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Al Wattar BH, Teh JJ, Clarke S, Abbara A, Morman R, Wilcox A, Talaulikar V. Healthcare and research priorities for women with polycystic ovary syndrome in the UK National Health Service: A modified Delphi method. Clin Endocrinol (Oxf) 2024; 100:459-465. [PMID: 38420872 DOI: 10.1111/cen.15038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) is a chronic lifelong condition affecting up to 20% of women worldwide. There is limited input from affected women to guide the provision of healthcare services and future research needs. Our objective was to scope the healthcare and research priorities of women with PCOS in the United Kingdom. DESIGN A three-staged modified Delphi method, consisting of two questionnaires and a consensus meeting involving lay representatives and healthcare professionals. PATIENTS AND MEASUREMENTS Lay patient representatives of women with PCOS. Participants were asked to identify and rank healthcare and research priorities for their importance. RESULTS Six hundred and twenty-four lay participants took part in our Delphi method. Over 98% were diagnosed with PCOS (614/624, 98.4%). More than half experienced difficulties to receive a PCOS diagnosis (375/624, 60%), and the majority found it difficult to access specialised PCOS health services in the NHS (594/624, 95%). The top two healthcare priorities included better education for health professionals on the diagnosis and management of PCOS (238/273, 87.1%) and the need to set up specialist PCOS services (234/273, 85.7%). The top two research priorities focused on identifying better treatments for irregular periods (233/273, 85.3%) followed by better tests for early PCOS diagnosis (230/273, 84.2%). CONCLUSIONS We identified 13 healthcare and 14 research priorities that reflect the current health needs of women with PCOS in the United Kingdom. Adopting these priorities in future healthcare and research planning will help to optimise the health of women with PCOS and increase patient satisfaction.
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Affiliation(s)
- Bassel H Al Wattar
- Beginnings Assisted Conception Unit, Epsom and St Helier University Hospitals, London, UK
- Comprehensive Clinical Trials Unit, Institute for Clinical Trials and Methodology, University College London, London, UK
| | - Jhia Jiat Teh
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Sophie Clarke
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| | - Ali Abbara
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Division of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Vikram Talaulikar
- Reproductive Medicine Unit, University College London Hospitals, London, UK
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Arbuzova S, Nikolenko M, Wright D, Cuckle H. Cholelithiasis is an additional pre-pregnancy clinical risk factor for preeclampsia. Arch Gynecol Obstet 2023; 308:1497-1503. [PMID: 36708426 PMCID: PMC10520082 DOI: 10.1007/s00404-023-06936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/15/2023] [Indexed: 01/29/2023]
Abstract
PURPOSE To investigate additional potential clinical risk factors for preeclampsia. METHODS This is a nested case-control study of preeclampsia and unaffected pregnancies. Cases were either from a prenatal screening database or from a national network of clinicians, and controls were from the same prenatal source. Preeclampsia was defined by international criteria which were endorsed by the Ukraine Ministry of Health. Questionnaires were used to record a range of pregnancy related factors, personal history of health conditions and family history, followed by a telephone interview to collect more details. RESULTS There were 103 cases, 56 from the prenatal database and 47 from the clinicians, and 480 controls from the database. The two types of case did not differ in terms of age, weight, BMI or parity. Known risk factors were more common in cases than controls. In addition there was a 17-fold higher prevalence of cholelithiasis in cases compared with controls (29.1% versus 1.7%), a highly statistically significant difference (P < 0.0001). There was also an 8.8-fold increase among the mothers of cases and controls (P < 0.0001), and if either the patient or her mother had the disease the increase was 6.4-fold (P < 0.0001). Including the father or sibling did not increase the relative risk. CONCLUSION Cholelithiasis is a clinical risk factor for preeclampsia which has not previously been reported. If confirmed by additional studies it may have utility in routine prenatal screening and provide insight into the pathogenesis of preeclampsia.
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Affiliation(s)
- Svitlana Arbuzova
- Eastern-Ukrainian Center for Medical Genetics and Prenatal Diagnosis, Mariupol & Kiev, Ukraine.
- Institute of Health Research, University of Exeter, Exeter, England.
