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Papers by Sonia grover

Journal of Clinical Medicine

Adolescents with differences of sex development (DSD) often have complex medical, surgical, and p... more Adolescents with differences of sex development (DSD) often have complex medical, surgical, and psychological care needs and require age-appropriate resources. This cross-sectional study describes the past and current experiences of adolescents and young adults with DSD and their need for information and support. Participants aged 14–30 years with DSD diagnoses were identified, either from departmental records at the Royal Children’s Hospital (RCH), Melbourne, Australia, or from the private practice of a gynecologist linked to RCH. Anonymized data were collected from a specifically designed online survey. Of the 314 successfully traced patients, 91 (28.9%) completed the survey. Amongst respondents, older age was strongly correlated with higher levels of distress at the time of disclosure (b = 0.67, p < 0.001). People who reported greater understanding of their condition (b = −0.45, p = 0.010) and higher levels of support (b = −0.40, p = 0.003) identified lower levels of current d...

Disorders|Differences of Sex Development, 2020

Over the last two decades, there have been increasing efforts to study, report and clarify the lo... more Over the last two decades, there have been increasing efforts to study, report and clarify the long-term outcomes of DSD. This is a challenge in itself for a number of reasons, which will be discussed in the introduction of this chapter. In this chapter, we review the long-term outcomes of different DSD. The social, cultural and ethnic background has a profound effect on the medical approach to a patient with DSD as well as on the long-term outcome, as observed by the patients themselves. The current deficiencies in management in many Western countries are leading to the establishment of regionalised, special centres, and this trend is likely to continue.

Australian and New Zealand Journal of Obstetrics and Gynaecology, 2022

BackgroundEndometriosis affects one in nine Australian women of reproductive age, and is often as... more BackgroundEndometriosis affects one in nine Australian women of reproductive age, and is often associated with pain and infertility. However, many women may be asymptomatic, or present with alternative symptoms.AimTo identify reasons for initial specialist referral among patients with endometriosis.Material and MethodsPatients were identified as having endometriosis intraoperatively based on International Classification of Diseases coding. Operation reports were reviewed and graded for severity of disease. This cohort was then retrospectively audited to identify reasons for initial referral to the general gynaecology, endosurgery, gynae‐oncology, reproductive medicine outpatient departments (OPD) at the Mercy Hospital for Women in Melbourne between 1 February 2015 and 31 December 2016.ResultsThree hundred patients were identified as having endometriosis at laparoscopy, including 90 women with Stage IV disease. Patients were a mean (SD) age of 33.1 (7.6) years. While pain remained a ...

DSD gene variants. Each variant found in a diagnostic gene (after the filtering and curation proc... more DSD gene variants. Each variant found in a diagnostic gene (after the filtering and curation process) is shown. In some cases where the gene is inherited in an autosomal recessive manner, two variants are grouped together. Inheritance has been indicated where familial samples were available: negative indicates negative for variant and N/A sample not available. De novo events have only been noted where both parental samples were available and found to be negative for the change. Previously reported refers to a variant being described in either ClinVar, HGMD, or a publication in a peer-reviewed journal via a PubMed search. Variants were classified consistent with previous MPS publications of DSD cohorts [8, 10] which were based on ACMG guidelines [15]. VUS were called for three reasons: 1 = fits phenotype but predicted to be benign; 2 = damaging but doesn't fit phenotype; or 3 = variant in the AR repetitive region. Patients marked with an asterisk were identified to have two or mo...

Results from a pediatric surgical centre justify early intervention in disorders of sex

International Journal of Gynecology & Obstetrics, 2021

Girls and adolescents, aged 0–19 years make up almost 30% of the world’s female population yet th... more Girls and adolescents, aged 0–19 years make up almost 30% of the world’s female population yet their specific healthcare needs often slip between the gaps of pediatrics and adult women’s health. Pediatric and adolescent gynecology is the clinical field that endeavors to address the reproductive health needs of this age group. The environment and psychosocial well‐being, social determinants of health, have direct bearing on reproductive health, affecting menstrual cycles, menstrual hygiene, and risks for unintended pregnancy and sexually transmitted infections. This narrative review will highlight common gynecologic conditions of adolescents, especially where diagnosis and management are distinct from adult women. It will also present preventive health strategies to improve reproductive health through vaccination, improved access to hygiene supplies and contraception.

