Search

Our primary objective is to assess public awareness of topical issues in gynaecology by observing Google Trends information on internet searches in Australia and explore the linear relationship with landmark changes in policy or management. Following notable interventions such as new government policies, action plans and publications, there has been a 26.4% increase in searches for endometriosis, 3.9% increase in searches into transvaginal mesh, a 48.8% increase in searches for cervical screening and a 20.9% overall increase in searches for polycystic ovarian syndrome. This analysis appears to show that patient interest largely mirrors real world events. [ABSTRACT FROM AUTHOR]

Background Pregnant women have been identified as high users of complementary and alternative medicine (CAM). However, no research to date has provided a detailed analysis of the prevalence and determinants of CAM consumption amongst pregnant women. Aim To examine the prevalence and determinants of CAM use by pregnant women, utilising a national representative sample. Methods The study sample was obtained via the Australian Longitudinal Study on Women's Health. This paper is based on a sub-study of 1,835 pregnant women, administered in 2010. The women answered questions about CAM use, demographics, pregnancy-related health concerns and health service utilisation. Results Complementary and alternative medicine use was found to be high with 48.1% ( n = 623) of pregnant women consulting a CAM practitioner and 52.0% ( n = 842) of women using CAM products (excluding vitamins and minerals) during pregnancy. CAM practitioner visits were more likely for selected pregnancy-related health concerns, namely back pain or back ache, neck pain and labour preparation. Women were less likely to consult a CAM practitioner if they suffered with headaches/migraines. Employment was also found to be predictive of pregnant women's visits to a CAM practitioner. Significant health history and demographic predictors of CAM product use were tiredness and fatigue, embarking on preparation for labour and having a university education. Conclusion Most pregnant women are utilising CAM products and/or services as part of their maternity care and obstetricians, general practitioners and midwives need to enquire with women in their care about possible CAM use to help promote safe, effective coordinated maternity care. [ABSTRACT FROM AUTHOR]

Little is published on cytomegalovirus (CMV) serological screening at the first antenatal visit or the contemporary CMV seroprevalence rates among the Australian pregnant population. We performed a retrospective analysis of public hospital births in a major tertiary centre (n = 840) over a two month period. We found that 13.6% (95% confidence interval (CI) 11.4–16.1%) of women had been screened for CMV at their first antenatal visit with their general practitioner. Of these, 43.0% (95% CI 34.3–52.1%) were CMV seronegative and therefore susceptible to primary infection. Seronegative women were also more likely to have been born in an economically developed country, to live in a socio‐economically advantaged postcode and to be nulliparous. The information from this study may help guide future studies of congenital CMV risk reduction strategies. [ABSTRACT FROM AUTHOR]

Nitrous oxide is commonly used in Australia for labour analgesia. Its use in labour is potentially associated with aerosol generation. During the first wave of the COVID‐19 pandemic of 2020, nitrous oxide was suspended on many birthing units to reduce the risk of transmission. We aimed to determine the impact of withholding nitrous oxide for labour analgesia, during the COVID‐19 pandemic, on epidural rates, opioid analgesia use, and maternal and neonatal outcomes. Withholding nitrous oxide for labour analgesia did not alter epidural rates but did significantly increase opioid analgesia use. Caesarean section rates, post‐partum blood loss and neonatal APGAR scores did not change. [ABSTRACT FROM AUTHOR]

Background: Antenatal education aims to prepare expectant parents for pregnancy, birth, and parenthood. Studies have reported antenatal education teaching breathing and relaxation methods for pain relief, termed psychoprophylaxis, is associated with reduction in caesarean section rates compared with general birth and parenting classes. Given the rising rates of caesarean section, we aimed to determine whether there was a difference in mode of birth in women based on the type of antenatal education attended. Materials and methods: A cross‐sectional antenatal survey of nulliparous women ≥28 weeks gestation with a singleton pregnancy was conducted in two maternity hospitals in Sydney, Australia in 2018. Women were asked what type of antenatal education they attended and sent a follow‐up survey post‐birth. Hospital birth data were also obtained. Education was classified into four groups: psychoprophylaxis, birth and parenting, other, or none. Results: Five hundred and five women with birth data were included. A higher proportion of women who attended psychoprophylaxis education had a vaginal birth (instrumental/spontaneous) (79%) compared with women who attended birth and parenting, other or no education (69%, 67%, 60%, respectively P = 0.045). After adjusting for maternal characteristics, birth and hospital factors, the association was attenuated (odds ratio 2.03; 95% CI 0.93–4.43). Conclusions: Women who attended psychoprophylaxis couple‐based education had a trend toward higher rates of vaginal birth. Randomised trials comparing different types of antenatal education are required to determine whether psychoprophylaxis education can reduce caesarean section rates and improve other birth outcomes. [ABSTRACT FROM AUTHOR]

Background: A significant barrier to the access of safe abortion is the lack of trained abortion providers. Recent studies show that with appropriate education, nurses and midwives can provide abortions as safely as medical practitioners. Aims: To examine the attitudes and practices of registered midwives (RMs) and sexual health nurses (SHNs) in Queensland toward abortion. Materials and Methods: A cross‐sectional mixed‐methods questionnaire was distributed to RMs and SHNs from the Queensland Nursing and Midwifery Union. Data were described and analysed both quantitatively and qualitatively. Results: There was a 20% response rate (n = 624) to the survey from the overall study population. There were 53.5% who reported they would support the provision of abortion in any situation at all; 7.4% held views based on religion or conscience that would make them completely opposed to abortion. There were 92.9% who felt that education surrounding abortion should be part of the core curriculum for midwifery and/or nursing students in Australia. The qualitative responses demonstrated a variety of views and suggestions regarding the practice of abortion. Conclusions: There was a wide variation in views toward induced abortion from RMs and SHNs in Queensland. While a proportion of respondents opposed abortion in most circumstances, a significant group was in support of abortion in any situation and felt involvement in initiating and/or performing abortion would be within the scope of RMs and SHNs. [ABSTRACT FROM AUTHOR]

Background: Surgical site infection (SSI) following caesarean section is a serious but underreported problem with an estimated incidence of 5–9%. It is essential to identify adherence to established prevention strategies to reduce the incidence rate. Aims: The aims of this study were to quantify unwarranted variation from evidence‐based practice on the prevention of SSI at caesarean section in Australia; and to identify predictors of not implementing an existing infection prevention bundle: pre‐incision antibiotic prophylaxis, vaginal preparation and spontaneous placenta removal. Materials and methods: An online cross‐sectional survey of obstetricians and obstetric Diplomates was conducted in 2016. The primary outcome was adherence to an existing infection prevention bundle, with demographic and clinical variables predicting adherence through multivariable binary logistic regression. Results: Forty‐nine percent of respondents (response rate 39.6%) reported implementing zero or only one element of the infection prevention bundle. The types of respondents most likely to have poor adherence were Diplomates (adjusted odds ratio (aOR) 2.58), obstetricians practising in private hospitals (aOR 3.34), those usually practising in public and private hospitals (aOR 2.23), and those not usually implementing a surgical safety checklist (aOR 3.77). Conclusions: Adherence to best practice at caesarean section is low among many Australian obstetricians. Infection control practitioners and obstetricians need to collaboratively implement surgical safety checklists at caesarean section, and monitor implementation using process key performance indicators, and audit and feedback. These strategies will reduce unwarranted variation from evidence‐based infection control practice. [ABSTRACT FROM AUTHOR]