| | - Margaryta Nikolenko
- Eastern-Ukrainian Center for Medical Genetics and Prenatal Diagnosis, Mariupol & Kiev, Ukraine
| | - David Wright
- Institute of Health Research, University of Exeter, Exeter, England
| | - Howard Cuckle
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Factors Associated with the Severity of Pregnancy-Related Hypertensive Disorder: Significance of Clinical, Laboratory, and Histopathological Features. Diagnostics (Basel) 2022; 12:diagnostics12092188. [PMID: 36140589 PMCID: PMC9498006 DOI: 10.3390/diagnostics12092188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this paper is to evaluate the association of maternal clinical and laboratory features and placental histopathological changes with disease severity in pregnancy-related hypertensive disorders. From January 2021 to December 2021, clinical and laboratory data at the time of delivery and histopathological features of the placenta were collected from pregnant women with pregnancy-related hypertensive disorders at a single institution. The women were classified according to the pregnancy-related hypertensive disorder clinical severity, and each variable was compared accordingly. Gestational age-matched normotensive groups were also compared. Univariate and multivariate regression analyses were used to identify factors influencing pregnancy-related hypertensive disorder severity. Fifty-eight pregnancies were analyzed. Maternal albumin levels before delivery (beta coefficient −0.83, p = 0.043) and increased placental syncytial knots (beta coefficient 0.71, p = 0.026) are important parameters that are closely related to disease severity in women with pregnancy-related hypertensive disorders. The combination of albumin, PAPP-A, total bilirubin, and eGFR levels appears to be optimal for predicting pregnancy-related hypertensive disorder severity.
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Haider S, Sadiq SN, Lufumpa E, Sihre H, Tallouzi M, Moore DJ, Nirantharakumar K, Price MJ. Predictors for diabetic retinopathy progression-findings from nominal group technique and Evidence review. BMJ Open Ophthalmol 2020; 5:e000579. [PMID: 33083555 PMCID: PMC7549478 DOI: 10.1136/bmjophth-2020-000579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives Risk stratification is needed for patients referred to hospital eye
services by Diabetic Eye Screening Programme UK. This requires a set of candidate predictors. The literature contains a large number of predictors. The objective of this research was to arrive at a small set of clinically important predictors for the outcome of the progression of diabetic retinopathy (DR). They need to be evidence based and readily available during the clinical consultation. Methods and analysis Initial list of predictors was obtained from a systematic review of prediction models. We sought the clinical expert opinion using a formal qualitative study design. A series of nominal group technique meetings to shorten the list and to rank the predictors for importance by voting were held with National Health Service hospital-based clinicians involved in caring for patients with DR in the UK. We then evaluated the evidence base for the selected predictors by critically appraising the evidence. Results The source list was presented at nominal group meetings (n=4), attended by 44 clinicians. Twenty-five predictors from the original list were ranked as important predictors and eight new predictors were proposed. Two additional predictors were retained after evidence check. Of these 35, 21 had robust supporting evidence in the literature condensed into a set of 19 predictors by categorising DR. Conclusion We identified a set of 19 clinically meaningful predictors of DR progression that can help stratify higher-risk patients referred to hospital eye services and should be considered in the development of an individual risk stratification model. Study design A qualitative study and evidence review. Setting Secondary eye care centres in North East, Midlands and South of England.
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Affiliation(s)
| | | | | | | | | | - David J Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Malcolm James Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Ismail-Pratt I, Mayeaux EJJ, Ngo QV, Lee J, Ng J. A sustainable model for raising colposcopy expertise in low-to-middle-income countries. Int J Gynecol Cancer 2020; 30:1124-1128. [PMID: 32709697 DOI: 10.1136/ijgc-2020-001306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The objective of the study was to assess the effectiveness of training low-to-middle-income countries' local healthcare providers using the Train-the-trainers model in basic colposcopy for cervical cancer prevention. METHOD This project was designed based on a philosophy known as Train-the-trainers which train proficient colposcopists and a cadre of local trainers who can continue to train and maintain their expertise in a self-sustaining system. The Train-the-trainers workshop is a 1-day program that focuses on three domains; knowledge, communication, and practical skills. Trainer candidates were given pre-course reading assignments and presentation decks. The expert trainers provided feedback on their presentations and tips on communication skills. The practical aspects of the training are supported by proficiency at the Loop Electro-excision procedure simulator and their responses to frequently asked questions. RESULTS Sixteen physicians from Vietnam attended the Colposcopy Workshop in 2018 and are used as controls. Eleven attended a workshop conducted by trainer candidates who went through the training program outlined above in 2019. A Wilcoxon Signed-ranks test indicated that differences between pre- and post-quizzes' scores were statistically significant in both the 2018 (Z=4.21, P=0.003, r=1.26) and 2019 cohorts (Z=3.558, P<0.001, r=0.89) while Mann-Whitney U test did not detect the difference between the 2018 and 2019 cohorts, U=70.0, P=0.359, r=0.176. The subjective feedback scores from Year 2019 were similar to scores to Year 2018. CONCLUSION Our preliminary data did not highlight any differences between lectures delivered by expert trainers and lectures delivered by trainer candidates trained in the program. Train-the- trainers might be a more sustainable model for organically raising expertise to effectively provide cervical cancer screening and prevention in low-to-middle-income countries.