Disorders|Differences of Sex Development, 2020

Social Science Research Network, 2021

Background: Gynecological and reproductive problems that arise during childhood and adolescence c... more Background: Gynecological and reproductive problems that arise during childhood and adolescence can have a significant impact on individuals, families and society, and they are increasingly recognized as a public health priority. Methods: We conducted a retrospective study based on the electronic medical records of 207,287 gynecological visits over a period of 13 years (January 2006 to December 2018) at the Department of Pediatric and Adolescent Gynecology of The Children’s Hospital, Zhejiang University Medical School. The final analyses included 97,252 patients with gynecological problems. Additionally, we conducted a systematic review focused on previous studies examining PAG problems in China. Findings: The number of first-visit PAG patients increased from 4,582 to 11,876 during 2006-2018. Overall, genital inflammation was the most common presentation (57·0%), followed by early puberty (18·2%) and consultation of growth and development (10·2%). The proportion of other problems su...

DSD gene variants in different global regions. DSD gene variants among the international cohort o... more DSD gene variants in different global regions. DSD gene variants among the international cohort of 46,XY DSD patients. For ease of analysis, countries were grouped together into regions: Asia comprises Indonesia (97), Pakistan (25), Vietnam (35), Cambodia (16), India (1), a total of 174 patients ; Europe comprises the Netherlands (38), Austria (15), Belgium (6), and Italy (2), a total of 61 patients; and AUS & NZL comprises Australia (83) and New Zealand (7), a total of 90 patients. All curated variants are shown; those which have been curated and called pathogenic, likely pathogenic, and VUS. In the cohort from Asia, 35% of the patients were found to have a diagnostic variant (pathogenic or likely pathogenic), while this was 44% for Europe and 45% for AUS/NZL. Two patients from Canada were not included in the diagram. (PPTX 158 kb)

Tienda online donde Comprar Disorders Of Sex Development, An Integrated Approach To Management al... more Tienda online donde Comprar Disorders Of Sex Development, An Integrated Approach To Management al precio 159,55 € de John M. Hutson | Garry L. Warne | Sonia Grover, tienda de Libros de Medicina, Libros de Pediatria - Pediatria general

Objective: To determine the endometrial thickness at which endometrial sampling is indicated in a... more Objective: To determine the endometrial thickness at which endometrial sampling is indicated in asymptomatic post-menopausal women referred with thickened endometrium on ultrasound. Design: Retrospective case series Setting: Mercy Hospital for Women, Melbourne Population: Post-menopausal women without bleeding, undergoing hysteroscopy for thickened endometrium Methods: Logistic regression was used to examine the association between a range of variables and pre-malignant or malignant pathology and endometrial thickness Main outcome measures: The primary outcome was endometrial malignancy/pre-malignancy and its relation to endometrial thickness. Secondary outcomes focused on identifying additional predictors which may influence endometrial malignancy such as ultrasound findings, years since menopause, age, obesity, diabetes, and tamoxifen use. Results: A total of 404 postmenopausal women met the inclusion criteria for this study. The mean (SD) age of patients at presentation was 65 (9...

Current Pharmaceutical Design, 2021

It is well-established that adults with polycystic ovary syndrome (PCOS) have an increased preval... more It is well-established that adults with polycystic ovary syndrome (PCOS) have an increased prevalence of several cardiometabolic risk factors, including obesity, insulin resistance, type 2 diabetes mellitus, and dyslipidemia. Accumulating data suggest that these risk factors are already present in adolescence in patients with PCOS. This has major implications for the management of this population since the timely identification of these risk factors is essential for preventing cardiovascular disease in adulthood. The present review summarizes the existing evidence regarding the prevalence of traditional and non-traditional cardiometabolic risk factors in adolescents with PCOS.

