1
|
Wijeratne D, Gibson JFE, Fiander A, Rafii-Tabar E, Thakar R. The global burden of disease due to benign gynecological conditions: A call to action. Int J Gynaecol Obstet 2024; 164:1151-1159. [PMID: 37987165 DOI: 10.1002/ijgo.15211] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Focusing on low- and middle-income countries (LMICs), this article uses data from the Global Burden of Disease (GBD) database to highlight the burden of morbidity due to benign gynecological conditions (BGCs). METHODS We analyzed 2019 morbidity data for all BGCs, measured as years lost to disability (YLDs). Disease burden was calculated for individual conditions, BGCs overall, and percentages of overall disease burden from all conditions. The same data extraction was performed for malaria, tuberculosis, and HIV/AIDS for comparison. The data were subcategorized by age and World Bank income level. RESULTS BGCs are major causes of disease morbidity worldwide. For women aged 15 years and over in high-income countries (HICs), 3 588 157 YLDs (3.94% of all YLDs) were due to BGC. In LMICs, 18 242 989 YLDs (5.35% of all YLDs) were due to BGCs. The highest burden of BGCs is seen during the reproductive years where conditions driven or exacerbated by reproductive hormones are the major causes of morbidity. In LMICs, for women aged 15-49, 14 574 100 YLDs (7.75% of all YLDs) were due to BGCs, declining to 3 152 313 YLDs (3.04%) in women aged 50-69 and 529 399 YLDs (1.06%) in women age 70+. CONCLUSION These data demonstrate a huge burden of morbidity due to BGCs. There is an urgent need for international stakeholders to prioritize the treatment and prevention of BGCs.
Collapse
Affiliation(s)
- Dileep Wijeratne
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals, Leeds, UK
| | - Joanna F E Gibson
- Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals, Leeds, UK
| | | | - Elizabeth Rafii-Tabar
- Centre for Women's Global Health, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Ranee Thakar
- Royal College of Obstetricians and Gynaecologists, London, UK
| |
Collapse
|
2
|
Cameron NJ, Wertaschnigg D, Davey MA, Burger RJ, Mol BW, Woolner AM. Incidence and management of premature rupture of membranes in Victoria, Australia: A retrospective cohort study of 636 590 births between 2009 and 2017. Aust N Z J Obstet Gynaecol 2023. [PMID: 37985389 DOI: 10.1111/ajo.13773] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/28/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Premature rupture of membranes (PROM) is a complication affecting 7-12% of pregnancies in which fetal chorioamniotic membranes rupture before labour begins. Preterm PROM (PPROM) (ie <37 weeks gestation) precedes one-third of preterm births, exposing the fetus to increased morbidity from placental abruption, respiratory distress syndrome and sepsis. AIM To analyse trends in the incidence and mode of birth in preterm and term PROM in Victoria, Australia between 2009 and 2017. MATERIALS AND METHODS This retrospective population-based cohort study included all singleton pregnancies from 2009 to 2017. We examined women with PROM (both <37 weeks (PPROM) and at term). Management was assessed in three categories: (a) expectant management; (b) induction of labour (IOL); and (c) elective caesarean section (elCS). A multinomial logistic regression model was used to adjust for confounders influencing the choice of management. RESULTS Of 636 590 singleton pregnancies, 52 669 (8.3%) births with PROM at term (42 439; 6.7%) or PPROM (10 230; 1.6%) were identified. Of these, the majority were managed expectantly (n = 22 726; 43.1%), or with IOL (25 931; 49.2%). While elCS represented only 7.6% of these cases (n = 4012), its use rose consistently from 2009 to 2017 for PROM at term and PPROM alike. For women with PPROM at 34-36 weeks the odds of elCS increased by 5% annually (adjusted odds ratio (aOR) 1.05; 95% CI 1.02-1.08) and 2% for IOL (aOR 1.02; 95% CI 1.00-1.05) vs expectant management. CONCLUSIONS The use of elCS and IOL in PPROM is rising in Victoria, particularly between 34 and 36 completed weeks of pregnancy. Research is needed to determine the drivers for this increase.
