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Outcome of diagnostic hysteroscopy for suspected endometrial polyp on Ultrasound: the Birmingham Women's Experience
e164
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e128–e193
Imaging in gynaecology
Infections in obstetrics and gynaecology
Oral Presentation
Oral Presentation
Outcome of diagnostic hysteroscopy for suspected endometrial polyp on Ultrasound: the Birmingham Women’s Experience
Juvenile recurrent respiratory papillomatosis in pregnancy: a case report
Ayesha Mahmud 1,2,∗ , Mugahid Abbasher 2 , Natalie Nunes 3 , Ismail Hassan 2 1
University of Birmingham, Birmingham, UK Birmingham Women’s NHS Foundation Trust, Birmingham, UK 3 West Middlesex University Hospital, London, UK E-mail address: [email protected] (A. Mahmud).
Michelle L. Malabanan ∗ , Brenda Zamora St. Luke’s Medical Center, Philippines E-mail address: [email protected] (M.L. Malabanan).
2
Objectives: Polyps are frequently associated with sub-fertility and menstrual disturbances. Hysteroscopy and directed biopsy is gold standard for uterine cavity assessment and treatment. In recent years the introduction of Transvaginal ultrasound scanning (TVS) for diagnosing endometrial polyps has revolutionised the diagnosis and treatment of polyps. TVS is known to have a positive predictive value (PPV) of 75–100%. The addition of colour or power Doppler increases the capacity of TVS to diagnose endometrial polyps. Therefore, TVS provides reliable information for the detection of endometrial polyps and should be the investigation of choice where available. Our objectives were to compare ultrasound PPV of diagnosing endometrial polyps with national figures and to develop and improve guidelines for the diagnosis and management of endometrial polyps in order to minimize unnecessary invasive interventions. Methodology: This was a prospective observational audit performed from October 2012 to January 2013 at Birmingham Women’s NHS foundation Trust. Formal approval from the audit department was taken and data was collected from radiology and the one-stop hysteroscopy clinic. Cases were selected at random, data collected and analysed using excel. Results: A total of 50 cases were reviewed with an age range of 21–70 years. 6% of these were postmenopausal. 30% had a BMI of more than 30 and for 28% of patients no BMI was recorded. Out of 50 of the cases reviewed, 39 referrals were for menstrual abnormalities and 19 for subfertility. TVS was performed in 48 (96%) of cases, while in 2 (4%) cases MRI was performed. TVS with Doppler was performed in only 62% of cases. The average polyp size was 1.6 cm. On hysteroscopy polyp was confirmed in 27 (54%) of the cases. No polyp was identified in the rest. Out of the 27 confirmed polyps on hysteroscopy only 24 were confirmed on histology. Therefore, our positive predictive value was 54% in the audit group. Conclusion: Hysteroscopy is gold standard for uterine cavity assessment. Our Positive Predictive Value is 54%. This indicates that there may is room for improvement with the referral pathway. The suggested recommendations in cases of suspected polyps prior to referral for hysteroscopy are; using Doppler with TVS, hydrosonography is also useful in cases when unsure about the presence of a polyp or performing the ultrasound scan in the follicular stage of the women’s cycle as this makes it easier to define the polyp. These recommendations are likely to improve the PPV of TVS. http://dx.doi.org/10.1016/j.ejogrb.2016.07.407
Recurrent respiratory papillomatosis (RRP) is a rare disease of the larynx, prevalence of which is 1.11 per 100,000 in the western world. It is usually acquired by vertical transmission upon vaginal delivery. Human Papilloma Virus (HPV) is the etiologic agent and most common types involved are 6 and 11 and are considered at low risk for malignant transformation. It is characterized by exophytic, wart-like lesions of the upper airway that tend to recur and have the potential to spread throughout the respiratory tract. It is associated with low mortality but with significant morbidity. There are two forms described, an adult onset (AORRP) and the more aggressive juvenile onset (JORRP). Reports say that pregnancy was related with accelerated papilloma growth in RRP, while RRP may have an effect on the outcome of pregnancy due to chronic maternal hypoxemia. There is no specific report on effects of RRP in pregnancy for there are only few cases seen. However, RRP is associated with hypoxia and there are reports that chronic hypoxic environment may cause significantly reduced birth weight. Hence, pregnant patients with RRP are prone to have growth-restricted neonates. So, how does pregnancy increase recurrence of RRP? The role of estrogen on the growth of RRP has been conjectured, since it has been discovered that RRP exhibits increased binding of estrogen. We present a case of O.K. a 27-year-old Gravida 2 Para 1 with an obstetric score of 1-0-0-1 came in for labor pains at 36–37 weeks age of gestation. She is a diagnosed case of recurrent laryngeal papillomatosis since 3 years of age presenting as sudden loss of voice. She undergoes 3-5 procedures a year and as of to date, a total of 83 excisions were done. She is non-hypertensive, nondiabetic, with no history of thyroid problems or other diseases. First seen at 7 weeks age of gestation and on her 12th week of pregnancy, patient complaints of increasing episodes of dyspnea, upon examination of Ears, nose, throat (ENT) service, there was note of papillomatous lesion completely obliterating the airway at the level of the glottis. She then underwent tracheobronchoscopy and direct laryngoscopy with microlaryngeal excision of laryngeal papillomatosis under general anaesthesia. Regular follow up and serial ultrasound was done and at 36 weeks patient underwent labor and delivered by outlet forceps extraction to a live preterm newborn male. In conclusion, RPR accelerates in the presence of increased estrogen concentrations; hence, all women known to have RRP should be warned of the possibility of the worsening of their airway disease during pregnancy. Even if this not always the case, multidisciplinary management with other services is vital and close monitoring by their otolaryngologist and perinatologist is advised. http://dx.doi.org/10.1016/j.ejogrb.2016.07.408
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e128–e193
Imaging in gynaecology
Infections in obstetrics and gynaecology
Oral Presentation
Oral Presentation
Outcome of diagnostic hysteroscopy for suspected endometrial polyp on Ultrasound: the Birmingham Women’s Experience
Juvenile recurrent respiratory papillomatosis in pregnancy: a case report
Ayesha Mahmud 1,2,∗ , Mugahid Abbasher 2 , Natalie Nunes 3 , Ismail Hassan 2 1
University of Birmingham, Birmingham, UK Birmingham Women’s NHS Foundation Trust, Birmingham, UK 3 West Middlesex University Hospital, London, UK E-mail address: [email protected] (A. Mahmud).