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Affiliation(s)
- Ida Ismail-Pratt
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, National University of Singapore, Singapore
| | - Edward John Jr Mayeaux
- Department of Family Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Quang Van Ngo
- Da Nang Center for Disease Control, Vietnam, Da Nang, Vietnam
| | - Jieying Lee
- Keio-NUS CUTE Center, Smart Systems Insitute, National University of Singapore, Singapore
| | - Joseph Ng
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, National University of Singapore, Singapore
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Thangaratinam S, Allotey J, Marlin N, Mol BW, Von Dadelszen P, Ganzevoort W, Akkermans J, Ahmed A, Daniels J, Deeks J, Ismail K, Barnard AM, Dodds J, Kerry S, Moons C, Riley RD, Khan KS. Development and validation of Prediction models for Risks of complications in Early-onset Pre-eclampsia (PREP): a prospective cohort study. Health Technol Assess 2017; 21:1-100. [PMID: 28412995 DOI: 10.3310/hta21180] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The prognosis of early-onset pre-eclampsia (before 34 weeks' gestation) is variable. Accurate prediction of complications is required to plan appropriate management in high-risk women. OBJECTIVE To develop and validate prediction models for outcomes in early-onset pre-eclampsia. DESIGN Prospective cohort for model development, with validation in two external data sets. SETTING Model development: 53 obstetric units in the UK. Model transportability: PIERS (Pre-eclampsia Integrated Estimate of RiSk for mothers) and PETRA (Pre-Eclampsia TRial Amsterdam) studies. PARTICIPANTS Pregnant women with early-onset pre-eclampsia. SAMPLE SIZE Nine hundred and forty-six women in the model development data set and 850 women (634 in PIERS, 216 in PETRA) in the transportability (external validation) data sets. PREDICTORS The predictors were identified from systematic reviews of tests to predict complications in pre-eclampsia and were prioritised by Delphi survey. MAIN OUTCOME MEASURES The primary outcome was the composite of adverse maternal outcomes established using Delphi surveys. The secondary outcome was the composite of fetal and neonatal complications. ANALYSIS We developed two prediction models: a logistic regression model (PREP-L) to assess the overall risk of any maternal outcome until postnatal discharge and a survival analysis model (PREP-S) to obtain individual risk estimates at daily intervals from diagnosis until 34 weeks. Shrinkage was used to adjust for overoptimism of predictor effects. For internal validation (of the full models in the development data) and external validation (of the reduced models in the transportability data), we computed the ability of the models to discriminate between those with and without poor outcomes (c-statistic), and the agreement between predicted and observed risk (calibration slope). RESULTS The PREP-L model included maternal age, gestational age at diagnosis, medical history, systolic blood pressure, urine protein-to-creatinine ratio, platelet count, serum urea concentration, oxygen saturation, baseline treatment with antihypertensive drugs and administration of magnesium sulphate. The PREP-S model additionally included exaggerated tendon reflexes and serum alanine aminotransaminase and creatinine concentration. Both models showed good discrimination for maternal complications, with anoptimism-adjusted c-statistic of 0.82 [95% confidence interval (CI) 0.80 to 0.84] for PREP-L and 0.75 (95% CI 0.73 to 0.78) for the PREP-S model in the internal validation. External validation of the reduced PREP-L model showed good performance with a c-statistic of 0.81 (95% CI 0.77 to 0.85) in PIERS and 0.75 (95% CI 0.64 to 0.86) in PETRA cohorts for maternal complications, and calibrated well with slopes of 0.93 (95% CI 0.72 to 1.10) and 0.90 (95% CI 0.48 to 1.32), respectively. In the PIERS data set, the reduced PREP-S model had a c-statistic of 0.71 (95% CI 0.67 to 0.75) and a calibration slope of 0.67 (95% CI 0.56 to 0.79). Low gestational age at diagnosis, high urine protein-to-creatinine ratio, increased serum urea concentration, treatment with antihypertensive drugs, magnesium sulphate, abnormal uterine artery Doppler scan findings and estimated fetal weight below the 10th centile were associated with fetal complications. CONCLUSIONS The PREP-L model provided individualised risk estimates in early-onset pre-eclampsia to plan management of high- or low-risk individuals. The PREP-S model has the potential to be used as a triage tool for risk assessment. The impacts of the model use on outcomes need further evaluation. TRIAL REGISTRATION Current Controlled Trials ISRCTN40384046. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London, London, UK.,Pragmatic Clinical Trials Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - John Allotey
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London, London, UK.,Pragmatic Clinical Trials Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nadine Marlin
- Pragmatic Clinical Trials Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ben W Mol
- School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia
| | - Peter Von Dadelszen
- Institute of Cardiovascular and Cell Sciences, University of London, London, UK
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Joost Akkermans
- Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Asif Ahmed
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Jane Daniels
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Jon Deeks
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Khaled Ismail
- Birmingham Centre for Women's and Children's Health, University of Birmingham, Birmingham, UK
| | | | - Julie Dodds
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London, London, UK.,Pragmatic Clinical Trials Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sally Kerry
- Pragmatic Clinical Trials Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carl Moons
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Richard D Riley
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Khalid S Khan
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London, London, UK.,Pragmatic Clinical Trials Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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7