Collapse
Affiliation(s)
- Natalie Jardine Cameron
- Department of Obstetrics and Gynaecology, NHS Grampian, Aberdeen, United Kingdom
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Dagmar Wertaschnigg
- Fetal Medicine Service, Ambulatorium für Fetalmedizin, Feldkirch, Austria
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Renée Janne Burger
- Amsterdam UMC location University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, The Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Andrea Mary Woolner
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| |
Collapse
|
3
|
Petry CJ, Burling KA, Barker P, Hughes IA, Ong KK, Dunger DB. Pregnancy Serum DLK1 Concentrations Are Associated With Indices of Insulin Resistance and Secretion. J Clin Endocrinol Metab 2021; 106:e2413-e2422. [PMID: 33640968 PMCID: PMC8424055 DOI: 10.1210/clinem/dgab123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Delta like noncanonical notch ligand 1 (DLK1) is a paternally expressed imprinted gene that encodes an epidermal growth factor repeat-containing transmembrane protein. A bioactive, truncated DLK1 protein is present in the circulation and has roles in development and metabolism. OBJECTIVE We sought to investigate links between maternal pregnancy circulating DLK1 concentrations and: (1) maternal and fetal DLK1 genotypes, (2) maternal insulin resistance and secretion, and (3) offspring size at birth. PATIENTS, DESIGN, AND SETTING We measured third-trimester maternal serum DLK1 concentrations and examined their associations with parentally transmitted fetal and maternal DLK1 genotypes, indices of maternal insulin resistance and secretion derived from 75-g oral glucose tolerance tests performed around week 28 of pregnancy, and offspring size at birth in 613 pregnancies from the Cambridge Baby Growth Study. RESULTS Maternal DLK1 concentrations were associated with the paternally transmitted fetal DLK1 rs12147008 allele (P = 7.8 × 10-3) but not with maternal rs12147008 genotype (P = 0.4). Maternal DLK1 concentrations were positively associated with maternal prepregnancy body mass index (P = 3.5 × 10-6), and (after adjustment for maternal body mass index) with both maternal fasting insulin resistance (Homeostatic Model Assessment of Insulin Resistance: P = 0.01) and measures of maternal insulin secretion in response to oral glucose (insulinogenic index: P = 1.2 × 10-3; insulin disposition index: P = 0.049). Further positive associations were found with offspring weight (P = 0.02) and head circumference at birth (P = 0.04). CONCLUSION These results are consistent with a partial paternal or placental origin for the maternal circulating DLK1 which may lead to increased maternal circulating DLK1 concentrations, stimulation of maternal insulin resistance and compensatory hyperinsulinemia during pregnancy, and the promotion of fetal growth.
Collapse
Affiliation(s)
- Clive J Petry
- Department of Paediatrics, Cambridge Biomedical Campus, Cambridge, UK
- Correspondence: Clive Petry, Department of Paediatrics, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK.
| | - Keith A Burling
- NIHR Biomedical Research Centre Core Biochemistry Assay Lab, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Peter Barker
- NIHR Biomedical Research Centre Core Biochemistry Assay Lab, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Ieuan A Hughes
- Department of Paediatrics, Cambridge Biomedical Campus, Cambridge, UK
| | - Ken K Ong
- Department of Paediatrics, Cambridge Biomedical Campus, Cambridge, UK
- MRC Epidemiology Unit, Cambridge Biomedical Campus, Cambridge, UK
- Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - David B Dunger
- Department of Paediatrics, Cambridge Biomedical Campus, Cambridge, UK
- Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| |
Collapse
|
4
|
Bourne T, Shah H, Falconieri N, Timmerman D, Lees C, Wright A, Lumsden MA, Regan L, Van Calster B. Burnout, well-being and defensive medical practice among obstetricians and gynaecologists in the UK: cross-sectional survey study. BMJ Open 2019; 9:e030968. [PMID: 31767585 PMCID: PMC6887071 DOI: 10.1136/bmjopen-2019-030968] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/06/2019] [Accepted: 10/10/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To determine the prevalence of burnout in doctors practising obstetrics and gynaecology, and assess the association with defensive medical practice and self-reported well-being. DESIGN Nationwide online cross-sectional survey study; December 2017-March 2018. SETTING Hospitals in the UK. PARTICIPANTS 5661 practising obstetrics and gynaecology consultants, specialty and associate specialist doctors and trainees registered with the Royal College of Obstetricians and Gynaecologists. