15 results on '"Jennifer Pontré"'
Search Results
2. ‘My devil womb’: Patients’ perspectives on, and understanding of, endometriosis: An observational cross-sectional study
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Nadine Chilton, Sarah van Oudtshoorn, Jennifer Pontré, Krishnan Karthigasu, and Bernadette McElhinney
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03 medical and health sciences ,030219 obstetrics & reproductive medicine ,0302 clinical medicine ,030212 general & internal medicine - Abstract
Objective: To gain insight into patients’ understanding of endometriosis, utilised sources of information on endometriosis and perceptions of available treatment options. Design: Observational cross-sectional study. Setting: Data were collected from an outpatient specialist endometriosis clinic within a tertiary hospital. Participants: New patients referred with symptoms suggestive of endometriosis. Methods: A paper based questionnaire was completed by new patients on their first presentation to the clinic. Main outcome measures: Patient understanding of symptoms and causes of endometriosis, types and expectations of treatment, and sources of information utilised by patients in researching endometriosis. Results: Approximately half of all included patients were unsure of the aetiology of endometriosis. Patients who relied on information from specialist gynaecologists were more optimistic about the outcome of surgical treatment, while those who relied on general practitioners were more optimistic about the outcome of medical treatment, when compared to those who sought information from online sources. Conclusions: Endometriosis is a chronic and debilitating condition, yet there is limited data available regarding both the sources of information that patients’ access, and their perceptions of the disease. Given the high proportion of patients in our study who lacked knowledge of endometriosis, and the negative correlation between the use of social media for information and perception of treatment, there is a clear need for improved access to evidence-based resources for patient education. more...
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- 2021
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3. Interposition of a biological mesh may not affect the rate of rectovaginal fistula after excision of large rectovaginal endometriotic nodules: a pilot study of 209 patients
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Clemence Klapczynski, Jennifer Pontré, Haitham Khalil, Clotilde Hennetier, Horace Roman, Sophia Braund, Jean-Jacques Tuech, and Valérie Bridoux
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medicine.medical_specialty ,biological mesh ,Permacol ,deep endometriosis ,Endometriosis ,Pilot Projects ,medicine ,Humans ,In patient ,Retrospective Studies ,business.industry ,Deep endometriosis ,rectovaginal endometriosis ,Gastroenterology ,Rectovaginal Fistula ,rectovaginal fistula ,Surgical Mesh ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Rectal Diseases ,Treatment Outcome ,Rectovaginal fistula ,Staple line ,Anal verge ,Vagina ,Female ,business - Abstract
Aim: The aim of this work was to assess whether placement of a biological mesh (Permacol®) between the vaginal and rectal sutures reduces the rate of rectovaginal fistula in patients with deep rectovaginal endometriosis. Method: We report a retrospective, comparative study enrolling patients with vaginal infiltration of more than 3 cm in diameter and rectal involvement in two centres. They benefited from complete excision of rectovaginal endometriotic nodules with or without a biological mesh placed between the vaginal and rectal sutures. The rate of rectovaginal fistula was compared between the two groups. Results: Two hundred and nine patients were enrolled: 42 patients underwent interposition of biological mesh (cases) and 167 did not (controls). Ninety-two per cent of cases and 86.2% of controls had rectal infiltration more than 3 cm in diameter. Cases underwent rectal disc excision more frequently (64.3% vs. 49.1%) and had a smaller distance between the rectal staple line and the anal verge (4.4 ± 1.4 cm vs. 6 ± 2.9 cm). Rectovaginal fistulas occurred in 4 cases (9.5%) and 12 controls (7.2%). Logistic regression analyses revealed no difference in the rate of rectovaginal fistula following the use of mesh (adjusted OR 1.6, 95% CI 0.3–9.5). A distance of less than 7 cm between the rectal staple line and the anal verge was found to be an independent risk factor for the development of rectovaginal fistula (adjusted OR 15.1, 95% CI 1.7–132). Conclusion: Our results suggest that the placement of a biological mesh between the vagina and rectal sutures may not affect the rate of formation of postoperative rectovaginal fistula following excision of deep infiltrating rectovaginal endometriosis. more...
