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1. A review of the open laparoscopic Hasson technique and retrieval of adnexal specimen via umbilicus

Author

B. Anglim, N. A. Wahab, Noreen Gleeson, and L. F. A. Wong

Subjects
Adult, medicine.medical_specialty, Adolescent, Umbilicus (mollusc), Postoperative pain, Young Adult, 03 medical and health sciences, Laparoscopy procedure, Gynecologic Surgical Procedures, 0302 clinical medicine, medicine, Humans, In patient, 030212 general & internal medicine, Laparoscopy, Veress needle, Aged, Retrospective Studies, Ultrasonography, Ovarian Neoplasms, Pain, Postoperative, 030219 obstetrics & reproductive medicine, Umbilicus, medicine.diagnostic_test, business.industry, Obstetrics and Gynecology, Middle Aged, University hospital, Surgery, Adnexal Diseases, Female, business
Abstract

Laparoscopic entry techniques vary amongst surgeons and gynaecologists, with gynaecologists favouring Veress needle entry. Recent RCOG/BSGE recommendations have recommended retrieval of ovarian masses via the umbilical port with resultant less postoperative pain and a faster retrieval time than with retrieval through lateral ports of the same size. This is a prospective observational study reviewing the Hasson entry technique and the introduction of retrieval of specimens via the umbilicus in patients scheduled for a laparoscopy procedure at our day surgery unit. We found no immediate or major surgical complications and all specimens were successfully retrieved through the umbilicus. Pain scores were low. We recommend the technique for extirpative gynaecological surgery. Impact Statement This study confirms that conversion from the closed Veress to the open Hasson technique is achievable in a university hospital setting. Operator confidence during the learning phase is enhanced by the use of ultrasound to locate and measure the depth of the umbilical ligament. Retrieval of benign adnexal specimens through the umbilicus was very satisfactory.

Published
2017
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2. Prevena™, negative pressure wound therapy applied to closed Pfannenstiel incisions at time of caesarean section in patients deemed at high risk for wound infection

Author

B Anglim, H O'Connor, and S Daly

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, Wound Breakdown, Dehiscence, Pregnancy, Risk Factors, Negative-pressure wound therapy, Surgical Wound Dehiscence, Humans, Surgical Wound Infection, Medicine, In patient, Caesarean section, Retrospective Studies, integumentary system, Cesarean Section, business.industry, Obstetrics and Gynecology, Abdominal Wound Closure Techniques, Retrospective cohort study, Wound infection, Obesity, Morbid, Surgery, Anesthesia, Female, business, Elective caesarean, Negative-Pressure Wound Therapy
Abstract

The aim of our retrospective study is to report on our experience using the Prevena™ wound system in obese patients undergoing caesarean section delivery. A total of 26 cases were identified from July 2012 to October 2013. The median BMI of these women was 45.3 kg/m(2). Elective caesarean sections were performed in 20 women (77%). There were four cases (15%) of superficial dehiscence. Factors associated with wound breakdown were wound infection (p = 0.03), increasing BMI (p < 0.001) and emergency LSCS (p = 0.04). In a logistic regression model the presence of infection was the only factor which remained associated with wound breakdown. Wound disruption is a major cause of morbidity following caesarean section in morbidly obese patients. The wound complication rate in our experience was low with the Prevena™ dressing with no cases of sheath dehiscence, and no patient required a second operation. The presence of infection is the most important factor in wound breakdown and should be the focus for management protocols.

Published
2014
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3. Reproductive endocrinology