BackgroundChronic pelvic pain (CPP) is a common condition which significantly impacts the quality... more BackgroundChronic pelvic pain (CPP) is a common condition which significantly impacts the quality of life and wellbeing of many women.Laparoscopy with histopathology is recommended for investigation of pelvic pain and identification of endometriosis with concurrent removal. Never-the-less, the association between endometriosis and pelvic pain is challenging, with endometriosis identified in only 30-50% of women with pain.AimsTo explore the predictors for undergoing surgery, for identifying endometriosis and endometriosis severity in a cohort of women with CPP.Materials and MethodsThis study forms part of the Persistent Pelvic Pain project, a prospective observational cohort study (ANZCTR:ACTRN12616000150448). Women referred to a public gynaecology clinic with pain were randomised to one of 2 gynaecology units for routine care and followed for 36-months with 6-monthly surveys assessing demographics, medical history, quality of life, and pain symptoms measured on a Likert scale. Opera...

Journal of Paediatrics and Child Health, 2021

Management of children with differences/disorders of sex development (DSD) is complex with limite... more Management of children with differences/disorders of sex development (DSD) is complex with limited evidence to guide clinical decisions. Regular multidisciplinary team meetings were set up in Sydney and Melbourne paediatric hospitals to enable systematic peer review of complex decision‐making. We aim to describe the workload and role of these meetings.

Australian and New Zealand Journal of Obstetrics and Gynaecology, 2021

BackgroundPersistent pelvic pain affects between 10–20% of women with a significant impact on the... more BackgroundPersistent pelvic pain affects between 10–20% of women with a significant impact on their physical and mental health, sexual relationships, families and society. Estimates of the cost to women and the community is over $9 billion/annum. Although endometriosis is considered a leading cause of pelvic pain, no symptoms reliably allow the identification of those with and without endometriosis. Furthermore, the significance of mild endometriosis is now debated. The optimal clinical approach for pelvic pain and endometriosis remains unclear, with increasing evidence of other contributing factors such as central sensitisation. Studies to date have significant limitations due to their sample size, relatively short follow‐up, and inclusion of only women with laparoscopically identified endometriosis.AimsTo undertake a real‐world study of women referred with pain to gynaecology outpatients of a women’s hospital and explore factors influencing three‐year outcomes.Materials and method...

Journal of Obstetrics and Gynaecology Research, 2020

AimTo describe the characteristics, management and outcomes of a cohort of young people with dysm... more AimTo describe the characteristics, management and outcomes of a cohort of young people with dysmenorrhea presenting to a tertiary adolescent gynecology service, managed primarily with medical interventions.MethodsA retrospective cohort study was conducted at the Royal Children's Hospital in Melbourne, Australia. Data were collected from medical records of patients presenting with dysmenorrhea and/or pelvic pain.ResultsOf 154 patients, mean age of presentation was 15.7 years (SD = 2.2) and mean duration of pain was 14.9 months (SD = 10.8). Regular cycles were reported by 64.5%, and heavy menstrual bleeding (HMB) in 67.8%. Patients self‐reporting HMB reported less pain on the day prior to menses than those not reporting HMB (P < 0.005). At follow‐up, therapeutic interventions included nonsteroidal anti‐inflammatory drugs, tranexamic acid and cyclic or continuous combined oral contraceptive pills. Laparoscopies were undertaken in 12 (8.1%) patients, with normal findings in 8 (6...

Australian Journal of General Practice, 2020

Background and objective Heavy menstrual bleeding (HMB) in adolecents is predominantly related to... more Background and objective Heavy menstrual bleeding (HMB) in adolecents is predominantly related to an immature hypothalamic-pituitary-ovarian axis. Structural causes in this population are extremely rare; therefore, pelvic ultrasonography is not required as a firstline investigation. Anecdotally, it has been observed that pelvic ultrasounds of adolescents with HMB are normal and do not change clinical care. The aim of this study was to analyse all female patients aged ≤18 years who were referred to a tertiary paediatric hospital for HMB over a 12-month period. Method Medical records were reviewed to determine if pelvic ultrasonography was ordered during the diagnostic process and whether the imaging altered management. Results No pelvic ultrasounds ordered for adolescents with HMB altered clinical management. General practitioners (GP) were the most likely to refer patients to the tertiary paediatric hospital and to order pelvic ultrasonography, likely reflecting that most female adolescents are seen by a GP within the community. Discussion Providing clinical updates and ongoing education to health professionals managing female adolescent patients is recommended.

