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Schulte RL, Fox R, Anderson J, Young N, Davis L, Saxton V, Mooney SS. Medical management of retained products of conception: A prospective observational study. Eur J Obstet Gynecol Reprod Biol 2023; 285:153-158. [PMID: 37120911 DOI: 10.1016/j.ejogrb.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/12/2023] [Accepted: 04/16/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE(S) To measure the success rate of primary medical therapy in managing retained products of conception (RPOC) in women with secondary postpartum haemorrhage (PPH) and to identify factors associated with need for surgical management. STUDY DESIGN Postpartum patients presenting to a tertiary women's hospital Emergency Department between July 2020 and December 2022 with secondary PPH and evidence of RPOC on ultrasound were recruited. Clinical information relating to the presentation was collected prospectively. Antenatal and intrapartum data were collected from medical record and Birthing Outcome System database review. The primary outcome was the success of medical management for RPOC, defined by the implementation of medical or expectant management without subsequent need for surgical intervention. RESULTS Forty-one patients with RPOC underwent primary medical or expectant management. Twelve patients (29%) were managed successfully with medical management, while twenty-nine (71%) proceeded to surgical management. Medical management involved antibiotics (n = 37, 90%), prostaglandin E1 analogue (n = 14, 34%) and other uterotonics (n = 3, 7%). A greater endometrial thickness on ultrasound was significantly associated with a requirement for secondary surgical intervention (p < 0.05). There was an association approaching statistical significance between a higher sonographic volume of RPOC and the failure of medical management (p = 0.07). There was no statistically significant association between the mode of delivery or the number of days postpartum with the success of medical management. CONCLUSION(S) For patients presenting with secondary PPH and sonographic RPOC, over two thirds required surgical management. Increased endometrial thickness was associated with an increased requirement for surgical management.
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Affiliation(s)
- Rhea L Schulte
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Melbourne, Victoria, Australia.
| | - Rachael Fox
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Melbourne, Victoria, Australia
| | - Jessica Anderson
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Melbourne, Victoria, Australia
| | - Nicole Young
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Melbourne, Victoria, Australia
| | - Laura Davis
- Department of Obstetrics and Gynaecology, Northeast Health, Wangaratta, Victoria, Australia
| | - Virginia Saxton
- Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Melbourne, Victoria, Australia
| | - Samantha S Mooney
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Heidelberg, Melbourne, Victoria, Australia; Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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Lalzad A, Wong FY, Singh N, Coombs P, Brockley C, Brennan S, Ditchfield M, Rao P, Watkins A, Saxton V, Schneider M. Surveillance Practice for Sonographic Detection of Intracranial Abnormalities in Premature Neonates: A Snapshot of Current Neonatal Cranial Ultrasound Practice in Australia. Ultrasound Med Biol 2020; 46:2303-2310. [PMID: 32616429 DOI: 10.1016/j.ultrasmedbio.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
There are no publications reporting on scan duration and Doppler use during neonatal cranial ultrasound scans. We investigated current practice of neonatal cranial ultrasound at four large tertiary neonatal intensive care units in Australia. Cranial scans were prospectively recorded between March 2015 and November 2016. Variables, including total number of scans, scan duration and frequency and duration of colour and spectral Doppler mode, were extracted. A total of 196 scans formed the final cohort. The median (range) number of scans for each neonate was 1 (1-12). The median (range) overall total scan duration was 309 (119-801) s. Colour mode with or without spectral Doppler mode was used in approximately half of the cohort (106/196, 54%). Our findings comport with our hypotheses. Operators performing neonatal cranial scans in Australia have low overall scan durations. Although the use of Doppler mode during neonatal cranial scans is not standard practice in all neonatal intensive care units, it is used widely irrespective of the degree of prematurity or the presence of brain pathology. Further efforts are required to incorporate recommendations on scan duration and the routine use of Doppler mode during neonatal cranial scans. This is especially imperative given that the most vulnerable neonates with the greater neural tissue sensitivity are likely to be scanned more often.