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Thangaratinam S, Allotey J, Marlin N, Dodds J, Cheong-See F, von Dadelszen P, Ganzevoort W, Akkermans J, Kerry S, Mol BW, Moons KGM, Riley RD, Khan KS. Prediction of complications in early-onset pre-eclampsia (PREP): development and external multinational validation of prognostic models. BMC Med 2017; 15:68. [PMID: 28356148 PMCID: PMC5372261 DOI: 10.1186/s12916-017-0827-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/23/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Unexpected clinical deterioration before 34 weeks gestation is an undesired course in early-onset pre-eclampsia. To safely prolong preterm gestation, accurate and timely prediction of complications is required. METHOD Women with confirmed early onset pre-eclampsia were recruited from 53 maternity units in the UK to a large prospective cohort study (PREP-946) for development of prognostic models for the overall risk of experiencing a complication using logistic regression (PREP-L), and for predicting the time to adverse maternal outcome using a survival model (PREP-S). External validation of the models were carried out in a multinational cohort (PIERS-634) and another cohort from the Netherlands (PETRA-216). Main outcome measures were C-statistics to summarise discrimination of the models and calibration plots and calibration slopes. RESULTS A total of 169 mothers (18%) in the PREP dataset had adverse outcomes by 48 hours, and 633 (67%) by discharge. The C-statistics of the models for predicting complications by 48 hours and by discharge were 0.84 (95% CI, 0.81-0.87; PREP-S) and 0.82 (0.80-0.84; PREP-L), respectively. The PREP-S model included maternal age, gestation, medical history, systolic blood pressure, deep tendon reflexes, urine protein creatinine ratio, platelets, serum alanine amino transaminase, urea, creatinine, oxygen saturation and treatment with antihypertensives or magnesium sulfate. The PREP-L model included the above except deep tendon reflexes, serum alanine amino transaminase and creatinine. On validation in the external PIERS dataset, the reduced PREP-S model showed reasonable calibration (slope 0.80) and discrimination (C-statistic 0.75) for predicting adverse outcome by 48 hours. Reduced PREP-L model showed excellent calibration (slope: 0.93 PIERS, 0.90 PETRA) and discrimination (0.81 PIERS, 0.75 PETRA) for predicting risk by discharge in the two external datasets. CONCLUSIONS PREP models can be used to obtain predictions of adverse maternal outcome risk, including early preterm delivery, by 48 hours (PREP-S) and by discharge (PREP-L), in women with early onset pre-eclampsia in the context of current care. They have a potential role in triaging high-risk mothers who may need transfer to tertiary units for intensive maternal and neonatal care. TRIAL REGISTRATION ISRCTN40384046 , retrospectively registered.
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Affiliation(s)
- Shakila Thangaratinam
- Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Queen Mary University of London, London, UK
| | - John Allotey
- Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Queen Mary University of London, London, UK
| | - Nadine Marlin
- Pragmatic Clinical Trials Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Julie Dodds
- Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Queen Mary University of London, London, UK
| | - Fiona Cheong-See
- Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Queen Mary University of London, London, UK
| | - Peter von Dadelszen
- Institute of Cardiovascular and Cell Sciences, St George’s, University of London, London, UK
| | - Wessel Ganzevoort
- Departments of Obstetrics and Gynecology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Joost Akkermans
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sally Kerry
- Pragmatic Clinical Trials Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Ben W. Mol
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
- The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Karl G. M. Moons
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Richard D. Riley
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire UK
| | - Khalid S. Khan
- Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Multidisciplinary Evidence Synthesis Hub (mEsh), Queen Mary University of London, London, UK
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Blood pressure patterns in women with gestational hypertension or mild preeclampsia at term. Eur J Obstet Gynecol Reprod Biol 2017; 210:360-365. [DOI: 10.1016/j.ejogrb.2017.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/14/2017] [Accepted: 01/16/2017] [Indexed: 11/13/2022]
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Allotey J, Marlin N, Mol BW, Von Dadelszen P, Ganzevoort W, Akkermans J, Ahmed A, Daniels J, Deeks J, Ismail K, Barnard AM, Dodds J, Kerry S, Moons C, Khan KS, Riley RD, Thangaratinam S. Development and validation of prediction models for risk of adverse outcomes in women with early-onset pre-eclampsia: protocol of the prospective cohort PREP study. Diagn Progn Res 2017; 1:6. [PMID: 31093538 PMCID: PMC6457143 DOI: 10.1186/s41512-016-0004-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/09/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Early-onset pre-eclampsia with raised blood pressure and protein in the urine before 34 weeks' gestation is one of the leading causes of maternal deaths in the UK. The benefits to the child from prolonging the pregnancy need to be balanced against the risk of maternal deterioration. Accurate prediction models of risks are needed to plan management. METHODS We aim to undertake a multicentre prospective cohort study (Prediction of Risks in Early onset Pre-eclampsia (PREP)) to develop clinical prediction models in women with early-onset pre-eclampsia, for risk of adverse maternal outcomes by 48 h and by discharge. We will externally validate the models in two independent cohorts with 634 and 216 women. In the secondary analyses, we will assess risk of adverse fetal and neonatal outcomes at birth and by discharge. DISCUSSION The PREP study will quantify the risk of maternal complications at various time points and provide individualised estimates of overall risk in women with early-onset pre-eclampsia to plan the management. TRIAL REGISTRATION ISRCTN registry, ISRCTN40384046.
