient anxiety as higher (mean 73.7% (SD 21.3) compared to O&Gs (mean 63.1% (SD 24.1)). Both groups showed a strong preference for improved training rather than patient-focused technology (above 70% for both groups). Conclusion: Further development of clinician training in perinatal psychotropic prescription is warranted. Keywords : psychotropics, teratogenicity, pregnant, prescribing, foetal, perception
{"title":"Prescribing antidepressants and anxiolytic medications to pregnant women: The perception of risk of foetal teratogenicity amongst Australian specialists and trainees","authors":"Summer Williams, G. Bruxner, E. Ballard, A. Kothari","doi":"10.21203/rs.2.20146/v1","DOIUrl":"https://doi.org/10.21203/rs.2.20146/v1","url":null,"abstract":"\u0000 Background: The decision of whether to prescribe antidepressants (AD) and anxiolytics (AX) to pregnant women is complex, with serious potential ramifications. Clinicians’ perception of the risk of teratogenicity significantly influences their prescribing decisions and in turn impacts maternal decision making. Our study sought to discern differences in perceived risk between Obstetricians and Gynaecologists (O&Gs) and General Practitioners (GPs) when prescribing these medications in pregnancy. Furthermore, we investigated factors impacting perception, clinicians’ willingness to prescribe and their approach to provision of patient information. Methods: This study was conducted via a nation-wide online SurveyMonkey extended to Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) database-derived affiliates: GP diplomates, fellows and trainees (5409 survey invitations: 545 respondents). Descriptive statistics were used to present responses for clinicians overall and separately for GPs and O&Gs. Results: GPs reported higher rates of being aware of up-to-date medication prescription recommendations (57.6%) compared with O&Gs (44.2%). GPs also reported higher rates of training adequacy in psychotropic prescription (56.1% versus 29.0%). There was evidence to suggest GPs level of confidence in knowledge base, initiation and prescription of antidepressants and anxiolytics was higher than those of O&Gs. The mean perception of patient non-compliance was similar between clinician groups (approximately 35%), but GPs perceived the extent of patient anxiety as higher (mean 73.7% (SD 21.3) compared to O&Gs (mean 63.1% (SD 24.1)). Both groups showed a strong preference for improved training rather than patient-focused technology (above 70% for both groups). Conclusion: Further development of clinician training in perinatal psychotropic prescription is warranted. Keywords : psychotropics, teratogenicity, pregnant, prescribing, foetal, perception","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"125 1","pages":"137-137"},"PeriodicalIF":0.0,"publicationDate":"2020-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44383310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Eastwood, F. Khanum, A. Hunter, D. McCance, I. Young, C. Patterson, V. Holmes
{"title":"The impact of maternal characteristics on acquisition of placental volume images and vascularisation indices in high risk pregnancies in the first trimester.","authors":"K. Eastwood, F. Khanum, A. Hunter, D. McCance, I. Young, C. Patterson, V. Holmes","doi":"10.1111/1471-0528.14099","DOIUrl":"https://doi.org/10.1111/1471-0528.14099","url":null,"abstract":"","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"123 1","pages":"85-96"},"PeriodicalIF":0.0,"publicationDate":"2016-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/1471-0528.14099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62693526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Variation in calmodulin dependent kinase ii (CaMK2) delta and gamma subunit expression in human myometrium during pregnancy and labour","authors":"J. Lartey, J. Taggart, S. Robson, M. Taggart","doi":"10.1111/1471-0528.14106","DOIUrl":"https://doi.org/10.1111/1471-0528.14106","url":null,"abstract":"","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/1471-0528.14106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62693649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Paravaginal repair - has it a pace in modern gynaecology?","authors":"T. Rudra, S. Whelan, D. Ludwig","doi":"10.1111/1471-0528.14108","DOIUrl":"https://doi.org/10.1111/1471-0528.14108","url":null,"abstract":"","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"123 1","pages":"185-185"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/1471-0528.14108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62693842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Cunningham, D. Drage, Allgar, E. Kilpatrick, S. Maguiness, Jochen F Mueller, S. Atkin, T. Sathyapalan
{"title":"Endocrine disrupting agents are present in the serum of women with and without polycystic ovary syndrome undergoing IVF in the UK","authors":"T. Cunningham, D. Drage, Allgar, E. Kilpatrick, S. Maguiness, Jochen F Mueller, S. Atkin, T. Sathyapalan","doi":"10.1111/1471-0528.14095","DOIUrl":"https://doi.org/10.1111/1471-0528.14095","url":null,"abstract":"","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"123 1","pages":"71-72"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/1471-0528.14095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62693372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Lavu, H. Uppal, A. Katragadda, A. Alasseri, R. Potluri