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- 2021
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4. Combined vaginal-laparoscopic approach vs. laparoscopy alone for prevention of bladder voiding dysfunction after removal of large rectovaginal endometriosis
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J.-N. Cornu, Jennifer Pontré, C. Klapczynski, Horace Roman, C. Hennetier, E. Desnyder, Jean-Jacques Tuech, P. Collard, Clinique Tivoli Ducos [Bordeaux], Aarhus University Hospital, Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis = Le Centre expert de diagnostic et de prise en charge multidisciplinaire de l’endométriose de Rouen, King-Edward Memorial Hospital, Perth, Australia., Clinique Saint-Hilaire [Rouen], Service d'urologie [Rouen], Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU), Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau (ADEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Normandie Université (NU)-Normandie Université (NU), Service de chirurgie digestive [CHU Rouen], CHU Rouen, and Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN) more...
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medicine.medical_specialty ,Incomplete bladder emptying ,Urinary Bladder ,Endometriosis ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Cohort Studies ,03 medical and health sciences ,Postoperative complications ,0302 clinical medicine ,Bladder atony ,medicine ,Humans ,In patient ,Vaginal approach ,BLADDER ATONY ,Laparoscopy ,ComputingMilieux_MISCELLANEOUS ,Retrospective Studies ,Deeply infiltrating endometriosis ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Surgery ,Rectal Diseases ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Abnormal results ,business ,Bladder dysfunction ,Pelvic splanchnic nerve ,Cohort study - Abstract
Summary Study objective To assess whether the combined vaginal-laparoscopic route may reduce the risk of postoperative bladder atony, when compared to an exclusively laparoscopic approach, in patients presenting with deeply infiltrating rectovaginal endometriosis with extensive vaginal infiltration. Design Retrospective comparative cohort study using data prospectively recorded in the CIRENDO database. Setting Academic Tertiary Care Centre. Patients One hundred and thirty-two consecutive patients who underwent surgery of rectovaginal endometriosis with vaginal infiltration measuring greater than 3 cm diameter. Interventions Combined vaginal-laparoscopic versus laparoscopic approach. Measurement and main results Sixty-two patients underwent excision of endometriosis via a combined vaginal-laparoscopic approach (study group, or cases), while 71 patients underwent surgery via an exclusively laparoscopic route (controls). Rates of preoperative cyclical voiding difficulty and sensation of incomplete bladder emptying were comparable between the two groups. Preoperative urodynamic assessment was carried out in 18% of cases and 38% of controls, with abnormal results in 27.3% and 11.1% of cases and controls respectively. Early postoperative voiding difficulty (post-void residual > 100 mL) occurred in 14.7% and 24.3% of cases and controls respectively. There was a significant reduction in risk of intermittent self-catheterisation of 13% at time of discharge in the study cases. Three months postoperatively, one case and 6 controls had persistent voiding dysfunction requiring prolonged self-catheterisation. Conclusion The combined vaginal-laparoscopic approach for large rectovaginal endometriotic nodules could reduce the risk of postoperative bladder dysfunction, when compared to an exclusively laparoscopic approach, most likely due to a reduced risk of damage to the pelvic splanchnic nerves at the paravaginal level. more...
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- 2021
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5. The Early Life Influences on Male Reproductive Health
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Jennifer Pontré and Roger Hart
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business.industry ,InformationSystems_INFORMATIONSTORAGEANDRETRIEVAL ,Medicine ,business ,GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries) ,Early life ,Reproductive health ,Demography - Published
- 2020
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6. The interval transfer of a frozen-thawed embryo is more successful than a fresh embryo transfer for women undergoing IVF with recurrent implantation failure after cleavage stage embryo biopsy
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Jennifer Pontré, Andy Tan, Roger Hart, and John P. Ryan
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Adult ,Male ,0301 basic medicine ,medicine.medical_treatment ,Fertilization in Vitro ,Human chorionic gonadotropin ,Andrology ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Pregnancy ,Biopsy ,medicine ,Humans ,Embryo Implantation ,Genetic Testing ,Blastocyst ,Retrospective Studies ,Cryopreservation ,030219 obstetrics & reproductive medicine ,In vitro fertilisation ,medicine.diagnostic_test ,business.industry ,Pregnancy Outcome ,Obstetrics and Gynecology ,Embryo ,General Medicine ,Blastomere ,Embryo Transfer ,Embryo transfer ,030104 developmental biology ,medicine.anatomical_structure ,Female ,business ,Live birth ,Biomarkers - Abstract