Background: A renewed National Cervical Screening Program (NCSP) was introduced in Australia in December 2017. Under the renewed NCSP, there are limited data to guide the management of discordant colposcopy and biopsy results after a liquid‐based cytology (LBC) finding of 'possible high‐grade squamous intraepithelial lesion' (pHSIL). Aims: This study aims to determine the proportion of women referred with pHSIL who are found to have HSIL, identify influencing factors of women most at risk, and examine the role that cytopathology review plays in management decisions. Materials and Methods: Two‐hundred and thirty‐two women presenting to a tertiary women's hospital in Australia with pHSIL since December 2017 were identified. Women with HSIL following colposcopy directed biopsy were referred for treatment. When HSIL was not identified, these patients were referred for multidisciplinary clinicopathological review. Pathological outcomes and treatment recommendations are included. Main outcome measures: The primary outcome of the study was histological confirmation of HSIL. Results: Primary outcome data were available for 182 women (78.5%); 62 (34.1%) had HSIL on histology, three (1.7%) had adenocarcinoma in situ (AIS) and one (1%) had cervical squamous cell carcinoma (SCC). There was no association between age and the presence of HSIL. The presence of human papillomavirus 16 and/or 18 increased the likelihood of HSIL on histology (relative risk 1.9; 95% CI 1.27–2.80, P = 0.002). Fifty‐nine (25.4%) women were referred for observation who had low‐grade squamous intraepithelial lesion/no dysplasia. Conclusions: Clinicopathological review optimises management and triage of patients with pHSIL on referral cytology. Understanding outcomes in these patients informs counselling and management. [ABSTRACT FROM AUTHOR]

Background: Maternal breastfeeding support and maternal obesity are concerns effectively addressed at the community level. International, national and regional surveys have established that elevated maternal body mass index (BMI) is a risk factor for early cessation of breastfeeding. However, the extent of these concerns in the local community is often an unknown and related to variables such as socioeconomic status, education, culture and ethnicity. Aims: We believed that a survey of post‐natal breastfeeding and BMI status would provide a valuable insight into developing targeted local health initiatives. Materials and Methods: In 2014, we teamed up with the Whittlesea Maternal and Child Health Service to complete a questionnaire of mothers and babies attending the eight‐week infant review. Data included: infant and maternal weight, medical conditions, breastfeeding experience and satisfaction, prime language, education level, support. Results: Maternal obesity at eight weeks postpartum was high at 28.9%, with 63.6% of mothers being overweight or obese. Obesity was associated with a lack of higher education (P < 0.05) and with English as the prime language (P < 0.05). Breastfeeding initiation was high across all BMI categories at 98.3%. By eight weeks, 32.2% of mothers had ceased breastfeeding. Breastfeeding continuation at eight weeks was negatively correlated with elevated BMI (P < 0.01). Breastfeeding cessation in mothers with elevated BMI correlated with psycho‐social concerns (P < 0.05) and lack of previous breastfeeding experience (P < 0.01). Conclusion: Elevated maternal BMI is prevalent in our community and significantly impacts the success of breastfeeding in the early post‐natal period. The survey data have allowed targeted health responses to be developed. [ABSTRACT FROM AUTHOR]

Background: Low Apgar scores are associated with neonatal morbidity and mortality, but effects of Apgar scores of 0–5, 6, 7, 8 and 9 (compared with 10) on longer‐term neurodevelopmental outcomes are less clear. Aim: To examine the associations between Apgar scores of 0–5, 6, 7, 8 and 9 (compared with 10) and children's educational outcomes as measured by the Australian National Assessment Program—Literacy and Numeracy (NAPLAN) tests at age eight. Materials and Methods: We merged perinatal data including all children born in South Australia from 1999 to 2008 with school assessment data (NAPLAN). School assessments included five learning areas (domains)—reading, writing, spelling, grammar and numeracy. Each domain was categorised according to performing at or below National Minimum Standards (≤NMS). Effects were estimated using Augmented Inverse Probability Weighting (AIPW) accounting for a range of maternal, perinatal and sociodemographic characteristics. Results: Risk differences comparing five‐minute Apgar scores of 0–5 with Apgar scores of 10 for children performing ≤NMS for each domain were: reading (0.07 (95% CI −0.16 to 0.29)), writing (0.27 (95% CI −0.14 to 0.68)), spelling (0.15 (95% CI −0.10 to 0.40)), grammar (0.04 (95% CI −0.21 to 0.29)) and numeracy (0.21 (95% CI −0.04 to 0.45)). Risk differences for children performing ≤NMS were also evident when Apgar score of 6 was compared with Apgar score of 10. Conclusions: Children with five‐minute Apgar scores of 0–5 and 6, compared with Apgar score of 10, are at higher risk of scoring at/below the NMS on the NAPLAN assessments at eight years. [ABSTRACT FROM AUTHOR]

Background: The prediction model M4 can successfully classify pregnancy of unknown location (PUL) into a low‐ or high‐risk group in developing ectopic pregnancy. M4 was validated in UK centres but in very few other countries outside UK. Aim: To validate the M4 model's ability to correctly classify PULs in a cohort of Australian women. Materials and Methods: A retrospective analysis of women classified with PUL, attending a Sydney‐based teaching hospital between 2006 and 2018. The reference standard was the final characterisation of PUL: failed PUL (FPUL) or intrauterine pregnancy (IUP; low risk) vs ectopic pregnancy (EP) or persistent PUL (PPUL; high risk). Each patient was entered into the M4 model calculator and an estimated risk of FPUL/IUP or EP/PPUL was recorded. Diagnostic accuracy of the M4 model was evaluated. Results: Of 9077 consecutive women who underwent transvaginal sonography, 713 (7.9%) classified with a PUL. Six hundred and seventy‐seven (95.0%) had complete study data and were included. Final outcomes were: 422 (62.3%) FPULs, 150 (22.2%) IUPs, 105 (15.5%) EPs and PPULs. The M4 model classified 455 (67.2%) as low‐risk PULs of which 434 (95.4%) were FPULs/IUPs and 21 (4.6%) were EPs or PPULs. EPs/PPULs were correctly classified with sensitivity of 80.0% (95% CI 71.1–86.5%), specificity of 75.9% (95% CI 72.2–79.3%), positive predictive value of 37.8% (95% CI 33.8–42.1%) and negative predictive value of 95.3% (95% CI 93.1–96.9%). Conclusions: We have externally validated the prediction model M4. It classified 67.2% of PULs as low risk, of which 95.4% were later characterised as FPULs or IUPs while still classifying 80.0% of EPs as high risk. [ABSTRACT FROM AUTHOR]

Background: Seasonal influenza and pertussis cause significant morbidity and mortality among expectant mothers and infants. Vaccination during the antenatal period is an important public health intervention, minimising rates of maternal, neonatal and infant infection. Aims: The primary aim of this project was to establish the rates of antenatal vaccine uptake. Secondly, the study aimed to determine socio‐demographic factors significant to vaccine uptake. Thirdly, the project aimed to produce a thematic analysis of the factors affecting vaccination uptake during pregnancy. Materials and Methods: A cross‐sectional observational study was conducted among women attending a large maternity hospital, in the western suburbs of Melbourne, for perinatal care. Data were collected via self‐completed questionnaires after delivery. Data from the questionnaires were entered into an electronic database, and STATA was used to undertake correlation analysis. Results: Over a 12‐month period 1678 women completed questionnaires and 1305 were eligible for further analysis. The uptake of influenza vaccine was 48.3%, pertussis vaccine uptake was higher, at 82.9%. Uptake of influenza and pertussis vaccines strongly correlated with recommendations from healthcare providers (odds ratios 29.7 and 63.8 respectively). Maternal country of birth, age and parity were significant predictors of vaccine uptake. In thematic analysis, healthcare provider recommendation and the perceived risk of the disease were factors resulting in vaccination. Conclusion: This study determined the rate of antenatal vaccine uptake and significant socio‐demographic determinants affecting uptake at a large maternity hospital in metropolitan Melbourne. Ensuring healthcare providers recommend vaccination is likely to improve coverage. [ABSTRACT FROM AUTHOR]