Author

A. Nazzaro, A. Salerno, L. Di Iorio, G. Landino, S. Marino, E. Pastore, F. Fabregues, A. Iraola, G. Casals, M. Creus, S. Peralta, J. Penarrubia, D. Manau, S. Civico, J. Balasch, I. Lindgren, Y. L. Giwercman, E. Celik, I. Turkcuoglu, B. Ata, A. Karaer, P. Kirici, B. Berker, J. Park, J. Kim, J. Rhee, M. Krishnan, O. Rustamov, R. Russel, C. Fitzgerald, S. Roberts, S. Hapuarachi, B. K. Tan, R. S. Mathur, A. van de Vijver, C. Blockeel, M. Camus, N. Polyzos, L. Van Landuyt, H. Tournaye, N. O. Turhan, D. Hizli, Z. Kamalak, A. Kosus, N. Kosus, H. Kafali, A. Lukaszuk, M. Kunicki, J. Liss, A. Bednarowska, G. Jakiel, K. Lukaszuk, M. Lukaszuk, B. Olszak-Sokolowska, T. Wasniewski, M. Neuberg, V. Cavalcanti, C. Peluso, B. L. Lechado, E. B. Cordts, D. M. Christofolini, C. P. Barbosa, B. Bianco, C. A. Venetis, E. M. Kolibianakis, J. Bosdou, B. C. Tarlatzis, M. Onal, D. N. Gungor, M. Acet, S. Kahraman, E. Kuijper, J. Twisk, M. Caanen, T. Korsen, P. Hompes, M. Kushnir, A. Rockwood, W. Meikle, C. B. Lambalk, X. Yan, X. Dai, J. Wang, N. Zhao, Y. Cui, J. Liu, F. Yarde, A. H. E. M. Maas, A. Franx, M. J. C. Eijkemans, J. T. Drost, B. B. van Rijn, J. van Eyck, Y. T. van der Schouw, F. J. M. Broekmans, F. Martyn, B. Anglim, M. Wingfield, T. Fang, G. J. Yan, H. X. Sun, Y. L. Hu, J. Chrudimska, P. Krenkova, M. Macek, J. Teixeira da Silva, M. Cunha, J. Silva, P. Viana, A. Goncalves, N. Barros, C. Oliveira, M. Sousa, A. Barros, S. M. Nelson, S. M. Lloyd, A. McConnachie, A. Khader, R. Fleming, D. A. Lawlor, L. Thuesen, A. N. Andersen, A. Loft, J. Smitz, M. Abdel-Rahman, S. Ismail, J. Silk, M. Abdellah, A. H. Abdellah, F. Ruiz, M. Cruz, M. Piro, D. Collado, J. A. Garcia-Velasco, A. Requena, Z. Kollmann, N. A. Bersinger, B. McKinnon, S. Schneider, M. D. Mueller, M. von Wolff, A. Vaucher, B. Weiss, P. Stute, U. Marti, J. Chai, W. Y. T. Yeung, C. Y. V. Lee, W. H. R. Li, P. C. Ho, H. Y. E. Ng, S. M. Kim, S. H. Kim, B. C. Jee, S. Ku, C. S. Suh, Y. M. Choi, J. G. Kim, S. Y. Moon, J. H. Lee, S. G. Kim, Y. Y. Kim, H. J. Kim, K. H. Lee, I. H. Park, H. G. Sun, Y. I. Hwang, N. Y. Sung, M. H. Choi, S. H. Cha, C. W. Park, J. Y. Kim, K. M. Yang, I. O. Song, M. K. Koong, I. S. Kang, H. O. Kim, C. Haines, W. Y. Wong, W. S. Kong, L. P. Cheung, T. K. Choy, P. C. Leung, R. Fadini, G. Coticchio, M. M. Renzini, M. C. Guglielmo, F. Brambillasca, A. Hourvitz, D. F. Albertini, P. Novara, M. Merola, M. Dal Canto, J. A. A. Iza, J. L. DePablo, C. Anarte, A. Domingo, E. Abanto, G. Barrenetxea, R. Kato, S. Kawachiya, D. Bodri, M. Kondo, T. Matsumoto, L. G. L. Maldonado, A. S. Setti, D. P. A. F. Braga, A. Iaconelli, E. Borges, C. Iaconelli, R. C. S. Figueira, K. Kitaya, S. Taguchi, M. Funabiki, Y. Tada, T. Hayashi, Y. Nakamura, M. Snajderova, D. Zemkova, V. Lanska, L. Teslik, R. N. - Calonge, L. Ortega, A. Garcia, S. Cortes, A. Guijarro, P. C. Peregrin, M. Bellavia, M. H. Pesant, D. Wirthner, L. Portman, D. de Ziegler, D. Wunder, X. Chen, S. H. L. Chen, Y. D. Liu, T. Tao, L. J. Xu, X. L. Tian, D. S. H. Ye, Y. X. He, A. Carby, E. Barsoum, S. El-Shawarby, G. Trew, S. Lavery, N. Mishieva, N. Barkalina, I. Korneeva, T. Ivanets, A. Abubakirov, R. Chavoshinejad, G. m. Hartshorne, W. Marei, A. a. Fouladi-nashta, G. Kyrkou, E. Trakakis, C. H. Chrelias, E. Alexiou, K. Lykeridou, G. Mastorakos, N. Bersinger, H. Ferrero, R. Gomez, C. M. Garcia-Pascual, C. Simon, A. Pellicer, A. Turienzo, B. Lledo, J. Guerrero, J. A. Ortiz, R. Morales, J. Ten, J. Llacer, R. Bernabeu, V. De Leo, R. Focarelli, A. Capaldo, A. Stendardi, L. Gambera, A. L. Marca, P. Piomboni, J. J. Kim, J. H. Kang, K. R. Hwang, S. J. Chae, S. H. Yoon, S. Y. Ku, S. Iliodromiti, T. W. Kelsey, R. A. Anderson, H. J. Lee, A. Weghofer, V. A. Kushnir, A. Shohat-Tal, E. Lazzaroni, D. H. Barad, N. N. Gleicher, T. Shavit, E. Shalom-Paz, O. Fainaru, M. Michaeli, E. Kartchovsky, A. Ellenbogen, J. Gerris, F. Vandekerckhove, A. Delvigne, N. Dhont, B. Madoc, J. Neyskens, M. Buyle, E. Vansteenkiste, E. De