Introduction - Lower success rates of in vitro fertilisation (IVF) in South East Asian countries compared to Western countries in informal studies and surveys was considered a reflection of variations in methodology and expertise. However, recent studies on the effects of ethnicity on success rates of infertility procedures in western countries have suggested other inherent contributing factors to the ethnic disparity but the evidence evaluating these is lacking. In our study we aim to investigate some of the comorbidities that might cause ethnic disparity to infertility and related procedures from hospital admissions data. Methods - Anonymous hospital admissions data on patients of various ethnic groups with infertility, comorbidities and infertility procedures from multiple hospitals in Birmingham andManchester, UK between 2000 and 2013 were obtained from the local health authority computerised hospital activity analysis register using ICD-10 and OPCS coding systems. Statistical analysis was performed using SPSS version 20.Results Of 522 223 female patients aged 18 and over, there were44 758 (8.4%) patients from South Asian (SA) community. 1156(13.4%) of the 8653 patients coded for infertility were SA, whichis a considerably higher proportion of the background SA population. For IVF procedures, the percentage of SA increased to15.4% (233 of the total 1479 patients). The mean age of SA codedfor infertility (30.6 ± 4.7 SD years versus 32.8 ± 4.9 SD years)and IVF (30.4 ± 4.3 SD years versus 32.7 ± 4.4 SD years) was significantly lower than caucasian patien ts (P < 0.001). A multivariate logistic regression model looking at patients with infertility, accounting for variations in age, showed that SA have significantly higher prevalence of hypothyroidism, obesity andiron-deficiency anaemia compared to caucasians but lower prevalence of endometriosis. Interestingly, psychiatric and psychological conditions diagnoses were seldom registered in infertility patients. Conclusion - Other studies suggest that various cultural, lifestyles, psychosocial and socio-economic factors may explain the disparities in IVF success rates between South Asians and caucasians. The fact that SA infertility and IVF patients, in ou rstudy, were significantly younger than caucasians and that their proportion is considerably higher than the background South Asian population suggests the influence of these factors. A significant psychiatric disease burden in other conditions and low numbers in our data suggest under diagnosis in this group.Despite the limitations of the coding data, from our study, we propose that hypothyroidism, obesity and/or iron-deficiency anaemia should be considered for the ethnic disparity. Further research in this topic is essential to fully investigate the reasons for such ethnic disparities.
{"title":"Potential causes of ethnic group disparities in infertility: a hospital database study","authors":"D. Lavu, H. Uppal, A. Katragadda, A. Alasseri, R. Potluri","doi":"10.1111/1471-0528.12784","DOIUrl":"https://doi.org/10.1111/1471-0528.12784","url":null,"abstract":"Introduction - Lower success rates of in vitro fertilisation (IVF) in South East Asian countries compared to Western countries in informal studies and surveys was considered a reflection of variations in methodology and expertise. However, recent studies on the effects of ethnicity on success rates of infertility procedures in western countries have suggested other inherent contributing factors to the ethnic disparity but the evidence evaluating these is lacking. In our study we aim to investigate some of the comorbidities that might cause ethnic disparity to infertility and related procedures from hospital admissions data. Methods - Anonymous hospital admissions data on patients of various ethnic groups with infertility, comorbidities and infertility procedures from multiple hospitals in Birmingham andManchester, UK between 2000 and 2013 were obtained from the local health authority computerised hospital activity analysis register using ICD-10 and OPCS coding systems. Statistical analysis was performed using SPSS version 20.Results Of 522 223 female patients aged 18 and over, there were44 758 (8.4%) patients from South Asian (SA) community. 1156(13.4%) of the 8653 patients coded for infertility were SA, whichis a considerably higher proportion of the background SA population. For IVF procedures, the percentage of SA increased to15.4% (233 of the total 1479 patients). The mean age of SA codedfor infertility (30.6 ± 4.7 SD years versus 32.8 ± 4.9 SD years)and IVF (30.4 ± 4.3 SD years versus 32.7 ± 4.4 SD years) was significantly lower than caucasian patien ts (P < 0.001). A multivariate logistic regression model looking at patients with infertility, accounting for variations in age, showed that SA have significantly higher prevalence of hypothyroidism, obesity andiron-deficiency anaemia compared to caucasians but lower prevalence of endometriosis. Interestingly, psychiatric and psychological conditions diagnoses were seldom registered in infertility patients. Conclusion - Other studies suggest that various cultural, lifestyles, psychosocial and socio-economic factors may explain the disparities in IVF success rates between South Asians and caucasians. The fact that SA infertility and IVF patients, in ou rstudy, were significantly younger than caucasians and that their proportion is considerably higher than the background South Asian population suggests the influence of these factors. A significant psychiatric disease burden in other conditions and low numbers in our data suggest under diagnosis in this group.Despite the limitations of the coding data, from our study, we propose that hypothyroidism, obesity and/or iron-deficiency anaemia should be considered for the ethnic disparity. Further research in this topic is essential to fully investigate the reasons for such ethnic disparities.","PeriodicalId":75620,"journal":{"name":"British journal of obstetrics and gynaecology","volume":"121 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/1471-0528.12784","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62691641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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