Background: Small for gestational age (SGA) is a major determinant of poor perinatal outcome. Detecting SGA at term using ultrasound is challenging and we often plan birth based on clinical assessment. Aims: To determine the incidence of SGA infants with birthweight <10th centile among women undergoing planned birth at term for suspected SGA despite a normal estimated fetal weight (EFW) on ultrasound at 35–37 weeks. Materials and Methods: We performed a retrospective study including all women with a fetal growth ultrasound at ≥35 weeks reporting an EFW ≥ 10th centile (appropriate for gestational age, AGA) who subsequently had an induction of labour or caesarean birth at ≥37 weeks due to ongoing clinical suspicion of SGA between 2012–2014. The primary outcome was the incidence of SGA newborns using customised centiles. Results: There were 532 women who had a planned birth for clinical suspicion of SGA during the study period. Of these, 205 (38.5%) had an AGA fetus on ultrasound ≥35 weeks but were subsequently delivered because of a persisting clinical suspicion of SGA on abdominal assessment. Sixty‐eight percent (n = 139/205) delivered an SGA infant. Furthermore, almost half of these SGA infants (47.5%) had a birthweight <3rd centile. Neonatal outcomes were worse for the SGA infants, with 15.1% (n = 21/205) requiring special care nursery compared to 1.5% (n = 1/205) of those AGA at birth. Conclusions: A reassuring ultrasound with EFW ≥10th centile in the late third trimester should not override clinical concerns of impaired fetal growth at term. [ABSTRACT FROM AUTHOR]

Background: Expediting delivery in the second stage of labour often involves a choice between a caesarean section at full dilatation or mid‐cavity instrumental delivery. Accumulating evidence suggests that the mode of delivery may influence the risk of preterm birth in the subsequent pregnancy. Aims: To directly compare first birth caesarean section at full dilatation with mid‐cavity instrumental delivery for the risk of preterm birth in the subsequent pregnancy (second birth). A further aim was to identify predictive factors associated with these index modes of delivery. Materials and Methods: This is a retrospective cohort study involving three maternity hospitals in western Sydney over the period of 2006–2017. Inclusion criteria were nulliparous women with a singleton term cephalic first birth delivered by caesarean section at full dilatation or mid‐cavity instrumental delivery, and whose second birth also occurred under our care. Data were analysed separately for first and second births. Results: There were 425 caesarean section at full dilatation and 874 mid‐cavity instrumental cases which met inclusion criteria. The risk of preterm birth in the second birth was 5.7% compared to 3.2%, respectively (risk ratio 1.76; 95% CI 1.04–3.00; P = 0.035). After excluding causes of preterm birth not related to previous mode of delivery, the risk of spontaneous preterm birth was 4.3% compared to 2.0%, respectively (risk ratio 2.18; 1.14–4.19; P = 0.019). Conclusion: Caesarean section at full dilatation is associated with a significantly higher rate of preterm birth in the subsequent pregnancy compared to a mid‐cavity instrumental delivery. This should be considered in second‐stage mid‐cavity decision‐making. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of information regarding perineal injuries in women who achieve vaginal birth after caesarean section (VBAC). Aims: To ascertain the rate of severe perineal injuries in women achieving VBAC at a major tertiary obstetric hospital, and to determine if vaginal birth is more likely to be associated with perineal injuries in women with one previous caesarean section compared with nulliparous women. Materials and Methods: A retrospective cohort study was undertaken of women with singleton pregnancies at term who delivered vaginally between 2013 and 2016. We compared nulliparous women with women who had undergone one previous caesarean section. The primary outcome analysed was the rate of third and fourth degree tears in each group. Secondary outcomes were major post‐partum haemorrhage and instrumental delivery. Results: Totals of 10 663 nulliparous women and 629 VBAC women achieved vaginal birth. Of the VBAC women, 418 achieved their first vaginal birth (first VBAC group). Overall, there was no significant difference in the rate of third and fourth degree tears in the VBAC group compared with the nulliparous group (6.0% vs 5.6%; P = 0.73). There was no significant increase in anal sphincter injuries in the first VBAC group compared with the nulliparous group (6.0% vs 7.4%; P = 0.25). Conclusion: No overall difference in the rate of severe perineal injuries between VBAC women and nulliparous women who achieve vaginal birth was observed in this study. [ABSTRACT FROM AUTHOR]

Background: Maternal smoking is associated with a number of adverse outcomes with a dose‐dependent increase in risk. The aim of this study was to evaluate the obstetric and perinatal outcomes in women who smoked during pregnancy. Methods: This was a retrospective cohort study of women who smoked during pregnancy and birthed at a major perinatal centre in Australia between January 2000 and April 2017. The study cohort was compared to a cohort of women who did not smoke in pregnancy. Smoking status was ascertained on history and included all types of smoking. Demographic characteristics and obstetric, intrapartum and perinatal outcomes were compared between the two groups. Results: The study cohort included 20 477 (14.6%) women who smoked during pregnancy and 119 396 controls. Women who smoked tended to be younger, of higher body mass index (BMI), Caucasian and Indigenous ethnicity. Smokers were less likely to be nulliparous, but more likely to be hypertensive and have a lower socioeconomic status compared to non‐smokers. Women who smoked were more likely to have a caesarean section for non‐reassuring fetal status (adjusted odds ratio (aOR) 1.16, 95%CI 1.07–1.26, P < 0.001). The infants of women who smoked were more likely to be born preterm, have a lower median birth weight and birth weights <10th (aOR 1.76, 95%CI 1.66–1.86, P < 0.001) and <5th centile (aOR 2.00, 95%CI 1.86–2.16, P < 0.001). Neonatal outcomes in the smoking cohort were worse with an increase in neonatal intensive care unit admission (aOR 1.34, 95%CI 1.27–1.43, P < 0.001), severe acidosis (aOR 1.41, 95%CI 1.27–1.43, P < 0.001) and a composite of severe neonatal outcomes (18.0% vs 12.0%, aOR 1.35, 95%CI 1.28–1.43, P < 0.001). Conclusion: Women who smoke in pregnancy have worse obstetric and perinatal outcomes compared to controls and should be managed as high risk. [ABSTRACT FROM AUTHOR]

