ORCID Profile
0000-0001-5183-2892
Current Organisations
Royal Children's Hospital
,
Austin Health
,
Murdoch Children's Research Institute
,
Mercy Hospital for Women
,
University of Melbourne
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Publisher: Cold Spring Harbor Laboratory
Date: 05-03-2023
DOI: 10.1101/2023.03.03.23286728
Abstract: Objective: To establish the rate of bleeding disorders amongst women with confirmed endometriosis and clarify predictive features on history. Methods: Eight-two women with confirmed diagnosis of endometriosis were recruited from a tertiary womens hospital. General bleeding tendency was evaluated with a modified internationally standardised questionnaire, and a bleeding score was calculated. Menstrual loss was evaluated by obtaining current and heaviest-ever menses profile using Pictorial Blood loss Assessment Chart(PBAC). Forty-one women satisfied criteria for a significant bleeding tendency and underwent coagulation tests including Prothrombin time(PT), activated partial thromboplastin time(aPTT), Platelet Function Analyser-100(PFA-100) and von Willebrand factor(vWF)/Factor VIII(FVIII) studies. Results : The prevalence of abnormal screening haemostasis tests for the population was 17.72% (95% CI 10.04-27.94) for all tests, 8.54%(95% CI 3.50-16.80) for vWF tests, and 12.99%( 95% CI 6.41-22.59) for PFA-100. Receiver Operator Characteristic curve analysis demonstrated a very good performance of the bleeding score as a diagnostic test for haemostatic abnormalities for nulliparous women with endometriosis. Bleeding symptoms in idually were not predictive. Logistic regression suggested the combination of mittleschmerz, cutaneous bleeding symptoms, heavy menstrual bleeding and prolonged bleeding from minor wounds as predictive for haemostatic abnormalities (p=0.0197). Conclusion: The prevalence of abnormal bleeding tests in women with endometriosis on preliminary testing was higher than the population rate of bleeding abnormalities and thus people with histologically proven endometriosis warrant a higher index of suspicion with respect to testing for mild bleeding disorders.
Publisher: Wiley
Date: 29-05-2020
DOI: 10.1111/JPC.14501
Abstract: To review presentations, diagnostic processes and time to diagnosis of presentations of imperforate hymen at one tertiary paediatric hospital over a 10-year period. The aim was to improve knowledge, enable targeted education and reduce unnecessary tests and diagnostic delay for this congenital obstructive disorder of the female reproductive tract. A pragmatic, retrospective, observational study was conducted of all female patients, aged younger than or equal to 18 years of age, presenting to the Royal Children's Hospital, Melbourne, over an 18-year period. Presenting symptom(s), time to diagnosis, investigations ordered and number of health-care professionals consulted prior to diagnosis were recorded. A total of 27 patients met eligibility criteria, and 85% presented with pain (23/27). Pain was frequently associated with other symptoms (15/23). Over three quarters of patients consulted more than one health-care professional prior to diagnosis (22/27). Of the 27 patients, 19 had imaging undertaken prior to diagnosis. Paediatric and adolescent females managed at our tertiary paediatric hospital are experiencing diagnostic uncertainty and the unnecessary ordering of imaging prior to a diagnosis of imperforate hymen. Targeted education is recommended to health professionals managing female paediatric and adolescent patients.
Publisher: Cold Spring Harbor Laboratory
Date: 02-2021
DOI: 10.1101/2021.01.29.21250806
Abstract: Chronic 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. To explore the predictors for undergoing surgery, for identifying endometriosis and endometriosis severity in a cohort of women with CPP. This 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. Operative notes were reviewed, and endometriosis staged. Of 471 women recruited, 102 women underwent laparoscopy or laparotomy, of whom 52 had endometriosis (n=37 stage I-II n=15 stage III-IV). Gynaecology unit, pelvic pain intensity and lower parity were all predictors of surgery (Odds ratio (OR) 0.342 95%CI 0.209-0.561 OR 1.303 95%CI: 1.079-1.573 OR 0.767 95%CI: 0.620-0.949 respectively). There were no predictors identified for endometriosis diagnosis and the only predictor of severity was increasing age (OR 1.155 95%CI: 1.047-1.310). Pain intensity and gynaecology unit were key predictors of undergoing laparoscopy, however, pain severity did not predict endometriosis diagnosis or staging. These findings indicate the need to review current frameworks guiding practice towards surgery for pelvic pain.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.JPAG.2022.04.010
Abstract: Exposure to adverse childhood experiences (ACEs) has been associated with poor health outcomes, including chronic pain. However, little is known about the potential impact on the development of pelvic pain in adolescents and young adults. This systematic review was conducted to explore the association between ACEs and dysmenorrhea, pelvic pain, and dyspareunia in adolescents and young adults. Medline, Embase, and PsycNET were searched, using keywords related to childhood adversity, dysmenorrhea, pelvic pain, and dyspareunia. Of the 566 articles identified, 19 studies were included. There was an association between the number and severity of ACEs and the risk of dysmenorrhea. Sexual abuse and posttraumatic stress disorder appeared to be associated with dysmenorrhea, pelvic pain, and dyspareunia, but it was unclear whether this relationship was mediated by poorer mental health. No association was found for immigration and bullying, and findings were inconsistent regarding female genital mutilation, parental separation, and parental death. Future research should include longitudinal follow-up and use validated tools to assess childhood adversity. A greater understanding of the risk of ACEs among adolescents and young adults with dysmenorrhea, chronic pelvic pain, and dyspareunia could provide insight into the development of these conditions.
