Alec Ekeroma

Publications

• 1.32

  Impact points

  Antenatal care, identification of suboptimal fetal growth and risk of late stillbirth: Findings from the Auckland Stillbirth Study.

  Tomasina Stacey, John M D Thompson, Edwin A Mitchell, Jane M Zuccollo, Alec J Ekeroma, Lesley M E McCowan

  The Australian & New Zealand journal of obstetrics & gynaecology. 01/2012;

  INTRODUCTION: Stillbirth remains an important public health problem in Australia and New Zealand. The role that antenatal care plays in the prevention of stillbirth in high-income countries is unclear. METHODS: Cases were women with a singleton, late stillbirth without congenital abnormality, booked... [more] INTRODUCTION: Stillbirth remains an important public health problem in Australia and New Zealand. The role that antenatal care plays in the prevention of stillbirth in high-income countries is unclear. METHODS: Cases were women with a singleton, late stillbirth without congenital abnormality, booked to deliver in the Auckland region and born between July 2006 and June 2009. Two controls with ongoing pregnancies were randomly selected at the same gestation at which the stillbirth occurred. Data were collected through interview-administered questionnaires and from antenatal records. RESULTS: One hundred and fifty five of 215 (72%) cases and 310 of 429 (72%) controls consented to take part in the study. Accessing <50% of recommended antenatal visits was associated with a more than twofold increase in late stillbirth (adjusted odds ratio, aOR, 2.68; 95% CI, 1.04-6.90) compared with accessing the recommended number of visits. Small-for-gestational-age (SGA) babies that had not been identified as SGA prior to birth were significantly more at risk of being stillborn (aOR, 9.46; 95% CI, 1.98-45.13) compared with SGA babies that were identified as such in the antenatal period. No relationship was found between type or model of maternity care provider at booking and late stillbirth risk. DISCUSSION: This study reinforces the importance of regular antenatal care attendance. Identification of SGA may be one way by which antenatal care reduces stillbirth.
• 1.92

  Impact points

  Maternal perception of fetal activity and late stillbirth risk: findings from the Auckland Stillbirth Study.

  Tomasina Stacey, John M D Thompson, Edwin A Mitchell, Alec Ekeroma, Jane Zuccollo, Lesley M E McCowan

  Birth (Berkeley, Calif.). 12/2011; 38(4):311-6.

    Maternal perception of decreased fetal movements has been associated with adverse pregnancy outcomes, including stillbirth. Little is known about other aspects of perceived fetal activity. The objective of this study was to explore the relationship between maternal perception of fetal activity and... [more]   Maternal perception of decreased fetal movements has been associated with adverse pregnancy outcomes, including stillbirth. Little is known about other aspects of perceived fetal activity. The objective of this study was to explore the relationship between maternal perception of fetal activity and late stillbirth (≥28 wk gestation) risk.   Participants were women with a singleton, late stillbirth without congenital abnormality, born between July 2006 and June 2009 in Auckland, New Zealand. Two control women with ongoing pregnancies were randomly selected at the same gestation at which the stillbirth occurred. Detailed demographic and fetal movement data were collected by way of interview in the first few weeks after the stillbirth, or at the equivalent gestation for control women.   A total of 155/215 (72%) women who experienced a stillbirth and 310/429 (72%) control group women consented to participate in the study. Maternal perception of increased strength and frequency of fetal movements, fetal hiccups, and frequent vigorous fetal activity were all associated with a reduced risk of late stillbirth. In contrast, perception of decreased strength of fetal movement was associated with a more than twofold increased risk of late stillbirth (aOR: 2.37; 95% CI: 1.29-4.35). A single episode of vigorous fetal activity was associated with an almost sevenfold increase in late stillbirth risk (aOR: 6.81; 95% CI: 3.01-15.41) compared with no unusually vigorous activity.   Our study suggests that maternal perception of increasing fetal activity throughout the last 3 months of pregnancy is a sign of fetal well-being, whereas perception of reduced fetal movements is associated with increased risk of late stillbirth.
• 1.32

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  The Auckland Stillbirth study, a case-control study exploring modifiable risk factors for third trimester stillbirth: methods and rationale.