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Affiliation(s)
- Assema Lalzad
- Department of Medical Imaging and Radiation Sciences, Faculty of medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Department of Medical Imaging, St. Francis Xavier Cabrini Hospital, Malvern, Victoria, Australia; Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Flora Y Wong
- Monash Newborn, Monash Medical Centre, Clayton, Victoria, Australia; The Ritchie Centre, Hudson's Institute of Medical Research, Melbourne, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Nabita Singh
- Department of Medical Imaging and Radiation Sciences, Faculty of medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Peter Coombs
- Department of Medical Imaging and Radiation Sciences, Faculty of medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Department of Medical Imaging, Monash Medical Centre, Clayton, Victoria, Australia
| | - Cain Brockley
- Department of Medical Imaging, Royal Childrens Hospital, Parkville, Victoria, Australia
| | - Sonja Brennan
- Department of Medical Imaging, Townsville General Hospital, Douglas, Queensland, Australia
| | | | - Padma Rao
- Department of Medical Imaging, Royal Childrens Hospital, Parkville, Victoria, Australia
| | - Andrew Watkins
- Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Virginia Saxton
- Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Faculty of medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
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Humphries‐Hart F, Bethune M, Saxton V. Vasa praevia diagnosis in the mid trimester ultrasound. Sonography 2020. [DOI: 10.1002/sono.12222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ffion Humphries‐Hart
- Medical Imaging DepartmentThe Mercy Hospital for Women Heidelberg Victoria Australia
- Specialist Imaging for Women Ivanhoe Victoria Australia
| | - Michael Bethune
- Medical Imaging DepartmentThe Mercy Hospital for Women Heidelberg Victoria Australia
- Specialist Women's Ultrasound Box Hill Victoria Australia
| | - Virginia Saxton
- Medical Imaging DepartmentThe Mercy Hospital for Women Heidelberg Victoria Australia
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Humphries‐Hart F, Davies B, Bethune M, Saxton V. Detection of vasa praevia in the mid‐trimester ultrasound by Australian sonographers. Sonography 2019. [DOI: 10.1002/sono.12191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ffion Humphries‐Hart
- Medical Imaging DepartmentThe Mercy Hospital for Women Heidelberg Victoria Australia
- Specialist Imaging for Women Ivanhoe Victoria Australia
| | - Braidy Davies
- Medical Imaging DepartmentThe Mercy Hospital for Women Heidelberg Victoria Australia
- Specialist Imaging for Women Ivanhoe Victoria Australia
| | - Michael Bethune
- Medical Imaging DepartmentThe Mercy Hospital for Women Heidelberg Victoria Australia
- Specialist Women's Ultrasound Box Hill Victoria Australia
| | - Virginia Saxton
- Medical Imaging DepartmentThe Mercy Hospital for Women Heidelberg Victoria Australia
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Lalzad A, Wong F, Singh N, Coombs P, Brockley C, Brennan S, Ditchfield M, Rao P, Watkins A, Saxton V, Schneider M. Knowledge of Safety, Training, and Practice of Neonatal Cranial Ultrasound: A Survey of Operators. J Ultrasound Med 2018; 37:1411-1421. [PMID: 29152774 DOI: 10.1002/jum.14481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Ultrasound can lead to thermal and mechanical effects in interrogated tissues. This possibility suggests a potential risk during neonatal cranial ultrasound examinations. The aim of this study was to explore safety knowledge and training of neonatal cranial ultrasound among Australian operators who routinely perform these scans. METHODS An online survey was administered on biosafety and training in neonatal cranial ultrasound, targeting all relevant professionals who can perform neonatal cranial ultrasound examinations in Australia: namely, radiologists, neonatologists, sonographers, and pediatricians. The survey was conducted between November 2013 and May 2014. RESULTS A total of 282 responses were received. Twenty of 208 (10%) answered all ultrasound biosafety questions correctly, and 49 of 169 (29%) correctly defined the thermal index. Two-thirds (134 of 214 [63%]) of respondents failed to recognize that reducing the overall scanning time is the most effective method of reducing the total power exposure. Only 13% (31 of 237) indicated that a predetermined fixed period of training or that a specified minimum number of supervised scans was used during training. The reported number of supervised scans during training was highly variable. Almost half of the participants (82 of 181 [45%]) stated that they had received supervision for 10 to 50 scans (median, 20 scans). CONCLUSIONS There is a need to educate operators on biosafety issues and approaches to minimize power outputs and reduce the overall duration of cranial ultrasound scans. Development of standardized training requirements may be warranted.