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Affiliation(s)
- John Allotey
- 0000 0001 2171 1133grid.4868.2Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London, London, UK
| | - Nadine Marlin
- 0000 0001 2171 1133grid.4868.2Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ben W. Mol
- 0000 0004 1936 7304grid.1010.0The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - Peter Von Dadelszen
- 0000 0001 2161 2573grid.4464.2Institute of Cardiovascular and Cell Sciences, St George’s, University of London, London, UK
| | - Wessel Ganzevoort
- 0000000404654431grid.5650.6Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Joost Akkermans
- 0000000089452978grid.10419.3dDepartment of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Asif Ahmed
- 0000 0004 0376 4727grid.7273.1Aston Medical School, Aston University, Birmingham, UK
| | - Jane Daniels
- 0000 0004 1936 7486grid.6572.6University of Birmingham Clinical Trials Unit, Edgbaston, Birmingham, UK
| | - Jon Deeks
- 0000 0004 1936 7486grid.6572.6School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Khaled Ismail
- 0000 0004 1936 7486grid.6572.6Birmingham Centre for Women’s and Children’s Health, University of Birmingham, Birmingham, UK
| | | | - Julie Dodds
- 0000 0001 2171 1133grid.4868.2Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London, London, UK
| | - Sally Kerry
- 0000 0001 2171 1133grid.4868.2Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carl Moons
- 0000000090126352grid.7692.aJulius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Khalid S. Khan
- 0000 0001 2171 1133grid.4868.2Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London, London, UK
| | - Richard D. Riley
- 0000 0004 0415 6205grid.9757.cResearch Institute of Primary Care and Health Sciences, Keele University, Keele, UK
| | - Shakila Thangaratinam
- 0000 0001 2171 1133grid.4868.2Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London, London, UK
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Zwertbroek EF, Broekhuijsen K, Langenveld J, van Baaren GJ, van den Berg PP, Bremer HA, Ganzevoort W, van Loon AJ, Mol BW, van Pampus MG, Perquin DA, Rijnders RJ, Scheepers HC, Sikkema MJ, Woiski MD, Groen H, Franssen MT. Prediction of progression to severe disease in women with late preterm hypertensive disorders of pregnancy. Acta Obstet Gynecol Scand 2016; 96:96-105. [DOI: 10.1111/aogs.13051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/16/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Eva F. Zwertbroek
- Department of Obstetrics and Gynecology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Kim Broekhuijsen
- Department of Obstetrics and Gynecology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Josje Langenveld
- Department of Obstetrics and Gynecology; Atrium Medical Center Parkstad; Heerlen The Netherlands
| | - Gert-Jan van Baaren
- Department of Obstetrics and Gynecology; Academic Medical Center; Amsterdam The Netherlands
| | - Paul P. van den Berg
- Department of Obstetrics and Gynecology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Henk A. Bremer
- Department of Obstetrics and Gynecology; Reinier de Graaf Gasthuis; Delft The Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology; Academic Medical Center; Amsterdam The Netherlands
| | - Aren J. van Loon
- Department of Obstetrics and Gynecology; Martini Hospital; Groningen The Netherlands
| | - Ben W.J. Mol
- The Robinson Research Institute; School of Pediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| | - Maria G. van Pampus
- Department of Obstetrics and Gynecology; Onze Lieve Vrouwe Gasthuis; Amsterdam The Netherlands
| | - Denise A.M. Perquin
- Department of Obstetrics and Gynecology; Medical Center Leeuwarden; Leeuwarden The Netherlands
| | - Robbert J.P. Rijnders
- Department of Obstetrics and Gynecology; Jeroen Bosch Hospital; ‘s-Hertogenbosch The Netherlands
| | - Hubertina C.J. Scheepers
- Department of Obstetrics and Gynecology; Grow, School for Oncology and Developmental Biology; Maastricht University Medical Center; Maastricht The Netherlands
| | - Marko J. Sikkema
- Department of Obstetrics and Gynecology; ZGT Almelo; Amelo The Netherlands
| | - Mallory D. Woiski
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Henk Groen
- Department of Epidemiology-HPC FA40; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Maureen T.M. Franssen
- Department of Obstetrics and Gynecology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
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Rogozinska E, D'Amico MI, Khan KS, Cecatti JG, Teede H, Yeo S, Vinter CA, Rayanagoudar G, Barakat R, Perales M, Dodd JM, Devlieger R, Bogaerts A, van Poppel MNM, Haakstad L, Shen GX, Shub A, Luoto R, Kinnunen TI, Phelan S, Poston L, Scudeller TT, El Beltagy N, Stafne SN, Tonstad S, Geiker NRW, Ruifrok AE, Mol BW, Coomarasamy A, Thangaratinam S. Development of composite outcomes for individual patient data (IPD) meta-analysis on the effects of diet and lifestyle in pregnancy: a Delphi survey. BJOG 2015; 123:190-8. [DOI: 10.1111/1471-0528.13764] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 12/01/2022]
