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Vaginal Birth After Cesarean

Vaginal Birth After Cesarean
Christopher C. B-Lynch , GORSL (MA Oxon), FRCOG, FRCS, D Univ (Honoris Causa) OU 1997
Milton Keynes Hospital NHS Foundation Trust, (Oxford Deanery), United Kingdom

Matthew Mak, MBBS, BSc (Hons)
Clinical Research Fellow, Milton Keynes Hospital NHS Foundation Trust (Oxford Deanery), United Kingdom

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Surgical Management Of Intractable Pelvic Hemorrhage

Surgical Management of Intractable Pelvic Hemorrhage
Louis G. Keith, MD, PhD
Emeritus Professor, Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois, USA

Christopher B Lynch, MBBS, FRCS, FRCOG
Consultant Obstetrician & Gynecological Surgeon, Professor (visiting) Cranfield University (Health Faculty), Milton Keynes General Hospital NHS Foundation Trust (Oxford Deanery), Milton Keynes, UK

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Acute Abdomen Secondary To Rare Yolk Sac Tumour

Arch Gynecol Obstet DOI 10.1007/s00404-008-0796-z

Hooman Soleymani Majd · Sally Ann Turner ·

Kiyoshi Choji · Khin Lwin · Christopher B-Lynch

Received: 15 July 2008 / Accepted: 1 September 2008

© Springer-Verlag 2008

Abstract A 36-year-old woman presented unwell, with abdominal pain. A pelvic mass was found and being investigated but when she deteriorated and became peritonitic. An emergency laparotomy was performed and she required a pelvic clearance for a Stage IIB ovarian tumour, later confirmed as a yolk sac tumour. Accurate staging and tumourreductive surgery strongly affects the prognosis of yolk sac tumours. Thus ability to perform a meticulous surgical clearance may well positively impact on the outcome for these young patients. This case describes the challenges that generalists will be faced with when highly suspicious cancer patients present as an emergency.

Keywords Female · Yolk sac tumour · Cancer ·

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Successful Use Of Uterine Artery Embolisation To Treat Placenta Increta In The First Trimester

Hooman Soleymani Majd · Maithili Srikantha ·
Subrata Majumdar · Christopher B-Lynch ·
Kiyoshi Choji · Manivannan Canthaboo · Lamiese Ismail
Received: 31 May 2008 / Accepted: 25 August 2008
© Springer-Verlag 2008
Abstract A 39-year-old Asian woman was admitted to hospital with persistent, heavy vaginal bleeding following an uncomplicated Wrst trimester surgical termination of pregnancy (STOP). Her heavy bleeding continued after the
STOP and she had recurrent hospital admissions which included two procedures to evacuate presumed retained products of conception. She eventually had a MRI scan performed which suggested placental tissue in the fundal
region, extended into the uterine wall. The Wndings were consistent with placenta increta and the patient had a bilateral uterine artery embolisation (UAE), following which her symptoms rapidly subsided. We describe the First successfully
managed case of persistent vaginal bleeding secondary to abnormal placentation. It would seem to substantiate the eYcacy of UAE as a therapeutic modality for the conservative management of invasive placentation
in the Wrst trimester of pregnancy.

Keywords Uterine artery embolisation · Placenta increta ·
ERPOC · First trimester · Bleeding · Treatment

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Acute Uterine Inversion: A Novel Replacement Technique Using The B-Lynch Non-Instrumental Stepwise Reduction Procedure

3049 Int J Fertil Wom Med 52(4) p 143-146 ©2007 MSP International, Inc.
C. B-Lynch (Consultant)
D. Danso (Senior Registrar)
G.D. Thanigaimani (SHO)
Department of Obstetrics and Gynecology
Milton Keynes Hospital NHS Foundation Trust
(Oxford Deanery)
United Kingdom
CASE REPORT
Mrs. N.C., a 24-year-old Caucasian primigravida, presented in November 2004 with an uneventful pregnancy at 41 weeks gestation. She booked at 12 weeks and […]

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Spontaneous Urethral Extrusion Of A Filshie Clip