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Affiliation(s)
- Assema Lalzad
- Departments of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia
- Department of Medical Imaging, St Francis Xavier Cabrini Hospital, Malvern, Victoria, Australia
- Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Flora Wong
- Department of Pediatrics, Monash University, Clayton, Victoria, Australia
- Monash Newborn, Monash Medical Center, Clayton, Victoria, Australia
- Ritchie Center, Hudson's Institute of Medical Research, Melbourne, Victoria, Australia
| | - Nabita Singh
- Departments of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia
| | - Peter Coombs
- Departments of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia
| | - Cain Brockley
- Department of Medical Imaging, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sonja Brennan
- Department of Medical Imaging, Townsville General Hospital, Douglas, Queensland, Australia
| | | | - Padma Rao
- Department of Medical Imaging, Monash Medical Center, Clayton, Victoria, Australia
- Department of Medical Imaging, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Andrew Watkins
- Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Virginia Saxton
- Department of Medical Imaging, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Michal Schneider
- Departments of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia
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Forster DE, Koumoundouros E, Saxton V, Fedai G, Holberton J. Cerebral blood flow velocities and cerebrovascular resistance in normal-term neonates in the first 72 hours. J Paediatr Child Health 2018; 54:61-68. [PMID: 28845537 DOI: 10.1111/jpc.13663] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 04/20/2017] [Accepted: 06/22/2017] [Indexed: 11/27/2022]
Abstract
AIM To determine the range of cerebral blood flow velocities (CBFVs) and Doppler indices of cerebrovascular resistance in normal-term neonates as a baseline for a study of hypoxic-ischaemic encephalopathy. METHODS The CBFVs, resistive index (RI) and pulsatility index (PI) were measured in the anterior and middle cerebral arteries (ACA and MCA) of 38 normal neonates. RESULTS The mean peak systolic, end diastolic and time-averaged velocities (PSV, EDV and TAV) were 36.3 ± 6.6, 12.4 ± 3.9 and 22.0 ± 4.0 cm/s (ACA) and 41.4 ± 13.2, 13.0 ± 5.5 and 25.8 ± 7.9 cm/s (MCA), respectively. All CBFVs in the ACA correlated with gestation; only EDV was correlated to post-natal age. The RI in the ACA (0.67 ± 0.06) and MCA (0.68 ± 0.07) were correlated (r = 0.72, P < 0.001); RI correlated to post-natal age. Two infants with RI < 0.55 were both fed within 25 mins of the study; RI correlated with post-prandial time (dichotomous, pivot 25 min). The mean PI was 1.11 ± 0.18 (ACA) and 1.17 ± 0.23 (MCA). Correlations were observed with post-natal age and post-prandial time (dichotomous). The average angle of insonation was greater in the ACA than in the MCA (median of 5° vs. 18°). CONCLUSIONS Results corresponded with previous published studies. No correlation was observed between Doppler indices and gestation as component velocities all increase with advancing gestation. Less variation and smaller standard deviation of CBFV's was associated with a smaller angle of insonation. Low RIs (<0.55), without a pathological cause, warrants further study.
