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Rombauts L.,Monash IVF | Rombauts L.,Monash University | Motteram C.,Monash IVF | Berkowitz E.,Monash Health | And 2 more authors.
Human Reproduction | Year: 2014

STUDY QUESTION Is endometrial thickness measured prior to embryo transfer associated with placenta praevia? SUMMARY ANSWER Following IVF, the risk of placenta praevia is increased 4-fold in women with an endometrial thickness of >12 mm compared with women with an endometrial thickness of <9 mm. WHAT IS KNOWN ALREADY Placenta praevia is a serious complication of pregnancy with adverse maternal and neonatal outcomes. Placenta praevia is 2- to 6-fold more likely to occur following IVF treatment but it remains unknown what factors contribute to that increased risk. STUDY DESIGN, SIZE, DURATION Retrospective cohort study involving 4007 women who had 4537 singleton assisted reproduction technology (ART) births occurring between January 2006 and June 2012 with no loss to follow-up. The primary outcome measure was the diagnosis of placenta praevia, made by the treating obstetrician on a transvaginal ultrasound in the third trimester. PARTICIPANTS/MATERIALS, SETTING, METHODS Women who had singleton births following single embryo transfer performed at Monash IVF in Melbourne, Australia were included. Of the 4537 cycles leading to a singleton ART birth, 2951 were stimulated cycles with fresh embryo transfers; 355 were hormone replacement therapy frozen embryo transfers and 1231 were natural cycles with frozen embryo transfers. The dataset was analysed using binary logistic general estimating equations to calculate odds ratios for placenta praevia adjusted (aOR) for known confounders. MAIN RESULTS AND THE ROLE OF CHANCE The study groups did not differ significantly in age, BMI and aetiologies of infertility prior to IVF treatment. When compared with stimulated cycles, placenta praevia was less common in women undergoing natural cycles with frozen embryo transfers (OR 0.44, 95% confidence interval (CI) 0.27-0.70, P < 0.01) but hormone replacement therapy frozen embryo transfer cycles were not associated with a lower risk (OR 0.89, 95% CI 0.48-1.63). After adjusting for confounders, smoking (aOR 2.58, 95% CI 1.07-6.24, P = 0.04, endometriosis (aOR 2.01, 95% CI 1.21-3.33, P < 0.01) and endometrial thickness remained statistically significant as independent risk factors for placenta praevia. Compared with women with an endometrial thickness of <9 mm, women with an endometrial thickness of 9-12 mm had an aOR of 2.02 (95% CI 1.12-3.65, P = 0.02) and women with an endometrial thickness >12 mm had an aOR of 3.74 (95% CI 1.90-7.34, P < 0.01). These differences remained statistically significant after performing a sensitivity analysis limited to women with no previous births. LIMITATIONS, REASONS FOR CAUTION The study is retrospective in nature, not all confounders may have been accounted for and details on previous intrauterine surgery, a known risk factor, were not available. In addition, ultrasound assessments were carried out by several highly trained operators measuring the endometrial thickness, the main independent variable, in a two-dimensional plane and some inter-observer variability may therefore be present. WIDER IMPLICATIONS OF THE FINDINGS The findings of a higher risk of placenta praevia in patients with endometriosis and in those that smoke are in agreement with the current literature on natural conception. There have so far been no reports of an association between endometrial thickness and placenta praevia after ART. This novel finding warrants further study to elucidate the underlying cause of the association and to assess how to minimize harm to IVF patients and their offspring. The fact that the observed increased risk is not linked to the type of embryo transfer (fresh/frozen) but to the type of endometrial preparation, suggests that the risk of placenta praevia in ART can be reduced by considering an elective frozen embryo transfer in a natural cycle, especially given the growing evidence that this strategy also provides a number of other maternal and neonatal benefits. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. Source


Egerton-Warburton D.,Monash Health | Gosbell A.,Policy and Research | Wadsworth A.,Policy and Research | Fatovich D.M.,University of Western States | Richardson D.B.,Australian National University
Medical Journal of Australia | Year: 2014

Objective: To determine the proportion of alcohol-related presentations to emergency departments (EDs) in Australia and New Zealand, at a single time point on a weekend night shift.Design, setting and participants: A point prevalence survey of ED patients either waiting to be seen or currently being seen conducted at 02:00 local time on 14 December 2013 in 106 EDs in Australia and New Zealand.Main outcome measures: The number of ED presentations that were alcoholrelated, defined using World Health Organization ICD-10 codes.Results: At the 106 hospitals (92 Australia, 14 New Zealand) that provided data, 395 (14.3%; 95% CI, 13.0%–15.6%) of 2766 patients in EDs at the study time were presenting for alcohol-related reasons; 13.8% (95% CI, 12.5%–15.2%) in Australia and 17.9% (95% CI, 13.9%–22.8%) in New Zealand. The distribution was skewed left, with proportions ranging from 0 to 50% and a median of 12.5%. Nine Australian hospitals and one New Zealand hospital reported that more than a third of their ED patients had alcohol-related presentations; the Northern Territory (38.1%) and Western Australia (21.1%) reported the highest proportions of alcohol-related presentations.Conclusions: One in seven ED presentations in Australian and New Zealand at this 02:00 snapshot were alcohol-related, with some EDs seeing more than one in three alcohol-related presentations. This confirms that alcohol-related presentations to EDs are currently underreported and makes a strong case for public health initiatives. Source


