A. Siozos - Academia.edu (original) (raw)

Papers by A. Siozos

Research paper thumbnail of Rare disease: A case of true tubal hydatidiform mole and literature review

Tubal hydatidiform mole is an uncommon condition with about 40 confirmed cases in the accessible ... more Tubal hydatidiform mole is an uncommon condition with about 40 confirmed cases in the accessible literature. The patient usually presents with symptoms and signs of a classical ectopic pregnancy and it is only after histological examination and DNA ploidy analysis of the conceptus that a hydatidiform mole is diagnosed. Management requires complete removal of the conceptus and follow-up needs to be arranged with an appropriate supraregional centre. The authors present a case of complete molar tubal pregnancy and a review of the literature. BACKGROUND

Research paper thumbnail of Peri-operative morbidity associated with abdominal myomectomy for very large fibroid uteri

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2013

To evaluate the safety of abdominal myomectomy for very large fibroid uteri, and to assess the ef... more To evaluate the safety of abdominal myomectomy for very large fibroid uteri, and to assess the effect of relevant confounding variables on the occurrence of major peri-operative complications. A cohort study of 200 abdominal myomectomies for fibroid uteri of 16 gestational weeks or greater. Logistic regression analysis was used to examine the influence of important clinical variables on the risk of complications. A systematic literature search was conducted for evidence related to peri-operative morbidity associated with abdominal myomectomy for very large fibroid uteri. The mean (±standard deviation) uterine size was 21±5 weeks. The overall rate of major complications was 30%. Peri-operative bleeding necessitating blood transfusion occurred in 49 (24.5%) cases. During surgery, two patients had bowel injury, two had bladder injury, seven women returned to theatre and two (1%) had hysterectomy. Four patients were re-admitted within 14 days of surgery. Multivariable logistic regression analysis showed that the risk of major complications was significantly higher in cases with a uterine size of 20 gestational weeks or more [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.1-10.2; p=0.03], where 10 or more fibroids were removed (OR 3.5, 95% CI 1.1-10.8; p=0.05) and where midline skin incision was required (OR 6.1, 95% CI 1.7-22.3; p=0.006). On comparison of primary vs repeat abdominal myomectomy, there was significantly higher blood loss (mean 1023±1112 ml vs 579±787 ml; p=0.02) and risk of major complications in the repeat myomectomy group (40% vs 5%; p<0.001). The systematic review identified only one study that reported a comparable risk of major complications related to abdominal myomectomy for very large fibroid uteri. The risk of organ injury, hysterectomy, re-operation or hospital re-admission after abdominal myomectomy for very large fibroid uteri is low, but the procedure is associated with a significant risk of bleeding necessitating blood transfusion. This risk is increased after repeat myomectomy, and in patients with a uterine size of 20 gestational weeks or larger, requiring removal of 10 or more fibroids, and requiring a midline skin incision.

Research paper thumbnail of Reproductive outcome following abdominal myomectomy for a very large fibroid uterus

Journal of Obstetrics & Gynaecology, 2015

The aim of this study was to assess the long-term reproductive outcome following abdominal myomec... more The aim of this study was to assess the long-term reproductive outcome following abdominal myomectomy in women with very large fibroid uteri. It is a retrospective study of 90 subfertile women with the main outcome measure of live-birth rate following spontaneous and assisted conception. Mean age of the study population was 37 ± 5 years and mean uterine size was 21 ± 6 weeks. During follow-up (mean 50 ± 10 months), 28 (31%) pregnancies occurred; 18 spontaneous and 10 following IVF. The live-birth rate was 20% and the miscarriage rate was 32%. Multivariate analysis demonstrated that the chance of live birth was significantly reduced with increasing female age at the time of surgery (OR = 0.67, 95% CI 0.51-0.86, p = 0.002). The perioperative blood transfusion rate was 30% and the incidence of major complications was 6%. Fertility after abdominal myomectomy for very large fibroid uteri is possible, and its major determinant is female age at the time of surgery.

