Perineal outcomes after delivery in 179 mothers with IBD compared to 31,258 controls - a single centre cohort study

2021 ◽  
Author(s):  
Gillian Lever ◽  
Hlupe Chipeta ◽  
Tracey Glanville ◽  
Christian Selinger
Keyword(s):  
Anal Sphincter ◽  
Pelvic Floor Dysfunction ◽  
Perineal Trauma ◽  
Obstetric Outcomes ◽  
Single Centre ◽  
Perineal Tear ◽  
Increased Risk ◽  
Clinically Significant ◽  
Singleton Pregnancies

Abstract Background Patients with IBD have an increased risk for caesarean section (CS) in women but perineal obstetric outcomes, which may have significant consequences for women with IBD, have not been previously studied. Method Maternal outcomes in singleton pregnancies of IBD and non-IBD patients (2014-2018) in a single centre were studied. Results In 31,528 Non-IBD and 179 IBD patients delivery by CS was more likely in IBD patients (p=0.0021, RR 1.45, CI 1.16-1.81). Elective CS in IBD patients occurred in 40% for IBD indications, all in accordance with current international guidelines. Perineal trauma, including tears involving the anal sphincter, were equally uncommon in IBD (2.23%) and Non-IBD patients (3.40%; p=0.35, RR 0.64, CI 0.24-1.68). Of the four IBD patients with clinically significant tears, none had pelvic floor dysfunction or incontinence at follow-up in a specialist postnatal perineal trauma clinic. One IBD patient who had a clinically non-significant second degree perineal tear reported incontinence a year after giving birth. Previous perianal disease was not associated with significant perineal trauma. Conclusion The low rate of perineal trauma is reassuring for promotion of vaginal delivery in most IBD patients. In those who experienced tears involving the anal sphincter no continence issues occurred. Women with IBD had greater incidence of delivery by CS only partially explained by IBD indications.

scholarly journals Managing Anterior Communicating Artery Aneurysms—Are We Doing It Right?

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Lauren Harris ◽  
Ciaran S Hill ◽  
Matthew Elliot ◽  
Teresa Fitzpatrick ◽  
Alejandro Feria ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Open Surgery ◽  
Group Analysis ◽  
Mass Effect ◽  
Anterior Communicating Artery ◽  
Single Centre ◽  
Increased Risk ◽  
Aneurysm Morphology ◽  
Csf Diversion

Abstract INTRODUCTION The natural history and optimal treatment—of previously ruptured anterior communicating artery (ACOM) aneurysms that recur is unclear. This study determines whether our management decisions of endovascular treatment vs open surgery is correct with respect to recurrence and rebleeding rates. METHODS A retrospective observational study. All patients presenting to a single centre with a subarachnoid haemorrhage (SAH) secondary to an ACOM aneurysm were included. Data was collected from November 2012 to September 2018. Data collected included baseline demographics, aneurysm characteristics, management, complications, follow-up imaging, and outcomes. RESULTS A total of 137 patients were included in the study. A total of 113 aneurysms were coiled and 19 were clipped. The indication for clipping was due to aneurysm morphology or the presence of a haematoma exerting mass effect. Rates of vasospasm, infarction, cerebrospinal fluid (CSF) diversion, rebleed, length of stay, and functional outcome were not significantly different in the 2 cohorts. Residual and recurrence was higher in the coiled cohort n = 46 vs clipping n = 2 (P = .0140) with over a quarter of these patients requiring further treatment at a median time of 16 mo. In a subgroup group analysis of coiled aneurysms, there was no statistical differences in rates of rebleed or functional outcome in those that recurred/had a residual and those that did not. CONCLUSION Patients treated with coiling have an increased risk of recurrence vs those treated with clipping. However, the risk of rebleed was not statistically significant. The prevention and impact of recurrence and residual aneurysms remain incompletely understood. Hence, treatment decisions should be considered carefully in a multidisciplinary setting.

scholarly journals Maternal Heart Failure

2021 ◽  
Author(s):  
Rachel A. Bright ◽  
Fabio V. Lima ◽  
Cecilia Avila ◽  
Javed Butler ◽  
Kathleen Stergiopoulos
Keyword(s):  
Heart Failure ◽  
Neonatal Intensive Care ◽  
Direct Care ◽  
Obstetric Outcomes ◽  
Patient Counseling ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Increased Risk ◽  
Timing Of Onset