Background: Clinical risk prediction tools for gestational diabetes (GDM) may be enhanced by measuring biomarkers in early pregnancy. Aim: To evaluate a two‐step GDM risk prediction tool incorporating fasting glucose (FG) and serum biomarkers in early pregnancy. Materials and methods: High molecular weight (HMW) adiponectin, omentin‐1 and interleukin‐6 (IL‐6) were measured at 12–15 weeks gestation in women with high risk of GDM from a randomised trial using a clinical risk prediction tool. GDM diagnosis (24–28 weeks) was evaluated using 1998 Australian Diabetes in Pregnancy (ADIPS) criteria and newer International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Associations between biomarkers and development of GDM were examined using multivariable regression analysis. Area under the receiver‐operator curve (AUC), sensitivity and specificity were calculated to determine classification ability of each model compared to FG and maternal characteristics. Results: HMW adiponectin improved prediction of ADIPS GDM (AUC 0.85, sensitivity 50%, specificity 96.2%, P = 0.04), compared to FG and maternal factors (0.78, 35% and, 98.1%, respectively). HMW adiponectin <1.53 μg/mL further improved the model (AUC 0.87, sensitivity 75%, specificity 88.2%, P = 0.01). HMW adiponectin did not improve prediction of IADPSG GDM (AUC 0.84, sensitivity 64%, specificity 97.9%, P = 0.22) compared to FG and maternal factors (0.79, 56%, 93.8%). Omentin‐1 and IL‐6 did not significantly improve classification ability for GDM. Conclusions: A two‐step approach combining FG and HMW adiponectin to a validated clinical risk prediction tool improved sensitivity and predictive ability for ADIPS GDM. Further research is required to enhance GDM prediction using IADPSG criteria for application in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Following a primary caesarean section (CS), women must decide between attempted vaginal birth after caesarean (VBAC) and elective repeat caesarean section (ERCS) in subsequent pregnancies. Both options carry potential morbidity and mortality for mother and child, with the most feared being uterine rupture and its consequences. In attempts to reduce morbidity, several predictive nomograms have been developed to assist in delivery mode decisions. Aim: To assess the validity of the predictive nomogram developed by Grobman et al. in our regional Australian population. Materials and Methods: In our retrospective analysis, patients at term, with one previous CS who had a trial of labour were assigned a 'Grobman score' based on antenatal details. Outcomes were noted and patient groups analysed according to percentage deciles of estimated VBAC success, compared with actual VBAC success rates. Results: A total of 395 women underwent trial of labour after a single prior CS, with a VBAC success rate of 83%. The Grobman model displayed adequate calibration and the re‐calibrated model good calibration with the slope coefficient of 0.87 (95% CI 0.54–1.19) and intercept 0.19 (95% CI −0.34–0.72). Discrimination was moderate with receiver operating characteristic area of 0.71 (95% CI 0.67–0.76). Conclusion: This analysis supports further validation studies in larger Australian settings, and suggests that use of the original Grobman predictive nomogram may be appropriate in Australia. [ABSTRACT FROM AUTHOR]

Background: Recent guidelines suggest screening high‐risk women in early pregnancy for gestational diabetes (GDM); however, there is little evidence to support this. Aims: To compare pregnancy outcomes associated with diabetes for women with risk factors for GDM according to gestation of diagnosis. Early GDM was defined as a positive test before 20 weeks gestation, late GDM as a positive test at 20 or more weeks and no GDM when both tests were negative. Materials and methods: Retrospective analysis in an Australian tertiary hospital of women who underwent a glucose tolerance test in pregnancy prior to 20 weeks gestation, and a repeat test after 20 weeks gestation if the initial test was negative. Results were adjusted for maternal demographics. Results: Women with early GDM (n = 170) were no more likely to experience the obstetric composite outcome than women with late GDM (n = 171) or no GDM (n = 547) (early odds ratio (OR) 1.16, 95%CI 0.79–1.71; late OR 0.78, 95%CI 0.53–1.12). Infants of women with early GDM, but not late GDM, were more likely (early OR 1.8, 95%CI 1.15–2.92; late OR 1.4, 95%CI 0.90–2.23) to have the neonatal composite outcome than infants of women without GDM, predominantly due to an increase in neonatal hypoglycaemia. Conclusions: This result may be due to careful management of GDM, or because, after adjustment for maternal demographics, the early diagnosis of GDM does not substantially increase rates of adverse outcomes compared to GDM diagnosed in later pregnancy or no GDM in women with risk factors for GDM. [ABSTRACT FROM AUTHOR]

Background: Pre‐labour rupture of membranes (PROM) at term is a common event with early induction of labour reducing infectious morbidity without increasing the caesarean rate. Syntocinon is commonly used for induction but prostaglandins are also routinely used. Large studies have shown no difference in the maternal and neonatal outcomes with either method. Aim: To assess the safety and efficacy of vaginal prostaglandin (PG) compared to syntocinon for induction of labour in term‐PROM. Method: This was a single‐centre randomised controlled trial at Ipswich Hospital of women presenting at ≥37 weeks gestation with PROM. Women were randomised and managed in labour as per local guidelines. Analysis was by intention to treat. Results: One hundred and eighty‐four women were recruited, 90 in the PG group and 94 in the oxytocin group. Women in both arms were of similar demographics and 53% of women in the PG group did not require any oxytocin. There was a statistically significant lower incidence of fetal heart rate abnormality in the PG group, 4.4% versus 12.8%. There was no difference in epidural use, caesarean section, maternal infection, admission to special care nursery or neonatal sepsis. Time to onset of labour was significantly longer in the PG group, 25.7 h versus 19.7 h but with no difference in the length of first stage. Maternal satisfaction was high in both groups with no significant difference in breastfeeding rates. Conclusion: Induction of labour with oxytocin or vaginal prostaglandins are safe and efficacious options for women in the context of PROM at term. [ABSTRACT FROM AUTHOR]

Background: There is limited information relating to routine depression screening and psychosocial assessment programs in private maternity settings in Australia. Aims: To describe the psychosocial profile of a sample of private maternity patients who participated in a depression screening and psychosocial risk assessment program as part of routine antenatal care, and to explore women's experience of receiving this component of pregnancy care. Materials and methods: We conducted a retrospective medical records audit of 455 consecutive women having a routine psychosocial assessment and referral. Assessment was undertaken using the Edinburgh Postnatal Depression Scale (EPDS) and the Antenatal Risk Questionnaire (ANRQ) for psychosocial risk; 101 women completed a feedback survey about their experience of receiving routine psychosocial care. Results: Of the 87.7% of women who completed both EPDS and ANRQ, 4.3% scored 13 or more on the EPDS. On the ANRQ, 25.3% of women endorsed one risk factor, 11.6% two risk factors and 10.5% three or more risk factors. Elevated EPDS scores were associated with major stresses in the last 12 months, high trait anxiety and significant past mental health issue/s. Acceptability of depression screening and psychosocial risk assessment was high. Conclusions: This study highlights the need for, and acceptability of, depression and psychosocial assessment in the private maternity sector. These findings are particularly timely given the provision of new Medicare Benefits Scheme items for obstetricians to undertake psychosocial assessment (both antenatally and postnally) in line with recommended clinical best practice. [ABSTRACT FROM AUTHOR]

Background: Research supports water immersion for labour if women are healthy, with no obstetric or medical risk factors. Aims: To evaluate the obstetric and neonatal outcomes of women intending to use immersion in water for labour or birth. Methods: Retrospective audit of clinical outcomes for women intending to labour or birth in water conducted between July 2015 and June 2016, at a tertiary maternity hospital in Western Australia. Obstetric and neonatal data were collected from medical records. Multivariable logistic regression was utilised to investigate women who laboured in water stratified by those who birthed in water. Results: A total of 502 women intended to labour or birth in water; 199 (40%) did not and 303 (60%) did. The majority of women using water immersion (179 of 303; 59%) birthed in water. Multiparous women were more likely than primparous to birth in water (73% vs 46%; P < 0.001). Women who birthed in water were at increased odds of: a first stage labour ≤240 min (odds ratio (OR) 2.56, 95% CI 1.34–4.87, P = 0.004); a second stage ≤60 min (OR 3.53, 95% CI 1.82–6.84, P < 0.000); a third stage labour of 11–30 min (OR 2.15, 95% CI 1.23–3.78, P = 0.008); and having an intact perineum (OR 3.10, 95% CI 1.70–5.64, P < 0.000). Conclusion: Not all women who set out to labour and birth in water achieve their aim. There is a need for high‐quality collaborative research into this option of labour and birth, so women can make an informed choice around this birth option. [ABSTRACT FROM AUTHOR]

This retrospective study was conducted to identify the incidence and characteristics associated with readmissions for surgical site infections following caesarean section in a tertiary hospital from 2012 to 2015. Of 6334 patients who underwent caesarean section, 165 (2.6%) were readmitted, most commonly for surgical site infection (25.5%, n = 42). Thirty‐seven of these patients (88%) had an emergency caesarean compared to five (12%) following an elective caesarean section. Of the women with surgical site infections, 69% were overweight and 14% had diabetes. Emergency caesarean sections were responsible for the majority of readmissions, particularly in women with co‐morbidities that predisposed them to infection. [ABSTRACT FROM AUTHOR]