Journal of Clinical Medicine

Adolescents with differences of sex development (DSD) often have complex medical, surgical, and p... more Adolescents with differences of sex development (DSD) often have complex medical, surgical, and psychological care needs and require age-appropriate resources. This cross-sectional study describes the past and current experiences of adolescents and young adults with DSD and their need for information and support. Participants aged 14–30 years with DSD diagnoses were identified, either from departmental records at the Royal Children’s Hospital (RCH), Melbourne, Australia, or from the private practice of a gynecologist linked to RCH. Anonymized data were collected from a specifically designed online survey. Of the 314 successfully traced patients, 91 (28.9%) completed the survey. Amongst respondents, older age was strongly correlated with higher levels of distress at the time of disclosure (b = 0.67, p < 0.001). People who reported greater understanding of their condition (b = −0.45, p = 0.010) and higher levels of support (b = −0.40, p = 0.003) identified lower levels of current d...

Disorders|Differences of Sex Development, 2020

Over the last two decades, there have been increasing efforts to study, report and clarify the lo... more Over the last two decades, there have been increasing efforts to study, report and clarify the long-term outcomes of DSD. This is a challenge in itself for a number of reasons, which will be discussed in the introduction of this chapter. In this chapter, we review the long-term outcomes of different DSD. The social, cultural and ethnic background has a profound effect on the medical approach to a patient with DSD as well as on the long-term outcome, as observed by the patients themselves. The current deficiencies in management in many Western countries are leading to the establishment of regionalised, special centres, and this trend is likely to continue.

Australian and New Zealand Journal of Obstetrics and Gynaecology, 2022

BackgroundEndometriosis affects one in nine Australian women of reproductive age, and is often as... more BackgroundEndometriosis affects one in nine Australian women of reproductive age, and is often associated with pain and infertility. However, many women may be asymptomatic, or present with alternative symptoms.AimTo identify reasons for initial specialist referral among patients with endometriosis.Material and MethodsPatients were identified as having endometriosis intraoperatively based on International Classification of Diseases coding. Operation reports were reviewed and graded for severity of disease. This cohort was then retrospectively audited to identify reasons for initial referral to the general gynaecology, endosurgery, gynae‐oncology, reproductive medicine outpatient departments (OPD) at the Mercy Hospital for Women in Melbourne between 1 February 2015 and 31 December 2016.ResultsThree hundred patients were identified as having endometriosis at laparoscopy, including 90 women with Stage IV disease. Patients were a mean (SD) age of 33.1 (7.6) years. While pain remained a ...

DSD gene variants. Each variant found in a diagnostic gene (after the filtering and curation proc... more DSD gene variants. Each variant found in a diagnostic gene (after the filtering and curation process) is shown. In some cases where the gene is inherited in an autosomal recessive manner, two variants are grouped together. Inheritance has been indicated where familial samples were available: negative indicates negative for variant and N/A sample not available. De novo events have only been noted where both parental samples were available and found to be negative for the change. Previously reported refers to a variant being described in either ClinVar, HGMD, or a publication in a peer-reviewed journal via a PubMed search. Variants were classified consistent with previous MPS publications of DSD cohorts [8, 10] which were based on ACMG guidelines [15]. VUS were called for three reasons: 1 = fits phenotype but predicted to be benign; 2 = damaging but doesn't fit phenotype; or 3 = variant in the AR repetitive region. Patients marked with an asterisk were identified to have two or mo...

Results from a pediatric surgical centre justify early intervention in disorders of sex

International Journal of Gynecology & Obstetrics, 2021

Girls and adolescents, aged 0–19 years make up almost 30% of the world’s female population yet th... more Girls and adolescents, aged 0–19 years make up almost 30% of the world’s female population yet their specific healthcare needs often slip between the gaps of pediatrics and adult women’s health. Pediatric and adolescent gynecology is the clinical field that endeavors to address the reproductive health needs of this age group. The environment and psychosocial well‐being, social determinants of health, have direct bearing on reproductive health, affecting menstrual cycles, menstrual hygiene, and risks for unintended pregnancy and sexually transmitted infections. This narrative review will highlight common gynecologic conditions of adolescents, especially where diagnosis and management are distinct from adult women. It will also present preventive health strategies to improve reproductive health through vaccination, improved access to hygiene supplies and contraception.

