ProfessorGeorge Condous

George Condous is an Academic Gynaecologist with special interests in advanced gynaecological ultrasound and advanced laparoscopic surgery.

His research themes include early pregnancy complications and diagnosis of endometriosis.

Early pregnancy themes include the ultrasound morphology of tubal ectopic pregnancy and its impact on non-surgical interventions, mathematical modelling to rationalise the follow up of women withpregnancy of unknown location (PUL), prediction risk model to predict miscarriage in women who present with a viable pregnancy at the first early pregnancy ultrasound.

Research has shown that women with an incomplete miscarriage are most suitable for expectant management. These are women who do not have a well-defined gestation sac, but still have retained products of conception (RPOC). A recent study using a power Doppler color scoring (PDCS) system has found that an absence of vascularization of the RPC (Denoted by a score of 1) predicted higher spontaneous resolutions by expectant management than the presence of vascularization (scores 2-4). However, color scoring is subjective; no research has been done to study the reproducibility of the PDCS system. By analyzing the inter- and intra-observer reproducibility of the PDCS system, it is hoped that this diagnostic tool would allow for more conservative and effective management decision making for women who suffer an incomplete miscarriage in their first trimester.

Single dose intramuscular methotrexate is commonly used in the medical management of ectopic pregnancy and significantly increases the rate of resolution without the need for surgery. A 15% fall in bhCG between Day 4 and 7 has been validated as a good indicator of the likely success of methotrexate in avoiding surgery. As such, most institutions have implemented a monitoring regimen where bhCG is monitored at days 1 (day of methotrexate administration), 4 and 7. A fall of less than 15% between Day 4 and 7, necessitates the administration of a second dose of methotrexate with weekly bhCG thereafter until efficacy is confirmed. Recent research suggests bhCG testing at day 1 and 7 is equal in its prediction of women requiring a second dose of methotrexate, obviating the need for bhCG testing on day 4. We aim tovalidate this finding usingdata collected through the early pregnancy unit at Nepean Hospital. Additionally, we will look at the pre-treatment hCG ratio (hCG 48 hrs/hCG 0 hrs) in women with an ectopic pregnancy managed non-surgically.

Spontaneous miscarriage in the first trimester accounts for 10 – 20% of pregnancies. However, not all of these are first defined as viable pregnancies through transvaginal sonography. The rate of subsequent miscarriage during the first trimester in pregnancies where viability is demonstrated is between 2 and 16%. Previous models to determine a viable pregnancies risk of miscarriage in the first trimester have been developed by Oates et al. and then refined further by Stamatopoulos et al.This project aims to look at the model proposed by Stamatopoulos et al. and to see how it works in a clinical setting across several sites. The aim of this is to confirm the accuracy of the model, and to see how this data can help patients, and assist patient care. Our overall aim is to reduce the negative psychological effects associated with miscarriage by creating an early warning system for women.

The Ultrasound Based Endometriosis Staging System (UBESS) was developed as a preoperative triaging tool to predict the complexity of subsequent laparoscopic surgery in women with suspected endometriosis. The staging system employs the Society of Reproductive Surgeons recommendations on laparoscopic procedures and the necessary skill required. These recommendations divide surgical skill into 3 categories, which are recognised in both the United States (US) and the United Kingdom (UK). Similarly, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Australasian Gynaecological Endoscopy and Surgery Society (AGES) have released guidelines for the skill level required to perform certain laparoscopic surgeries. These guidelines stratify procedures and associated skills required into 6 levels. The aim of this project is to standardise the UBESS to the laparoscopy guidelines released by RANZCOG and AGES. In the future, this project may allow for external validation of the UBESS. Implementation of UBESS in the diagnosis and management of endometriosis could potentially reduce the number of procedures that patients undergo and significantly reduce risk. It would ensure that each surgical case would be managed by surgeon with the appropriate skill level.

Obliteration of the pouch of Douglas (POD) can be due to concurrentdeep infiltrating endometriosis of the rectum and rectosigmoid. Often, the primary laparoscopy is performed by a general gynaecological laparoscopic surgeon who does not necessarily have the surgical skills to effectively remove severe endometriosis. This leads to the patient having potentially more than one laparoscopy with all the associated morbidities. The efficacy of transvaginal ultrasound scan in diagnosing POD obliterationis well established. To date however there are no data assessing the performance of general gynaecological surgeons versus advanced laparoscopic surgeons in predicting POD obliteration at the time of laparoscopy. Furthermore, if transvaginal ultrasound scan is found to be superior than laparoscopic diagnosis of POD obliteration, then unnecessary laparoscopic surgeries can be avoided. This study aims to discover whether ultrasound in experienced hands is comparable to laparoscopy (both at the general and the expert laparoscopic level) at predicting obliteration of the POD.

A/Professor Condous currently supervises three PhD fellows, each on a 3 year program, through Sydney Medical School Nepean. Dr Nicole Stamatopoulos is studying biomodelling to predict first trimester outcome; Dr Mathew Leonardi is studying new ultrasound techniques to predict endometriosis; and Dr Bassem Gerges is studying different imaging modlaities to predict endometriosis.

Dr Shannon Reid recently completed her PhD through the University of Sydney in the use of ultrasound to predict endometriosis.