Objective: To establish whether the infusion method trial of void (TOV) after a mid‐urethral sling procedure, in contrast to the standard auto‐fill TOV, permits discharge home from recovery, as these procedures are eminently suited to same day discharge, and the delay in achieving a successful TOV often keeps the patient in hospital overnight. Method: A randomised controlled trial performed between December 2014 and April 2016 at the University Hospital, enrolling 40 women undergoing a mid‐urethral sling procedure for stress urinary incontinence. The women were randomised to infusion method or auto‐fill method TOV. The primary outcome was discharge home from the recovery area of theatre. Results: Discharge from recovery was not different between the two groups (odds ratio (OR) 1.3 95% CI: 0.3–5.9, P = 0.71). The rate of TOV being successfully passed in recovery was higher in the infusion‐fill group compared to the standard auto‐fill group (OR 4.5 95% CI 1.2–17.4, P = 0.025). This means that three women will undergo the infusion‐fill to achieve one more successful TOV in recovery. Conclusions: The infusion method resulted in more women passing their TOV in recovery but this did not translate into more discharges from recovery. [ABSTRACT FROM AUTHOR]

Background Adolescent pregnancy is defined as pregnancy in girls aged 10-19 years and can be associated with increased risks. Aim To investigate obstetric and perinatal outcomes in a cohort of adolescent girls from a major Australian tertiary centre. Materials and Methods This was a nine-year retrospective cohort study of women who birthed at the Mater Mother's Hospital ( MMH) in Brisbane, Australia between 1 January 2007 and 31 December 2015. The adolescent cohort was aged <19 years and the control group was aged 20-24 years. Results Over the study period the total study cohort comprised 8904 women. Of these, the adolescent cohort consisted of 1625 girls (18.2%) and the control group consisted of 7279 women (81.8%). Adolescents were more likely to be nulliparous, single, of Indigenous ethnicity or to have refugee status. They had higher rates of smoking, asthma, diabetes mellitus and thyroid disease. They were more likely to have an uncomplicated spontaneous vaginal delivery but were less likely to have an intact perineum and had higher rates of pre-term delivery and low birth weight babies. There were no differences in rates of postpartum haemorrhage. Conclusions Teenage pregnancy results in poorer obstetric and perinatal outcomes. A focus on optimising maternal health care and providing culturally appropriate antenatal and intrapartum care is imperative to improving outcomes. [ABSTRACT FROM AUTHOR]

Background Preterm birth continues to be a major cause of infant morbidity and mortality worldwide, but advances have recently been made in its prediction and prevention. A short cervix (<25 mm) in the second trimester on transvaginal ultrasound scan and fetal fibronectin are important predictive tests. For over ten years, the Preterm Labour Clinic at the Royal Women's Hospital, Melbourne, Australia has provided care for women at high risk of preterm birth, including those with a previous preterm birth, previous cervical surgery, uterine malformation or incidental finding of short cervix at routine ultrasound. The purpose of this study was to review this clinic's outcomes for the first decade. Methods This was a retrospective cohort study of all referrals to the Preterm Labour Clinic during the period 2004-2013 inclusive. Seven hundred and fifty-six cases met the study inclusion criteria of appropriate risk factor, singleton pregnancy, surveillance undertaken and outcome data available. Results The preterm birth rate (<37 weeks) was 21.4%. The rate of preterm birth by year decreased significantly when adjusted for risk ( P = 0.002). A short cervix was diagnosed in 32% of the sample, and positively correlated with lower gestational age at delivery. Fetal fibronectin and serum alkaline phosphatase were independent predictors of preterm birth <34 weeks and <37 weeks. Conclusion The adjusted preterm birth rate at the Royal Women's Hospital's Preterm Labour Clinic has decreased significantly over the decade studied. Positive fetal fibronectin at 26 weeks and elevated serum alkaline phosphatase are independent predictors of preterm birth. [ABSTRACT FROM AUTHOR]

Background In Australia, more than 20% of women giving birth are 35 years or older. Advanced maternal age ( AMA) is a risk factor for stillbirth, and many clinicians now recommend induction of labour ( IOL) at around term gestation. The aim of this study is to determine if AMA is associated with emergency caesarean section ( CS) following IOL. Methods A retrospective cohort study was undertaken using routinely collected de-identified data. Live-born, singleton, cephalic, non-anomalous pregnancies undergoing IOL between 37 + 0 and 42 + 0 weeks were included. Previous CS and privately insured admission status were excluded. Mode of delivery was compared for women ≥38 years ( AMA) and women <38 years. The primary outcome was birth by CS. Bivariate and multivariate logistic regression analyses were undertaken. Results A total of 7459 women were included (≥38 years n = 718, 9.6%; <38 years n = 6741, 90.4%). AMA women had similar rates of unassisted vaginal births ( OR 1.15, 95% CI 0.98-1.35, P = 0.080) and CS ( OR 1.08, 95% CI 0.90-1.30, P = 0.407) but fewer instrumental deliveries ( OR 0.69, 95% CI 0.55-0.87, P = 0.002) compared to women <38 years. When controlled for confounders, AMA was independently associated with a two-fold increase in birth by CS following IOL ( adjusted OR 2.29; 95% CI 1.64-3.20; P < 0.001). There were no differences in neonatal outcomes. Conclusion Following IOL, AMA was associated with a two-fold increased likelihood of birth by CS in both nulliparous and multiparous women. However, the majority of AMA women birthed vaginally. Clinicians may find this information useful when counselling older women who are undergoing term IOL. [ABSTRACT FROM AUTHOR]

Background Caesarean section (CS) rates are known to vary by country, migration status and social group. However, little population-based, confounder adjusted evidence exists on caesarean rate for African immigrants in Australia. Aim To investigate disparities in first-time caesarean, mainly unplanned caesarean in labour for women born in Eritrea, Ethiopia, Somalia and Sudan relative to Australian-born women in public care. Methods A population-based study of 237 943 Australian and 4057 Eastern African singleton births between 1999 and 2007, was conducted using Victorian Perinatal Data Collection. Descriptive and multivariable logistic regression analysis by parity, adjusting for confounders selected a priori, was performed for first-time unplanned caesarean in labour and overall caesarean. Results Primiparae born in each of the Eastern African countries had elevated odds of unplanned caesarean in labour: Eritrea adjusted odds ratio (ORadj) 2.04 95% CI (1.41, 2.97), Ethiopia ORadj 2.08 95% CI (1.62, 2.68), Somalia ORadj 1.62 95% CI (1.25, 2.10) and Sudan ORadj 1.39 95% CI (1.03, 1.87). Similarly, multiparae from Eastern African countries had elevated odds of unplanned caesarean in labour: Eritrea ORadj 2.13 95% CI(1.15, 3.97), Ethiopia ORadj 2.05 95% CI (1.38, 3.03), Somalia ORadj 2.16 95% CI (1.69, 2.77) and Sudan ORadj 1.81 95% CI (1.32, 2.49). The odds of any first-time caesarean (planned or unplanned) were elevated for primiparae born in all countries except Sudan and for multiparae born in Ethiopia and Somalia. Conclusions We observed substantial variations in a first-time CS between Eastern African and Australian-born women in Victoria, Australia. However, these disparities were unexplained by socio-demographic and clinical risks, suggesting the potential importance of other factors such as communication difficulties, support systems for immigrant pregnant women and possible differences in care. [ABSTRACT FROM AUTHOR]