Background Recurrent implantation failure (RIF) is repeated unsuccessful embryo transfers (ETs). Aims To identify predictive embryonic markers of implantation in RIF, following pre-implantation genetic screening (PGS) of cleavage stage embryos, after accounting for male and female factors. Materials and methods Retrospective analysis of RIF patients undergoing PGS after correction of modifiable causes. Results Eighty-four patients underwent 140 in vitro ferilisation cycles. Forty-one cycles were excluded: 12 (no embryo for transfer), four (double ETs) and 25 (no biopsy). Sixty-three patients underwent 99 single euploid ETs (48 fresh, 51 frozen) resulting in 11 biochemical pregnancies, 36 clinical pregnancies (CP), and six miscarriages and 30 live births (LB). Frozen ET was more successful than fresh; respective live birth rate (LBR) and clinical pregnancy rate (CPR), 39.2% versus 20.8%, (P = 0.02), 45.1% versus 27.1% (P = 0.04). LBR and CPR were lower when 5-6 blastomeres were present at embryo biopsy, compared to embryos with ≥7 blastomeres: 15.4% versus 32.6% (P = 0.185) and 15.4% versus 39.5% (P = 0.074) respectively. Serum β human chorionic gonadotropin (βhCG) concentration was greater when a more developed embryo was biopsied (r = 0.448, P = 0.017 and r = 0.476, P = 0.118, fresh and frozen transfers, respectively). Embryo morphokinetic analysis demonstrated faster development to blastocyst stage when more cells were present at biopsy: mean 103.3, 102.2 and 96.0 h for biopsy at the 5-6, 7-8 or ≥9 cell stage respectively (P = 0.040 for difference between 7-8 cells vs ≥9). Conclusions After cleavage stage biopsy, frozen ET was more successful than fresh ET. Chance of conception and serum βhCG concentration correlated with number of cells present at time of biopsy. more...
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- 2018
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7. Case report and surgical video presentation: Combined laparoscopic and cystoscopic partial bladder cystectomy for excision of deeply infiltrating endometriosis
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Bernadette Brown, Krishnan Karthigasu, Jessica M.A. Yin, Bernadette McElhinney, and Jennifer Pontré
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medicine.medical_specialty ,medicine.medical_treatment ,Endometriosis ,Cystectomy ,03 medical and health sciences ,0302 clinical medicine ,Case report ,medicine ,Dysuria ,Laparoscopy ,Deeply infiltrating endometriosis ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,Medical treatment ,business.industry ,Cystoscopy ,General Medicine ,Institutional review board ,medicine.disease ,Surgery ,030220 oncology & carcinogenesis ,Presentation (obstetrics) ,medicine.symptom ,business - Abstract
Introduction Whilst endometriosis is a relatively common condition, deeply infiltrating endometriosis (DIE) of the bladder is less so, and when medical treatment fails, surgical management is an effective option. We present a case report and surgical video of a patient undergoing combined laparoscopic and cystoscopic excision of deeply infiltrating endometriosis of the bladder. Design Case report (Canadian Task Force Classification III) and step-by-step explanation of the surgery using video. Exemption was granted from the local institutional review board. Presentation of case We present a case report and surgical video of a 36-year-old nulliparous patient presenting with a 12-month history of sudden onset cyclical dysuria and haematuria. Imaging demonstrated a deeply infiltrating endometriotic nodule involving the bladder. The patient underwent a combined laparoscopic and cystoscopic excision of deeply infiltrating endometriosis of the bladder. The procedure was uneventful and the patient progressed to a full recovery. Discussion DIE is a highly invasive form of endometriosis which is defined arbitrarily as endometriosis infiltrating beneath the peritoneum by 5mm or greater. When medical therapy is declined or fails, surgical excision by partial cystectomy would appear to be the most effective management option. A combination of cystoscopy and laparoscopy has been shown to be a safe and feasible procedure, with a low rate of complications. It represents the ideal way by which to identify the resection limits for complete excision of the lesion, and allows for optimal repair of the bladder defect. Conclusion Combined laparoscopic and cystoscopic partial cystectomy for excision of deeply infiltrating bladder endometriosis is a safe and feasible procedure in our institution., Highlights • A case of surgical management of deeply infiltrating endometriosis of the bladder is reported. • Combined cystoscopic and laparoscopic excision can be performed for the treatment of this form of endometriosis. • This approach is safe, feasible and has a low rate of complications in the current literature. more...