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of burnout using the Maslach Burnout Inventory and defensive medical practice (avoiding cases or procedures, overprescribing, over-referral) using a 12-item questionnaire. The odds ratios (OR) of burnout with defensive medical practice and self-reported well-being. RESULTS 3102/5661 doctors (55%) completed the survey. 3073/3102 (99%) met the inclusion criteria (1462 consultants, 1357 trainees and 254 specialty and associate specialist doctors). 1116/3073 (36%) doctors met the burnout criteria, with levels highest amongst trainees (580/1357 (43%)). 258/1116 (23%) doctors with burnout reported increased defensive practice compared with 142/1957 (7%) without (adjusted OR 4.35, 95% CI 3.46 to 5.49). ORs of burnout with well-being items varied between 1.38 and 6.37, and were highest for anxiety (3.59, 95% CI 3.07 to 4.21), depression (4.05, 95% CI 3.26 to 5.04) and suicidal thoughts (6.37, 95% CI 95% CI 3.95 to 10.7). In multivariable logistic regression, being of younger age, white or 'other' ethnicity, and graduating with a medical degree from the UK or Ireland had the strongest associations with burnout. CONCLUSIONS High levels of burnout were observed in obstetricians and gynaecologists and particularly among trainees. Burnout was associated with both increased defensive medical practice and worse doctor well-being. These findings have implications for the well-being and retention of doctors as well as the quality of patient care, and may help to inform the content of future interventions aimed at preventing burnout and improving patient safety.
Collapse
Affiliation(s)
- Tom Bourne
- Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Harsha Shah
- Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - Nora Falconieri
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Dirk Timmerman
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Christoph Lees
- Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - Alison Wright
- Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK
| | - Mary Ann Lumsden
- Department of Obstetrics and Gynaecology, University of Glasgow, Glasgow, UK
| | - Lesley Regan
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Ben Van Calster
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
| |
Collapse
|
5
|
Yap J, Fox R, Narsia N, Pinheiro-Maia S, Pounds R, Woodman C, Luesley D, Ganesan R, Kehoe S, Dawson C. Under expression of the Sonic Hedgehog receptor, Patched1 (PTCH1), is associated with an increased risk of local recurrence in squamous cell carcinoma of the vulva arising on a background of Lichen Sclerosus. PLoS One 2018; 13:e0206553. [PMID: 30379908 PMCID: PMC6209322 DOI: 10.1371/journal.pone.0206553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Dysregulation of the Hedgehog (Hh) pathway has been described in a variety of cancers, including cervical cancer, a disease which shares a common aetiology with vulval squamous cell carcinoma (VSCC). Here, we investigate a large number of primary VSCC cases for evidence of Hedgehog pathway activation and examine the implications of pathway activity on clinical outcomes in a cohort of patients with primary VSCC. Methods Archival histology blocks containing VSCC and histologically normal adjacent epithelium were retrieved from a cohort of 91 patients who underwent treatment for primary VSCC. Immunohistochemistry staining was undertaken to assess for the expression of key Hh pathway components (SHH, PTCH1, GLI1). A competing risks statistical model was used to evaluate the implications of the levels of key Hh pathway components on clinical outcomes. Results We show that 92% of primary VSCC cases over-expressed one or more components of the Hh signalling pathway when compared to the adjacent normal epithelium. While expression of SHH and GLI1 did not correlate with any clinicopathological criteria, over- or under-expression of PTCH1 was associated with a reduced or increased risk of developing a local disease recurrence, respectively. In VSCC arising on a background of Lichen Sclerosus, the risk of local recurrence was potentiated in cases where PTCH1 was under-expressed. Conclusions Our findings reveal, for the first time, that the Hh pathway is activated in VSCC and that PTCH1 expression can be used as a biomarker to stratify patients and inform clinicians of the risk of their local recurrence, particularly in cases of VSCC associated with LS.
