Woman First

06/02/2022

Excellent team at Princess Grace Hospital. The best of robotic surgery!

26/02/2021

Long‐term durability of uterine artery embolisation for treatment of symptomatic adenomyosis

Adenomyosis is a benign condition characterised by ectopic endometrial invasion of the underlying myometrium, resulting in hyperplasia and hypertrophy of this muscular layer of the uterus. Clinically, adenomyosis may manifest as debilitating heavy menstrual bleeding (HMB), dysmenorrhoea, symptoms related to uterine enlargement, chronic pelvic pain and dyspareunia.

Uterine artery embolisation is a valid option to treat adenomyosis. This study has demonstrated a good long term outcome. Long-term durability of UAE for treatment of adenomyosis was demonstrated, with cumulative success rate of 80% at mean 52 months.
The alternative surgical option is the hysterectomy which nowadays has been less invasive surgery performed, in selective cases, as day case procedure.

Link to the article
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/ajo.13304

23/02/2021

Endometriosis usually occurs in menstruating women up to 15%. Most common gastrointestinal involvement of endometriosis is found in the sigmoid colon, re**um and terminal ileum in 3%–37% of women. Proliferation and infiltration of the intestinal wall with endometrial implants may cause fibrotic reaction with formation of strictures and adhesions, probably from the effect of cyclical hormonal influences of menstruation. Endometriosis of the distal ileum is very rare; it can asymptomatic or presents itself as infrequent cause of intestinal obstruction. How should we treat those cases?
https://youtu.be/47PZFHzLjwA

17/02/2021

This is an education video to demonstrate a safe laparoscopic procedure for diaphragmatic infiltrative endometriosis and severe pelvic endometriosis. The operation consisted of the excision of severe endometriosis in the pelvis with opening of para-re**al spaces and bowel shave. There were 3 surgeons participating to the procedure to ensure safety and the complete excision of the disease. As diaphragmatic endometriosis is almost always associated with severe pelvic involvement, it is important to treat those cases with a multidisciplinary and minimally invasive approach in a tertiary referral centre. https://youtu.be/tMxMY_UkSVA

12/02/2021

Intestinal involvement in deep endometriosis is estimated to occur in 8% to 12% of patients, with 90% of occurrences being located in the colore**al segment. Deep endometriosis of the recto-sigmoid is defined as endometriosis involving the muscular layer of the bowel wall, usually more than 5 mm deep, thus excluding superficial lesions that only affect the serosal layer. In case of bowel deep infiltrating endometriosis, there are recognised surgical techniques - re**al shaving, disc excision, and segmental resection. However, it is less clear what to do if the lesion is maximum few millimetres and in multiple locations. The video demonstrates the surgical technique for those cases done under the gynaecologist at the time of diagnosis/treatment of endometriosis. https://youtu.be/eRKV5m6usEo

09/02/2021

Very interesting article published on American Journal Obstetrics & Gynaecology January 2021 on ” Early vaginal progesterone versus placebo in twin pregnancies for the prevention of spontaneous preterm birth: a randomised, double-blind trial”

In women with a singleton pregnancy and sonographic short cervix in mid-gestation, vaginal administration of progesterone reduces the risk of early preterm birth and improves neonatal outcomes. The current study was analysing the effect of progesterone on twin pregnancy, where the rate of spontaneous early preterm birth is 10 times higher than in singletons.
The result was that in women with twin pregnancies, universal treatment with vaginal progesterone did not reduce the incidence of spontaneous birth between 24 +0 and 33 +6 weeks’ gestation. However, in women with a cervical length of

19/10/2020

ISUOG 2020: ultrasound only under gynaecologists.
During the ISUOG conference October 2020, there was a clear statement that ultrasound scans should be done by the clinician looking after the patient. This is a necessary shift in culture.
Ultrasound's dynamic nature makes it much more appropriate to be done by gynaecologists and increase the accuracy in diagnosis.

18/10/2020

ISUOG 2020: ultrasound only under gynaecologists.
During the ISUOG conference October 2020, there was a clear statement that ultrasound scans should be done by the clinician looking after the patient. This is a necessary shift in culture.
Ultrasound's dynamic nature makes it much more appropriate to be done by gynaecologists and increase the accuracy in diagnosis.