  Tomasina Stacey, John M D Thompson, Edwin A Mitchell, Alec J Ekeroma, Jane M Zuccollo, Lesley M E McCowan

  The Australian & New Zealand journal of obstetrics & gynaecology. 02/2011; 51(1):3-8.

  In high-income countries, stillbirth rates have been static in recent decades. Unexplained stillbirths account for up to 50% of these deaths. A case-control study was conducted in Auckland, New Zealand, from July 2006 to June 2009 to explore modifiable risk factors for late stillbirth (≥28 weeks of ... [more] In high-income countries, stillbirth rates have been static in recent decades. Unexplained stillbirths account for up to 50% of these deaths. A case-control study was conducted in Auckland, New Zealand, from July 2006 to June 2009 to explore modifiable risk factors for late stillbirth (≥28 weeks of gestation). Eligible participants were women who had a singleton late stillbirth without a congenital abnormality. Two controls with ongoing pregnancies were randomly selected at the same gestation as each case. Data were collected through face-to-face interviews and from clinical records. A total of 155/215 (72%) cases and 310/429 (72%) controls consented to take part in the study. Women who had a late stillbirth were more likely to be of Pacific ethnicity and of parity ≥4 (OR = 1.7, 95% CI: 1.1-2.6 and 2.7, 95% CI: 1.4-5.3, respectively). The median gestational age at diagnosis of fetal death was 261 days (IQR 239-279), and the median gestation at which the controls were interviewed was 264.5 days (IQR 240-274) P = 0.48. 'Unexplained antepartum death' (n = 61, 39.4%) and 'fetal growth restriction' (n = 29, 18.7%) accounted for almost 60% of stillbirths. The post-mortem rate for all cases was 47% (73/155) and 43% (26/61) for those classified as 'unexplained antepartum death'.   This study of risk factors for stillbirth is novel in that it used gestation-matched controls with ongoing pregnancies. Its detailed investigation into maternal health and behaviour during pregnancy has the potential to lead to a better understanding of modifiable risk factors for late stillbirth.
• 1.72

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  Relationship between obesity, ethnicity and risk of late stillbirth: a case control study.

  Tomasina Stacey, John M D Thompson, Edwin A Mitchell, Alec J Ekeroma, Jane M Zuccollo, Lesley M E McCowan

  BMC pregnancy and childbirth. 01/2011; 11:3.

  In high income countries there has been little improvement in stillbirth rates over the past two decades. Previous studies have indicated an ethnic disparity in the rate of stillbirths. This study aimed to determine whether maternal ethnicity is independently associated with late stillbirth in New Z... [more] In high income countries there has been little improvement in stillbirth rates over the past two decades. Previous studies have indicated an ethnic disparity in the rate of stillbirths. This study aimed to determine whether maternal ethnicity is independently associated with late stillbirth in New Zealand. Cases were women with a singleton, late stillbirth (≥ 28 weeks' gestation) without congenital abnormality, born between July 2006 and June 2009 in Auckland, New Zealand. Two controls with ongoing pregnancies were randomly selected at the same gestation at which the stillbirth occurred. Women were interviewed in the first few weeks following stillbirth, or at the equivalent gestation for controls. Detailed demographic data were recorded. The study was powered to detect an odds ratio of 2, with a power of 80% at the 5% level of significance, given a prevalence of the risk factor of 20%. A multivariable regression model was developed which adjusted for known risk factors for stillbirth, as well as significant risk factors identified in the current study, and adjusted odds ratios and 95% confidence intervals were calculated. 155/215 (72%) cases and 310/429 (72%) controls consented. Pacific ethnicity, overweight and obesity, grandmultiparity, not being married, not being in paid work, social deprivation, exposure to tobacco smoke and use of recreational drugs were associated with an increased risk of late stillbirth in univariable analysis. Maternal overweight and obesity, nulliparity, grandmultiparity, not being married and not being in paid work were independently associated with late stillbirth in multivariable analysis, whereas Pacific ethnicity was no longer significant (adjusted Odds Ratio 0.99; 0.51-1.91). Pacific ethnicity was not found to be an independent risk factor for late stillbirth in this New Zealand study. The disparity in stillbirth rates between Pacific and European women can be attributed to confounding factors such as maternal obesity and high parity.