Research paper thumbnail of The influence of delayed blastocyst formation on the outcome of frozen-thawed blastocyst transfer: a systematic review and meta-analysis

Human Reproduction, 2010

background: There are conflicting results on whether the rate of blastocyst development before fr... more background: There are conflicting results on whether the rate of blastocyst development before freezing influences the outcome of frozen-thawed blastocyst transfers. methods: We conducted a systematic review and meta-analysis of controlled studies to compare pregnancy outcomes following transfer of thawed blastocysts that were frozen either on Day 5 or Day 6 following fertilization in vitro. Searches were conducted on MEDLINE, EMBASE, Cochrane Library and Web of Science. Study selection and data extraction were conducted independently by two reviewers. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. results: We identified 15 controlled studies comprising 2502 frozen-thawed transfers involving blastocysts that were either frozen on Day 5 or Day 6. Meta-analysis of these studies showed significantly higher clinical pregnancy rate [relative risk (RR) ¼ 1.14, 95% confidence interval (CI): 1.03 -1.26, P ¼ 0.01] and ongoing pregnancy/live birth rate (RR ¼ 1.15, 95% CI: 1.01-1.30, P ¼ 0.03) with Day 5 compared with Day 6 frozen-thawed blastocyst transfers. Sensitivity analysis of those studies where blastocysts frozen on Day 5 or Day 6 were at the same stage of development showed no significant difference in the clinical pregnancy rate (RR ¼ 1.07, 95% CI: 0.87 -1.33, P ¼ 0.51) and ongoing pregnancy/live birth rate (RR ¼ 1.08, 95% CI: 0.92 -1.27, P ¼ 0.36).

Research paper thumbnail of Posters * Embryology (Embryo Selection)

Research paper thumbnail of A new handheld vacuum extraction device: a randomised control trial

BJOG: An International Journal of Obstetrics and Gynaecology, 2006

Research paper thumbnail of A case of true tubal hydatidiform mole and literature review

Case Reports, 2010

Tubal hydatidiform mole is an uncommon condition with about 40 confirmed cases in the accessible ... more Tubal hydatidiform mole is an uncommon condition with about 40 confirmed cases in the accessible literature. The patient usually presents with symptoms and signs of a classical ectopic pregnancy and it is only after histological examination and DNA ploidy analysis of the conceptus that a hydatidiform mole is diagnosed. Management requires complete removal of the conceptus and follow-up needs to be arranged with an appropriate supraregional centre. The authors present a case of complete molar tubal pregnancy and a review of the literature.

Research paper thumbnail of Reproductive outcome following abdominal myomectomy for a very large fibroid uterus

Journal of Obstetrics & Gynaecology, 2015

The aim of this study was to assess the long-term reproductive outcome following abdominal myomec... more The aim of this study was to assess the long-term reproductive outcome following abdominal myomectomy in women with very large fibroid uteri. It is a retrospective study of 90 subfertile women with the main outcome measure of live-birth rate following spontaneous and assisted conception. Mean age of the study population was 37 ± 5 years and mean uterine size was 21 ± 6 weeks. During follow-up (mean 50 ± 10 months), 28 (31%) pregnancies occurred; 18 spontaneous and 10 following IVF. The live-birth rate was 20% and the miscarriage rate was 32%. Multivariate analysis demonstrated that the chance of live birth was significantly reduced with increasing female age at the time of surgery (OR = 0.67, 95% CI 0.51-0.86, p = 0.002). The perioperative blood transfusion rate was 30% and the incidence of major complications was 6%. Fertility after abdominal myomectomy for very large fibroid uteri is possible, and its major determinant is female age at the time of surgery.