Background Recent pertussis epidemics have triggered implementation of cocooning, involving caregiver vaccination to indirectly protecting susceptible infants. Aim To determine patient, provider and setting factors associated with maternal pertussis booster vaccination ( dTpa) within 5-10 years before childbirth. Materials and Methods Cross-sectional survey using Health Belief Model constructs among postpartum women in a tertiary referral centre and a private hospital in Sydney, Australia. Results Pertussis vaccination was current among 33.7% of the 2483 new mothers (0.5% vaccinated during pregnancy). Women were more likely to be vaccinated if they had heard of 'whooping cough' from a health professional ( OR: 2.59, P < 0.001, 95% CI: 1.70-3.95), were recommended the vaccine ( OR: 2.48, P < 0.00, 95% CI: 1.55-4.00), perceived pertussis as 'severe' for adults ( OR: 1.21, p0.009, 95% CI: 1.05-1.39) and 'common' within their community ( OR: 1.38, P < 0.001, 95% CI: 1.18-1.61). They more often agreed that it was their parental responsibility to be vaccinated ( OR: 1.61, P = 0.002, 95% CI: 1.19-2.18), and this would help prevent their baby from contracting pertussis ( OR: 1.22, P = 0.046, 95% CI: 1.00-1.47). Vaccinated women were less likely to report vaccination barriers: time constraints ( OR: 0.75, P < 0.001, 95% CI: 0.66-0.85) and having safety concerns ( OR: 0.80, P < 0.001, 95% CI: 0.69-0.92). Additionally, their partners reported three times higher uptake (76% vs 49%; P < 0.001; 95% CI: 2.66-3.85). Conclusions Current pertussis vaccination in only one in every three postpartum participants may indicate insufficient coverage to protect newborns. Practitioners are instrumental in raising awareness and addressing vaccine concerns. Integrating vaccination into routine obstetric care, whether antenatally or postnatally, may minimise barriers. [ABSTRACT FROM AUTHOR]

Background Previous research has found a higher lifetime prevalence of eating disorders in women undergoing fertility treatment. Aims This study aimed to gauge the prevalence of eating disorders in women attending a fertility clinic and to compare current disordered eating attitudes and exercise amongst different infertility categories. Materials and Methods Three hundred and eighty-five women were grouped according to infertility diagnosis: male factor, unexplained infertility, ovulatory disorders, polycystic ovarian syndrome ( PCOS) and heterogeneous causations. Participants anonymously completed the Eating Disorder Examination Questionnaire ( EDE-Q), the International Physical Activity Questionnaire ( IPAQ) and a Demographics questionnaire. Results The lifetime history of self-reported eating disorders for women in the sample was similar to Australian community rates. Profile analysis revealed on the EDE-Q that women with ovulatory disorders were not significantly different from women with PCOS; however, they were significantly different to women with other infertility diagnoses (all P < 0.05), suggesting increased vulnerability to disordered eating. There were no between-group differences in exercise quantity ( IPAQ, P = 0.625) although women with ovulatory disorders and PCOS had a significantly higher risk of engaging in compulsive, 'driven' exercise ( OR = 6.98, CI = 1.39, 34.90, P = 0.018) as a means to control weight or shape. Conclusions Contrary to previous research, our findings do not confirm a greater lifetime prevalence rate of eating disorders in women attending an infertility clinic. This study does highlight the importance of screening women with forms of an ovulatory disorder for features of disordered eating attitudes and driven exercise behaviours. [ABSTRACT FROM AUTHOR]

Objective Evaluating cost-effectiveness of induction of labour ( IOL) using outpatient mechanical cervical ripening using a Foley catheter ( OFC) compared to inpatient chemical ripening using prostin gel ( IPG). Study Design Cost-effectiveness analysis from a hospital perspective alongside a RCT. Women in a metropolitan Australian maternity hospital with an unfavourable cervix requiring IOL at term were randomised to IPG ( n = 51) or OFC ( n = 50). Primary economic measures were mean patient costs, incremental cost per predelivery inpatient hour prevented, and incremental cost per vaginal delivery within 12 h of admission to the birthing unit. Bootstrapping estimates were used to construct 95% confidence intervals. Estimates of net monetary benefit were calculated to aid interpretation of the results. Results Mean hospital costs per woman were nonsignificantly higher ($6524 OFC vs $5876 IPG) and mean difference $643; 95% CI −$366 to $1652. OFC group experienced fewer predelivery inpatient hours, resulting in an incremental cost per inpatient hour prevented of $57 (95% CI −$79.44 to $190.65). However, OFC patients were less likely to deliver vaginally within 12 h of admission to birthing unit. Other cost influencing clinical outcomes, including caesarean section rates and total inpatient hours, were not statistically different. Results were not sensitive to changes in costs or the cost-effectiveness thresholds. Conclusion OFC had fewer inpatient hours and costs prior to birth. However, OFC did not reduce overall inpatient hours and failed to achieve comparable rates of vaginal delivery within 12 h of birthing unit admission. Therefore, OFC is unlikely to be considered cost-effective compared to IPG in current hospital settings. [ABSTRACT FROM AUTHOR]

Background American evidence suggests women are not well informed about the optimal duration of pregnancy or the earliest time for safe birth. Similar evidence does not exist in Australia. Aims To explore pregnant women's beliefs about the duration of pregnancy and the earliest time for safe birth, and to compare the results with US data. Methods A cross-sectional survey of pregnant women attending antenatal clinics at four public hospitals in Sydney, Australia, included information on maternal and pregnancy characteristics, and two questions exploring women's beliefs about the duration of pregnancy, and the earliest time for safe birth. Responses were grouped as: late preterm (34-36 weeks), early term (37-38 weeks) and full term (39-40 weeks). Results Of the 784 surveyed women, 52% chose 39-40 weeks as the duration of a full-term pregnancy, while for the earliest time for safe birth, 10% chose 39-40 weeks and 57% chose 37-38 weeks. Some maternal characteristics were associated with women's beliefs, including having a medical and/or pregnancy complication, country of birth, level of education, employment status and attending a tertiary hospital. The associations were different for each question. In comparison with US studies, Australian women were more likely to choose later gestations for both the duration of pregnancy and the earliest time for safe birth. Conclusions A significant proportion of women believe that full-term pregnancy and earliest time for safe birth occur before 39 weeks, suggesting opportunities for better communication about the benefits and risks of birthing at different gestations. [ABSTRACT FROM AUTHOR]

Background Although influenza vaccination is an important component of antenatal care and is recommended and funded by the Australian government, vaccination uptake has been low. Aims This study compared seasonal influenza vaccination uptake among pregnant Western Australian ( WA) women and identified factors associated with vaccination uptake. Materials and Methods Adult women who were pregnant during the 2012 and 2013 influenza vaccination seasons were selected at random and invited to complete a computer-assisted telephone interview survey about whether they received influenza vaccination during pregnancy. Data analyses were weighted to the age distribution of women of reproductive age in WA. Multivariate logistic regression was used to identify factors associated with vaccination uptake. Results Between 2012 and 2013, the proportion of WA women whose antenatal care provider recommended influenza vaccination increased from 37.6 to 62.1% and vaccination uptake increased from 23.0 to 36.5%. The antenatal care provider's advice to have influenza vaccine was the single most important factor associated with vaccination ( OR 11.1, 95% CI 7.9-15.5). Most women (63.7%) were vaccinated in general practice, 18.8% in a public hospital antenatal clinic and 11.0% at their workplace. Wanting to protect their infant from infection (91.2%) and having the vaccine recommended by their GP (60.0%) or obstetrician (51.0%) were commonly reported reasons for vaccination; worrying about side effects was a common reason for nonvaccination. Conclusions To optimise maternal and infant health outcomes, Australian antenatal care providers and services need to incorporate both the recommendation and delivery of influenza vaccination into routine antenatal care. [ABSTRACT FROM AUTHOR]