• Association between maternal sleep practices and risk of late stillbirth: a case-control study.

  Tomasina Stacey, John M D Thompson, Ed A Mitchell, Alec J Ekeroma, Jane M Zuccollo, Lesley M E McCowan

  BMJ (Clinical research ed.). 01/2011; 342:d3403.

  To determine whether snoring, sleep position, and other sleep practices in pregnant women are associated with risk of late stillbirth. Prospective population based case-control study. Auckland, New Zealand Cases: 155 women with a singleton late stillbirth (≥ 28 weeks' gestation) without congenit... [more] To determine whether snoring, sleep position, and other sleep practices in pregnant women are associated with risk of late stillbirth. Prospective population based case-control study. Auckland, New Zealand Cases: 155 women with a singleton late stillbirth (≥ 28 weeks' gestation) without congenital abnormality born between July 2006 and June 2009 and booked to deliver in Auckland. Controls: 310 women with single ongoing pregnancies and gestation matched to that at which the stillbirth occurred. Multivariable logistic regression adjusted for known confounding factors. Maternal snoring, daytime sleepiness (measured with the Epworth sleepiness scale), and sleep position at the time of going to sleep and on waking (left side, right side, back, and other). The prevalence of late stillbirth in this study was 3.09/1000 births. No relation was found between snoring or daytime sleepiness and risk of late stillbirth. However, women who slept on their back or on their right side on the previous night (before stillbirth or interview) were more likely to experience a late stillbirth compared with women who slept on their left side (adjusted odds ratio for back sleeping 2.54 (95% CI 1.04 to 6.18), and for right side sleeping 1.74 (0.98 to 3.01)). The absolute risk of late stillbirth for women who went to sleep on their left was 1.96/1000 and was 3.93/1000 for women who did not go to sleep on their left. Women who got up to go to the toilet once or less on the last night were more likely to experience a late stillbirth compared with women who got up more frequently (adjusted odds ratio 2.28 (1.40 to 3.71)). Women who regularly slept during the day in the previous month were also more likely to experience a late stillbirth than those who did not (2.04 (1.26 to 3.27)). This is the first study to report maternal sleep related practices as risk factors for stillbirth, and these findings require urgent confirmation in further studies.

• Relationship between obesity, ethnicity and risk of late stillbirth: a case control study

  Tomasina Stacey, John Thompson, Edwin Mitchell, Alec Ekeroma, Jane Zuccollo, Lesley McCowan

  BMC Pregnancy and Childbirth. 01/2011;

  Abstract Background In high income countries there has been little improvement in stillbirth rates over the past two decades. Previous studies have indicated an ethnic disparity in the rate of stillbirths. This study aimed to determine whether maternal ethnicity is independently associated with late... [more] Abstract Background In high income countries there has been little improvement in stillbirth rates over the past two decades. Previous studies have indicated an ethnic disparity in the rate of stillbirths. This study aimed to determine whether maternal ethnicity is independently associated with late stillbirth in New Zealand. Methods Cases were women with a singleton, late stillbirth (≥28 weeks&apos; gestation) without congenital abnormality, born between July 2006 and June 2009 in Auckland, New Zealand. Two controls with ongoing pregnancies were randomly selected at the same gestation at which the stillbirth occurred. Women were interviewed in the first few weeks following stillbirth, or at the equivalent gestation for controls. Detailed demographic data were recorded. The study was powered to detect an odds ratio of 2, with a power of 80% at the 5% level of significance, given a prevalence of the risk factor of 20%. A multivariable regression model was developed which adjusted for known risk factors for stillbirth, as well as significant risk factors identified in the current study, and adjusted odds ratios and 95% confidence intervals were calculated. Results 155/215 (72%) cases and 310/429 (72%) controls consented. Pacific ethnicity, overweight and obesity, grandmultiparity, not being married, not being in paid work, social deprivation, exposure to tobacco smoke and use of recreational drugs were associated with an increased risk of late stillbirth in univariable analysis. Maternal overweight and obesity, nulliparity, grandmultiparity, not being married and not being in paid work were independently associated with late stillbirth in multivariable analysis, whereas Pacific ethnicity was no longer significant (adjusted Odds Ratio 0.99; 0.51-1.91). Conclusions Pacific ethnicity was not found to be an independent risk factor for late stillbirth in this New Zealand study. The disparity in stillbirth rates between Pacific and European women can be attributed to confounding factors such as maternal obesity and high parity.