Schepper, L. Pil, N. Van Keirsbilck, W. Verpoest, D. Debacquer, L. Annemans, P. De Sutter, M. Von Wolff, N. a. Bersinger, F. F. Verit, S. Keskin, A. K. Sargin, S. Karahuseyinoglu, O. Yucel, S. Yalcinkaya, A. N. Comninos, C. N. Jayasena, G. M. K. Nijher, A. Abbara, A. De Silva, J. D. Veldhuis, R. Ratnasabapathy, C. Izzi-Engbeaya, A. Lim, D. A. Patel, M. A. Ghatei, S. R. Bloom, W. S. Dhillo, M. Colodron, J. J. Guillen, D. Garcia, O. Coll, R. Vassena, V. Vernaeve, H. Pazoki, G. Bolouri, F. Farokhi, M. A. Azarbayjani, M. S. Alebic, N. Stojanovic, R. Abali, A. Yuksel, C. Aktas, C. Celik, S. Guzel, G. Erfan, O. Sahin, H. Zhongying, L. Shangwei, M. Qianhong, F. Wei, L. Lei, X. Zhun, W. Yan, A. De Baerdemaeker, K. Tilleman, S. Vansteelandt, J. B. A. Oliveira, R. L. R. Baruffi, C. G. Petersen, A. L. Mauri, A. M. Nascimento, L. Vagnini, J. Ricci, M. Cavagna, F. C. Massaro, A. Pontes, J. G. Franco, W. El-khayat, M. Elsadek, F. Foroozanfard, H. Saberi, A. Moravvegi, M. Kazemi, Y. S. Gidoni, A. Raziel, S. Friedler, D. Strassburger, D. Hadari, E. Kasterstein, I. Ben-Ami, D. Komarovsky, B. Maslansky, O. Bern, R. Ron-El, M. P. Izquierdo, F. Araico, O. Somova, O. Feskov, I. Feskova, I. Bezpechnaya, I. Zhylkova, O. Tishchenko, S. K. Oguic, D. P. Baldani, L. Skrgatic, V. Simunic, H. Vrcic, D. Rogic, J. Juras, M. S. Goldstein, L. Garcia De Miguel, M. C. Campo, A. Gurria, J. Alonso, A. Serrano, E. Marban, L. Shalev, Y. Yung, G. Yerushalmi, C. Giovanni, J. Has, E. Maman, M. Monterde, A. Marzal, O. Vega, J. m. Rubio, C. Diaz-Garcia, A. Eapen, A. Datta, A. Kurinchi-selvan, H. Birch, G. M. Lockwood, M. C. Ornek, U. Ates, T. Usta, C. P. Goksedef, A. Bruszczynska, J. Glowacka, K. Jaguszewska, S. Oehninger, S. Nelson, P. Verweij, B. Stegmann, H. Ando, T. Takayanagi, H. Minamoto, N. Suzuki, N. Rubinshtein, S. Saltek, B. Demir, B. Dilbaz, C. Demirtas, W. Kutteh, B. Shapiro, H. Witjes, K. Gordon, M. P. Lauritsen, A. Pinborg, N. L. Freiesleben, A. L. Mikkelsen, M. R. Bjerge, P. Chakraborty, S. K. Goswami, B. N. Chakravarty, M. Mittal, R. Bajoria, N. Narvekar, R. Chatterjee, J. G. Bentzen, T. H. Johannsen, T. Scheike, L. Friis-Hansen, S. Sunkara, A. Coomarasamy, R. Faris, P. Braude, Y. Khalaf, A. Makedos, S. Masouridou, K. Chatzimeletiou, L. Zepiridis, A. Mitsoli, G. Lainas, I. Sfontouris, A. Tzamtzoglou, D. Kyrou, T. Lainas, A. Fermin, L. Crisol, A. Exposito, B. Prieto, R. Mendoza, R. Matorras, Y. Louwers, O. Lao, M. Kayser, A. Palumbo, V. Sanabria, J. P. Rouleau, M. Puopolo, M. J. Hernandez, J. M. Rubio, S. Ozturk, B. Sozen, A. Yaba-Ucar, D. Mutlu, N. Demir, H. Olsson, R. Sandstrom, L. Grundemar, E. Papaleo, L. Corti, E. Rabellotti, V. S. Vanni, M. Potenza, M. Molgora, P. Vigano, M. Candiani, M. Fernandez-Sanchez, E. Bosch, H. Visnova, P. Barri, B. J. C. M. Fauser, J. C. Arce, P. Peluso, C. M. Trevisan, F. A. Fonseca, P. Bakas, N. Vlahos, D. Hassiakos, D. Tzanakaki, O. Gregoriou, A. Liapis, G. Creatsas, E. Adda-Herzog, J. Steffann, S. Sebag-Peyrelevade, M. Poulain, A. Benachi, R. Fanchin, D. Zhang, F. Aybar, S. Temel, O. Hamdine, N. S. Macklon, J. S. Laven, B. J. Cohlen, A. Verhoeff, P. A. van Dop, R. E. Bernardus, G. J. E. Oosterhuis, C. A. G. Holleboom, G. C. van den Dool-Maasland, H. J. Verburg, P. F. M. van der Heijden, A. Blankhart, B. C. J. M. Fauser, F. J. Broekmans, J. Bhattacharya, A. Mitra, G. B. Dutta, A. Kundu, M. Bhattacharya, S. Kundu, P. Pigny, A. Dassonneville, S. Catteau-Jonard, C. Decanter, D. Dewailly, J. Pouly, F. Olivennes, N. Massin, M. Celle, N. Caizergues, M. Gaudoin, M. Messow, L. Vanhove, M. Peigne, P. Thomas, and G. Robin