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- 2018
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8. The cumulative success of ovulation induction therapy with gonadotrophins in therapy-naïve anovulatory women: An observational study
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Jennifer Pontré, Kevin Murray, Fiona Langdon, Janet Livingston, and Roger Hart
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Ovarian hyperstimulation syndrome ,Anovulation ,03 medical and health sciences ,Ovarian Hyperstimulation Syndrome ,0302 clinical medicine ,Ovulation Induction ,Pregnancy ,Follicular phase ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Birth Rate ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,General Medicine ,Fertility Agents, Female ,medicine.disease ,Pregnancy rate ,Gestation ,Ovulation induction ,Female ,Pregnancy, Multiple ,business ,Live birth ,Infertility, Female ,Gonadotropins - Abstract
Background The use of gonadotrophins as a first-line treatment for anovulatory infertility has been limited by a perception of a risk of multi-fetal gestation and ovarian hyperstimulation syndrome (OHSS). However, it has recently been recognised as an acceptable first-line treatment if appropriate monitoring is performed. Aims To determine the cumulative live birth rate, incidence of multiple gestation, cycle cancellation rate and incidence of OHSS for therapy-naive anovulatory women undergoing ovulation induction with gonadotrophins. Materials and methods A prospective observational study of 258 patients undergoing ovulation induction with a 'low-dose step-up' protocol was performed over a three-year period across two fertility centres (40% of patients were currently or recently prescribed metformin). Results Twenty-six percent of patients required concurrent use of luteinising hormone. The cumulative pregnancy and live birth rates were 22.5% and 18.2%, 40.3% and 34.5%, 47.7% and 41.1% after completion of the first, second and third cycles of stimulation, respectively, with a median duration of stimulation of 15 days. No patients developed OHSS and 10.5% of cycles were cancelled due to an excessive or no follicular response. The multiple pregnancy rate was 2%. The cumulative pregnancy rate was reduced for women over 35 years of age (23.8 vs 55.3%, P = 0.006) and for women with a body mass index greater than 25 kg/m2 (40.6 vs 56.7%, P = 0.027). CONCLUSIONS: This study demonstrated that ovulation induction with gonadotrophin therapy, in the context of appropriate monitoring, is a safe and effective treatment for young therapy-naive patients with anovulatory infertility. more...
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- 2019
9. Are obstetric and gynaecological trainees in Australia and New Zealand adequately trained in the management of the infertile couple?
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Roger Hart, Phillipa Robertson, Jennifer Pontré, and Paige E. Tucker
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Adult ,Male ,Infertility ,medicine.medical_specialty ,medicine.medical_treatment ,education ,Limited access ,03 medical and health sciences ,0302 clinical medicine ,Obstetrics and gynaecology ,Surveys and Questionnaires ,Humans ,Medicine ,030212 general & internal medicine ,Response rate (survey) ,Assisted reproductive technology ,business.industry ,030503 health policy & services ,Australia ,Internship and Residency ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Obstetrics ,Infertility clinic ,Gynecology ,Family medicine ,Female ,Private healthcare ,Clinical Competence ,0305 other medical science ,business ,New Zealand - Abstract
BACKGROUND Increasingly, couples are seeking assistance to conceive. It is not clear whether obstetric and gynaecological trainees in Australia and New Zealand receive adequate training and exposure to infertility training. AIMS To determine the perspectives of Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG) trainees regarding their experience of infertility management during training, in order to better inform discussions of training in this area. MATERIALS AND METHODS RANZCOG trainees were invited to participate in an anonymous online survey containing 17 questions. Data collected included demographic details, training year, cumulative infertility experience as a trainee, and perspectives regarding infertility experience during training. RESULTS Of the 191 RANZCOG trainees who participated in the study (25.7% response rate), the majority reported they had never had the opportunity to attend an infertility clinic as part of their training (53.2%). Lack of experience in infertility medicine was associated with a high dissatisfaction rate (89.8%). CONCLUSIONS Trainees in Australia and New Zealand have limited access to infertility medicine during training with associated high dissatisfaction rates. Access to training in a private healthcare setting or the expansion of public in vitro fertilisation may improve trainees' experiences. more...
