Accuracy of ultrasound in estimating fetal weight in New Zealand.

INTRODUCTION: Ultrasound estimation of fetal weight is an important factor guiding antenatal management. We aimed to review the accuracy of ultrasound in predicting fetal weight and birthweight category and identify influencing factors. METHODS: We performed a retrospective study of term pregnant women who underwent ultrasound within 7 days of delivery at National Women's Health between January 2019 and January 2020. Stillbirths, major fetal anomalies and multiple pregnancies were excluded. Estimated fetal weight (EFW) was calculated using Hadlock formula and compared with birthweights. We evaluated change in weight categories due to these errors. RESULTS: Of 560 fetuses included, three quarters (n = 425, 76%) of EFWs were within 10% of birthweight. 135 fetuses had EFWs either less than 90% (n = 19) or greater than 110% (n = 116). Fetuses with EFW < 90% had longer times between scanning and delivery, lower EFW and higher maternal BMI. Fetuses with EFW > 110% were associated with higher EFW, later gestational age and older maternal age. US incorrectly estimated 71 (12.7%) fetal birthweight categories. Underestimated weight category (8.9%) was associated with higher maternal BMI. DISCUSSION: Inaccurate EFWs were more common at the extremes of fetal weight. A significant association was underestimation birthweight in mothers with increased BMI, who are at increased risk for perinatal and surgical complications. CONCLUSION: Our accuracy of 76% correctly predicted EFWs compares favourably with previous studies. Clinicians and sonographers should be aware of the increased risk for inaccurate categorisation of fetuses at the extremes of EFW and in mothers with increased BMI.

Appendiceal neuroendocrine neoplasms in the era of laparoscopic appendicectomy.

BACKGROUND: Incidental appendiceal neuroendocrine neoplasms are identified in 1% of surgical resections for suspected appendicitis. A proportion of these patients will require further surgery because of high risk features, which include mesoappendiceal involvement or an involved margin. While an open appendicectomy technique usually involves en bloc mesoappendiceal resection, the increasingly common laparoscopic method often skeletonizes the appendix, leaving the mesoappendix in situ. This retrospective observational study investigates whether routine resection of the mesoappendix rather than skeletonization would reduce the need for further surgery in patients with an incidental finding of appendiceal neuroendocrine neoplasm. METHODS: We included appendicectomies performed over an 11-year period at Auckland City Hospital and identified all cases of incidental appendiceal neuroendocrine neoplasms. Histological data were collected to assess the risk of lymphatic spread and need for further surgery. Mesoappendix resection versus preservation and its effect on the recommendation for further surgery was recorded. RESULTS: An appendiceal neuroendocrine neoplasm was present in 73 (1%) of 7109 appendicectomy specimens. Of these, 10 patients (14%) required right hemicolectomy. Five of these could potentially have been spared the need for further surgery had the mesoappendix been removed en bloc with the appendix. DISCUSSION: We recommend en bloc mesoappendix resection during appendicectomy in order to better stage the neoplasm and reduce the need for unnecessary further surgery.

Introduction of sacral neuromodulation for the treatment of faecal incontinence.

INTRODUCTION: Faecal incontinence (FI) is a condition that impairs quality of life and ability to function socially. Over the last 15 years a promising new therapy (sacral neuromodulation, SNM) has been introduced which has been associated with marked improvement in many incontinence symptoms. AIMS: To assess the early results of SNM in Auckland in terms of improved continence in those undergoing implantation of a permanent stimulator, and determine whether these results are comparable to overseas data. METHODS: Patients who met the criteria for SNM; severe faecal incontinence, failure to respond to other measures including biofeedback, dietary modification, and appropriate surgical intervention were offered this treatment. After an initial bowel diary, patients underwent lead placement connected to an external stimulator and only those who responded had an implanted stimulator placed. Results were assessed by repeated bowel diary, QoL scores and continence scores. RESULTS: Of 29 patients who had initial percutaneous stimulation, 27 showed adequate improvement and went on to permanent implanted stimulator. Of these, results were available on 26. The median number of FI episodes per week preoperatively was 7.25. The median post implantation was one. FI episodes improved following SNM by a mean of 12.21 episodes per week (95% confidence interval 4.91 to 19.51, p value=0.002). For those with longer follow up the initial improvement was sustained. There was a mean follow up time of 10.7 months (range 1 to 30 months). CONCLUSION: Early results are encouraging, with a significant improvement in faecal incontinence following SNM. The results in Auckland in terms of improvement in symptom severity and quality of life are significant and comparable to other centres. SNM offers a good alternative for patients with end-stage FI.