Background In ectopic pregnancy ( EP) management, failure of β hCG to fall more than 15% between Days 4 and 7 after methotrexate administration indicates the need for a second dose. Regimens preferring a 25% fall in β hCG between methotrexate administration and Day 7 have been proposed. Aims Our study analysed these and other regimens' performance in predicting treatment success. Secondarily, we investigated how each regimen guided the prescription of additional methotrexate doses. Methods Medical files of 88 women with ultrasound confirmed tubal EP and pretreatment β hCG <6000 IU/L, unsuitable for expectant management, were retrospectively analysed. The β hCG monitoring regimens studied were (i) 15% fall Day 4-7, (ii) 25% fall Day 0/1-7, (iii) any fall Day 0/1-7, (iv) any fall Day 0/1-4 and (v) 20% fall Day 0/1-4. Treatment success was defined if the EP resolved without surgical intervention. Statistical analysis was performed using McNemar's test. Results Overall, treatment success with methotrexate was 92% ( n = 81/88). Predicting success of methotrexate ( PPV 98-100%) and detecting those needing surgery (specificity 86-100%) were equivalent across all monitoring regimens. However, the 25% Day 0/1-7 fall (and the Day 0/1-4 regimens) over-selected women for a second dose of methotrexate ( P < 0.05). Conclusion The performance of each regimen is equivalent to the traditional 15% fall Day 4-7 regimen in predicting treatment success. However, a regimen aiming for a 25% fall in β hCG Day 0/1-7 over-selects patients for a second methotrexate dose. In comparison, any drop in β hCG Day 0/1-7 does not over-select women and eliminates Day 4 testing. [ABSTRACT FROM AUTHOR]

Background Caesarean section rates in Australia have risen to >30%, with repeat caesarean delivery the most common indication. One method of reducing caesarean delivery rates is to increase rates of vaginal birth after caesarean section ( VBAC). Aims To determine the combined effect of two management strategies on the rates of successful VBAC in women experiencing their first pregnancy following primary caesarean section. Methods Prospective cohort study from May 2009 to October 2010 at a metropolitan Australian teaching hospital. The strategies studied were (i) allocating responsibility for VBAC candidates attempting labour to the hospital's three high-risk obstetric consultants and (ii) implementing a next birth after caesarean ( NBAC) antenatal clinic designed to counsel and support women deciding on mode of birth for their next pregnancy after a primary caesarean section. Data were collected from Obstetrix, a NBAC logbook and medical records of 396 eligible women who gave birth during the study period. Results Overall VBAC rates improved from 17.2% in 2006 prior to implementation of the combined strategies, to 27.0% over the studied period ( P < 0.001). Of those women who desired and attempted a VBAC, the success rate was 64.4%. Regression analysis identified an increased likelihood of attempted vaginal birth where malpresentation was the indication for previous caesarean, while Eastern Asian ethnicity was associated with increased likelihood of choosing repeat caesarean. Conclusions A dedicated NBAC clinic and more consistent approach to labour management can help improve VBAC rates. Further targeted counselling towards women with previous malpresentation and/or East Asian descent may further improve VBAC attempt rates. [ABSTRACT FROM AUTHOR]

Background There are minimal data involving predictors of success of external cephalic version (ECV) in an Australian healthcare setting. Aims To determine the predictors of successful ECV as well as the success rate of ECV and the mode of, and presentation at, delivery for women undergoing ECV for breech presentation from 36-weeks gestation. Methods A prospective review was carried out on all women who had undergone ECV from 36-weeks gestation at the Mater Mothers Hospital over an 8-year period from 2001 to 2008. Data were collected prospectively and were collated in conjunction with database review, chart review and telephonic patient interviews. Results A total of 355 women underwent ECV for breech presentation. The overall success rate was 66% (57% for nulliparous, 76% for multiparous). A woman who underwent ECV had a 46% chance of a vaginal birth. If the ECV was successful, she had a 70% chance of vaginal birth. From bivariate analysis, parity, amniotic fluid index (AFI) and estimated fetal weight (EFW) were determined to be possible predictors of success of ECV and were included in the logistic regression modelling. In the regression analysis, multiparity increased the odds of successful ECV by 2.18. For every one unit increase in AFI, the odds of successful ECV increased by 1.18. Conclusions Multiparity and amniotic fluid volume as assessed by AFI were the significant predictors of immediate success of ECV. Conversely, lower AFI and nulliparity are factors that are likely to reduce the likelihood of successful ECV. [ABSTRACT FROM AUTHOR]

Background Chlamydia trachomatis is the most common reportable infection in Australia. Since 2006, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists ( RANZCOG) have recommended chlamydia screening in pregnant women aged <25 years. Aims To assess clinical uptake and policy integration of the 2006 RANZCOG recommendation on chlamydia testing in pregnant women aged <25 years. Methods A mixed method approach was used involving a literature review, a survey of obstetricians and gynaecologists, and survey of hospital managers from April 2010 to May 2010. Results Of the 1644 participating RANZCOG Fellows, Trainees, and Diplomates, 21.2% reported universal screening for pregnant women <25 years (25% of primary care clinicians, 23% of those working in the public hospital sector, 16% of those working in both public and private hospitals, and 13% of those in private hospitals or private practice). There was a strong association between members who agreed with the guideline and offering universal screening to pregnant women aged <25 years (adjusted odds ratio = 17.1, 95% CI: 6.0-49.2, P < 0.01). Of the 143 participating hospital managers who completed the hospital policy questionnaire; 20% reported that their hospital had a formal screening guideline. There were two national and four state/local policy documents recommending chlamydia screening in pregnancy. Conclusions This study shows low uptake of chlamydia screening of young pregnant women by RANZCOG Fellows, Trainees, and Diplomates involved in antenatal care and highlights the need for national clinical leadership regarding screening for chlamydia among pregnant women aged <25 years. [ABSTRACT FROM AUTHOR]

A Web-based survey of Royal Australian and New Zealand College of Obstetricians and Gynaecologists ( RANZCOG) fellows and trainees who perform or act on umbilical artery Doppler showed heterogeneous reporting practices. Systolic: diastolic ratio is frequently used. Pulsatility index is favoured internationally and by many RANZCOG subspecialists. Unpublished charts are used more often than published. We summarise ideal methods of chart development but recognise that chart choice is guided by professional opinion leaders, day-to-day accessibility and other factors. [ABSTRACT FROM AUTHOR]

Background Previous studies indicate that cervical cancer is the second most frequent cancer and most common cause of cancer mortality among women in Fiji. There is little published data on the epidemiology of cervical cancer in Pacific countries. Aims To determine the incidence 2003-2009 of, and mortality 2003-2008 from, cervical cancer by ethnicity and period in Fiji, identify evidence of secular change and relate these data to other Pacific countries, Australia and New Zealand. Methods Counts of incident cervical cancer cases (2003-2009) and unit record mortality data (2003-2008) from the Fiji Ministry of Health were used to calculate age-standardised (to the WHO World Population) cervical cancer incidence and mortality rates, and cervical or uterine cancer mortality rates, by ethnicity, with 95% confidence intervals. On the basis of comparison of cervical cancer mortality with cervical or uterine cancer mortality in Fiji with similar populations, misclassification of cervical cancer deaths is unlikely. Results There is no evidence of secular change in cervical cancer incidence and mortality rates for the study period. For women of all ages and ethnicities, the age-standardised incidence rate of cervical cancer (2003-2009) was 27.6 per 100 000 (95% CI 25.4-29.8) and the age-standardised mortality rate (2003-2008) was 23.9 per 100 000 (95% CI 21.5-26.4). The mortality/incidence ratio was 87%. Fijians had statistically significant higher age-standardised incidence and mortality rates than Indians. Fiji has one of the highest estimated rates of cervical cancer incidence and mortality in the Pacific region. Conclusion Cervical cancer screening in Fiji needs to be expanded and strengthened. [ABSTRACT FROM AUTHOR]