Disorders|Differences of Sex Development, 2020

Social Science Research Network, 2021

Background: Gynecological and reproductive problems that arise during childhood and adolescence c... more Background: Gynecological and reproductive problems that arise during childhood and adolescence can have a significant impact on individuals, families and society, and they are increasingly recognized as a public health priority. Methods: We conducted a retrospective study based on the electronic medical records of 207,287 gynecological visits over a period of 13 years (January 2006 to December 2018) at the Department of Pediatric and Adolescent Gynecology of The Children’s Hospital, Zhejiang University Medical School. The final analyses included 97,252 patients with gynecological problems. Additionally, we conducted a systematic review focused on previous studies examining PAG problems in China. Findings: The number of first-visit PAG patients increased from 4,582 to 11,876 during 2006-2018. Overall, genital inflammation was the most common presentation (57·0%), followed by early puberty (18·2%) and consultation of growth and development (10·2%). The proportion of other problems su...

DSD gene variants in different global regions. DSD gene variants among the international cohort o... more DSD gene variants in different global regions. DSD gene variants among the international cohort of 46,XY DSD patients. For ease of analysis, countries were grouped together into regions: Asia comprises Indonesia (97), Pakistan (25), Vietnam (35), Cambodia (16), India (1), a total of 174 patients ; Europe comprises the Netherlands (38), Austria (15), Belgium (6), and Italy (2), a total of 61 patients; and AUS & NZL comprises Australia (83) and New Zealand (7), a total of 90 patients. All curated variants are shown; those which have been curated and called pathogenic, likely pathogenic, and VUS. In the cohort from Asia, 35% of the patients were found to have a diagnostic variant (pathogenic or likely pathogenic), while this was 44% for Europe and 45% for AUS/NZL. Two patients from Canada were not included in the diagram. (PPTX 158 kb)

Tienda online donde Comprar Disorders Of Sex Development, An Integrated Approach To Management al... more Tienda online donde Comprar Disorders Of Sex Development, An Integrated Approach To Management al precio 159,55 € de John M. Hutson | Garry L. Warne | Sonia Grover, tienda de Libros de Medicina, Libros de Pediatria - Pediatria general

Objective: To determine the endometrial thickness at which endometrial sampling is indicated in a... more Objective: To determine the endometrial thickness at which endometrial sampling is indicated in asymptomatic post-menopausal women referred with thickened endometrium on ultrasound. Design: Retrospective case series Setting: Mercy Hospital for Women, Melbourne Population: Post-menopausal women without bleeding, undergoing hysteroscopy for thickened endometrium Methods: Logistic regression was used to examine the association between a range of variables and pre-malignant or malignant pathology and endometrial thickness Main outcome measures: The primary outcome was endometrial malignancy/pre-malignancy and its relation to endometrial thickness. Secondary outcomes focused on identifying additional predictors which may influence endometrial malignancy such as ultrasound findings, years since menopause, age, obesity, diabetes, and tamoxifen use. Results: A total of 404 postmenopausal women met the inclusion criteria for this study. The mean (SD) age of patients at presentation was 65 (9...

Current Pharmaceutical Design, 2021

It is well-established that adults with polycystic ovary syndrome (PCOS) have an increased preval... more It is well-established that adults with polycystic ovary syndrome (PCOS) have an increased prevalence of several cardiometabolic risk factors, including obesity, insulin resistance, type 2 diabetes mellitus, and dyslipidemia. Accumulating data suggest that these risk factors are already present in adolescence in patients with PCOS. This has major implications for the management of this population since the timely identification of these risk factors is essential for preventing cardiovascular disease in adulthood. The present review summarizes the existing evidence regarding the prevalence of traditional and non-traditional cardiometabolic risk factors in adolescents with PCOS.