Research paper thumbnail of Peri-operative morbidity associated with abdominal myomectomy for very large fibroid uteri

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2013

To evaluate the safety of abdominal myomectomy for very large fibroid uteri, and to assess the ef... more To evaluate the safety of abdominal myomectomy for very large fibroid uteri, and to assess the effect of relevant confounding variables on the occurrence of major peri-operative complications. A cohort study of 200 abdominal myomectomies for fibroid uteri of 16 gestational weeks or greater. Logistic regression analysis was used to examine the influence of important clinical variables on the risk of complications. A systematic literature search was conducted for evidence related to peri-operative morbidity associated with abdominal myomectomy for very large fibroid uteri. The mean (±standard deviation) uterine size was 21±5 weeks. The overall rate of major complications was 30%. Peri-operative bleeding necessitating blood transfusion occurred in 49 (24.5%) cases. During surgery, two patients had bowel injury, two had bladder injury, seven women returned to theatre and two (1%) had hysterectomy. Four patients were re-admitted within 14 days of surgery. Multivariable logistic regression analysis showed that the risk of major complications was significantly higher in cases with a uterine size of 20 gestational weeks or more [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.1-10.2; p=0.03], where 10 or more fibroids were removed (OR 3.5, 95% CI 1.1-10.8; p=0.05) and where midline skin incision was required (OR 6.1, 95% CI 1.7-22.3; p=0.006). On comparison of primary vs repeat abdominal myomectomy, there was significantly higher blood loss (mean 1023±1112 ml vs 579±787 ml; p=0.02) and risk of major complications in the repeat myomectomy group (40% vs 5%; p<0.001). The systematic review identified only one study that reported a comparable risk of major complications related to abdominal myomectomy for very large fibroid uteri. The risk of organ injury, hysterectomy, re-operation or hospital re-admission after abdominal myomectomy for very large fibroid uteri is low, but the procedure is associated with a significant risk of bleeding necessitating blood transfusion. This risk is increased after repeat myomectomy, and in patients with a uterine size of 20 gestational weeks or larger, requiring removal of 10 or more fibroids, and requiring a midline skin incision.

Research paper thumbnail of Rare disease: A case of true tubal hydatidiform mole and literature review

Tubal hydatidiform mole is an uncommon condition with about 40 confirmed cases in the accessible ... more Tubal hydatidiform mole is an uncommon condition with about 40 confirmed cases in the accessible literature. The patient usually presents with symptoms and signs of a classical ectopic pregnancy and it is only after histological examination and DNA ploidy analysis of the conceptus that a hydatidiform mole is diagnosed. Management requires complete removal of the conceptus and follow-up needs to be arranged with an appropriate supraregional centre. The authors present a case of complete molar tubal pregnancy and a review of the literature. BACKGROUND

Research paper thumbnail of Peri-operative morbidity associated with abdominal myomectomy for very large fibroid uteri

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2013

To evaluate the safety of abdominal myomectomy for very large fibroid uteri, and to assess the ef... more To evaluate the safety of abdominal myomectomy for very large fibroid uteri, and to assess the effect of relevant confounding variables on the occurrence of major peri-operative complications. A cohort study of 200 abdominal myomectomies for fibroid uteri of 16 gestational weeks or greater. Logistic regression analysis was used to examine the influence of important clinical variables on the risk of complications. A systematic literature search was conducted for evidence related to peri-operative morbidity associated with abdominal myomectomy for very large fibroid uteri. The mean (±standard deviation) uterine size was 21±5 weeks. The overall rate of major complications was 30%. Peri-operative bleeding necessitating blood transfusion occurred in 49 (24.5%) cases. During surgery, two patients had bowel injury, two had bladder injury, seven women returned to theatre and two (1%) had hysterectomy. Four patients were re-admitted within 14 days of surgery. Multivariable logistic regression analysis showed that the risk of major complications was significantly higher in cases with a uterine size of 20 gestational weeks or more [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.1-10.2; p=0.03], where 10 or more fibroids were removed (OR 3.5, 95% CI 1.1-10.8; p=0.05) and where midline skin incision was required (OR 6.1, 95% CI 1.7-22.3; p=0.006). On comparison of primary vs repeat abdominal myomectomy, there was significantly higher blood loss (mean 1023±1112 ml vs 579±787 ml; p=0.02) and risk of major complications in the repeat myomectomy group (40% vs 5%; p<0.001). The systematic review identified only one study that reported a comparable risk of major complications related to abdominal myomectomy for very large fibroid uteri. The risk of organ injury, hysterectomy, re-operation or hospital re-admission after abdominal myomectomy for very large fibroid uteri is low, but the procedure is associated with a significant risk of bleeding necessitating blood transfusion. This risk is increased after repeat myomectomy, and in patients with a uterine size of 20 gestational weeks or larger, requiring removal of 10 or more fibroids, and requiring a midline skin incision.