Authors: L. M. Palanivelu a; C. B-Lynch a
Affiliation:    a Department of Obstetrics and Gynaecology, Milton Keynes General Hospital NHS trust, Milton Keynes, UK
DOI: 10.1080/01443610701695107
Publication Frequency: 8 issues per year
Published in:  Journal of Obstetrics and Gynaecology, Volume 27, Issue 7 2007 , page 742
Subject: Obstetrics, Gynecology & Women’s Health;
http://www.informaworld.com/smpp/content~content=a784715710~db=jour

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Application Of The B-Lynch Brace Suture With Associated Intrauterine Balloon Catheter For Massive Haemorrhage Due To Placenta Accreta Following A Second-Trimester Miscarriage

Authors: N. Price a;  N. Whitelaw b; C. B-Lynch b
Affiliations:    a Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford
b Milton Keynes General Hospital, Milton Keynes, UK
DOI: 10.1080/01443610600555634
Publication Frequency: 8 issues per year
Published in:  Journal of Obstetrics and Gynaecology, Volume 26, Issue 3 April 2006 , pages 267 – 268
Subject: Obstetrics, Gynecology & Women’s Health;
http://www.informaworld.com/smpp/content~content=a745954296~db=jour

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Outcome Of Tension-Free Vaginal Tape (TVT) Procedure In Women With Stress Urinary Incontinence—Patients Perspective

AYSHA QURESHI,
JAYNE NICOLAOU,
C. B. LYNCH,
M. I. ANJUM and JUNE CLAY
Department of Obstetrics and Gynaecology, Milton Keynes General Hospital, Milton Keynes, UK
Journal of Obstetrics and Gynaecology (May 2003) Vol. 23, No. 3, 297-300

This was a subjective review of the success of the tension-free vaginal tape procedure in women with stress urinary incontinence. It was a retrospective study using a postal questionnaire for pre-and postoperative evaluation of symptoms. Ninety-six patients were sent the questionnaire and 71 % (n = 68) patients filled in the questionnaire. They were asked about pre- and postoperative symptoms. The enquiry was about their satisfaction with the procedure and its cure rate. A visual analogue scale was used to assess results at least 3 months postoperatively. Eighty-three per cent (n = 56) of patients considered their surgery to be successful and were cured without complications; 7% (« = 5) claimed partial success and 10% (n = 7) reported failure. The majority of patients found the TVT procedure to be simple and effective. Hospital stay was short. Their convalescence was short with early return to work. These observations show clear benefit to the patients’ health and Health Service economy.

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Ovarian Marsupialisation For Polycystic Ovarian Disease: Reality Or Fiction?

Authors: A. I. Aziz; C. B-Lynch
DOI: 10.1080/01443619965129
Publication Frequency: 8 issues per year
Published in:  Journal of Obstetrics and Gynaecology, Volume 19, Issue 3 May 1999 , pages 298 – 299
Subject: Obstetrics, Gynecology & Women’s Health;
Number of References: 5
http://www.informaworld.com/smpp/content~content=a713681751~db=jour

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Incidental Appendectomy During Gynaecological Surgery

Incidental appendectomy during gynecological surgery
C.B Lyncha, P Sinhab, S Jallohc

Volume 59, Issue 3, Pages 261-262 (1 December 1997)
Received 17 March 1997; received in revised form 19 August 1997; accepted 2 September 1997.
Keywords:  Incidental appendectomy, Gynecological surgery
http://www.ijgo.org/article/S0020-7292(97)00215-4/abstract

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A Clinical Analysis Of 500 Medico-Legal Claims Evaluating The Causes And Assessing The Potential Benefit Of Alternative Dispute Resolution

Christopher B-Lynch Consultant (Obstetrics)/Surgeon (Gynaecology), Adeyemi Coker Rotational Registrar (Obstetrics and Gynaecology), John A. Dua Locum Consultant (Obstetrics and Gynaecology) (1996) A clinical analysis of 500 medico-legal claims evaluating the causes and assessing the potential benefit of alternative dispute resolution
BJOG: An International Journal of Obstetrics and Gynaecology 103 (12) , 1236–1242 doi:10.1111/j.1471-0528.1996.tb09635.x
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1471-0528.1996.tb09635.x?journalCode=bjo