• Evaluation of Pacific obstetric and gynaecological ultrasound scanning capabilities, personnel, equipment and workloads.

  Hemal Kodikara, Jenny Mitchell, Alec Ekeroma, Peter Stone

  The New Zealand medical journal. 01/2010; 123(1327):58-67.

  There are no published data on the coverage, training or experience of ultrasound services in the Pacific. This study aimed to obtain information on the knowledge, experience and training of ultrasound operators and scanning equipment and workloads in the Pacific region. Participants for the survey ... [more] There are no published data on the coverage, training or experience of ultrasound services in the Pacific. This study aimed to obtain information on the knowledge, experience and training of ultrasound operators and scanning equipment and workloads in the Pacific region. Participants for the survey were recruited by post, via the Pacific Society of Reproductive Health (PSRH) website and at the PSRH conference. Questions obtained information on ultrasound scanning capabilities, personnel, equipment and workloads in the Pacific region 30 respondents from 17 hospitals in 11 countries provided completed questionnaires. Close to 50% of the responses were from Fiji. The majority of respondents were sonographers or obstetricians. Lack of transvaginal probes (7/17) in some facilities limit accuracy of early pregnancy scanning. 17/17 respondents felt an advanced course would be the preferred type of course. There is a sound basic level of ultrasound being performed in the Pacific region. A multimodal training programme, incorporating a practical hands-on course based in New Zealand, combined with CD/published materials appears to be the best method of developing more advanced skills in order to optimise antenatal care in the region.
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  Ethnicity and birth outcome: New Zealand trends 1980-2001. Part 1. Introduction, methods, results and overview.

  Elizabeth D Craig, Colin D Mantell, Alec J Ekeroma, Alistair W Stewart, Ed A Mitchell

  The Australian & New Zealand journal of obstetrics & gynaecology. 01/2005; 44(6):530-6.

  BACKGROUND: New Zealand Government policy during the past decade has placed a high priority on closing socioeconomic and ethnic gaps in health outcome. AIM: To analyse New Zealand's trends in preterm and small for gestational age (SGA) births and late fetal deaths during 1980-2001 and to underta... [more] BACKGROUND: New Zealand Government policy during the past decade has placed a high priority on closing socioeconomic and ethnic gaps in health outcome. AIM: To analyse New Zealand's trends in preterm and small for gestational age (SGA) births and late fetal deaths during 1980-2001 and to undertake ethnic specific analyses, resulting in risk factor profiles, for each ethnic group. METHODS: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for the period 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and New Zealand Deprivation Index decile. Trend analysis was undertaken for 1980-1994 while multivariate logistic regression was used to explore risk factors for 1996-2001. RESULTS: During 1980-1994, preterm birth rates were highest amongst Maori women. Preterm rates increased by 30% for European/other women, in contrast to non-significant declines of 7% for Maori women and 4% for Pacific women during this period. During the same period, rates of SGA were highest amongst Maori women. Rates of SGA declined by 30% for Pacific women, 25% for Maori women and 19% for European/other women during this period. Rates of late fetal death were highest amongst Pacific women during 1980-1994, but declined by 49% during this period, the rate of decline being similar for all ethnic groups. CONCLUSIONS: The marked differences in both trend data and risk factor profiles for women in New Zealand's largest ethnic groups would suggest that unless ethnicity is specifically taken into account in future policy and planning initiatives, the disparities seen in this analysis might well persist into future generations.
• 1.32

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  Ethnicity and birth outcome: New Zealand trends 1980-2001: Part 2. Pregnancy outcomes for Maori women.

  Colin D Mantell, Elizabeth D Craig, Alistair W Stewart, Alec J Ekeroma, Ed A Mitchell

  The Australian & New Zealand journal of obstetrics & gynaecology. 01/2005; 44(6):537-40.

