Purpose This study was designed to assess fragmentation of Large loop excision of the transformation zone (LLETZ) specimens, its influence on short-term cytological outcome, and the risk factors for specimen fragmentation, as we well as trainee performance on clinical outcome. Method This retrospective study was performed at a cancer center. Women who underwent LLETZ for suspected high-grade cervical intra-epithelial neoplasia (CIN) over a 5-year period were included. Patients were identified through a regional database. Data were obtained from hospital and regional databases. Fisher's exact test was used.Results 75 % of all specimens were obtained intact. When the LLETZ specimen was intact, 89 % of smear tests were reported as negative, against 86 % when the specimen was fragmented. Fragmentation was significantly associated with high-grade smear results at 6 months. Trainee status was significantly related to specimen fragmentation. Conclusion Fragmentation of LLETZ specimens is associated with an increased likelihood of obtaining a highgrade smear at 6 months post treatment. Enhancing the colposcopy training may help improve clinical outcome.
We present a thirty-six-year-old woman with a high risk pregnancy, complicated by multiple congenital anomalies, severe hyperemesis, a pulmonary embolus, and a large intramural fibroid. This fibroid grew in size during the pregnancy. At 34 + 5 weeks, there were reduced fetal movements and a pathological CTG. A live infant was delivered by an emergency cesarean section. Five weeks postpartum, she presented with abdominal pain, offensive vaginal discharge, and fevers. She was given antibiotics and ferrous sulphate. An abdominal ultrasound showed an 11 × 12 × 9 cm fibroid with a coarse degenerative appearance. Clinically, she showed signs of sepsis; a CT scan and laparotomy performed under general anesthetic did not find any collections as a source of sepsis. When stable, she was discharged. She re-presented two days later with a large mass (necrotic fibroid) in her vagina. This is the first case of spontaneous expulsion of fibroid six weeks after caesarean section. Presentation of pain and fever after the delivery may be due to red degeneration of the fibroid, caused by diminished blood supply, ischaemia, and necrosis. This case highlights the importance of considering fibroids as a cause for abdominal pain during and after pregnancy, even up to 6 weeks after delivery.
The prevalence of maternal obesity has increased to 16–19% in the early 2000s; it is one of the most common risk factors for maternal and fetal morbidity and mortality. About 50% of women who died were obese as reported by the last two ‘Saving Mothers’ Lives Reports’ in 20071 and 2011.2 RCOG and CMACE guidelines recommend that all obese women of child bearing age should be counselled pre-pregnancy and supported throughout their pregnancy to improve maternal and fetal outcomes. 3 Although such guidelines are present, there is uncertainty if this information is understood and accessible pre-pregnancy. Because of the high obesity population in our local area (27%), a leaflet has been produced to educate women of the risks and how they can be minimised pre- and during- pregnancy. It also contains information about antenatal appointments and what they should expect at each visit. Pregnant women with a BMI ≥30 attending our Obstetrics Department were given the leaflet. Following this, a questionnaire assessed their insights into risks associated with obesity in pregnancy, the importance of lifestyle changes, their motivation for change, their understanding of the leaflet and whether this information was provided pre-pregnancy. Preliminarily, we found that the majority of women received little or no pre-pregnancy counselling or advice regarding obesity and its risks. Women felt that they would have benefited from this leaflet in their local community prior to getting pregnant so that they could have acted upon its recommendations hence fulfilling the CMACE guidelines and improving quality of care. References The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer (2003–2005). 2007 Centre for Maternal and Child Enquiries (CMACE). Saving mothers’ lives. Reviewing maternal deaths to make motherhood safer: 2006–2008. BJOG. 2011 Oct;118(11):1402–3; discussion 3–4 Royal College of Obstetricians and Gynaecologists (RCOG), Centre for Maternal and Child Enquiries (CMACE). CMACE/RCOG Joint Guideline: Management of Women with Obesity in Pregnancy. 2010
<strong>Objective</strong>: Our study explored a cohort of pregnant women in pregnancy to evaluate clinical care antenatally, at delivery and postpartum. We piloted the use of two simple measures: firstly the use of a patient educational leaflet in improving knowledge of risks associated with obesity during pregnancy and secondly, the use of a proforma to improve documentation in the management of obese women in pregnancy. <strong>Study Design</strong>: This was an observational study performed in Ealing Hospital, a district general hospital within Greater London. Fifty pregnant women with a Body Mass Index (BMI) >30kg/m<sup>2</sup> were asked to complete a questionnaire to assess their knowledge and understanding of obesity during pregnancy, before and after reading a patient educational leaflet. The notes of pregnant women with a BMI >30 kg/m<sup>2</sup> were audited against the CMACE/RCOG joint guideline. The feedback from the questionnaire and data from the audit were used to develop a service model to improve the care of obese women in pregnancy. <strong>Results</strong>: 60% of women knew the meaning of BMI, but only 32% could recall their own BMI. 72% of women were taking the recommended dose of folic acid. The extensive risks of obesity on fetal and maternal health during pregnancy were largely unknown. Women welcomed an educational leaflet that improved their motivation to make lifestyle changes. We selected 50 sets of patient notes at random to audit; obesity was not recognised as a risk factor in over half the pregnant women with a BMI >30 kg/m<sup>2</sup>. Height and weight was recorded well but few took the recommended folic acid&amp;Vitamin D. Majority of women was offered GTT and received an appropriate anaesthetic review. There was no documentation of manual handling requirements and little discussion about complications. Blood pressure was measured appropriately in majority of cases but size of cuff was not documented in all. <strong>Conclusion</strong>: There was poor knowledge of obesity effects on pregnancy. An educational leaflet and care pro forma may help achieve standards of healthcare. If the suggested leaflet and pro forma were used, the management of women in antenatally should improve.
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