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Biomedical subjects

K O Oyelese

Publications and source records attributed to K O Oyelese.

5 recordsLinked to original sources
PubMed1999

Towards the modern management of ectopic pregnancy: a complete audit cycle of practice in a London teaching hospital.

We carried out a complete audit cycle of the management of ectopic pregnancy at a London teaching hospital over 2 years. Case notes of women presenting to St George's Hospital, London in 1995 with ectopic pregnancy were examined and management was assessed. The targets were low rates of rupture, high rates of sonographic diagnosis of ectopic pregnancy, acceptable rates of tubal conservation and laparoscopic surgery. We also considered levels of training of junior doctors in laparoscopic surgery for ectopic pregnancy and the acceptable duration of hospital stay for patients. Recommendations were made, the standards were modified, and the audit repeated for the year 1996. A substantial improvement in the quality of care of women with ectopic pregnancy was achieved. The main improvement was in the ultrasonographic diagnosis of ectopic pregnancy. There was also a reduction in ectopic pregnancies which were ruptured, possibly due to earlier diagnosis. The percentage of cases treated laparoscopically remained stable. More junior doctors performed laparoscopic surgery for the condition. Finally, we confirmed that laparoscopic management of ectopic pregnancy significantly reduces duration of hospital stay, conferring advantages to both patient and hospital.

Journal Article↗
PubMed1999

Vasa previa: an avoidable obstetric tragedy.

UNLABELLED: Vasa previa is a rarely reported condition in which the fetal blood vessels, unsupported by either the umbilical cord or placental tissue, traverse the fetal membranes of the lower segment of the uterus below the presenting part. The condition has a high fetal mortality due to fetal exsanguination resulting from fetal vessels tearing when the membranes rupture. Despite improvements in medical technology, vasa previa often remains unsuspected until this fatal fetal vessel rupture occurs. Significant reduction in the fetal mortality from this condition depends on a high index of suspicion leading to antenatal diagnosis, and elective delivery by cesarean. We believe transvaginal ultrasound in combination with color Doppler is the most effective tool in the antenatal diagnosis of vasa previa and should be utilized in patients at risk, specifically those with bilobed, succenturiate-lobed, and low-lying placentas, pregnancies resulting from in vitro fertilization, and multiple pregnancy. Where there has been antepartum or intrapartum hemorrhage, especially when associated with fetal heart irregularities, we also recommend a test to exclude fetal blood in the vaginal blood. Similarly, amnioscopy before amniotomy may help to diagnose this condition. Cesarean delivery is the method of delivery of choice, and aggressive resuscitation of the affected neonate may be life saving. With a high index of suspicion, antenatal diagnosis using transvaginal sonography in combination with color Doppler, elective delivery by cesarean, and aggressive resuscitation of the neonate where fetal vessel rupture has occurred, the mortality from this complication may be considerably reduced. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to identify the risk factors and associated conditions for vasa previa, to identify the various clinical presentations and management of vasa previa, and to be aware of the diagnostic tools available to make the antepartum diagnosis of vasa previa.

Cesarean Section↗
PubMed1998

A strategy for reducing the mortality rate from vasa previa using transvaginal sonography with color Doppler.

Vasa previa is a cause of sudden unanticipated fetal death, with a fetal mortality of 33-100%. Transvaginal sonography (TVS) and color Doppler may aid in making the diagnosis antenatally, allowing elective Cesarean delivery, thereby avoiding fetal death from exsanguination which would occur if the membranes were allowed to rupture in labor. Whilst it is not feasible to screen all pregnant women for vasa previa, antenatal examination with TVS and color Doppler of women at risk, specifically those with low-lying placentas, bi-lobed, multi-lobed and succenturiate-lobed placentas, multiple pregnancies and pregnancies resulting from in vitro fertilization may lead to antenatal diagnosis of the condition. We present the last three cases of vasa previa to have occurred in our institution, two of which were diagnosed antenatally using TVS and color Doppler. In all three cases, routine 20-week obstetric sonography revealed low-lying placentas; in only one of these did the placenta remain low at term. A low-lying placenta at 20 weeks may be a risk factor for vasa previa; we suggest that further studies be carried out to ascertain this. Judicious use of TVS and color Doppler in women considered at risk of vasa previa may help to reduce the mortality from this condition.

Cesarean Section↗
PubMed1998

A novel approach to the management of pregnancies complicated by uteroplacental insufficiency and previous stillbirth.

To our knowledge, this is the first time that a combination of aspirin and glyceryl trinitrate (GTN) has been used in the prophylaxis of preeclampsia and fetal growth retardation, and their use associated with not only Doppler screening of the uterine arteries but also regular Doppler follow-up of the fetal arterial and venous circulation. Whilst future trials are needed to prove whether screening, prophylaxis and Doppler management are individually beneficial, we propose that this combination of management strategies contributed to a good outcome in the cases described. Furthermore, randomized trials are required to determine the safety and efficacy of prophylactic low-dose aspirin combined with GTN treatment in pregnancies affected by an impaired uteroplacental circulation.

Adult↗