Amira El-Messidi

Effects of repeated treatment failure on the quality of life of couples with infertility.

OBJECTIVE To determine the impact of repeated treatment failure of clomiphene and intrauterine insemination on the quality of life of couples with infertility. METHODS A prospective comparative study involving 3 groups of 50 couples each. The first group consisted of infertile couples with repeated treatment failure (group FT), the second group consisted of infertile couples who had never attempted any medical treatment (group NT), and the third was a control group of couples with at least 1 child and no history of infertility. Participants completed a comprehensive questionnaire to assess 16 areas of quality of life. RESULTS The quality of life score of the control group was higher than the scores reported by groups NT and FT (P <.001). There was no significant difference in the quality of life score reported by group NT and group FT or between male and female partners. Among the women, a high quality of life was reported by 22% in group FT, 14% in group NT, and 54% in the control group. Among the men, a high quality of life was reported by 14% in group FT, 12% in group NT, and 60% in the control group. In contrast to their male partners, the women with repeated treatment failure placed higher importance on children and home than their counterparts who had not started the treatment (P <.05). CONCLUSION Although couples with repeated treatment failure of clomiphene and intrauterine insemination do not demonstrate a lower overall quality of life than other infertile couples beginning baseline assessment, the quality of life of infertile couples is lower than that of fertile couples.

Application of 3-D Angiography in the Management of Placenta Percreta Treated with Repeat Uterine Artery Embolization

BACKGROUND Rising Caesarean section rates have increased rates of abnormally invasive placentation. In the management of such invasive placentation, hysterectomy may result in greater morbidity than more conservative measures. Non-surgical interventions such as uterine artery embolization (UAE) attempt to decrease placental perfusion and augment placental resorption. Repeat UAE may decrease the risk of unpredictable hemorrhage requiring emergency intervention. Three-dimensional angiography is a novel technology for assessing volume with objective measures of internal flow. CASE We report a case of placenta previa percreta that was treated conservatively by repeat UAE for persistent densely perfused placenta. Three-dimensional angiography was used to objectively assess placental characterization and vascularization. CONCLUSION Repeat UAE may be beneficial in reducing the risk of delayed hemorrhage in women with placenta previa accreta or percreta managed conservatively. Objective assessment of placental volume and vascularity by 3-D angiography can provide data on patients at risk and allow case selection for repeat UAE.

Incidence and outcomes of women with non-Hodgkin's lymphoma in pregnancy: A population-based study on 7.9 million births

Non‐Hodgkins lymphoma (NHL) is a rare malignancy that can affect women of all ages. The purpose of our study was to estimate the incidence, maternal and fetal outcomes of pregnancy‐associated non‐Hodgkins lymphoma (PANHL).

Evaluation of management and surgical outcomes in pregnancies complicated by acute cholecystitis

Abstract Objective: To evaluate the management of pregnancies complicated by acute cholecystitis (AC) and determine whether pregnant women are more likely to have medical and surgical complications. Methods: We carried out a population-based matched cohort study using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2011. Pregnant women with AC were age matched to non-pregnant women with AC on a 1:5 ratio. Management and outcomes were compared using descriptive analysis and conditional logistic regression. Results: There were 11,835 pregnant women admitted with AC who were age matched to 59,175 non-pregnant women. As compared to non-pregnant women, women with AC were more commonly managed conservatively, odds ratio (OR) 6.1 (5.8–6.4). As compared to non-pregnant women, pregnant women with AC more commonly developed sepsis [OR 1.4 (1.0–1.9)], developed venous thromboembolism [OR 8.7 (4.3–17.8)] and had bowel obstruction [OR 1.3 (1.1–1.6)]. Among pregnant women with AC, surgical management was associated with a small but significant increased risk of septic shock and bile leak. Conclusion: AC, in the context of pregnancy, is associated with an increased risk of adverse outcomes. Although the literature favors early surgical intervention, pregnancies with AC appear to be more commonly managed conservatively with overall comparable outcomes to surgically managed AC. Conservative management may have a role in select pregnant women with AC.

Recommendation Patterns Among Obstetrician–Gynecologists and Radiologists for Complex Adnexal Masses on Ultrasonography [370]

INTRODUCTION: The follow-up recommendations of newly identified adnexal masses on ultrasound evaluation remain controversial among gynecologists and radiologists. The objective of this study is to compare patterns of recommendations for new adnexal masses described on ultrasonography based on the interpreter field of specialty. METHODS: In the McGill University Hospital Network, there are two hospitals that differ in the specialty department that reports gynecologic ultrasonographies: one has the ultrasonograms reported exclusively by gynecologists and the other exclusively by radiologists. We carried out a review of all pelvic ultrasonograms conducted at these two sites between May and June 2014 on all newly identified adnexal masses in nonpregnant women. Masses were classified by reported features, diagnosis, and management recommendations. &khgr;2 analyses were used to compare recommendations among specialty fields. RESULTS: Of the 1,111 reports reviewed, 201 were eligible, among which 69 (34%) were reported by gynecologists and 132 (66%) by radiologists. Complex masses were reported by gynecologists in 23 (33.3%) studies and in 54 (40.9%) studies by radiologists. Reported adnexal mass types were not significantly different between the two sites (P=.26). Among complex masses, gynecologists were less likely than radiologists to recommended follow-up ultrasonography (13.0% compared with 40.7%, P<.05), recommend computed tomography or magnetic resonance imaging (4.4% compared with 24.1%, P<.05), but more likely to commit to a strong suspicion of malignancy (17.4% compared with 3.7%, P<.05, respectively). CONCLUSION: There are significant differences in recommendation patterns between gynecologists and radiologists evaluating new adnexal masses on ultrasonography. This difference can have important effects on resource use and patient concerns.

Incidence and outcomes of women with Hodgkin’s lymphoma in pregnancy: a population-based study on 7.9 million births

Abstract Objective: The purpose of our study was to estimate the incidence and maternal and fetal outcomes of Hodgkin’s lymphoma (HL) in pregnancy. Methods: We carried out a population-based cohort study on all births identified in the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2011. We calculated disease incidence and used logistic regression analysis to estimate the adjusted effect of HL on maternal and neonatal outcomes. Results: There were 638 cases of HL in pregnancy among 7,916,388 births, for an overall incidence of 8.06 per 100,000 births, with no perceivable trend over the 8-year study period. Relative to controls, HL in pregnancy was more common among Caucasians and women aged 25–34 years. After adjusting for baseline characteristics, women with HL in pregnancy were more likely to have preterm births, odds ratio (OR) 1.93 (1.53, 2.42) require postpartum blood transfusion, OR 1.38 (1.05, 1.82), and have venous thromboembolism (VTE), OR 7.93 (2.97, 21.22). Conclusion: The incidence of HL in pregnancy appears to be higher than previously reported with no temporal trend over an 8-year period. Although there is a greater risk of preterm birth and maternal postpartum blood transfusion and VTE, overall maternal and neonatal major morbidity and mortality does not appear to be increased.