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- 2019
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10. Hysteroscopic guided, laparoscopic excision of caesarean scar defect: video presentation of a combined technique
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Jennifer Pontré, Krishnan Karthigasu, and Bernadette McElhinney
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Case Report ,Combined technique ,Menstrual symptoms ,Laparoscopic excision ,Surgery ,medicine ,Caesarean section ,Presentation (obstetrics) ,business ,Laparoscopy ,reproductive and urinary physiology - Abstract
With increasing rates of delivery by caesarean section has come an increase in rates of associated complications, including caesarean scar defect. Whilst the management of this issue remains controversial, evidence is building for surgical management of such a defect for resolution of menstrual symptoms, pain and subfertility. We present a case report and surgical video of a hysteroscopic guided, laparoscopic excision of a caesarean scar defect. Following the successful management of this case and a literature review of the technique, we conclude this to be a safe, feasible and effective procedure with a low rate of complications. more...
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- 2019
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11. Early intrauterine pregnancy during major surgery: the importance of preoperative assessment and advice
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Bernadette McElhinney and Jennifer Pontré
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Endometriosis ,Hysteroscopy ,Intrauterine pregnancy ,03 medical and health sciences ,0302 clinical medicine ,Obstetrics and gynaecology ,Pregnancy ,Medicine ,Humans ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,Curettage ,Surgery ,Pregnancy Complications ,030220 oncology & carcinogenesis ,Gestation ,Female ,Laparoscopy ,Learning from Errors ,business ,Live birth ,Live Birth - Abstract
We present a case of a live birth occurring post radical laparoscopic excision of endometriosis, hysteroscopy, curettage and test of tubal patency in the presence of an early intrauterine gestation. more...
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- 2018
12. Fertility Treatment for Women with PCOS
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Jennifer Pontré, Fiona Langdon, and Roger Hart
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medicine.medical_specialty ,Obstetrics ,business.industry ,media_common.quotation_subject ,medicine ,Fertility ,business ,GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries) ,media_common - Published
- 2017
13. Do Groin Drains Reduce Postoperative Morbidity in Women Undergoing Inguinofemoral Lymphadenectomy for Vulvar Cancer?
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Julia Harding, Paola Chivers, Jennifer Pontré, Yee Leung, Jason Tan, Stuart G. Salfinger, Paul A. Cohen, Ganendra R. Mohan, and Leah Loughlin
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medicine.medical_specialty ,medicine.medical_treatment ,Sentinel lymph node ,Gynecologic oncology ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,medicine ,Humans ,Aged ,Neoplasm Staging ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,Groin ,Vulvar Neoplasms ,Vulvectomy ,business.industry ,Obstetrics and Gynecology ,Retrospective cohort study ,Vulvar cancer ,medicine.disease ,Surgery ,Lymphedema ,medicine.anatomical_structure ,Oncology ,Inguinofemoral Lymphadenectomy ,030220 oncology & carcinogenesis ,Drainage ,Lymph Node Excision ,Female ,Morbidity ,business - Abstract
ObjectiveSentinel lymph node biopsy has been widely adopted in the surgical management of women with early-stage vulvar cancer, but many patients require inguinofemoral lymphadenectomy (IFL). Following IFL, many surgeons drain the groin to prevent lymphocyst formation despite a lack of evidence to support this practice. Our objective was to investigate whether groin drains after IFL are associated with reduced postoperative morbidity in women undergoing surgery for vulvar cancer.MethodsA retrospective cohort study of women diagnosed as having primary vulvar cancer who underwent vulvectomy/radical local excision and unilateral or bilateral IFL was conducted. Cases were ascertained from the weekly outcome reports of a statewide tertiary gynecologic oncology tumor board. Data including postoperative outcomes were abstracted from medical records. Patients were stratified into 1 of 2 groups according to whether a groin drain had been used.ResultsSeventy-one patients were included. Inguinal drains were used in 48 patients (67.6%) and 23 patients (32.4%) did not have their groin wound(s) drained. The most common postoperative complications recorded were wound infection (59.2%), groin lymphocyst (32.4%), and cellulitis (25.4%). The mean length of hospital admission was 11.5 days (2–40 days). Compared with patients in whom inguinal drains were placed, those in the “no drain” group had a significantly lower incidence of postoperative groin cellulitis (8.7% vs 25.4% P = 0.039). No significant differences were observed between patients in the “drain” and “no drain” groups in lymphocyst formation, wound infection, return to the operating room, duration of hospital stay, readmission post-discharge, and lower-limb lymphedema.ConclusionsIn this study of patients undergoing inguinofemoral dissection for primary vulvar cancer, postoperative cellulitis occurred less frequently in patients without an inguinal drain. The incidence of other postoperative complications was no different whether or not a groin drain was used. Prospective studies may be warranted. more...