Michelle L. Malabanan ∗ , Brenda Zamora St. Luke’s Medical Center, Philippines E-mail address: [email protected] (M.L. Malabanan).
2
Objectives: Polyps are frequently associated with sub-fertility and menstrual disturbances. Hysteroscopy and directed biopsy is gold standard for uterine cavity assessment and treatment. In recent years the introduction of Transvaginal ultrasound scanning (TVS) for diagnosing endometrial polyps has revolutionised the diagnosis and treatment of polyps. TVS is known to have a positive predictive value (PPV) of 75–100%. The addition of colour or power Doppler increases the capacity of TVS to diagnose endometrial polyps. Therefore, TVS provides reliable information for the detection of endometrial polyps and should be the investigation of choice where available. Our objectives were to compare ultrasound PPV of diagnosing endometrial polyps with national figures and to develop and improve guidelines for the diagnosis and management of endometrial polyps in order to minimize unnecessary invasive interventions. Methodology: This was a prospective observational audit performed from October 2012 to January 2013 at Birmingham Women’s NHS foundation Trust. Formal approval from the audit department was taken and data was collected from radiology and the one-stop hysteroscopy clinic. Cases were selected at random, data collected and analysed using excel. Results: A total of 50 cases were reviewed with an age range of 21–70 years. 6% of these were postmenopausal. 30% had a BMI of more than 30 and for 28% of patients no BMI was recorded. Out of 50 of the cases reviewed, 39 referrals were for menstrual abnormalities and 19 for subfertility. TVS was performed in 48 (96%) of cases, while in 2 (4%) cases MRI was performed. TVS with Doppler was performed in only 62% of cases. The average polyp size was 1.6 cm. On hysteroscopy polyp was confirmed in 27 (54%) of the cases. No polyp was identified in the rest. Out of the 27 confirmed polyps on hysteroscopy only 24 were confirmed on histology. Therefore, our positive predictive value was 54% in the audit group. Conclusion: Hysteroscopy is gold standard for uterine cavity assessment. Our Positive Predictive Value is 54%. This indicates that there may is room for improvement with the referral pathway. The suggested recommendations in cases of suspected polyps prior to referral for hysteroscopy are; using Doppler with TVS, hydrosonography is also useful in cases when unsure about the presence of a polyp or performing the ultrasound scan in the follicular stage of the women’s cycle as this makes it easier to define the polyp. These recommendations are likely to improve the PPV of TVS. http://dx.doi.org/10.1016/j.ejogrb.2016.07.407
Recurrent respiratory papillomatosis (RRP) is a rare disease of the larynx, prevalence of which is 1.11 per 100,000 in the western world. It is usually acquired by vertical transmission upon vaginal delivery. Human Papilloma Virus (HPV) is the etiologic agent and most common types involved are 6 and 11 and are considered at low risk for malignant transformation. It is characterized by exophytic, wart-like lesions of the upper airway that tend to recur and have the potential to spread throughout the respiratory tract. It is associated with low mortality but with significant morbidity. There are two forms described, an adult onset (AORRP) and the more aggressive juvenile onset (JORRP). Reports say that pregnancy was related with accelerated papilloma growth in RRP, while RRP may have an effect on the outcome of pregnancy due to chronic maternal hypoxemia. There is no specific report on effects of RRP in pregnancy for there are only few cases seen. However, RRP is associated with hypoxia and there are reports that chronic hypoxic environment may cause significantly reduced birth weight. Hence, pregnant patients with RRP are prone to have growth-restricted neonates. So, how does pregnancy increase recurrence of RRP? The role of estrogen on the growth of RRP has been conjectured, since it has been discovered that RRP exhibits increased binding of estrogen. We present a case of O.K. a 27-year-old Gravida 2 Para 1 with an obstetric score of 1-0-0-1 came in for labor pains at 36–37 weeks age of gestation. She is a diagnosed case of recurrent laryngeal papillomatosis since 3 years of age presenting as sudden loss of voice. She undergoes 3-5 procedures a year and as of to date, a total of 83 excisions were done. She is non-hypertensive, nondiabetic, with no history of thyroid problems or other diseases. First seen at 7 weeks age of gestation and on her 12th week of pregnancy, patient complaints of increasing episodes of dyspnea, upon examination of Ears, nose, throat (ENT) service, there was note of papillomatous lesion completely obliterating the airway at the level of the glottis. She then underwent tracheobronchoscopy and direct laryngoscopy with microlaryngeal excision of laryngeal papillomatosis under general anaesthesia. Regular follow up and serial ultrasound was done and at 36 weeks patient underwent labor and delivered by outlet forceps extraction to a live preterm newborn male. In conclusion, RPR accelerates in the presence of increased estrogen concentrations; hence, all women known to have RRP should be warned of the possibility of the worsening of their airway disease during pregnancy. Even if this not always the case, multidisciplinary management with other services is vital and close monitoring by their otolaryngologist and perinatologist is advised. http://dx.doi.org/10.1016/j.ejogrb.2016.07.408