Publisher: Wiley
Date: 25-03-2021
DOI: 10.1111/AJO.13330
Abstract: The high incidence and burden of pelvic pain are increasingly recognised in both the healthcare sector and by the general public. Current approaches to management assume that the diagnosis and remediation of identified lesions will ease this burden. The evidence base and successes in other areas of medicine would suggest that this assumption requires reconsideration.
Publisher: Wiley
Date: 17-10-2023
DOI: 10.1111/JPC.16248
Abstract: This study aimed to understand why adolescent girls and young women (AGYW) would seek consultation with a health professional about genital appearance concerns and/or request female genital cosmetic surgery (FGCS). The information derived from these participant interviews can inform clinical practice and help clinicians better navigate consultations with young women and girls requesting FGCS. A qualitative exploratory study was conducted using in‐depth, semi‐structured interviews with AGYW ( n = 11) in Victoria, Australia. Participants comprised 11 AGYW who sought consultation with a health professional when aged 13–19 years for genital appearance concerns and/or requests for FGCS. Key themes were identified using a thematic analysis approach. Of 11 participants, five had undergone FGCS between the ages of 13 and 23 years. Key reasons for seeking a consultation identified in the interviews included: ideas about what ‘normal’ genitals look like, experiences of sexual harassment and bullying, and concerns about genital appearance developing before sexual debut. It is important to understand why AGYW want to access these procedures, given the risks involved, and that FGCS is not recommended by paediatric specialist organisations. Understanding why AGYW seek consultation for FGCS can help inform clinical practice, and the views expressed by participants in this study can help clinicians who work in this area to better support their patients.
Publisher: Wiley
Date: 02-01-2021
DOI: 10.1111/AJO.13289
Publisher: Wiley
Date: 13-01-2018
DOI: 10.1111/JPC.13819
Abstract: To audit the clinical features and outcomes for all patients referred to our centre with concerns regarding labial appearance. Young females referred to a paediatric/adolescent gynaecology tertiary centre between 2000 and 2012 with concerns regarding their labial appearance were retrospectively identified. Adolescents presenting with anomalies were excluded. Retrospective chart review was undertaken to identify reasons for referral, patient characteristics, outcome of referral and concurrent health problems. In total, 46 females presenting with concerns about labial appearance were identified. Five were excluded. Median age of the study population was 14.5 years (range 5-21 years). Only four (9.8%) underwent surgery after a minimum of five consultations each, with mental health review in three of four cases prior to surgery. None of the 41 patients had documented abnormal labia however, 6 patients had asymmetry, and 3 had a labial width of >5 cm. Of mothers, 24% (n = 10) raised the initial concern regarding labial appearance to a physician, of whom, 50% of patients had a comorbid condition. In total, 70.7% initially reported interference with daily activities, and 87.8% were reassured following discussion. With appropriate education and counselling, the majority of girls with concerns regarding labial appearance can be managed without surgery. Overall, our data support current international policy that female cosmetic genital surgery not be performed in mature minors unless there are specific indications. More research about characteristics of patients referred with labial concerns, definition of labial size and long-term satisfaction of conservative versus surgical methods is necessary to determine the best approach.