  BACKGROUND: While traditionally Maori perinatal mortality has been similar to that of other ethnic groups, rates of preterm birth, small for gestational age (SGA) and teenage pregnancy have remained high. AIMS: To review current trends in preterm birth, SGA and teenage pregnancy for Maori during 198... [more] BACKGROUND: While traditionally Maori perinatal mortality has been similar to that of other ethnic groups, rates of preterm birth, small for gestational age (SGA) and teenage pregnancy have remained high. AIMS: To review current trends in preterm birth, SGA and teenage pregnancy for Maori during 1980-2001 and to highlight the major factors that have influenced Maori reproductive outcomes during this period. METHODS: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and NZ Deprivation Index decile. Trend analysis was undertaken for 1980-1994 and multivariate logistic regression was used to explore risk factors for 1996-2001. RESULTS: During 1980-1994, Maori women had the highest preterm birth rates of any ethnic group in New Zealand, but in relative terms, inequalities declined as a consequence of a non-significant 7% fall in rates being offset by a statistically significant 30% increase for the European/other ethnic group. Rates of SGA were also higher amongst Maori women but declined by 25% during the 1980-1994 period. In addition, Maori women experienced significant socioeconomic gradients in SGA, with risk for Maori women in the most deprived NZDep areas being double that of Maori living affluent areas. Paradoxically, while Maori women had high rates of teenage pregnancy, this did not confer additional risk for preterm birth or SGA during the 1996-2001 period. CONCLUSIONS: While high rates of teenage pregnancy amongst Maori women appear not to confer additional risk for preterm birth or SGA, the social consequences of early childbearing may well be significant. The persistence of elevated rates of preterm birth and large socioeconomic gradients in SGA amongst Maori suggest that broader social and policy interventions are necessary if Maori are to achieve optimal birth outcomes in the coming decades.
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  Ethnicity and birth outcome: New Zealand trends 1980-2001: Part 3. Pregnancy outcomes for Pacific women.

  Alec J Ekeroma, Elizabeth D Craig, Alistair W Stewart, Colin D Mantell, Ed A Mitchell

  The Australian & New Zealand journal of obstetrics & gynaecology. 01/2005; 44(6):541-4.

  BACKGROUND: Pacific women in New Zealand reside in areas of higher socioeconomic deprivation compared to women from other ethnic groups. Pacific women and their health are further disadvantaged because of genetic predisposition and sociocultural factors that cause ill-health. The correlations betwee... [more] BACKGROUND: Pacific women in New Zealand reside in areas of higher socioeconomic deprivation compared to women from other ethnic groups. Pacific women and their health are further disadvantaged because of genetic predisposition and sociocultural factors that cause ill-health. The correlations between pregnancy outcomes, risk factors and other health indices in Pacific women need evaluation. AIMS: To examine trends in preterm birth, small for gestational age (SGA) and late fetal death for Pacific women during 1980-2001 and to explore risk factors which make this group vulnerable to adverse birth outcome. METHODS: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and NZ Deprivation Index decile. Trend analysis was undertaken for 1980-1994 and multivariate logistic regression was used to explore risk factors for 1996-2001. RESULTS: Pacific women had the lowest rates of preterm birth and SGA when compared to Maori and European women. In addition, preterm birth rates underwent a non-significant 4% decline and SGA rates a 30% decline during 1980-1994. Although there has been a 49% decline in late fetal deaths during 1980-1994, the rate remained higher for Pacific women than for Maori and European/other women. CONCLUSIONS: Despite residing in areas of high socioeconomic deprivation, which is associated with poor pregnancy outcomes for Maori and European/other women, Pacific women had better pregnancy outcomes, with lower preterm and SGA rates. The significant decline in rates of late fetal death during the past two decades is a cause for celebration; however, the rate remains higher for Pacific women than for other ethnic groups. Biological, cultural and social factors might explain the better pregnancy outcomes for Pacific women and these factors should be considered when developing future prevention programmes.
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  Ethnicity and birth outcome: New Zealand trends 1980-2001: Part 4. Pregnancy outcomes for European/other women.