22/09/2020

Here a pilot study to evaluate superficial endometriosis using SonoPODography: A new diagnostic technique for visualizing superficial endometriosis
SonoPODography was performed by installing saline into the pouch of Douglas (POD) via an intrauterine balloon catheter to create an acoustic window between the ultrasound probe and surrounding structures. The pelvis was then assessed for the presence or absence of superficial endometriosis using pre-defined features. Direct visualization at laparoscopy and histological assessment of excised endometriosis confirmed the outcome.

42 consecutive participants underwent sonoPODography. Superficial endometriosis was identified by sonoPODography in 24/42 (57.1 %) and in 37/42 (88.1 %) participants by direct visualization at laparoscopy. The overall diagnostic performance of sonoPODography was: accuracy 69.1 %, sensitivity 64.9 %, specificity 100.0 %.
SonoPODography is a novel ultrasound-based procedure that permits the direct visualization of superficial with respectable diagnostic accuracy. The findings of this pilot study are promising and justify the initiation of a larger outpatient study. SonoPODography may establish new avenues for the non-invasive diagnosis and investigation of endometriosis.

20/09/2020

Here a pilot study to evaluate superficial endometriosis using SonoPODography: A new diagnostic technique for visualizing superficial endometriosis

SonoPODography was performed by installing saline into the pouch of Douglas (POD) via an intrauterine balloon catheter to create an acoustic window between the ultrasound probe and surrounding structures. The pelvis was then assessed for the presence or absence of superficial endometriosis using pre-defined features. Direct visualization at laparoscopy and histological assessment of excised endometriosis confirmed the outcome.

42 consecutive participants underwent sonoPODography. Superficial endometriosis was identified by sonoPODography in 24/42 (57.1 %) and in 37/42 (88.1 %) participants by direct visualization at laparoscopy. The overall diagnostic performance of sonoPODography was: accuracy 69.1 %, sensitivity 64.9 %, specificity 100.0 %.
SonoPODography is a novel ultrasound-based procedure that permits the direct visualization of superficial with respectable diagnostic accuracy. The findings of this pilot study are promising and justify the initiation of a larger outpatient study. SonoPODography may establish new avenues for the non-invasive diagnosis and investigation of endometriosis

To perform a pilot diagnostic accuracy study of a novel transvaginal ultrasonography procedure called saline-infusion sonoPODography to predict superf…

14/09/2020

‘No safe level’ of caffeine consumption for pregnant women

A review of findings from observational studies and meta-analyses concludes that maternal caffeine consumption is ‘reliably’ associated with several adverse outcomes of pregnancy. Pregnant women advised ‘to avoid caffeine’. Behind the advice lies a ‘narrative review’ of 48 original observational studies and meta-analyses published in the past two decades reporting results of coffee associations with one or more of six negative pregnancy and neonatal outcomes: miscarriage, stillbirth, low birth weight and/or small for gestational age, preterm birth, childhood acute leukaemia, and childhood overweight and obesity. Many professional organisations, including the UK’s NHS, the American College of Obstetricians and Gynaecologists, the European Food Safety Authority, set this safe level at 200 mg caffeine.
Now, however, this recent review (1261 papers initially identified), concludes that ‘there is no safe level of consumption’ - that there is dose-responsive nature of the associations between caffeine and adverse pregnancy outcomes.
James JE. Maternal caffeine consumption and pregnancy outcomes: a narrative review with implications for advice to mothers and mothers-to-be. BMJ Evidence Based Medicine 2020

14/09/2020

‘No safe level’ of caffeine consumption for pregnant women
We offer specialised advices for woman looking for pregnancy and early stages of pregnancy. A review concludes that maternal caffeine consumption is ‘reliably’ associated with several adverse outcomes of pregnancy. It reported results of coffee associations with one or more of six negative pregnancy and neonatal outcomes: miscarriage, stillbirth, low birth weight and/or small for gestational age, preterm birth, childhood acute leukaemia, and childhood overweight and obesity. Although many observational studies have already reported possible increased risks for several negative pregnancy outcomes, current policy advice assumes that 'moderate' caffeine consumption during pregnancy appears to be safe. Many professional organisations, including the UK’s NHS, the American College of Obstetricians and Gynaecologists, the European Food Safety Authority, set this safe level at 200 mg caffeine (two cups). Now, this recent review (1261 papers initially identified), actually concludes that ‘there is no safe level of consumption’ and that there is dose-responsive nature of the associations between caffeine and adverse pregnancy outcomes. James
JE. Maternal caffeine consumption and pregnancy outcomes.BMJ Evidence Based Medicine 2020