Collapse
Affiliation(s)
- Jason Yap
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, West Midlands, United Kingdom
- * E-mail: (JY); (CD)
| | - Richard Fox
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Natalie Narsia
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
- Department of Clinical and Molecular Pathology & Laboratory of Molecular Pathology, Palacky University, Olomouc, Moravia, Czech Republic
| | - Sonia Pinheiro-Maia
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Rachel Pounds
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Ciaran Woodman
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - David Luesley
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, West Midlands, United Kingdom
| | - Raji Ganesan
- Department of Histopathology, Birmingham Women’s NHS Foundation Trust, Birmingham, West Midlands, United Kingdom
| | - Sean Kehoe
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
- Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham, West Midlands, United Kingdom
| | - Christopher Dawson
- Birmingham Cancer Research UK Cancer Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
- * E-mail: (JY); (CD)
| |
Collapse
|
6
|
Drury JA, Parkin KL, Coyne L, Giuliani E, Fazleabas AT, Hapangama DK. The dynamic changes in the number of uterine natural killer cells are specific to the eutopic but not to the ectopic endometrium in women and in a baboon model of endometriosis. Reprod Biol Endocrinol 2018; 16:67. [PMID: 30021652 PMCID: PMC6052567 DOI: 10.1186/s12958-018-0385-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 07/09/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Endometriosis is a common condition associated with growth of endometrial-like tissue beyond the uterine cavity. Previous reports have suggested a role for uNK cells in the pathogenesis of endometriosis postulating that survival and accumulation of menstrual endometrial tissue in the peritoneal cavity may relate to a reduction in the cytotoxic activity of peripheral blood NK cells. We aimed to assess the differences in percentage of uNK cells and their phenotypical characterization in eutopic and ectopic endometrial samples from women with and without endometriosis and baboons with induced endometriosis. METHODS Eutopic and ectopic endometrial samples from 82 women across the menstrual cycle with/without endometriosis and from 8 baboons before and after induction of endometriosis were examined for CD56 and NKp30 expression with immunohistochemistry, quantified using computer assisted image analysis. Curated secretory phase endometrial microarray datasets were interrogated for NK cell receptors and their ligands. In silico data was validated by examining the secretory phase eutopic endometrium of women with and without endometriosis (n = 8/group) for the immuno-expression of BAG6 protein. RESULTS The percentage of uNK cells increased progressively from the proliferative phase with the highest levels in the late secretory phase in the eutopic endometrium of women with and without endometriosis. The percentage of uNK cells in ectopic lesions remained significantly low throughout the cycle. In baboons, induction of endometriosis increased the percentage of uNK in the ectopic lesions but not NKp30. Published eutopic endometrial microarray datasets demonstrated significant upregulation of NKp30 and its ligand BAG6 in women with endometriosis compared with controls. Immunohistochemical staining scores for BAG6 was also significantly higher in secretory phase eutopic endometrium from women with endometriosis compared with the endometrium of healthy women (n = 8/group). CONCLUSIONS The dynamic increase in the percentage of uNK cells in the secretory phase is preserved in the endometrium of women with endometriosis. The low number of uNK cells in human and baboon ectopic lesions may be due to their exaggerated reduction in hormonal responsiveness (progesterone resistance).