Abstract Heart failure (HF) remains the most common major cardiovascular complication arising in pregnancy and the postpartum period. Mothers who develop HF have been shown to experience an increased risk of death as well as a variety of adverse cardiac and obstetric outcomes. Recent studies have demonstrated that the risk to neonates is significant, with increased risks in perinatal morbidity and mortality, low Apgar scores, and prolonged neonatal intensive care unit stays. Information on the causal factors of HF can be used to predict risk and understand timing of onset, mortality, and morbidity. A variety of modifiable, nonmodifiable, and obstetric risk factors as well as comorbidities are known to increase a patient's likelihood of developing HF, and there are additional elements that are known to portend a poorer prognosis beyond the HF diagnosis. Multidisciplinary cardio‐obstetric teams are becoming more prominent, and their existence will both benefit patients through direct care and increased awareness and educate clinicians and trainees on this patient population. Detection, access to care, insurance barriers to extended postpartum follow‐up, and timely patient counseling are all areas where care for these women can be improved. Further data on maternal and fetal outcomes are necessary, with the formation of State Maternal Perinatal Quality Collaboratives paving the way for such advances.

Advanced Age at Transplant Increases the Risk of Second Solid Malignancy (SSM) after Haematopoetic Stem Cell Transplantation (HSCT)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3952-3952
Author(s):  
John Murray ◽  
John Chadwick ◽  
Adrian Bloor ◽  
Jim Cavet ◽  
Mike Dennis ◽  
...  
Keyword(s):  
Stem Cell ◽  
Research Funding ◽  
Second Malignancy ◽  
Single Centre ◽  
Solid Malignancy ◽  
Increased Risk ◽  
Cell Transplants ◽  
Long Term Survivors

Abstract Introduction: It is increasingly important to understand the long term risk associated with transplantation because the number of long term survivors is steadily growing. In comparison to other long term risks following transplantation like infertility, cataracts, endocrine dysfunction, etc. the risk of second malignancy is likely to be associated with increased risk of mortality and hence significant impact on survival outcomes. This retrospective, single centre analysis was undertaken to evaluate the risk of second solid malignancy in patients undergoing HSCT. Methods: From February 1973 to November 2013, 1983 patients (median age: 45yr., range: 14-76 yr.; M: 1259, F: 724) received stem cell transplants for haematological malignancies (Ac. Leuk: 507, Chr. Leuk: 97, lymphoma:645, myeloma:621, solid tumours:113). Donor was allogeneic (n=528) or autologous (n=1455) and conditioning was with (n=556) or without TBI (n=1427). Donor was sibling (n=302), matched unrelated (n=220) or cord blood (n=6). Source of stem cell was marrow (n=322), PBSC (n=1627), both (n=28) or cord blood (n=6). GVH prophylaxis included Campath in 203 cases. Of all the patients 1774 received single transplant but 209 received more than one transplant. Data was analysed as of 01/12/2013 using competing risk models with death as the competing event. Patients who developed second haematological malignacy were not included in this analysis. Results: Patient follow-up was more than 10 years in 382 cases (19%), between 5 to 10 years in 328 (17%), 1 to 5 years in 667 (34%) and less than 1 year in 606 cases (31%). Second solid malignancy developed in 70 patients with the incidence of 1% at 5yr (95% CI: 0.5-1.6), 2.2% at 10 yr (95% CI: 1.6-3.3), 4.8% at 15yr (95% CI: 3.6-6.8) and 8% (95% CI: 5.9-10.5) at 20 years. Site of second malignancy was brain (n=2), breast (n=15), cervix (n=3), GIT (n=11), genitourinary (n=9), lung (n=3), skin (n=17), head & neck (n=7), thyroid (n=3) and non EBV related lymphoma (n=3). In univariate analysis 10 yr. probability of developing SSM was not influenced by gender, stage of disease, primary diagnosis, type of HSCT, use of TBI, cranial top-up radiation, type of donor or year of transplant. It was significantly higher with use of PBSC (1.4% vs. 2.6%, p=0.02) and age above 65yr. (1.5% vs. 11%, p=0.001). In multi-variate analysis age above 65yr. (RR: 1.8, 95% CI: 1.1-2.9, p=0.02) and PBSC (RR: 9.4, 95% CI: 1-99, p=0.05) were independently associated with increased risk of SMN. 19 patients have died due to SSM (27%) and survival was significantly shorter with gastrointestinal, genitourinary and lung cancers. Conclusion: This single centre analysis shows that the risk of developing SSM increases with advancing age, longer follow-up and the survival is poor. Long term survivors of stem cell transplants need follow-up probably for life in speciality clinics. Continued vigilance, avoidance of known carcinogens and life style changes are strongly recommended. Disclosures Bloor: GSK: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Cavet:Novartis: Research Funding; BMS: Research Funding.