  Elizabeth D Craig, Ed A Mitchell, Alistair W Stewart, Colin D Mantell, Alec J Ekeroma

  The Australian & New Zealand journal of obstetrics & gynaecology. 01/2005; 44(6):545-8.

  BACKGROUND: In the early 1980s European/other women made up 80% of New Zealand's population and experienced rates of preterm birth that were lower than for other ethnic groups. Rates of small for gestational age (SGA) and late fetal death were intermediate between those of Maori and Pacific wome... [more] BACKGROUND: In the early 1980s European/other women made up 80% of New Zealand's population and experienced rates of preterm birth that were lower than for other ethnic groups. Rates of small for gestational age (SGA) and late fetal death were intermediate between those of Maori and Pacific women. AIMS: To examine trends in preterm birth, SGA and late fetal death for European/other women during 1980-2001 and to explore risk factors which make this group vulnerable to adverse birth outcome. METHODS: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and NZ Deprivation Index decile. Trend analysis was undertaken for 1980-1994 and multivariate logistic regression was used to explore risk factors for 1996-2001. RESULTS: During 1980-1994, rates of preterm birth rose by 30% for European/other women, in contrast to a non-significant decline of 7% for Maori women and 4% for Pacific women. Rates of SGA declined 19% for European/other women, compared to 25% for Maori and 30% for Pacific women. Preterm birth and SGA were positively associated with teenage pregnancy and increasing NZDep deprivation. During 1980-1994, rates of late fetal death declined by 49%, with declines being similar for all ethnic groups. CONCLUSIONS: The progressive rise in preterm birth during the past two decades is a cause of concern for European/other women, particularly as it appears confined to this ethnic group. While rates of SGA have declined, albeit at a slower rate than for other ethnic groups, the elevated risk amongst teenagers and those living in the more deprived NZDep areas suggests that greater gains are achievable if interventions are targeted towards these particular groups.
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  Women's choice in the gender and ethnicity of her obstetrician and gynaecologist.

  Alec Ekeroma, Mahesh Harillal

  The Australian & New Zealand journal of obstetrics & gynaecology. 11/2003; 43(5):354-9.

  OBJECTIVE: To ascertain women's preferences in the gender and ethnicity of her obstetrician or gynaecologist and to determine whether there were differences in preferences among different ethnic and age groups. STUDY DESIGN: A simple 11-item questionnaire was placed at the antenatal and gynaecol... [more] OBJECTIVE: To ascertain women's preferences in the gender and ethnicity of her obstetrician or gynaecologist and to determine whether there were differences in preferences among different ethnic and age groups. STUDY DESIGN: A simple 11-item questionnaire was placed at the antenatal and gynaecological clinics provided by South Auckland Health. The questionnaire was voluntary and 848 women completed the questionnaire over a 4-month period. RESULTS: Half of the women preferred a woman doctor and the other half had no preference. There was a 6% increase in preference for a woman doctor where an examination was required. Of the women who preferred a female doctor, 45% would change their preference if a chaperone were present. There was no disproportionate increase in preference for a woman doctor by the patient's ethnicity or age group. Most of the women did not think the ethnicity of her doctor mattered; however, 18% preferred the ethnicity of her doctor be similar to hers. There were more European women who preferred a European doctor and fewer Maori women would prefer a Maori doctor. Of the 9% of women who did not prefer a doctor of the same ethnicity to hers, Pacific Island women were over-represented. CONCLUSION: This is the first study of this nature in New Zealand and the findings on preference for a female doctor are similar to those from other countries. The results of the present study did not show any difference in preference by women from the ethnicities studied and by age group. The use of a chaperone where a male doctor suggests an examination will reassure nearly half of those women who preferred a female doctor. Although most women did not think the ethnicity of her doctor mattered, there were distinct differences by ethnicity with more European women preferring a European doctor and fewer Maori women preferring a Maori doctor. A qualitative study is needed to ascertain reasons for these differences in preference.
• 1.62

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  A systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women.

  Cynthia Farquhar, Alec Ekeroma, Susan Furness, Bruce Arroll

  Acta obstetricia et gynecologica Scandinavica. 07/2003; 82(6):493-504.