Publisher: Wiley
Date: 24-05-2021
DOI: 10.1111/AJO.13379
Abstract: Chronic 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. To explore the predictors for undergoing surgery, for identifying endometriosis and endometriosis severity in a cohort of women with CPP. This 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 two 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. Operative notes were reviewed and endometriosis staged. Of 471 women recruited, 102 women underwent laparoscopy or laparotomy, of whom 52 had endometriosis ( n = 37 stage I–II n = 15 Stage III–IV). Gynaecology unit, pelvic pain intensity and lower parity were all predictors of surgery (odds ratio (OR) 0.342 95% CI 0.209–0.561 OR 1.303 95% CI: 1.079–1.573 OR 0.767 95% CI: 0.620–0.949, respectively). There were no predictors identified for endometriosis diagnosis and the only predictor of severity was increasing age (OR 1.155 95% CI: 1.047–1.310). Gynaecology unit and pain intensity were key predictors of undergoing laparoscopy however, pain severity did not predict endometriosis diagnosis or staging. These findings indicate the need to review current frameworks guiding practice toward surgery for pelvic pain.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.JPUROL.2018.01.006
Abstract: Congenital adrenal hyperplasia (CAH) is an autosomal recessive condition resulting in excess androgen production. Females are typically born with ambiguous genitalia and often undergo feminising genitoplasty in infancy or childhood. Recently, there has been considerable international debate as to whether distressing urinary symptoms in CAH patients are truly present and, if so, whether these urinary problems are a consequence of the feminising genitoplasty. To identify and assess any urinary symptoms in an Australian cohort of adolescent and adult women with CAH who have undergone feminising genitoplasty in infancy, childhood or adolescence as a part of their management. Females with CAH aged 12-40 years, who had undergone feminising genitoplasty, and were identified from a hospital database (n = 72). Those aged 12-15 years were assessed using the Paediatric Incontinence Symptom Index questionnaire in conjunction with sections of the Bristol Female Lower Urinary Tract Symptoms Scored Form questionnaire. Those aged 16-40 years were assessed using the Bristol Female Lower Urinary Tract Symptoms Scored Form questionnaire. Uroflowmetry studies and post-void residual volume ultrasounds were also conducted. Previously published normative data were used for the control population. Responses to the questionnaire indicated that CAH patients had a higher incidence of urgency, frequency, urge incontinence, unexplained incontinence and nocturnal incontinence, when compared to previously published control data. Average and maximum urine flow rates measured by uroflowmetry were within normal range however, the 16-40-year-old age group had significantly increased mean post-void residual volumes (P < 0.001) (Summary table). The presence of lower urinary tract symptoms in these patients has previously been interpreted as a direct outcome of feminising genitoplasty however, these results could also be accounted for by the virilisation of pelvic floor musculature. Androgens have been shown to increase skeletal muscle mass, but their exact impact on the pelvic floor musculature requires further research. Three previous studies have measured post-void residual volumes in patients with CAH, all of which found it them be raised. Patients with CAH appeared to have overall normal urinary flow but increased post-void residual volumes. The data suggested that this population of patients has an increased probability of incontinence, urgency, and frequency when compared to a control population. These results confirmed findings of other small studies however, it remains unclear if these changes reflected the underlying diagnosis or were a consequence of management.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Wiley
Date: 13-02-2018
DOI: 10.1111/JPC.13847
Abstract: This study sought to observe the rate and timing of spontaneous resolution of labial adhesions that had been diagnosed in pre-pubertal girls. The secondary aim was to evaluate the conservative approach to management of labial adhesions that has been advocated by the Gynaecology Department, by assessing the rates of concurrent uro-gynaecological symptoms in this population, as well as parent satisfaction with their child's management. A retrospective chart review was performed of all patients diagnosed with labial adhesions in the Department of Paediatric and Adolescent Gynaecology between 2000 and 2017. Patients and their parents (depending on the age of the patient at the time of this study) were then invited to participate in follow-up surveys and questionnaires and clinical examination. Of 148 girls identified, the median age of the follow-up participants (n = 45) was 6.1 years (2.6-27.2 years), compared with that of the entire cohort of 7.4 years (1-27 years). After a median follow-up period of 2.6 years (0.4-20.7 years), 40% (18/45) of girls reported and/or had findings that supported resolution of labial adhesions without treatment. Two parents (4%) sought treatment elsewhere after their appointment. A history of UTI was reported in 30% (14/45) of patients, and 16% (7/45) had a known history of vulvovaginitis. Our findings support the natural history of spontaneous resolution of labial adhesions. Concurrent uro-gynaecological conditions that developed were successfully treated according to standard treatments. A conservative approach to the management of labial adhesions is associated with very low rates of parental concern and intervention.