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Bonrath EM, Grantcharov TP. Contemporary management of paraesophaegeal hernias: establishing a European expert consensus. Surg Endosc 2014; 29:2180-95. [PMID: 25361649 DOI: 10.1007/s00464-014-3918-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/22/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND The surgical treatment of paraesophageal hernias remains a challenge due to the lack of consensus regarding principles of operative treatment. The objectives of this study were to achieve consensus on key topics through expert opinion using a Delphi methodology. METHODS A Delphi survey combined with a face-to-face meeting was conducted. A panel of European experts in foregut surgery from high-volume centres generated items in the first survey round. In subsequent rounds, the panel rated agreement with statements on a 5-point Likert-type scale. Internal consistency (consensus) was predefined as Cronbach's α > .80. Items that >70 % of the panel either rated as irrelevant/unimportant, or relevant/important were selected as consensus items, while topics that did not reach this cut-off were termed "undecided/controversial". RESULTS Three survey rounds were completed: 19 experts from 10 countries completed round one, 18 continued through rounds two and three. Internal consistency was high in rounds two and three (α > .90). Fifty-eight additional/revised items derived from comments and free-text entries were included in round three. In total, 118 items were rated; consensus agreement was achieved for 70 of these. Examples of consensus topics are the relevance of the disease profile for assessing surgical urgency and complexity, the role of clinical history as the mainstay of patient follow-up, indications for revision surgery, and training and credentialing recommendations. Topics with the most "undecided/controversial" items were follow-up, postoperative care and surgical technique. CONCLUSIONS This Delphi study achieved expert consensus on key topics in the operative management of paraesophageal hernias, providing an overview of the current opinion among European foregut surgeons. Moreover, areas with substantial variability in opinions were identified reflecting the current lack of empirical evidence and opportunities for future research.
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Affiliation(s)
- E M Bonrath
- University of Toronto, 30 Bond Street, Toronto, ON, M5B1W8, Canada,
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13
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Fong FM, Sahemey MK, Hamedi G, Eyitayo R, Yates D, Kuan V, Thangaratinam S, Walton RT. Maternal genotype and severe preeclampsia: a HuGE review. Am J Epidemiol 2014; 180:335-45. [PMID: 25028703 DOI: 10.1093/aje/kwu151] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Severe preeclampsia is a common cause of maternal and perinatal morbidity worldwide. The disease clusters in families; however, individual genetic studies have produced inconsistent results. We conducted a review to examine relationships between maternal genotype and severe preeclampsia. We searched the MEDLINE and Embase databases for prospective and retrospective cohort and case-control studies reporting associations between genes and severe preeclampsia. Four reviewers independently undertook study selection, quality assessment, and data extraction. We performed random-effects meta-analyses by genotype and predefined functional gene group (thrombophilic, vasoactive, metabolic, immune, and cell signalling). Fifty-seven studies evaluated 50 genotypes in 5,049 cases and 16,989 controls. Meta-analysis showed a higher risk of severe preeclampsia with coagulation factor V gene (proaccelerin, labile factor) (F5) polymorphism rs6025 (odds ratio = 1.90, 95% confidence interval: 1.42, 2.54; 23 studies, I(2) = 29%), coagulation factor II (thrombin) gene (F2) mutation G20210A (rs1799963) (odds ratio = 2.01, 95% confidence interval: 1.14, 3.55, 9 studies, I(2) = 0%), leptin receptor gene (LEPR) polymorphism rs1137100 (odds ratio = 1.75, 95% confidence interval: 1.15, 2.65; 2 studies, I(2) = 0%), and the thrombophilic gene group (odds ratio = 1.87, 95% confidence interval: 1.43, 2.45, I(2) = 27%). There were no associations with other gene groups. There was moderate heterogeneity between studies and potential for bias from poor-quality genotyping and inconsistent definition of phenotype. Further studies with robust methods should investigate genetic factors that might potentially be used to stratify pregnancies according to risk of complications.