  BACKGROUND: To determine the accuracy of transvaginal ultrasonography, sonohysterography and diagnostic hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. DESIGN: Systematic review of common diagnostic imaging tests. DATA SOURCES: Relevant papers were identified ... [more] BACKGROUND: To determine the accuracy of transvaginal ultrasonography, sonohysterography and diagnostic hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. DESIGN: Systematic review of common diagnostic imaging tests. DATA SOURCES: Relevant papers were identified through electronic searching of MEDLINE (1980 to July 2001) and EMBASE (1980 to July 2001) and manual searching of a bibliography of primary and review articles. REVIEW METHODS: Studies were selected if accuracy of transvaginal ultrasonography, sonohysterography and diagnostic hysteroscopy was compared with a reference standard and included data that could be abstracted into a two-by-two table in order to calculate sensitivity and specificity. Quality assessment and data extraction were performed by at least two independent reviewers. Diagnostic accuracy was determined by calculating positive and negative likelihood ratios for all intrauterine pathologies, submucous fibroids and endometrial hyperplasia. RESULTS: Nineteen studies met the inclusion criteria. Statistically significant heterogeneity was present between the likelihood ratios for studies of transvaginal ultrasound. A positive test result with sonohysterography diagnosed submucous fibroids with a pooled likelihood ratio of 29.7 (17.8, 49.6). A positive test result with hysteroscopy diagnosed submucous fibroids with a pooled likelihood ratio of 29.4 (13.4, 65.3), and any intrauterine pathology with a pooled likelihood ratio of 7.7 (4.3, 13.7). A negative test result with hysteroscopy for diagnosing any intrauterine pathology had a pooled likelihood ratio of 0.07 (0.04, 0.15). CONCLUSION: Although there was considerable variability present between the studies, all three diagnostic tests were moderately accurate in detecting intrauterine pathology. However, sonohysterography and hysteroscopy performed better than transvaginal ultrasound in detecting submucous fibroids.

• Marching from the margin.

  A Ekeroma

  The New Zealand medical journal. 11/2001; 114(1141):457-8.
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  An evidence-based guideline for the management of uterine fibroids.

  C Farquhar, B Arroll, A Ekeroma, G Fentiman, A Lethaby, L Rademaker, H Roberts, L Sadler, J Strid

  The Australian & New Zealand journal of obstetrics & gynaecology. 06/2001; 41(2):125-40.

• Blood transfusion in obstetrics and gynaecology.

  A J Ekeroma, A Ansari, G M Stirrat

  British journal of obstetrics and gynaecology. 04/1997; 104(3):278-84.
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  Ovarian response to purified FSH in infertile women with long-standing hypogonadotrophic hypogonadism.

  R Fox, A Ekeroma, P Wardle

  The Australian & New Zealand journal of obstetrics & gynaecology. 03/1997; 37(1):92-4.

  It has previously been proposed that all anovulatory women requiring exogenous gonadotrophin therapy could be treated by purified FSH alone in the follicular phase. We have studied the ovarian response to purified FSH in 5 amenorrhoeic women with low endogenous LH production as a result of long-stan... [more] It has previously been proposed that all anovulatory women requiring exogenous gonadotrophin therapy could be treated by purified FSH alone in the follicular phase. We have studied the ovarian response to purified FSH in 5 amenorrhoeic women with low endogenous LH production as a result of long-standing hypothalamic amenorrhoea. Follicles developed in all of the women but the rise in oestradiol was very slow. As a consequence of the HCG injection being delayed to allow the follicles to become functionally mature, too many follicles attained a preovulatory size. After the treatment was changed to more conventional preparations containing both FSH and LH, the women had improved ovarian responses and 3 of them conceived. It is clear that FSH alone will promote follicular growth but that LH is needed to stimulate follicular function. We conclude that LH does play an important role in follicular maturation and that it is a critical component of exogenous gonadotrophin therapy for women with prolonged hypogonadotrophic hypogonadism.
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  Abnormal fetal behavior and cardiotocography associated with a congenital meningo-encephalitis.

  R Fox, A Ekeroma, T Draycott

  Acta obstetricia et gynecologica Scandinavica. 10/1996; 75(8):774-6.