Publisher: Wiley
Date: 03-2021
DOI: 10.1111/HAE.14283
Publisher: Wiley
Date: 21-08-2022
DOI: 10.1111/AJO.13604
Abstract: An incidental finding of a thickened endometrium on ultrasound in the postmenopausal patient without bleeding is a common presentation to gynaecological services however there is limited evidence to guide clinical practice as to when hysteroscopic evaluation and endometrial s ling is required. To determine the endometrial thickness at which endometrial s ling is indicated in asymptomatic postmenopausal women referred with thickened endometrium on ultrasound. A single‐centre retrospective case series of postmenopausal women without bleeding undergoing hysteroscopy was conducted. Logistic regression was used to examine the association between a range of variables and pre‐malignant or malignant pathology and endometrial thickness. The optimal endometrial thickness threshold was identified to maximise model sensitivity. A total of 404 postmenopausal women were included in this study, having undergone a hysteroscopy at the study site between 1 July 2008 and 30 June 2018. The mean (SD) age of patients at presentation was 65 (9.09) years and the mean body mass index was 29.86 kg/m 2 (6.52). Of these women, nine (2.2%) were diagnosed with endometrial carcinoma and seven (1.7%) had endometrial hyperplasia with atypia. The most common histopathological finding was of a benign endometrial polyp (153: 37.9%). When including hyperplasia with or without atypia in histopathology of interest, a cut‐off of ≥9 mm provides the greatest sensitivity (83.3%) and specificity (63.8%) for a diagnosis of pre‐malignant or malignant pathology (classification accuracy of 64.8% area under the receiver operating characteristic: 0.7358, 95% CI: 0.6439, 0.8278) in this cohort. Using an endometrial thickness of ≥9 mm can be used as a cut‐off for endometrial s ling in postmenopausal women without bleeding.
Publisher: Wiley
Date: 22-09-2023
DOI: 10.1111/AJO.13749
Publisher: Informa UK Limited
Date: 24-11-2022
Publisher: Bentham Science Publishers Ltd.
Date: 10-2021
DOI: 10.2174/1381612826666201127123357
Abstract: 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.
Publisher: Wiley
Date: 30-04-2021
DOI: 10.1111/JPC.15474
Abstract: 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. The multidisciplinary team forum includes invited representatives from endocrinology, urology, gynaecology, genetics, psychology, social work, clinical ethics, laboratory and hospital executive and meetings occur 1–3 times monthly. Descriptive data were collected from de‐identified meeting referrals and minutes between August 2012 to August 2018 (Sydney) and January 2014 to August 2018 (Melbourne). A total of 192 referrals (142 new and 50 follow‐ups) aged 1 week to 17 years were discussed across the two sites. 46, XY DSD ( n = 81) was the most common sub‐classification. Consideration of surgical options and optimal management of gonads with malignant potential were amongst the common reasons for referral to the multidisciplinary team meetings. Surgical interventions were considered but not recommended after review for 38 of 154 (24.7%) procedures. Gonad retention to allow potential functional benefit was recommended in 15/46 (32.6%) referrals. Evidence of premalignant or malignant changes was found in 20/57 (35%) gonads removed, with dysgenetic features and atrophy/streak features in 6 (10.5%) and 27 (47.4%) gonads respectively. Formal DSD multidisciplinary team meetings provide a framework and opportunity for multi and interdisciplinary discussions amongst representatives from several specialities to help make complex decision‐making.
Publisher: Wiley
Date: 07-02-2023
DOI: 10.1111/JPC.16366
Abstract: The aim of this study was to describe the clinical features and investigations of vaginal bleeding in prepubertal children. We performed a retrospective case series of children under the age of 10 who presented with vaginal bleeding to our institution between 2018 and 2019. There were 32 cases identified during the timeframe, with a mean age of 5.5 years (standard deviation 3.2 years, range 5.5 days to 9.6 years). Vulvovaginitis was the most common diagnosis ( n = 12, 37.5%), followed by precocious puberty ( n = 5, 15.6%). Uncommon but serious causes were vaginal rhabdomyosarcoma ( n = 1), and sexual abuse (one patient presenting with gonorrhoea and one with a non‐accidental injury). Vaginoscopy was performed in nine patients (28.1%) for various reasons, and a vaginal foreign body was identified in two patients (6.3%). All the patients who had a serious cause of bleeding (neoplasm or sexual assault) or who required specific treatment (precocious puberty, lichen sclerosus, urethral prolapse) presented with red flags on history and/or examination: recurrent episodes of vaginal bleeding, heavy bleeding, associated general symptoms (poor feeding and growth), presence of thelarche, abdominal mass, associated profuse vaginal discharge and abnormal genital examination (skin changes, urethral prolapse or protruding mass from the vagina). A thorough history‐taking and clinical examination aiming at identifying red flags may help to discriminate between benign causes of vaginal bleeding, where no further investigations are indicated, and alternative diagnoses with a poor outcome and/or requiring specific treatment and additional investigations.
No related grants have been discovered for Sonia R Grover.