scholarly journals Increased Risk of Clinically Significant Gallstones following an Appendectomy: A Five-Year Follow-Up Study

PLoS ONE ◽  
2016 ◽  
Vol 11 (10) ◽  
pp. e0165829 ◽  
Author(s):  
Shiu-Dong Chung ◽  
Chung-Chien Huang ◽  
Herng-Ching Lin ◽  
Ming-Chieh Tsai ◽  
Chao-Hung Chen
Keyword(s):  
Follow Up Study ◽  
Increased Risk ◽  
Clinically Significant

scholarly journals Group physiotherapy with survivors of torture in urban and camp settings in Jordan and Kenya

2021 ◽  
Vol 30 (3) ◽  
pp. 27-42
Author(s):  
Laura Janet Pizer Gueron ◽  
Arobogust Amoyi ◽  
Winnie Chao ◽  
Justine Chepngetich ◽  
Jepkemoi Joanne Kibet ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Group Treatment ◽  
Community Education ◽  
Pelvic Floor Dysfunction ◽  
Interdisciplinary Treatment ◽  
Care Providers ◽  
Biopsychosocial Perspective ◽  
Clinically Significant ◽  
The Impact

Introduction:  In this paper we report provisional field results on the impact of CVT’s (the Center for Victims of Torture) interdisciplinary group treatment on physiotherapy indicators in refugees living in urban and camp settings in Kenya and Jordan. The physiotherapy component of this model includes pain neuroscience education, sleep hygiene, posture and body mechanics instruction and healing of pain and trauma from a biopsychosocial perspective, in a program of ten weekly sessions. This program is supported by a clinical assessment that records a broad set of indicators of participant experience and functioning. In addition, some survivors report having pelvic floor dysfunction and data will be offered about a subset of survivors looking at prevalence of these issues. Methods: Survivors are identified through referral systems, community education and sensitization campaigns, contacts and trainings with other NGOs and health care providers. Prospective survivors are screened into CVT services or referred to other agencies that can better meet their needs. CVT focuses its services on refugees with physical and emotional difficulties that may be effectively treated through its interdisciplinary treatment model and who have survived torture or related human rights violations. Following an informed consent process, survivors participate in a comprehensive individual assessment and then progress to the 10-week program. Wherever possible, follow-up assessments are conducted 2 weeks after the sessions end, and at 3, and 9 months following completion of the 10-week long intervention. Results: On average, participants who completed 3-month follow-up assessments showed statistically and clinically significant improvements on physiotherapy indicators. Discussion: Provisional results are encouraging and suggest that the model is adaptable to the needs of different populations and settings. As nearly all participants receive both counseling and physiotherapy, it is difficult to know which benefits can be attributed to physiotherapy alone. 

Abstract 17233: Implantable Loop Recorder Monitoring Detects a High Incidence of Bradycardia Leading to Pacemaker Implant in Hemodialysis Patients: Preliminary Results From the Monitoring in Dialysis (MiD) Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Bruce A Koplan ◽  
David M Charytan ◽  
Amber S Podoll ◽  
Vikranth Reddy ◽  
Prabir Roy-Chaudhury ◽  
...  
Keyword(s):  
Permanent Pacemaker ◽  
Implantable Loop Recorder ◽  
Loop Recorder ◽  
Premature Ventricular Contractions ◽  
Increased Risk ◽  
High Incidence ◽  
Clinically Significant ◽  
Multi Center Study ◽  
Esrd Patients