BackgroundChronic pelvic pain (CPP) is a common condition which significantly impacts the quality... more BackgroundChronic pelvic pain (CPP) is a common condition which significantly impacts the quality of life and wellbeing of many women.Laparoscopy with histopathology is recommended for investigation of pelvic pain and identification of endometriosis with concurrent removal. Never-the-less, the association between endometriosis and pelvic pain is challenging, with endometriosis identified in only 30-50% of women with pain.AimsTo explore the predictors for undergoing surgery, for identifying endometriosis and endometriosis severity in a cohort of women with CPP.Materials and MethodsThis study forms part of the Persistent Pelvic Pain project, a prospective observational cohort study (ANZCTR:ACTRN12616000150448). Women referred to a public gynaecology clinic with pain were randomised to one of 2 gynaecology units for routine care and followed for 36-months with 6-monthly surveys assessing demographics, medical history, quality of life, and pain symptoms measured on a Likert scale. Opera...

Journal of Paediatrics and Child Health, 2021

Management of children with differences/disorders of sex development (DSD) is complex with limite... more Management of children with differences/disorders of sex development (DSD) is complex with limited evidence to guide clinical decisions. Regular multidisciplinary team meetings were set up in Sydney and Melbourne paediatric hospitals to enable systematic peer review of complex decision‐making. We aim to describe the workload and role of these meetings.

Australian and New Zealand Journal of Obstetrics and Gynaecology, 2021

BackgroundPersistent pelvic pain affects between 10–20% of women with a significant impact on the... more BackgroundPersistent pelvic pain affects between 10–20% of women with a significant impact on their physical and mental health, sexual relationships, families and society. Estimates of the cost to women and the community is over $9 billion/annum. Although endometriosis is considered a leading cause of pelvic pain, no symptoms reliably allow the identification of those with and without endometriosis. Furthermore, the significance of mild endometriosis is now debated. The optimal clinical approach for pelvic pain and endometriosis remains unclear, with increasing evidence of other contributing factors such as central sensitisation. Studies to date have significant limitations due to their sample size, relatively short follow‐up, and inclusion of only women with laparoscopically identified endometriosis.AimsTo undertake a real‐world study of women referred with pain to gynaecology outpatients of a women’s hospital and explore factors influencing three‐year outcomes.Materials and method...

Journal of Obstetrics and Gynaecology Research, 2020

AimTo describe the characteristics, management and outcomes of a cohort of young people with dysm... more AimTo describe the characteristics, management and outcomes of a cohort of young people with dysmenorrhea presenting to a tertiary adolescent gynecology service, managed primarily with medical interventions.MethodsA retrospective cohort study was conducted at the Royal Children's Hospital in Melbourne, Australia. Data were collected from medical records of patients presenting with dysmenorrhea and/or pelvic pain.ResultsOf 154 patients, mean age of presentation was 15.7 years (SD = 2.2) and mean duration of pain was 14.9 months (SD = 10.8). Regular cycles were reported by 64.5%, and heavy menstrual bleeding (HMB) in 67.8%. Patients self‐reporting HMB reported less pain on the day prior to menses than those not reporting HMB (P < 0.005). At follow‐up, therapeutic interventions included nonsteroidal anti‐inflammatory drugs, tranexamic acid and cyclic or continuous combined oral contraceptive pills. Laparoscopies were undertaken in 12 (8.1%) patients, with normal findings in 8 (6...

Australian Journal of General Practice, 2020

Background and objective Heavy menstrual bleeding (HMB) in adolecents is predominantly related to... more Background and objective Heavy menstrual bleeding (HMB) in adolecents is predominantly related to an immature hypothalamic-pituitary-ovarian axis. Structural causes in this population are extremely rare; therefore, pelvic ultrasonography is not required as a firstline investigation. Anecdotally, it has been observed that pelvic ultrasounds of adolescents with HMB are normal and do not change clinical care. The aim of this study was to analyse all female patients aged ≤18 years who were referred to a tertiary paediatric hospital for HMB over a 12-month period. Method Medical records were reviewed to determine if pelvic ultrasonography was ordered during the diagnostic process and whether the imaging altered management. Results No pelvic ultrasounds ordered for adolescents with HMB altered clinical management. General practitioners (GP) were the most likely to refer patients to the tertiary paediatric hospital and to order pelvic ultrasonography, likely reflecting that most female adolescents are seen by a GP within the community. Discussion Providing clinical updates and ongoing education to health professionals managing female adolescent patients is recommended.