One in five cancers in women is diagnosed prior to and during a woman's fertile years. Our study evaluates mortality risks in offspring of mothers with history of cancer. From the Swedish Multi-generation Register and the Cancer Register, we identified all 174,893 children whose mother had been diagnosed with cancer between 1958 and 2001. We categorized offspring into those born before (>1 year before), around (within 1 year before and after diagnosis) and after (>1 year after) their mother's cancer diagnosis and compared their risks of death (standardized mortality ratios, SMRs) and causes of death to the background population. Overall, offspring of mothers diagnosed with cancer had no increased mortality risk (SMR, 1.00; 95% confidence interval [CI], 0.97-1.03). Increased mortality risks were found in offspring of mothers with tobacco-related cancers (head and neck, thoracic and cervical) (SMR, 1.23; 95% CI, 1.13-1.33), in children born around their mother's diagnosis (SMR, 1.66; 95% CI, 1.25-2.13) and in children born after their mother's hematopoietic cancer diagnosis (SMR, 2.07; 95% CI, 1.10-3.35). Compared to the background population, children born around their mother's diagnosis were more likely to die of congenital and perinatal conditions. Overall, offspring of women diagnosed with cancer were not at increased risk of death, except for certain subgroups. Timing of pregnancy in relation to diagnosis and cancer site modifies mortality risks in the offspring.Eighteen percent of female cancers are diagnosed prior to and during a woman's fertile years.1 About one in 1,000 pregnancies is complicated by a cancer diagnosis 2 and substantial proportion of cancer survivors give birth after their diagnosis (unpublished data). Pregnancy during or after a malignancy has repeatedly been shown not to affect maternal prognosis.3-5 However, exposure to (the effects of) diagnostic investigations, radiation therapy and systemic treatment before and around the time of birth may have adverse effects on the child. 3,4,[6][7][8] Population-based estimates on the outcome of offspring of cancer survivors are lacking. Most studies on childbirth after cancer are hampered by small numbers, as pregnancy during and after cancer is a relatively rare event. As such, these studies are underpowered to pick up small, but real increases in mortality risks in the offspring. Although small effects may not be so relevant on an individual patient level, small increases in risk of complications or death in offspring of cancer patients are important from a public health perspective, especially in the light of the growing number of young cancer survivors and improvement in fertility preservation techniques.With our study, using data of the large population-based Swedish Multi-Generation Registry including over three million families and eleven million individuals, we assess mortality risks in offspring of women with a history of cancer in relation to timing of birth and cancer site. MethodsWe linked data from the Multi-Generation Register (incl...

Introduction: Cervical screening programmes differ in the age of women recommended for primary human papillomavirus (HPV) testing. This study aims to determine the clinical efficacy and impact of 14-high-risk HPV DNA testing for women from 25 years old. Method: This was a retrospective analysis of data collected prospectively from women 25 years or older who attended hospital-based gynaecology clinics for cervical screening. Women with history of cervical neoplasia or abnormal cytology were excluded. High-risk HPV DNA testing with partial genotyping for HPV-16 and HPV-18 were performed on cobas 4800 System (Roche Diagnostics International AG, Rotkreuz, Switzerland). Women tested positive for the 12 other high-risk HPV subtypes (HPV-12 other) had a reflex cytology test. Positive screening included positive for HPV-16 and/or HPV-18, HPV-12 other with cytology abnormalities equal to or greater than atypical squamous cells of undetermined significance, and repeated positive HPV at 12 months. HPV detection and colposcopy referral rates, and detection of high-grade neoplasia were determined. Results: Of 10,967 women studied, 822 (7.50%) were HPV DNA positive. The overall discharge rate to routine screening according to screening protocol was 93.1%. Colposcopy referral rate was 4.4%. The screening detected 41 cervical intraepithelial neoplasia grade 2+ (CIN2+) (0.37%) and 31 (0.28%) CIN3+. The number of colposcopies needed per case of CIN2+ was 9.5, similar for women below and above 30 years old. The number of colposcopies needed per case of CIN3+ for HPV-16 positivity was 8.5, compared to 17.0 for other categories (P=0.040). Colposcopy efficacy was similar for HPV-18 and HPV-12 other positivity with abnormal cytology. Conclusion: Taking CIN2+ detection and colposcopy referral rate as endpoints, HPV testing in Singapore can be extended to include women from 25 years old. Keywords: Cervical cancer screening, cervical intraepithelial neoplasia, colposcopy, obstetrics and gynaecology, Pap smear

Objective Since the outbreak of Coronavirus Disease 2019 (COVID-19) in Singapore in January 2020, our maternity centre at Singapore General Hospital has devised and implemented contingency protocols to manage COVID-19 suspected or infected pregnant mothers. These aimed to deliver effective care while ensuring the safety of our front-line healthcare workers. Methods The epidemiology and pathogenicity of SARS-COV-2 was compared to the Severe Acute Respiratory Syndrome outbreak in 2003. Our protocols were constructed following multidisciplinary discussions. These workflow processes include triage, isolation, determination of admission criteria and subsequent secured transfers to dedicated isolation wards. Intrapartum management policies including mode of delivery were reviewed with the focus on minimising maternal-fetal transmission. Postpartum care (breastfeeding and skin-to-skin contact) policies were re-evaluated. Results The Centre conducted several multidisciplinary in-situ simulations which identified potential latent threats and deficiencies in infection containment. These were gaps in communication and coordination between operating theatre, obstetrics and neonatal teams resulting in delayed transfers. A particular vulnerability was the consistent breaches observed in the donning and doffing of personal protective equipment. This led to a need for additional personnel to guide and police strict adherence among healthcare workers. Conclusion Operational readiness leverage on robust contingency protocols which must be subjected to simulation and scrutiny with subsequent revision. We recommend deploying additional supervisory manpower to maintain strict adherence to infection prevention protocols. Effective preparation is key in maintaining high clinical standards of obstetric care while ensuring safety of healthcare workers during this ongoing pandemic.

No abstract

This article was migrated. The article was not marked as recommended. ObjectiveThe 360° multisource feedback (MSF) is an assessment tool used to assess a physician's competency, skills and communication by gathering feedback from multiple groups of assessors. Studies on its use in the residency selection process is limited. This study aims to determine if 360° MSF affects faculty perception of a candidate and its influence on residency selection.MethodsFor the selection of the 2015 SingHealth Obstetrics and Gynaecology Residency Programme, 360° MSF was gathered and collated prior to the interview. During the ranking exercise, selection panel members voted on a candidate based on their performance during the interview and review of their curriculum vitae. The selection panel was then given each candidate's 360° MSF and was asked to vote for a second time. Results of the voting before and after 360° MSF were analysed.ResultsComparing scores before and after 360° MSF, the mean difference was 0.193 with a standard deviation of 0.380. Paired t-test of the candidate's scores before and after 360° MSF showed a significant difference after 360° MSF was revealed (p=0.018).ConclusionFaculty perception is influenced by 360° MSF and can lead to changes in voting patterns of a residency selection process.