Research paper thumbnail of Reproductive outcome following abdominal myomectomy for a very large fibroid uterus

Journal of Obstetrics & Gynaecology, 2015

The aim of this study was to assess the long-term reproductive outcome following abdominal myomec... more The aim of this study was to assess the long-term reproductive outcome following abdominal myomectomy in women with very large fibroid uteri. It is a retrospective study of 90 subfertile women with the main outcome measure of live-birth rate following spontaneous and assisted conception. Mean age of the study population was 37 ± 5 years and mean uterine size was 21 ± 6 weeks. During follow-up (mean 50 ± 10 months), 28 (31%) pregnancies occurred; 18 spontaneous and 10 following IVF. The live-birth rate was 20% and the miscarriage rate was 32%. Multivariate analysis demonstrated that the chance of live birth was significantly reduced with increasing female age at the time of surgery (OR = 0.67, 95% CI 0.51-0.86, p = 0.002). The perioperative blood transfusion rate was 30% and the incidence of major complications was 6%. Fertility after abdominal myomectomy for very large fibroid uteri is possible, and its major determinant is female age at the time of surgery.

Research paper thumbnail of The influence of delayed blastocyst formation on the outcome of frozen-thawed blastocyst transfer: a systematic review and meta-analysis

Human Reproduction, 2010

background: There are conflicting results on whether the rate of blastocyst development before fr... more background: There are conflicting results on whether the rate of blastocyst development before freezing influences the outcome of frozen-thawed blastocyst transfers. methods: We conducted a systematic review and meta-analysis of controlled studies to compare pregnancy outcomes following transfer of thawed blastocysts that were frozen either on Day 5 or Day 6 following fertilization in vitro. Searches were conducted on MEDLINE, EMBASE, Cochrane Library and Web of Science. Study selection and data extraction were conducted independently by two reviewers. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. results: We identified 15 controlled studies comprising 2502 frozen-thawed transfers involving blastocysts that were either frozen on Day 5 or Day 6. Meta-analysis of these studies showed significantly higher clinical pregnancy rate [relative risk (RR) ¼ 1.14, 95% confidence interval (CI): 1.03 -1.26, P ¼ 0.01] and ongoing pregnancy/live birth rate (RR ¼ 1.15, 95% CI: 1.01-1.30, P ¼ 0.03) with Day 5 compared with Day 6 frozen-thawed blastocyst transfers. Sensitivity analysis of those studies where blastocysts frozen on Day 5 or Day 6 were at the same stage of development showed no significant difference in the clinical pregnancy rate (RR ¼ 1.07, 95% CI: 0.87 -1.33, P ¼ 0.51) and ongoing pregnancy/live birth rate (RR ¼ 1.08, 95% CI: 0.92 -1.27, P ¼ 0.36).