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Affiliation(s)
- Danielle E Forster
- Neonatal Intensive Care Unit, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Medical Imaging, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Electrical and Electronic Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Emmanuel Koumoundouros
- Neonatal Intensive Care Unit, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Electrical and Electronic Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Virginia Saxton
- Department of Medical Imaging, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Gabrielle Fedai
- Department of Medical Imaging, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - James Holberton
- Neonatal Intensive Care Unit, Mercy Hospital for Women, Melbourne, Victoria, Australia
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Johnson K, Kelley J, Saxton V, Walker SP, Hui L. Declining invasive prenatal diagnostic procedures: A comparison of tertiary hospital and national data from 2012 to 2015. Aust N Z J Obstet Gynaecol 2017; 57:152-156. [PMID: 28295165 DOI: 10.1111/ajo.12590] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/09/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND In recent years, the superior accuracy of maternal plasma cell-free DNA-based prenatal screening has resulted in >50% national decline in amniocenteses and chorionic villus sampling (CVS), creating new implications for specialist training. OBJECTIVE To compare the annual figures on amniocenteses and CVS in a tertiary hospital with national population-based trends between 2012 and 2015. METHODS Retrospective study examining the amniocentesis and CVS procedures performed in a tertiary hospital between 2012 and 2015. Numbers of procedures, indications for testing, type of test and diagnostic results were analysed. Trends in the annual numbers of procedures were compared to national population-based data from Medicare Benefits Schedule database. RESULTS The annual numbers of diagnostic procedures in our tertiary centre fell from 267 to 215 over the study period, representing a 19.5% decline. This was significantly smaller than the corresponding national decline of 53.7% for the same period (P < 0.0001). In 2015, ultrasound abnormality (including nuchal translucency ≥ 3.5 mm) surpassed high-risk screening results as the most common indication for invasive testing. Thirty percent of procedures performed for an ultrasound abnormality occurred prior to 18 weeks gestation. CONCLUSION Our tertiary centre experienced a relatively smaller decline in prenatal diagnostic procedures compared with national figures, largely due to an increase in testing for ultrasound abnormalities. Our results demonstrate the increasing contribution of first trimester ultrasound in the detection of fetal abnormalities in the cell-free DNA era and the continued viability of specialist training in invasive procedures.
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Affiliation(s)
- Kristine Johnson
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanne Kelley
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Virginia Saxton
- Department of Medical Imaging, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Susan P Walker
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Hui
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Public Health Genetics Group, Melbourne, Victoria, Australia
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Abstract
The operative rate in intussusception has been significantly reduced by (1) expansion of the indications for attempted enema reduction of intussusception to include all children except those with peritonitis or septicaemia and (2) use of the gas (oxygen) enema rather than barium. This prospective study looked at the value of performing a delayed repeat gas enema in children in whom only partial reduction was achieved during the first enema, and who remained clinically stable. Twenty-one patients (of 156 with proven intussusception) had a repeat delayed gas enema, 30 minutes or more after the first attempt at reduction. This was successful in over 50%, reducing the number of patients requiring surgery at our institution by 24% and saving approximately five children a year from surgery.
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Affiliation(s)
- V Saxton
- Department of Radiology, Royal Children's Hospital, Parkville, Victoria, Australia
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Abstract
Doppler carotid artery studies were performed in 12 glaucoma patients with marked asymmetry in bilateral visual field loss. The resistance index and the pulsatility index of the internal carotid artery velocity waveforms were significantly greater on the same side as the eye with the greater visual field loss. The increased resistance to blood flow in the internal carotid artery on the side with advanced field loss might predispose the eye on this side to the effects of raised intraocular pressure by causing a reduction in the perfusion pressure at the optic nerve head. The role of ocular perfusion pressure in the pathogenesis of glaucoma is discussed. More extensive studies are necessary.
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Affiliation(s)
- C O'Brien
- Department of Ophthalmology, King's College Hospital, London
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