- Published
- 2017
14. Angiomatosis of the uterus, cervix and fallopian tubes: a rare and benign cause of intractable, heavy menstrual bleeding
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Victor Ojedo, Jennifer Pontré, and Bernadette McElhinney
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Adult ,medicine.medical_specialty ,Angiomatosis ,Uterus ,Hysterectomy ,Uterine Cervical Diseases ,03 medical and health sciences ,0302 clinical medicine ,Obstetrics and gynaecology ,Uterus/Cervix ,medicine ,Humans ,Cervix ,Menorrhagia ,030219 obstetrics & reproductive medicine ,business.industry ,urogenital system ,Laparoscopic hysterectomy ,General Medicine ,Fallopian Tube Diseases ,medicine.disease ,female genital diseases and pregnancy complications ,Surgery ,medicine.anatomical_structure ,Menstrual bleeding ,VASCULAR ABNORMALITY ,030220 oncology & carcinogenesis ,Female ,business ,Findings That Shed New Light on the Possible Pathogenesis of a Disease or an Adverse Effect - Abstract
Angiomatosis of the uterus, cervix and fallopian tubes is a rare and benign entity that has not been reported in the literature previously. We present a case of a 27-year-old patient with severe and intractable heavy menstrual bleeding unresponsive to all conservative and conventional forms of treatment. Following a laparoscopic hysterectomy, the histopathological finding of angiomatosis, a vascular abnormality in the uterus, cervix and fallopian tubes, provided a plausible explanation in this situation. more...
- Published
- 2017
15. Onsite midwife-led birth units (OMBUs) for care around the time of childbirth: a systematic review
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Emma R. Allanson, Özge Tunçalp, Ahmet Metin Gülmezoglu, Qian Long, Jennifer Pontré, and G. J. Hofmeyr
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Health Policy ,Research ,Public Health, Environmental and Occupational Health ,Psychological intervention ,MEDLINE ,CINAHL ,03 medical and health sciences ,0302 clinical medicine ,Family medicine ,Relative risk ,medicine ,Forest plot ,Childbirth ,Observational study ,030212 general & internal medicine ,business ,Cohort study - Abstract
Introduction To ensure timely access to comprehensive emergency obstetric care in low- and middle-income countries, a number of interventions have been employed. This systematic review assesses the effects of onsite midwife-led birth units (OMBUs) embedded within hospitals which provide comprehensive emergency obstetric and newborn care. Methods Both interventional and observational studies that compared OMBUs with standard medical-led obstetric care were eligible for inclusion. Cochrane Central Register of Controlled Trials, PubMed/Medline, EMBASE, CINAHL, Science Citation and Social Sciences Citation Index, Global Health Library and one Chinese database were searched. Meta-analysis was conducted to synthesise data from randomised controlled trials (RCTs). Findings of observational studies were summarised by forest plots with brief narratives. Results Three RCTs, one controlled before-and-after study and six cohort studies were included. There were no or very few maternal and perinatal deaths in either OMBUs or standard obstetric units, with no significant differences between the two. Women giving birth in OMBUs were less likely to use epidural analgesia (risk ratio (RR) 0.67, 95% CI 0.55 to 0.82; three trials, n=2431). The UK national cohort study and two other cohorts in China and Nepal found less oxytocin augmentation, more spontaneous vaginal deliveries, fewer caesarean sections and fewer episiotomies performed in OMBUs than in standard obstetric units. These differences were not statistically significant in RCTs and the remaining cohorts. One study investigated satisfaction with midwife-led birth care among women and midwives, with positive findings in both groups favouring OMBUs. In addition, two studies found that the total cost of birth was lower in OMBUs than in standard obstetric units. Conclusions OMBUs could be an alternative model for providing safe and cost-effective childbirth care, which may be particularly important in low- and middle-income countries to meet the growing demand for facility-based birth for low-risk women and improve efficiency of health systems. more...
- Published
- 2016
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