Research paper thumbnail of Posters * Embryology (Embryo Selection)

Research paper thumbnail of A new handheld vacuum extraction device: a randomised control trial

BJOG: An International Journal of Obstetrics and Gynaecology, 2006

Research paper thumbnail of A case of true tubal hydatidiform mole and literature review

Case Reports, 2010

Tubal hydatidiform mole is an uncommon condition with about 40 confirmed cases in the accessible ... more Tubal hydatidiform mole is an uncommon condition with about 40 confirmed cases in the accessible literature. The patient usually presents with symptoms and signs of a classical ectopic pregnancy and it is only after histological examination and DNA ploidy analysis of the conceptus that a hydatidiform mole is diagnosed. Management requires complete removal of the conceptus and follow-up needs to be arranged with an appropriate supraregional centre. The authors present a case of complete molar tubal pregnancy and a review of the literature.

Research paper thumbnail of Reproductive outcome following abdominal myomectomy for a very large fibroid uterus

Journal of Obstetrics & Gynaecology, 2015

The aim of this study was to assess the long-term reproductive outcome following abdominal myomec... more The aim of this study was to assess the long-term reproductive outcome following abdominal myomectomy in women with very large fibroid uteri. It is a retrospective study of 90 subfertile women with the main outcome measure of live-birth rate following spontaneous and assisted conception. Mean age of the study population was 37 ± 5 years and mean uterine size was 21 ± 6 weeks. During follow-up (mean 50 ± 10 months), 28 (31%) pregnancies occurred; 18 spontaneous and 10 following IVF. The live-birth rate was 20% and the miscarriage rate was 32%. Multivariate analysis demonstrated that the chance of live birth was significantly reduced with increasing female age at the time of surgery (OR = 0.67, 95% CI 0.51-0.86, p = 0.002). The perioperative blood transfusion rate was 30% and the incidence of major complications was 6%. Fertility after abdominal myomectomy for very large fibroid uteri is possible, and its major determinant is female age at the time of surgery.

Research paper thumbnail of Peri-operative morbidity associated with abdominal myomectomy for very large fibroid uteri

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2013

To evaluate the safety of abdominal myomectomy for very large fibroid uteri, and to assess the ef... more To evaluate the safety of abdominal myomectomy for very large fibroid uteri, and to assess the effect of relevant confounding variables on the occurrence of major peri-operative complications. A cohort study of 200 abdominal myomectomies for fibroid uteri of 16 gestational weeks or greater. Logistic regression analysis was used to examine the influence of important clinical variables on the risk of complications. A systematic literature search was conducted for evidence related to peri-operative morbidity associated with abdominal myomectomy for very large fibroid uteri. The mean (±standard deviation) uterine size was 21±5 weeks. The overall rate of major complications was 30%. Peri-operative bleeding necessitating blood transfusion occurred in 49 (24.5%) cases. During surgery, two patients had bowel injury, two had bladder injury, seven women returned to theatre and two (1%) had hysterectomy. Four patients were re-admitted within 14 days of surgery. Multivariable logistic regression analysis showed that the risk of major complications was significantly higher in cases with a uterine size of 20 gestational weeks or more [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.1-10.2; p=0.03], where 10 or more fibroids were removed (OR 3.5, 95% CI 1.1-10.8; p=0.05) and where midline skin incision was required (OR 6.1, 95% CI 1.7-22.3; p=0.006). On comparison of primary vs repeat abdominal myomectomy, there was significantly higher blood loss (mean 1023±1112 ml vs 579±787 ml; p=0.02) and risk of major complications in the repeat myomectomy group (40% vs 5%; p<0.001). The systematic review identified only one study that reported a comparable risk of major complications related to abdominal myomectomy for very large fibroid uteri. The risk of organ injury, hysterectomy, re-operation or hospital re-admission after abdominal myomectomy for very large fibroid uteri is low, but the procedure is associated with a significant risk of bleeding necessitating blood transfusion. This risk is increased after repeat myomectomy, and in patients with a uterine size of 20 gestational weeks or larger, requiring removal of 10 or more fibroids, and requiring a midline skin incision.