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Objective: To prospectively determine the nature of adnexal masses diagnosed during pregnancy and investigate whether ultrasound was a reliable means of assessing these. Methods: A single-centre prospective observational cohort study was conducted in a large tertiary referral hospital in London. Pregnant women with an adnexal mass detected at or prior to the 12-week routine ultrasound received a detailed ultrasound by a level II ultrasound practitioner at the time of detection; at 12 weeks; 20 weeks; and 6 weeks postpartum. The following outcomes were recorded: subjective impression of the mass; International Ovarian Tumor Analysis simple rules classification; resolution and intervention rate; and the incidence of complications related to the mass. Results: A total of 28,683 pregnant patients were scanned and an adnexal masses was detected in 277 patients, yielding an incidence of 1%. 274 participants were included in the analysis. Subjective impression was as follows: simple 75.9%; dermoid 29.1%; endometrioma 6.6%; haemorrhagic 3.3%; para-ovarian 2.6%; torted simple 0.7%; decidualized endometrioma 0.4%; fibroma 0.4%; theca luteal 0.4%; and borderline ovarian tumour: 0.7%. There was a significant reduction in the volume at each scan (p < 0.0001). Approximately 74.2% of the masses resolved spontaneously. Surgery was performed in 14/274: 2 antenatally, 6 at caesarean section, and 6 postpartum. In 5/247 (2%), there were complications due to the mass. Using IOTA simple rules, 272/274 (99.3%) (p < 0.0001) were classifiable. Only 1/274 (0.4%) had malignant features as per IOTA (p = 0.05). As there were no confirmed malignancies, the accuracy of IOTA simple rules could not be calculated. Conclusions: Adnexal masses in pregnancy are uncommon and the majority spontaneously resolve. Malignancy is rare, as are complications. In the absence of concerns regarding malignancy or cyst accident, there is no need for additional monitoring of these masses during pregnancy. [ABSTRACT FROM AUTHOR]

Summary: There are limited data on contemporary outcomes for women with sickle cell disease (SCD) in pregnancy. We conducted a single‐site matched cohort study, comparing 131 pregnancies to women with SCD between 2007 and 2017 to a comparison group of 1310 pregnancies unaffected by SCD. Restricting our analysis to singleton pregnancies that reached 24 weeks of gestation, we used conditional Poisson regression to estimate adjusted risk ratios (aRRs) for perinatal outcomes. Infants born to mothers with SCD were more likely to be small for gestational age [aRR 1·69, 95% confidence interval (CI) 1·13–2·48], preterm (aRR 2·62, 95% CI 1·82–3·78) and require Neonatal Unit (NNU) admission (aRR 3·59, 95% CI 2·18–5·90). Pregnant women with SCD were at higher risk of pre‐eclampsia/eclampsia (aRR 3·53, 95% CI 2·00–6·24), more likely to receive induction of labour (aRR 2·50, 95% CI 1·82–1·76) and caesarean birth (aRR 1·44, 95% CI 1·18–1·76). In analysis stratified by genotype, the risk of adverse outcomes was highest in haemoglobin SS (HbSS) pregnancies (n = 80). There was no strong evidence that haemoglobin SC (HbSC) pregnancies (n = 46) were at higher risk of preterm birth, caesarean delivery, or NNU admission. Pre‐eclampsia/eclampsia was more frequently observed in HbSC pregnancies. Despite improvements in the care of pregnant women with SCD, the increased risk of adverse perinatal outcomes remains. [ABSTRACT FROM AUTHOR]

Rumen fluke (Calicophoron daubneyi) has emerged as a prominent parasite of ruminants in Europe over the past decades. Epidemiological questions remain regarding this observed increase in prevalence as well as the prospect for future paramphistomosis risk. This study aimed to identify factors associated with the temporal−spatial prevalence of rumen fluke as measured by veterinary surveillance in a temperate region using zero-inflated negative binomial mixed modelling. Modelling revealed that summer rainfall, raindays and sunshine hours and mean winter temperature as significant positively associated climate variables for rumen fluke prevalence over space and time (P < 0.05). Rumen fluke prevalence was also higher in counties with higher cattle/sheep densities and was positively associated with rumen fluke case rates in the previous years (P < 0.05). Equivalent models for fasciolosis prevalence revealed no significant association with winter temperature and sunshine hours, (P > 0.05). These results confirm a strong association between rainfall and the prevalence of both fluke species in a temperate environment, likely due to the role of Galba truncatula as their intermediate snail host. It also highlights the potential added importance of winter temperature and sunshine hours in rumen fluke epidemiology when compared to liver fluke. [ABSTRACT FROM AUTHOR]