Introduction: Hemodialysis (HD) pts have an increased incidence of syncope and sudden death. A greater understanding of the incidence of bradyarrhythmias as a potential risk factor for these events is needed. The MiD study enrolled maintenance HD pts to undergo implantable loop recorder (ILR) placement to determine the arrhythmia incidence in this population. Hypothesis: ILR monitoring will be useful in detecting bradyarrhythmias and guiding treatment in ESRD patients Methods: MiD is a prospective, multi-center study to characterize arrhythmias in HD pts during 12mo of ILR monitoring. All ILR-detected events with stored ECG are visually reviewed for confirmation during the initial 6mo. Clinically significant arrhythmias include bradycardia <=40bpm for 6sec, asystole >=3sec, or sustained VT >=130bpm for >=30sec. Results: Follow up is available for 45 pts [mean follow-up 6.4mo (0.6-12.0mo), mean age 56 (27-76yrs), 36% female]. Bradycardia events occurred in 16/45 pts (36%) with an incidence of 28.7 (95% CI 10.1-81.7) events per patient month in these 16 pts. Bradycardia was confirmed by visual review in 408 out of 456 ILR-detected brady events with stored ECG occurring during the first 6mo for a positive predictive value (PPV) of 89.5%. An additional 27 of these ILR-detected “brady events” were found to contain either premature ventricular contractions or atrial arrhythmias (PPV for any arrhythmia 95.5%). 4 of 45 subjects (8.9%) have undergone permanent pacemaker implant for bradyarrhythmias or symptomatic tachy-brady syndrome. In comparison, only one patient (2.2%) has been observed to have ventricular tachycardia (VT>=130bpm for >=30seconds). There was no association between timing of dialysis and bradyarrhythmias. Conclusions: ILR monitoring detects bradyarrhythmias with high PPV in > 1/3 of HD pts and is associated with a high incidence (9%) of permanent pacemaker implant. With improvement in ILR technology with respect to size and wireless capability, clinicians should have a low tolerance to evaluate HD patients for bradyarrhythmias. These findings may also have implications when considering ESRD patients at increased risk of sudden cardiac death for subcutaneous-only defibrillators that do not currently have permanent pacing capability.

scholarly journals Nonimmune Hydrops Fetalis—Prenatal Diagnosis, Genetic Investigation, Outcomes and Literature Review

2020 ◽  
Vol 9 (6) ◽  
pp. 1789
Author(s):  
Przemyslaw Kosinski ◽  
Pawel Krajewski ◽  
Miroslaw Wielgos ◽  
Aleksandra Jezela-Stanek
Keyword(s):  
Intrauterine Infection ◽  
Hydrops Fetalis ◽  
Single Centre ◽  
Family Counselling ◽  
Single Centre Study ◽  
Genetic Evaluations ◽  
Twin Pregnancies ◽  
Nonimmune Hydrops ◽  
Singleton Pregnancies

The aim of this paper is to review the outcomes and discuss the genetic and non-genetic aetiology of nonimmune hydrops fetalis in order to support differential ultrasound and genetic evaluations and family counselling. This single-centre study includes all cases of nonimmune hydrops fetalis diagnosed prenatally from 2009 to 2019. Two sources of data were used for this study (prenatal and neonatal) to compare and summarise the findings. Data from genetic testing and ultrasound scans were collected. In total, 33 pregnant women with prenatally diagnosed nonimmune hydrops fetalis were studied. The data included 30 cases of singleton (91%) and three cases (9%) of twin pregnancies. There were 14 survivors (43%), seven cases of postnatal deaths (21%), four cases of intrauterine foetal demises (12%), four cases of termination of pregnancy (12%), and four women without a follow up (12%). The total number of chromosomally normal singleton pregnancies was 29 (88%), and 14 foetuses had an anatomical abnormality detected on the ultrasound scan. The chance of survival was the highest in cases of isolated, idiopathic hydrops fetalis, which in most cases was due to an undetectable intrauterine infection. In many cases, the diagnosis could not be established throughout pregnancy. Each case of nonimmune hydrops fetalis should thus be analysed individually.

scholarly journals Pregnancy outcomes among women with thyrotoxicosis a retrospective cohort study

2021 ◽  
Author(s):  
Panwad Harn-a-morn ◽  
Prapai Dejkhamron ◽  
Theera Tongsong ◽  
Suchaya Luewan
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Obstetric Outcomes ◽  
Study Group ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
Singleton Pregnancies

Abstract Objective: To compare adverse outcomes between: 1) pregnant women with thyrotoxicosis and low risk pregnancies, 2) pregnant women with thyrotoxicosis requiring no anti-thyroid drug (ATD) and low risk pregnancies, and 3) those treated with methimazole (MMI) and propylthiouracil (PTU)Methods: The medical records of singleton pregnancies with thyrotoxicosis were comprehensively reviewed. Low-risk pregnancies matched for age and parity were randomly recruited as controls. The obstetric outcomes were compared between both groups, and the outcomes of various subgroups of the study group were also compared.Results: A total of 408 pregnant women with thyrotoxicosis were recruited. Compared with the controls, the women of the study group had significantly higher rates of low birth weight (LBW) (23.7% vs 17.7%; p:0.036), preterm birth (19.3% vs 12.3%; p:0.007), preeclampsia (8.5% vs 4.4%; p: 0.019) and cesarean section (21.5% vs 16.0%; p:0.046). In the study group (thyrotoxicosis), 67, 127, and 158 patients were treated with MMI, PTU and no anti-thyroid drug (ATD), respectively. All obstetric outcomes were comparable between the women treated with PTU and those with MMI, and between the controlled and uncontrolled groups. However, women who needed ATD had significantly higher rates of LBW and preterm birth than those without medications.Conclusions: Thyrotoxicosis, whether treated or not needing ATDs, was significantly associated with an increased risk of adverse pregnancy outcomes. Also, active disease, indicated by the need for ATD significantly increased the risk of such adverse outcomes, whereas the patients treated with MMI or PTU had comparable adverse outcomes.