Collapse
Affiliation(s)
- Josephine A. Drury
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kirstin L. Parkin
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI USA
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI USA
| | - Lucy Coyne
- Department of Gynecology, Liverpool Women’s Hospital, Liverpool, UK
- Hewitt Fertility Centre; Liverpool Women’s Hospital, Liverpool, UK
| | - Emma Giuliani
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI USA
- Department of Obstetrics and Gynecology, Grand Rapids Medical Education Partners/Michigan State University, Grand Rapids, MI USA
| | - Asgerally T. Fazleabas
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI USA
| | - Dharani K. Hapangama
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Gynecology, Liverpool Women’s Hospital, Liverpool, UK
| |
Collapse
|
7
|
Cooke WR, Hemmilä UK, Craik AL, Mandula CJ, Mvula P, Msusa A, Dreyer G, Evans R. Incidence, aetiology and outcomes of obstetric-related acute kidney injury in Malawi: a prospective observational study. BMC Nephrol 2018; 19:25. [PMID: 29394890 PMCID: PMC5797378 DOI: 10.1186/s12882-018-0824-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 01/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstetric-related acute kidney injury (AKI) is thought to be a key contributor to the overall burden of AKI in low resource settings, causing significant and preventable morbidity and mortality. However, epidemiological data to corroborate these hypotheses is sparse. This prospective observational study aims to determine the incidence, aetiology and maternal-fetal outcomes of obstetric-related AKI in Malawi. METHODS Women greater than 20 weeks gestation or less than 6 weeks postpartum admitted to obstetric wards at a tertiary hospital in Blantyre, Malawi, and at high-risk of AKI were recruited between 21st September and 11th December 2015. All participants had serum creatinine tested at enrolment; those with creatinine above normal range (> 82 μmol/L) underwent serial measurement, investigations to determine cause of kidney injury, and were managed by obstetric and nephrology teams. AKI was diagnosed and staged by Kidney Disease Improving Global Outcomes (KDIGO) criteria. Primary outcomes were the incidence proportion and aetiology of AKI. Secondary outcomes were in-hospital maternal mortality, need for dialysis, renal recovery and length of stay; in-hospital perinatal mortality, gestational age at delivery, birthweight and Apgar score. RESULTS 354 patients were identified at risk of AKI from the approximate 2300 deliveries that occurred during the study period. Three hundred twenty-two were enrolled and 26 (8.1%) had AKI (median age 27 years; HIV 3.9%). The most common primary causes of AKI were preeclampsia/eclampsia (n = 19, 73.1%), antepartum haemorrhage (n = 3, 11.5%), and sepsis (n = 3, 11.5%). There was an association between preeclampsia spectrum and AKI (12.2% AKI incidence in preeclampsia spectrum vs. 4.3% in other patients, p = 0.015). No women with AKI died or required dialysis and complete renal recovery occurred in 22 (84.6%) cases. The perinatal mortality rate across all high-risk admissions was 13.8%. AKI did not impact on maternal or fetal outcomes. CONCLUSIONS The incidence of AKI in high-risk obstetric admissions in Malawi is 8.1% and preeclampsia was the commonest cause. With tertiary nephrology and obstetric care the majority of AKI resolved with no effect on maternal-fetal outcomes. Maternal-fetal outcomes in Sub-Saharan Africa may be improved with earlier detection of hypertensive disease in pregnancy.
Collapse
Affiliation(s)
- William R. Cooke
- Department of Internal Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Obstetrics and Gynaecology, Royal Berkshire Hospital, Craven Road, Reading, RG1 5AN UK
| | - Ulla K. Hemmilä
- Department of Internal Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Alison L. Craik
- Department of Internal Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Chimwemwe J. Mandula
- Department of Internal Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Priscilla Mvula
- Department of Obstetrics and Gynaecology, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Ausbert Msusa
- Department of Obstetrics and Gynaecology, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Gavin Dreyer
- Department of Nephrology, Bart’s Health NHS Trust, London, UK
| | - Rhys Evans
- Department of Internal Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
- University College London Centre for Nephrology, Royal Free Hospital, Pond Street, London, NW3 2QG UK
| |
Collapse
|
8
|
Prior M, Bagness C, Brewin J, Coomarasamy A, Easthope L, Hepworth-Jones B, Hinshaw K, O'Toole E, Orford J, Regan L, Raine-Fenning N, Shakespeare J, Small R, Thornton J, Metcalf L. Priorities for research in miscarriage: a priority setting partnership between people affected by miscarriage and professionals following the James Lind Alliance methodology. BMJ Open 2017; 7:e016571. [PMID: 28838896 PMCID: PMC5629698 DOI: 10.1136/bmjopen-2017-016571] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To identify and prioritise important research questions for miscarriage. DESIGN A priority setting partnership using prospective surveys and consensus meetings following methods advocated by the James Lind Alliance. SETTING UK. PARTICIPANTS Women and those affected by miscarriage working alongside healthcare professionals. RESULTS In the initial survey, 1093 participants (932 women who have experienced miscarriage, 8 partners, 17 family members, friends or colleagues, 104 healthcare professionals and eight charitable organisations) submitted 3279 questions. A review of existing literature identified a further 64. Non-questions were removed, and the remaining questions were categorised and summarised into 58 questions. In an interim electronic survey, 2122 respondents chose their top 10 priorities from the 58 summary questions. The 25 highest ranked in the survey were prioritised at a final face-to-face workshop. In summary, the top 10 priorities were ranked as follows: research into preventative treatment, emotional aspects in general, investigation, relevance of pre-existing medical conditions, emotional support as a treatment, importance of lifestyle factors, importance of genetic and chromosomal causes, preconception tests, investigation after different numbers of miscarriage and male causal factors. CONCLUSIONS These results should be the focus of future miscarriage research. Presently, studies are being conducted to address the top priority; however, many other priorities, especially psychological and emotional support, are less well researched areas. We hope our results will encourage both researchers and funders to focus on these priorities.