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Medico-Legal Claims Evaluating The Causes And Assessing The Potential Benefit Of Alternative Dispute Resolution

*Christopher B-Lynch Consultant (Obstetrics) / Surgeon (Gynaecology),
*Adeyemi Coker Rotational Registrar (Obstetrics and Gynaecology),
**John A. Dua Locum Consultant (Obstetrics and Gynaecology)*Milton Keynes General Hospital NHS Trust (Anglian and Oxford Regional Health Authority);
**Central Middlesex Hospital, London
British Journal of Obstetrics & Gynaecology (December 1996)

Objectives
1. To evaluate the common causes of medico-legal dispute in obstetrics and gynaecology.
2. To assess the potential benefit of early alternative dispute resolution.

Design

A prospective analysis of over 500 cases submitted from over 100 solicitors between 1984 and 1994 for medical expert opinion on potential medico-legal claims.CasesFive hundred consecutive cases that met the inclusion criteria; 488 from the United Kingdom and 12 from abroad (Hong Kong, Republic of Ireland).Main outcome measuresThe main principles underlining medico-legal disputes and causes of such claimsResults Analysis of 500 claims show 46% were misguided allegations, 19% incompetent care, 12% error of judgement, 9% lack of expertise, 7% failure of communication, 6% poor supervision and 1% inadequate staffing. Of the misguided allegations 119/225 cases (59%) were obstetric and 111/275 (40%) cases were gynaecological. The most common cause of obstetric dispute was ‘cerebral palsy’ (22%), while the commonest cause of gynaecological dispute was failed sterilisation (19%). Settled claims were under-reported by solicitors.ConclusionBecause of the high percentage (46%) of misguided allegations, an alternative course of dispute resolution must be a realistic way forward. This course of action, combined with improved communication, could result in a major reduction in the costs of potential medical litigation. Early alternative dispute resolution should be considered in an attempt to reduce the escalating quantum of damages and costs. We recommend recruiting independent, experienced and unbiased consultants in active practice within the appropriate speciality to review such cases at the level of hospital complaints management as an in house review procedure, particularly for small and moderate-sized claims, as a means whereby doctors can retain control of medico-legal disputes, in contrast to control by the legal profession.

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Teratoma Of The Uterus

Authors: A. Coker a;  A. H. Lawal a;  S. Jalloh a; C. B-Lynch a
Affiliation:   a Milton Keynes General Hospital NHS Trust,
DOI: 10.3109/01443619609030106
Publication Frequency: 8 issues per year
Published in:  Journal of Obstetrics and Gynaecology, Volume 16, Issue 6 November 1996 , pages 568 – 570
Subject: Obstetrics, Gynecology & Women’s Health;
http://www.informaworld.com/smpp/35862437-55995100/content~content=a784389070~db=jour

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Borderline Ovarian Cancer, Bilateral Surgical Castration, Chemotherapy And A Normal Delivery After Ovum Donation And In Vitro Fertilisation-Embryo Transfer

A. H. Lawal Registrar, C. B-Lynch Consultant (1996) Borderline ovarian cancer, bilateral surgical castration, chemotherapy and a normal delivery after ovum donation and in vitro fertilisation-embryo transfer
BJOG: An International Journal of Obstetrics and Gynaecology 103 (9) , 931–932 doi:10.1111/j.1471-0528.1996.tb09917.x
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1471-0528.1996.tb09917.x

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Symptoms Relieved By Endoscopic Ventrosuspension

BJOG: An International Journal of Obstetrics and Gynaecology
Volume 102 Issue 7 Page 573-579, July 1995
To cite this article: (1995) Papers presented at Milton Keynes, 1-2 September, 1994. Nitric oxide and venodilation during pregnancy. Changes in regional blood flow following intrauterine tansfusion: an ovine model. First clinical experience with contraceptive implants (Norplant R and Implanon R) […]

