No abstract

Age at pregnancy (years): 33Signs: 19 weeks gestation: Visible corneal oedema with central opacity and conjunctival hyperaemia OD. Normal OS. BCVA (logMAR):Between 8 weeks gestation and 19 weeks gestation: decreased by +1.5 OD (counting fingers), no change OS. Levothyroxine 50 µg/day for 1 week. Corneal hydrops OD resolved in 6 weeks with normalisation of thyroid function. Corneal opacity remains OD. Information Classification: General No of pregnancies: One PKP scheduled postpartum. Author: Gatzioufas et al. Year: 2017 Country: United Kingdom Case report No. of patients identified with KCN: One. No. of eyes identified with KCN: Two. Age at pregnancy (years): 26 No of pregnancies: One BCVA with RGP lenses (logMAR): Between 2 years after DALK (<1 year before pregnancy) and <1 year postpartum: decreased by +0.12 OD, 0 OS. Topography maps: After DALK, OD, and PKP, OS: Irregular astigmatism OD; regular astigmatism OS. <1 year postpartum: recurrence of corneal ectasia OD; mild increased steepness and irregular astigmatism OS. Kmax (D): 3 years prior to delivery: 61 OD; 58 OS. <1 year postpartum: 54 OD; 46 OS. TCT (µm): 3 years prior to delivery: 344 OD; 355 OS. <1 year postpartum: 422 OD; 508 OS. At an unspecified time postpartum: CXL OD.

Fetal growth restriction (FGR) and maternal supine going‐to‐sleep position are both risk factors for late stillbirth. This study aimed to use magnetic resonance imaging (MRI) to quantify the effect of maternal supine position on maternal‐placental and fetoplacental blood flow, placental oxygen transfer and fetal oxygenation in FGR and healthy pregnancies. Twelve women with FGR and 27 women with healthy pregnancies at 34–38 weeks’ gestation underwent MRI in both left lateral and supine positions. Phase‐contrast MRI and a functional MRI technique (DECIDE) were used to measure blood flow in the maternal internal iliac arteries (IIAs) and umbilical vein (UV), placental oxygen transfer (placental flux), fetal oxygen saturation (FO2), and fetal oxygen delivery (delivery flux). The presence of FGR, compared to healthy pregnancies, was associated with a 7.8% lower FO2 (P = 0.02), reduced placental flux, and reduced delivery flux. Maternal supine positioning caused a 3.8% reduction in FO2 (P = 0.001), and significant reductions in total IIA flow, placental flux, UV flow and delivery flux compared to maternal left lateral position. The effect of maternal supine position on fetal oxygen delivery was independent of FGR pregnancy, meaning that supine positioning has an additive effect of reducing fetal oxygenation further in women with FGR, compared to women with appropriately grown for age pregnancies. Meanwhile, the effect of maternal supine positioning on placental oxygen transfer was not independent of the effect of FGR. Therefore, growth‐restricted fetuses, which are chronically hypoxaemic, experience a relatively greater decline in oxygen transfer when mothers lie supine in late gestation compared to appropriately growing fetuses. imageKey points Fetal growth restriction (FGR) is the most common risk factor associated with stillbirth, and early recognition and timely delivery is vital to reduce this risk. Maternal supine going‐to‐sleep position is found to increase the risk of late stillbirth but when combined with having a FGR pregnancy, maternal supine position leads to 15 times greater odds of stillbirth compared to supine sleeping with appropriately grown for age (AGA) pregnancies. Using MRI, this study quantifies the chronic hypoxaemia experienced by growth‐restricted fetuses due to 13.5% lower placental oxygen transfer and 26% lower fetal oxygen delivery compared to AGA fetuses. With maternal supine positioning, there is a 23% reduction in maternal‐placental blood flow and a further 14% reduction in fetal oxygen delivery for both FGR and AGA pregnancies, but this effect is proportionally greater for growth‐restricted fetuses. This knowledge emphasises the importance of avoiding supine positioning in late pregnancy, particularly for vulnerable FGR pregnancies.

No abstract

Objective The aim of this project was to identify gaps and research waste in the dissemination of Cochrane gynaecology evidence in the Cochrane database of systematic reviews (CDSR). Design A research article Setting The Cochrane Gynaecology and Fertility (CGF) Group’s specialised register of random controlled trials (RCTs). Sample Trials looking at benign gynaecological conditions, contained in the CGF specialised register, published between the years 2010-2011. Methods Gynaecology trials from the CGF specialised register were matched, by the specific gynaecological issue and treatment, to existing Cochrane reviews. Unmatched trials were categorised to develop and prioritise new review topics. Main outcome measures Proportions Results 740 trials, published from 2010 to 2011, were exported from the specialised register, after removing duplicates and out of scope trials, 185 of these trials were found to be already included in Cochrane reviews. 422 trials were found to be unused, however 192 (26%) of these could be included in an existing CGF SR if it were updated. 230 trials (32%) were not matched to any review title and from these 21 new review titles were developed. The topic with the largest number of associated ‘unused’ trials, was ‘Plant and herbal extracts for symptoms of menopause’. Conclusions This project was used to consider unused trials, prioritise new review topics and identify those reviews that need to be updated, thereby identifying the gaps in evidence for women with gynaecological problems.