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Fong F, Rogozinska E, Allotey J, Kempley S, Shah DK, Thangaratinam S. Development of maternal and neonatal composite outcomes for trials evaluating management of late-onset pre-eclampsia. Hypertens Pregnancy 2013; 33:115-31. [PMID: 24303960 DOI: 10.3109/10641955.2013.837176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Pre-eclampsia is associated with significant maternal and neonatal complications, and delivery is often expedited to minimise complications. For randomised trials evaluating interventions in women with late-onset (>34 weeks) mild to moderate pre-eclampsia, no single outcome has been identified to be the most clinically important. Existing composite outcomes with more than one clinically relevant endpoint to evaluate interventions in pre-eclampsia provide limited justification for selection of the components. Our objective was to develop robust, valid composite maternal and neonatal outcome measures for clinical trials evaluating interventions in women with late-onset mild and moderate pre-eclampsia. STUDY DESIGN A two-generational Delphi method was used to identify these clinically important maternal and neonatal outcomes. Composite outcomes were developed based on biological plausibility, independence from each other, frequency of occurrence and level of importance. RESULTS The final maternal composite outcome included maternal death, eclampsia, stroke or reversible ischaemic neurological deficit, pulmonary oedema, major obstetric haemorrhage, need for positive inotropic support, haemolysis, elevated liver enzymes and low platelets syndrome and placental abruption; and the neonatal composite outcome included neonatal death, respiratory distress syndrome needing ventilator support and neurological outcomes as cystic periventricular leukomalacia and grade III/IV intraventricular haemorrhage. CONCLUSION The composite outcomes developed will enable clinical trials to provide robust estimates on the effectiveness of the interventions in women with mild to moderate late onset pre-eclampsia to inform clinical practice. Caution is needed in the interpretation of composite outcomes due to variation in the importance of individual components.
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Affiliation(s)
- F Fong
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry
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Siraj N, Benerjee S, Cooper JC, Ismail KMK. Prioritisation of teaching topics in obstetrics and gynaecology: a Delphi survey of postgraduate trainees. J OBSTET GYNAECOL 2011; 31:692-4. [PMID: 22085055 DOI: 10.3109/01443615.2011.590909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Topics for theoretical teaching during the obstetrics and gynaecology specialty training programme are often chosen by tutors, with little input from the trainees. However, it is important to actively involve adults in their learning process to maintain their learning ownership and motivation. The Delphi methodology is a generic social science technique used to aggregate views and opinions of experts, the community and service users. In this study, we conducted a two generational Delphi study to achieve consensus between a group of trainees in obstetrics and gynaecology, regarding what they considered important topics for inclusion in their protected teaching programme. A total of 25 trainees from one deanery, participated in this study. We were able to produce a list of 26 topics in obstetrics and 30 in gynaecology, prioritised according to their importance for inclusion in the specialty protected teaching programme, as viewed by these trainees.
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Affiliation(s)
- N Siraj
- Maternity Centre, University Hospital of North Staffordshire, Stoke-on-Trent, Staff ordshire ST4 6QG, UK
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Van Der TUUK K, KOOPMANS CM, GROEN H, AARNOUDSE JG, Van Den BERG PP, Van BEEK JJ, COPRAIJ FJ, KLEIVERDA G, PORATH M, RIJNDERS RJ, Van Der SALM PC, SANTEMA JG, STIGTER RH, MOL BW, Van PAMPUS MG. Prediction of progression to a high risk situation in women with gestational hypertension or mild pre-eclampsia at term. Aust N Z J Obstet Gynaecol 2011; 51:339-46. [DOI: 10.1111/j.1479-828x.2011.01311.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Thangaratinam S, Koopmans CM, Iyengar S, Zamora J, Ismail KMK, Mol BWJ, Khan KS. Accuracy of liver function tests for predicting adverse maternal and fetal outcomes in women with preeclampsia: a systematic review. Acta Obstet Gynecol Scand 2011; 90:574-85. [PMID: 21355861 DOI: 10.1111/j.1600-0412.2011.01112.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Liver function tests are routinely performed in women as part of a battery of investigations to assess severity at admission and later to guide appropriate management. OBJECTIVE To determine the accuracy with which liver function tests predict complications in women with preeclampsia by a systematic review. DATA We conducted electronic searches without language restrictions in (1951-2010), (1980-2010) and the Cochrane Library (2009). METHODS OF STUDY SELECTION Primary articles that evaluated the accuracy of liver function tests in predicting complications in women with preeclampsia were chosen. Data was extracted by two reviewers independently. A bivariate model estimated area under the curve, sensitivity and specificity. RESULTS There were 13 primary articles including a total of 3 497 women assessing maternal (30 2×2 tables) and fetal (19 2×2 tables) outcomes. For predicting adverse maternal outcome, the point estimates of specificity were >70% in 18 tables with 0.79 (95%CI 0.51, 0.93). For predicting adverse fetal outcomes the specificity of the test was >70% in 2×2 tables. Sensitivity of the test was poor for both maternal and fetal outcomes. CONCLUSION In women with preeclampsia, function tests performed better in predicting adverse maternal than fetal outcomes. The presence of increased liver enzymes was associated with an increased probability of maternal and fetal complications, but normal liver enzyme levels did not rule out disease, as specificity was often higher than sensitivity.
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Affiliation(s)
- Shakila Thangaratinam
- Centre for Health Sciences, Institute of Health Sciences Education, Queen Mary University of London, London, UK.