Pasricha S.-R.,University of Melbourne | Pasricha S.-R.,Weatherall Institute of Molecular Medicine | Low M.,The Alfred Hospital | Thompson J.,University of Adelaide | And 2 more authors.
Journal of Nutrition | Year: 2014

Animal and human observational studies suggest that iron deficiency impairs physical exercise performance, but findings from randomized trials on the effects of iron are equivocal. Iron deficiency and anemia are especially common in women of reproductive age (WRA). Clear evidence of benefit from iron supplementation would inform clinical and public health guidelines. Therefore, we performed a systematic review and meta-analysis to determine the effect of iron supplementation compared with control on exercise performance in WRA. We searched the Cochrane Central Register of Clinical Trials, MEDLINE, Scopus (comprising Embase and MEDLINE), WHO regional databases, and other sources in July 2013. Randomized controlled trials that measured exercise outcomes in WRA randomized to daily oral iron supplementation vs. control were eligible. Random-effects meta-analysis was used to calculate mean differences (MDs) and standardized MDs (SMDs). Risk of bias was assessed using the Cochrane risk-of-bias tool. Of 6757 titles screened, 24 eligible studies were identified, 22 of which contained extractable data. Only 3 studies were at overall low risk of bias. Iron supplementation improved both maximal exercise performance, demonstrated by an increase in maximal oxygen consumption (VO2 max) [for relative VO2 max, MD: 2.35 mL/(kg · min); 95% CI: 0.82, 3.88; P = 0.003, 18 studies; for absolute VO2 max, MD: 0.11 L/min; 95% CI: 0.03, 0.20; P = 0.01, 9 studies; for overall VO2 max, SMD: 0.37; 95% CI: 0.11, 0.62; P = 0.005, 20 studies], and submaximal exercise performance, demonstrated by a lower heart rate (MD: -4.05 beats per minute; 95% CI: -7.25, -0.85; P = 0.01, 6 studies) and proportion of VO2 max (MD: -2.68%; 95%CI: -4.94, -0.41; P = 0.02, 6 studies) required to achieve defined workloads. Daily iron supplementation significantly improves maximal and submaximal exercise performance in WRA, providing a rationale to prevent and treat iron deficiency in this group. © 2014 American Society for Nutrition. Source


Kwong Y.,Monash Health | Troupis J.,Monash University
Journal of Cardiovascular Computed Tomography | Year: 2015

Left atrial occlusion devices are a recognized treatment option in patients with difficult to treat atrial fibrillation or intolerance to warfarin therapy. There are an increasing number of devices on the market, and good quality preoperative imaging is crucial to assess the feasibility of the procedure and help plan the occlusion. Electrocardiography-gated cardiac CT is ideal for this purpose as the high spatial and temporal resolution allow accurate measurements and reformats in multiple planes. As the imaging specialist reporting the CT may not necessarily be the interventionalist performing the implantation, this review will illustrate the important points in reporting the preimplant CT. The expected postoperative appearances and potential complications will also be described. © 2015 Society of Cardiovascular Computed Tomography. Source


Basnayake S.K.,Monash Health | Easterbrook P.J.,World Health Organization
Journal of Viral Hepatitis | Year: 2016

To evaluate the extent of heterogeneity in global estimates of chronic hepatitis B (HBV) and C (HCV) cited in the published literature, we undertook a systematic review of the published literature. We identified articles from 2010 to 2014 that had cited global estimates for at least one of ten indicators [prevalence and numbers infected with HBV, HCV, HIV-HBV or HIV-HCV co-infection, and mortality (number of deaths annually) for HBV and HCV]. Overall, 488 articles were retrieved: 239 articles cited a HBV-related global estimate [prevalence (n = 12), number infected (n = 193) and number of annual deaths (n = 82)]; 280 articles had HCV-related global estimates [prevalence (n = 86), number infected (n = 203) and number of annual deaths (n = 31)]; 31 had estimates on both HBV and HCV; 54 had HIV-HBV co-infection estimates [prevalence (n = 42) and number co-infected (n = 12)]; and 68 had estimates for HIV-HCV co-infection [prevalence (n = 40) and number co-infected (n = 28)]. There was considerable heterogeneity in the estimates cited and also a lack of consistency in the terminology used. Although 40% of 488 articles cited WHO as the source of the estimate, many of these were from outdated or secondary sources. Our findings highlight the importance of clear and consistent communication from WHO and other global health agencies on current consensus estimates of hepatitis B and C burden and prevalence, the need for standardisation in their citation, and for regular updates. © 2016 The Authors. Journal of Viral Hepatitis published by John Wiley & Sons Ltd. Source

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