Subjects
Gynecology, Gerontology, medicine.medical_specialty, Index (economics), Reproductive Medicine, business.industry, Rehabilitation, Obstetrics and Gynecology, Medicine, Stimulation, business
Abstract

Sao Paulo State Univ UNESP, Ctr Human Reprod Prof Franco Jr, Paulista Ctr Diag Res & Training, Dept Gynecol & Obstet,Botucatu Med Sch, Ribeirao Preto, Brazil

Published
2013
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4. Maternal Obesity and Neck Circumference

Author

B, Anglim, A, O'Higgins, N, Daly, M, Farren, and M J, Turner

Subjects
Adult, Pregnancy Complications, Young Adult, Pregnancy, Body Size, Humans, Female, Obesity, Neck
Abstract

Obese women are more likely to require general anaesthesia for an obstetric intervention than non-obese. Difficult tracheal intubation and oxygen desaturation is more common in pregnancy. Failed tracheal intubation has been associated with an increase in neck circumference (NC). We studied the relationship between maternal obesity and NC as pregnancy advanced in women attending a standard antenatal clinic. Of the 96 women recruited, 13.5% were obese. The mean NC was 36.8cm (SD 1.9) in the obese women compared with 31.5cm (SD 1.6) in women with a normal BMI (p0.001) at 18-22 weeks gestation. In the obese women it increased on average by 1.5cm by 36-40 weeks compared with an increase of 1.6 cm in women with a normal BMI. The antenatal measurement of NC is a simple, inexpensive tool that is potentially useful for screening obese women who may benefit from an antenatal anaesthetic assessment.