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Chandiramani M, Joash K, Shennan AH. Options and decision-making: hypertensive disorders of pregnancy. Future Cardiol 2010; 6:535-46. [PMID: 20608825 DOI: 10.2217/fca.10.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hypertension remains the most commonly encountered medical condition in pregnant women, complicating up to 15% of all pregnancies. It results in frequent hospital admissions, maternal morbidity and mortality and iatrogenic preterm birth with concomitant neonatal morbidity and mortality. Hypertensive disorders of pregnancy comprise a spectrum of severity ranging from a mild elevation of blood pressure to severe pre-eclampsia and hemolysis, elevated liver enzymes and low platelet syndrome that may result in transient or chronic multiorgan failure. As regular antenatal surveillance is the only manner by which to accurately identify those who are at risk, antenatal care schedules have been designed to detect hypertension and proteinuria. Early referral for specialist care for those who are at risk and those who develop hypertension is encouraged in the hope that this will translate into improved management of women with prophylactic, antihypertensive and anticonvulsant therapy. Advances in the understanding of the pathophysiology of the hypertensive disorders of pregnancy are likely to influence future research into both identifying those who are at risk and the role of interventions, and so lead to improved maternal and neonatal outcomes. This article highlights the pathophysiology of these conditions, the classification and identification of high-risk women, clinical manifestations and options for management.
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Affiliation(s)
- Manju Chandiramani
- 10th Floor North Wing, KCL Division of Reproduction & Endocrinology, Westminster Bridge Road, London SE1 7EH, UK.
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The prognostic role of uterine artery Doppler investigation in patients with severe early-onset preeclampsia. Am J Obstet Gynecol 2010; 202:559.e1-4. [PMID: 20347432 DOI: 10.1016/j.ajog.2010.01.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 10/08/2009] [Accepted: 01/19/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the prediction capacity of uterine artery Doppler investigation for maternal and neonatal complications in women who are admitted with severe early-onset preeclampsia. STUDY DESIGN A uterine artery Doppler examination was performed at admission for patients with severe early-onset (<34 weeks of gestation) preeclampsia. The maternal and neonatal outcome of women with abnormal uterine Doppler results was compared with those with normal Doppler results. RESULTS One hundred twenty patients were included. In 53% of them, uterine Doppler results were abnormal. This group had a lower gestational age at delivery (30.2 vs 32.7 weeks; P < .001) and a higher proportion of small-for-gestational age infants (87.5% vs 67.9%; P = .009). Neonatal (40.6% vs 14.3%; P = .01) and maternal (28.1% vs 5.4%; P = .001) complications were more common in the abnormal uterine Doppler group. CONCLUSION Women with severe early-onset preeclampsia are at higher risk of maternal and neonatal complications if abnormal uterine blood flow is present.
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Thangaratinam S, Coomarasamy A, Sharp S, O'Mahony F, O'Brien S, Ismail KMK, Khan KS. Tests for predicting complications of pre-eclampsia: a protocol for systematic reviews. BMC Pregnancy Childbirth 2008; 8:38. [PMID: 18694494 PMCID: PMC2553049 DOI: 10.1186/1471-2393-8-38] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Accepted: 08/11/2008] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pre-eclampsia is associated with several complications. Early prediction of complications and timely management is needed for clinical care of these patients to avert fetal and maternal mortality and morbidity. There is a need to identify best testing strategies in pre eclampsia to identify the women at increased risk of complications. We aim to determine the accuracy of various tests to predict complications of pre-eclampsia by systematic quantitative reviews. METHOD We performed extensive search in MEDLINE (1951-2004), EMBASE (1974-2004) and also will also include manual searches of bibliographies of primary and review articles. An initial search has revealed 19500 citations. Two reviewers will independently select studies and extract data on study characteristics, quality and accuracy. Accuracy data will be used to construct 2 x 2 tables. Data synthesis will involve assessment for heterogeneity and appropriately pooling of results to produce summary Receiver Operating Characteristics (ROC) curve and summary likelihood ratios. DISCUSSION This review will generate predictive information and integrate that with therapeutic effectiveness to determine the absolute benefit and harm of available therapy in reducing complications in women with pre-eclampsia.
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Affiliation(s)
- Shakila Thangaratinam
- Academic Unit of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, UK
| | - Arri Coomarasamy
- Assisted Conception Unit, Guy's and St Thomas Hospital, London, UK
| | - Steve Sharp
- NLH Specialist Library for ENT and Audiology, John Radcliffe Hospital, Oxford, UK
| | - Fidelma O'Mahony
- Academic Unit of Obstetrics and Gynaecology, Keele University School of Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - Shaughn O'Brien
- Academic Unit of Obstetrics and Gynaecology, Keele University School of Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - Khaled MK Ismail
- Academic Unit of Obstetrics and Gynaecology, Keele University School of Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - Khalid S Khan
- Academic Unit of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, UK
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