Collapse
Affiliation(s)
- Matthew Prior
- Department of Child Health Obstetrics and Gynaecology, University of Nottingham, Nottingham, UK
| | | | | | - Arri Coomarasamy
- School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, UK
| | - Lucy Easthope
- University of Lincoln Law School, Lincoln, Lincolnshire, UK
| | | | - Kim Hinshaw
- Department of Obstetrician and Gynaecologist, Sunderland Royal Hospital, Sunderland, UK
| | - Emily O'Toole
- Royal College of Obstetricians and Gynaecologists Women's Voices Involvement Panel, London, UK
| | - Julie Orford
- Royal College of Obstetricians and Gynaecologists Women's Voices Involvement Panel, London, UK
| | - Lesley Regan
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Nick Raine-Fenning
- Division of Obstetrics & Gynaecology, School of Clinical Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | | | - Rachel Small
- Department of Gynaecology, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - Leanne Metcalf
- The James Lind Alliance, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, Southampton, UK
| |
Collapse
|
9
|
Shabazz T, Parry-Smith W, Oates S, Henderson S, Mountfield J. Consultants as victims of bullying and undermining: a survey of Royal College of Obstetricians and Gynaecologists consultant experiences. BMJ Open 2016; 6:e011462. [PMID: 27324715 PMCID: PMC4916587 DOI: 10.1136/bmjopen-2016-011462] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/22/2016] [Accepted: 05/26/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To explore incidents of bullying and undermining among obstetrics and gynaecology (O&G) consultants in the UK, to add another dimension to previous research and assist in providing a more holistic understanding of the problem in medicine. DESIGN Questionnaire survey. SETTING Royal College of Obstetricians and Gynaecologists (RCOG). PARTICIPANTS O&G consultant members/fellows of the RCOG working in the UK. MAIN OUTCOME MEASURES Measures included a typology of 4 bullying and undermining consequences from major to coping. RESULTS There was a 28% (664) response rate of whom 44% (229) responded that they had been persistently bullied or undermined. Victims responded that bullying and undermining is carried out by those senior or at least close in the hierarchy. Of the 278 consultants who answered the question on 'frequency of occurrence', 50% stated that bullying and undermining occurs on half, or more, of all encounters with perpetrators and two-thirds reported that it had lasted more than 3 years. The reported impact on professional and personal life spans a wide spectrum from suicidal ideation, depression and sleep disturbance, and a loss of confidence. Over half reported problems that could compromise patient care. When victims were asked if the problem was being addressed, 73% of those that responded stated that it was not. CONCLUSIONS Significant numbers of consultants in O&G in the UK are victims of bullying and undermining behaviour that puts their own health and patient care at risk. New interventions to tackle the problem, rather than its consequences, are required urgently, together with greater commitment to supporting such interventions.
Collapse
Affiliation(s)
- Tariq Shabazz
- Royal College of Obstetricians and Gynaecologists, London, UK
| | | | - Sharon Oates
- RCOG Workplace Behaviour Champion, Shrewsbury and Telford Hospitals Trust, Princess Royal Hospital, Telford, UK
| | - Steven Henderson
- Head of Impact and Social Innovation, Southampton Solent University, Southampton, Hampshire, UK
| | | |
Collapse
|