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Carbon Dioxide Superpulse Laser Excision Conisation Of The Cervix: Assessment Of Specimen Histological Quality

BJOG: An International Journal of Obstetrics and Gynaecology
Volume 102 Issue 7 Page 573-579, July 1995
To cite this article: (1995) Papers presented at Milton Keynes, 1-2 September, 1994. Nitric oxide and venodilation during pregnancy. Changes in regional blood flow following intrauterine tansfusion: an ovine model. First clinical experience with contraceptive implants (Norplant R and Implanon R) […]

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Clinical, Biochemical And Biophysical Outcome Of Polycystic Ovarian Syndrome Patients Treated By Endoscopic Yag Laser Surgery

Gynaecological Endoscopy Vol 2 No 3 (1993) 143-147
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1471-0528.1993.tb15250.x
BJOG: An International Journal of Obstetrics and Gynaecology
Volume 100 Issue 3 Page 289-294, March 1993
To cite this article: (1993) Papers presented at the out-of-town meeting, University of Aberdeen, 3-4 September 1992. Structural characteristics of the rupture site of spontaneously ruptured term fetal membranes. The expression of retinoic acid […]

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Alternative Positions In The Second Stage Of Labour: A Randomized Controlled Trial

JASON GARDOSI, Registrar11Department of Obstetrics and Gynaecology, Milton Keynes General Hospital, Milton Keynes, Bucks, SHARON SYLVESTER, Midwife11Department of Obstetrics and Gynaecology, Milton Keynes General Hospital, Milton Keynes, Bucks, CHRISTOPHER B-LYNCH, Consultant11Department of Obstetrics and Gynaecology, Milton Keynes General Hospital, Milton Keynes, Bucks1Department of Obstetrics and Gynaecology, Milton Keynes General Hospital, Milton Keynes, Bucks
J. Gardosi, Department of Obstetrics and Gynaecology, St Mary’s Hospital, Paddington, London W2
Summary

A controlled clinical trial involving 151 primigravidae and 18 midwives assessed the acceptability and outcome of second-stage labour in upright positions. Women who had no specific antenatal preparation and preferences regarding labour positions were managed either conventionally (semi-recumbent and lateral), or encouraged to adopt upright positions (squatting, kneeling, sitting or standing) according to individual preference. Of the women allocated to the upright position 74% completed the second stage upright, with kneeling being the most favoured position, but squatting was, despite all assistance, too difficult to maintain. Adoption of upright positions resulted in a higher rate of intact perineums. There was a clinically apparent reduction of forceps deliveries in the upright group which influenced midwives’ attitudes. Moving the parturient from recumbent to upright positions was often perceived to be beneficial when there was slow progress. Estimated blood loss was similar in the two groups, as was the condition of the newborn (Apgar score and umbilical artery pH). Alternative positions in the second stage of labour, in particular kneeling, are achievable even without specific birth aids and antenatal preparation. They appear safe, acceptable to most parturients and their midwives, and arc easily integrated into modern labour ward practice; they may have clinical advantages which need further investigation.

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Randomised, Controlled Trial Of Squatting In The Second Stage Of Labour.

Gardosi J, Hutson N, B-Lynch C.
Department of Obstetrics and Gynaecology, Milton Keynes General Hospital, Buckinghamshire.

A new obstetric aid, the ‘Birth Cushion’ allows the parturient to sink into a supported squatting posture for the second stage of labour and delivery; it fits onto conventional delivery beds. A prospective, controlled trial of 427 primiparae compared the outcome of labour in women randomly allocated to squatting (218) or conventional semirecumbent (209) management. The squatting group had significantly fewer forceps deliveries (9% vs 16%) and significantly shorter second stages (median length of pushing 31 vs 45 min) than the semirecumbent group. There were fewer perineal tears, but more labial tears, in the squatting group. Apgar scores, blood loss, and post-partum vulvar oedema were similar in both groups. 82% of the women in the squatting group maintained upright positions for most of the second stage, and reported great satisfaction with the supported squatting position. The traditional birth posture of squatting can be easily adapted for modern labour management and has advantages for women in their first labour.

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