scholarly journals Surgical management of chronic fourth degree perineal tear: a single center experience

2018 ◽  
Vol 7 (12) ◽  
pp. 4919
Author(s):  
Ramesh Kumar R ◽  
Seema Chigateri ◽  
Leena Kamat ◽  
Divya Divya
Keyword(s):  
Success Rate ◽  
Anal Sphincter ◽  
Significant Finding ◽  
Perineal Tear ◽  
Duration Of Symptoms ◽  
Fourth Degree ◽  
Single Center Experience ◽  
Satisfactory Outcome ◽  
Duration Of Surgery

Background: The aim of this article is to present the ridge about the recognition, preoperative management, surgical technique and long term follow up of patients with chronic fourth degree perineal tear.Methods: Authors conducted a prospective study in the department of obstetrics and gynecology in SDM hospital of medical sciences from 2008 January to 2016 December. Data on age, parity, incontinence to flatus, solid or liquids stools, duration of symptoms, history of previous repair, duration of repair, post-operative stay, complications and recovery were collected and analyzed. A total of thirty cases of chronic perineal tear were studied.Results: A total of 30 patients underwent CPT repair. Average duration of surgery was 90 minutes. 27 out of 30 patients were discharged on post-operative day 10. Three patients were non-compliant to treatment. Of the total 30 patients, two patients were lost for follow up. Overall success rate was 93% including patients who underwent re-surgery for failed repair.Conclusions: The significant finding of the present study was that a secondary repair of an anal sphincter injury was not associated with an unfavorable subjective outcome in relation to symptoms of anal incontinence. A good insight of perineal and anal sphincter anatomy and adherence to the sound principles is essential. The success rate in this study is 93.3% highlighting that a diligently performed operation by a surgeon of adequate expertise likely results in satisfactory outcome.

Fatigue and Quality of Life After Risk-Reducing Salpingo-Oophorectomy in Women at Increased Risk for Hereditary Breast-Ovarian Cancer

2009 ◽  
Vol 19 (6) ◽  
pp. 1029-1036 ◽  
Author(s):  
Trond M. Michelsen ◽  
Anne Dørum ◽  
Claes G. Tropé ◽  
Sophie D. Fosså ◽  
Alv A. Dahl
Keyword(s):  
Quality Of Life ◽  
Ovarian Cancer ◽  
Cross Sectional ◽  
Hereditary Breast Ovarian Cancer ◽  
Increased Risk ◽  
General Population Norm ◽  
Clinically Significant ◽  
Risk Reducing

Background:Risk-reducing salpingo-oophorectomy (RRSO) is the safest intervention for prevention of ovarian cancer in women at increased risk for hereditary breast-ovarian cancer. Little is known about other effects of RRSO. The objective of this study was to investigate quality of life (QoL) and fatigue in a sample of women who had RRSO for increased cancer risk and to compare the findings with those of age-matched controls from the general population (NORM).Materials and Methods:In a cross-sectional follow-up mailed questionnaire design, 301 (67%) of 450 invited Norwegian women with RRSO attended. The questionnaire contained measures of QoL, fatigue, anxiety/depression, and body image, and questions about demography, lifestyle, and morbidity. The findings were compared with those of the NORM.Results:For RRSO women, mean age at survey was 53.7 years (SD, 9.2), mean age at RRSO was 48.4 years (SD 8.4), and median follow-up time was 5.0 years (range, 1-15 years). No clinically significant differences were observed between RRSO and NORM for any of the QoL or fatigue dimensions. In subgroup analyses of the RRSO group, no clinically significant differences in QoL and fatigue were observed between those who had surgery before or after age 50 years, or between BRCA1/2 carriers and women with unknown mutation statuses. Women who had cancer (32%), however, showed clinically significant lower levels of QoL and more fatigue than women without cancer.Conclusions:Women who had RRSO showed similar levels of QoL and fatigue as NORM. Women who had cancer before RRSO had lower levels of QoL and more fatigue.

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