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Background: Induction of labour (IOL) and caesarean section (CS) rates continue to increase in Australia, New Zealand and globally. There is evidence that CS rates are decreased in the context of medically indicated and elective IOL; therefore, the emerging concept of using IOL as means of preventing CS warrants investigation., Aims: To assess obstetricians' opinions of elective IOL at 39 weeks gestation, its feasibility, generalisability and utility as a means of preventing CS in Australia and New Zealand., Materials and Methods: A de-identified cross-sectional survey was distributed electronically to all Fellows and trainees of The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). The survey was voluntary and distributed with the approval of the RANZCOG Continuing Education Committee. The survey addressed opinions relating to rates of and indications for IOL, the perceived validity of those indications and explored the acceptability of using a screening tool to predict women at increased risk of intra-partum CS and tailoring obstetric management to include the option of IOL at 39 weeks gestation., Results: The overall response rate was 34% (492/1423) (including trainees) and the response rate was 53% (394/750) for currently practising obstetricians. The majority (90%) of responders agreed on medical and clinical indications for IOL. There was no consensus on the validity of IOL if a woman were at apparent high risk of intra-partum CS; however, 81% (360/443) of clinicians would be interested in a tool that could predict those women at risk., Conclusions: There is heterogeneity of obstetrician's beliefs on using IOL at 39 weeks as a mechanism to reduce the CS rate., (© 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Background: There is an extensive literature concerning caesarean section at maternal request, where no obstetric indication exists, yet little information about what motivates women to request such a delivery., Aims: This paper aims to ask women who had undergone maternal-request primary elective caesarean delivery about the reasons for their choice, their level of satisfaction with the delivery and their future childbearing plans., Methods: Anonymous postal survey of women who have undergone maternal-request primary caesarean section in private maternity hospitals in the eastern states of Australia., Results: The response rate was 68%, and 78 completed surveys were included in the study. The most common reason given was, 'I was concerned about risks to the baby' (46%). On a scale from 1 (totally unsatisfied) to 10 (completely satisfied), the mean satisfaction rating reported was 9.25/10 (95% confidence interval: 8.89, 9.60). Only eight respondents (10%) stated an intention for more than two caesarean deliveries., Conclusions: Women who underwent maternal-request caesarean delivery most commonly did so from concerns for the baby. Respondents were highly satisfied with their delivery, and few wished for more than two children.

This paper summarizes the problems which necessitated return to theatre at the Mercy Maternity Hospital, 1971-1982. There were 154 of 29,488 patients (0.5%) having obstetrical or gynaecological treatment in theatre who made this journey. They all survived, some after heroic resuscitative measures. Haemorrhage necessitated the patient's return to theatre following 0.2% of Caesarean sections and 0.2% of gynaecological operations. Many obstetric patients who return to theatre are potential maternal deaths. The assistance of an experienced colleague is essential in their management. When massive or continuing haemorrhage occurs at Caesarean section, hysterectomy should be considered, especially if the placenta appears to be morbidly adherent, these being the very patients at risk of a return to theatre if hysterectomy is not performed. With the increasing Caesarean section rate, placenta praevia accreta has become more common, to the extent that ultrasonographic localization of the placenta is recommended in all patients who have had a previous Caesarean section. Curettage is not indicated in the treatment of primary postpartum haemorrhage after Caesarean section; moreover, its performance in the management of secondary postpartum haemorrhage when the patient was delivered by Caesarean section should be regarded as a formidable procedure. When a patient who was delivered vaginally returns to theatre because of continuing haemorrhage after curettage performed for secondary postpartum haemorrhage hysterectomy is likely to be required. Safe methods of suturing the lower uterine segment incision at Caesarean section, and the lateral angles of the vaginal vault after abdominal hysterectomy are described.

Amniotic fluid embolism (AFE) is a dramatic, rare and frequently lethal complication of pregnancy. Perusal of the National Health and Medical Research Council reports on Maternal Deaths in the Commonwealth of Australia for the years 1964-1984 (1-7) shows that there have been 1,193 maternal deaths in this 21-year period, of which 54 (4.5%) were due to AFE. This paper presents data regarding these deaths and also describes 2 cases of AFE which occurred at Caesarean section performed for placenta praevia, one of which was lethal.