Published
2015

5. Body mass index and hypertensive disorders of pregnancy

Author

Vicky O'Dwyer, Michael J. Turner, Nadine Farah, B. Anglim, B Stuart, and Jennifer Hogan

Subjects
Gestational hypertension, medicine.medical_specialty, Pregnancy, Obstetrics, business.industry, Confounding, Outcome measures, Obstetrics and Gynecology, medicine.disease, Obesity, Internal Medicine, medicine, Observational study, business, Parity (mathematics), Body mass index
Abstract

We compared the incidence of the hypertensive disorders of pregnancy in obese women with women of a normal body mass index (BMI).Prospective observational study in which BMI was calculated accurately early in pregnancy. Women were enrolled after a sonographic confirmation of an ongoing pregnancy. To reduce confounding variables the study was confined to white European women with a singleton pregnancy.Incidence of pre-eclampsia and gestational hypertension.In 2230 women, 16.8% were obese. Pre-eclampsia was diagnosed in 3.3% (n=74) and gestational hypertension in 3.0% (n=67). Both pre-eclampsia (p=0.01) and gestational hypertension (p0.01) were common in obese women compared with normal weight women. Overall 13.1% of obese women developed a hypertensive disorder during pregnancy. When analysed by parity pre-eclampsia occurred in 2.1% of primigravidas and 0.3% of multigravidas. Pre-eclampsia was increased in obese multigravidas (p=0.001), but not obese primigravidas, suggesting that parity is more influential than obesity in the development of pre-eclampsia.Obese multigravidas are more likely to develop hypertensive disorders in pregnancy and obese primigravidas are more likely to develop gestational hypertension. This is important in clinical practice because maternal weight, unlike parity, is potentially modifiable before or during pregnancy.

Published
2011

6. Incidence of pre-eclampsia analysed by body mass index category and parity

Author

Nadine Farah, Jennifer Hogan, Mairead Kennelly, C. Fattah, Michael J. Turner, B. Anglim, Vicky O'Dwyer, and S O'Kelly

Subjects
Gynecology, medicine.medical_specialty, Pregnancy, Eclampsia, business.industry, Hypertension in Pregnancy, Obstetrics and Gynecology, General Medicine, medicine.disease, Obesity, Blood pressure, Pediatrics, Perinatology and Child Health, Gestation, Medicine, business, Parity (mathematics), Body mass index
Abstract

Background Hypertension in pregnancy is an important cause of pregnancy complications for both mother and baby in about 8% of pregnancies. Epidemiological reviews have reported an association between pre-eclampsia and maternal obesity, based on a body mass index (BMI) > 29.9 kg/m2. However, BMI measurements were usually based on self-reporting of maternal weight and height which has been shown to be inaccurate, particularly in pregnancy and in obese women. The purpose of this prospective cross-sectional study was to compare the incidence of pre-eclampsia in the different WHO BMI categories in both primigravidas and multigravidas. Methods Women were recruited at their convenience in the first trimester. Height and weight were measured digitally and BMI calculated. Pre-eclampsia was defined as hypertension (a systolic blood pressure of ≥140 mm Hg and/or a diastolic blood pressure of ≥90 mm Hg) measured on at least two separate occasions at least 6 h apart with proteinuria (≥300 mg over 24 h) after 20 weeks. Results Of the 2230 women, the mean age was 28.2 years and mean parity was 1.0. The mean gestation at recruitment was 11.2 weeks and the mean BMI was 25.6 kg/m2. The incidence of obesity was 17.4%. The incidence of pre-eclampsia analysed by BMI category is show in table 1. In both primigravidas and multigravidas, there was no increase in pre-eclampsia with obesity (p=0.23, p=0.07). Conclusions When maternal BMI is calculated accurately in early pregnancy, contrary to previous reports, there is no association between maternal obesity and pre-eclampsia.

Published
2011
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