Aims: The safety of preventive asthma medicines during pregnancy has already been established. The aim of this study was to assess asthma management by women during pregnancy. Methods: Pregnant women attending the out-patient clinics of an Australian maternity hospital completed a questionnaire about their asthma medication use and symptoms. Parameters associated with changes in asthma medicine use are presented as odds ratio with a 95% confidence level. P-values <0.05 indicated statistical significance. Results: Participants ( n = 102) self-reported worsening of their asthma symptoms during pregnancy compared with the pre-pregnancy period, both during the day ( P = 0.003) and night ( P = 0.044). The number of participants whose asthma was treated by a medical professional decreased from 81 (79.4%) before pregnancy to 67 (65.7%) during pregnancy ( P = 0.008). The use of regular asthma medicines (preventers and symptom controllers alone or in combination) decreased during pregnancy ( P < 0.001 and P = 0.012, respectively), while the use of intermittent therapies (relievers) increased ( P = 0.004) during pregnancy. Being treated by a medical professional during pregnancy ( P = 0.033), a history of asthma medicine use before pregnancy ( P = 0.015) and younger age of first asthma diagnosis ( P = 0.046) were associated with the use of asthma medicines during pregnancy. Conclusions: Despite worsening of asthma symptoms, many pregnant women do not take regular preventive asthma medicines. Ongoing assessment of asthma control during pregnancy, medication review and adjustments in therapy by health professionals might facilitate asthma management. [ABSTRACT FROM AUTHOR]

Background: Women with a history of hypertensive disorders of pregnancy (HDP) are known to be at increased risk of subsequent hypertension and cardiovascular disease. Aims: In this study, we aimed to assess whether the long-term follow-up, diagnosis and treatment of hypertension in these women is adequate. Methods: Prospective study of 2112 women who were part of a Birth Cohort Study - The Mater University of Queensland Study of Pregnancy, who received antenatal care at a major public hospital in Brisbane between 1981 and 1983 and were followed up at 21 years. Results: Of the 191 women who had HDP, 62 (32.46%) were hypertensive (29 adequately treated, 33 inadequately identified or managed). Of the 1921 women without HDP, 280 (14.58%) were hypertensive (113 adequately treated, 167 inadequately identified or managed). Women with HDP were at higher risk of hypertension (OR 4.09, 95% CI 2.76, 6.07). Women with a history of HDP were more likely to have hypertension that was inadequately identified or managed (OR 3.56, 95% CI 2.06, 5.97). Conclusion: Women with HDP are at increased risk of undiagnosed or undertreated hypertension. Attention needs to be given to appropriate follow-up of women who have a pregnancy complicated by hypertensive disorders. [ABSTRACT FROM AUTHOR]

Background: Most women use medications at some stage in their pregnancy. Medication nonadherence during pregnancy could be detrimental to both mother and fetus. Aims: To study the extent and nature of the use of prescribed medications during pregnancy and factors associated with medication nonadherence. Methods: All women ≥18 years presenting for their 36th week antenatal visit at the pregnancy clinic of a maternity hospital were invited to complete an anonymous questionnaire that contained 61 items, including the Morisky scale. Factors associated with nonadherence were identified in univariate analysis; factors with P < 0.1 were further analysed in a binary logistic regression model. Results: The participants ( n = 819) had a mean age of 30.8 ± 5.3 years. Most participants were born in Australia, lived with a partner, had university education, were nulliparous, carried one fetus and were nonsmokers. Of these participants, 322 (39.3%) reported a chronic health condition during pregnancy, the most common being asthma (104; 12.7%). Two hundred and seventeen (26.5%) were using prescribed medications, which included anti-anaemics (68; 8.3%), medicines for chronic airway conditions (64; 7.8%), vitamins and minerals (59; 7.2%) and anti-diabetics (43; 5.2%). Nonadherence was reported by 107 (59.1%) participants, mainly because of forgetting (79; 43.6%). Factors associated with nonadherence were having asthma (OR 0.26 (95% CI 0.095 - 0.72), P = 0.009) and using nonprescription dietary minerals (0.30 (0.10 - 0.87), P = 0.027). Conclusions: Adherence to prescribed medicines during pregnancy is alarmingly low. Health professionals should be more proactive in promoting adherence and assisting women avoid potential fetal harm because of nonadherence. [ABSTRACT FROM AUTHOR]

Objective: Absence or hypoplasia of the nasal bone is commonly reported in Down syndrome fetuses. We define normal ranges and the 2.5th centile for fetal nasal bone length (NBL) in a multiethnic Australian population at 18-20 weeks of gestation. Methods: A prospective cohort study of women attending for a routine anomaly scan. Ethnicity of the patient and their partner was recorded, and the nasal bone was measured three times. Two methods of nasal bone assessment were used to define normal ranges: a single (first) measurement and the mean value of three measurements. Mixed-effects regression models were employed to account for interoperator differences treating sonographers as random effects. Nonparametric methods were used to define the 2.5th centile for gestational age. Results: A total of 1199 women were included with a mean gestational age 19.1 (SD 0.4; range 18-20) weeks. There is significant linear relationship between NBL and gestational age ( P < 0.001). The mean of three nasal bone measurements had a smaller standard deviation than single nasal bone measurements. Nonparametric assessment was used to define the 2.5th centile, which is 4.4 mm at 18 weeks and 5.0 mm at 20 weeks of gestation. Conclusions: This study provides a reference range for fetal NBL at 18-20 weeks of gestation in an unselected multiethnic Australian population. Whilst NBL increases linearly from 18 to 20 weeks, the data are not normally distributed and nonparametric techniques are required to define the 2.5th centile. The mixed-effects model also accounts for variation in sonographer measurements. [ABSTRACT FROM AUTHOR]

Background: Much is known about severe maternal morbidity during pregnancy, but there has been little attention paid to the impact of pregnancy itself on women's general health and well-being. Aim: To investigate women's general health and well-being in early pregnancy and examine the relationship between maternal age and women's physical and mental health. Method: Cross-sectional analysis of baseline data from a multicentre, prospective nulliparous pregnancy cohort study. The baseline questionnaire included the SF-36 health status measure and individual items assessing a range of common maternal health issues. Results: A total of 1507 eligible women returned baseline questionnaires in early pregnancy (mean gestation 15 weeks, range 6-24 weeks) ranging from 18 to 49 years of age (mean age 30.1 years). Study participants reported significantly poorer health compared with age and gender-standardised population means on all SF-36 scales except general health. Two-thirds of women (68%) reported three or more health issues, the most common being exhaustion (87%), nausea (64%), back pain (46%), constipation (44%) and severe headaches/migraines (30%). Younger women (18-24 years) had significantly lower SF-36 scores (poorer self perceived health) compared with women ≥35 ( P ≤ 0.03). After adjusting for socio-demographic factors, maternal age remained significantly positively associated with women's mental and physical component scores. Younger women reported significantly more health issues than women ≥35 (4.39 and 3.27, mean difference = 1.12, 95% CI 0.75-1.79, P < 0.001). Conclusions: Common pregnancy symptoms have a marked impact on women's physical and mental health in early pregnancy, with the greatest impact apparent for younger women. [ABSTRACT FROM AUTHOR]

Background: With human papilloma virus (HPV) vaccines now approved for women up to 45 years of age, gynaecologists in Australia will be approached increasingly for advice on whether to have the HPV vaccine. Aim: We seek to establish the attitudes of gynaecologists to HPV vaccination when advising women in various age groups. Methods: Fellows, members and trainees of Royal Australian and New Zealand College of Obstetricians and Gynaecologists were approached in early 2009 to complete an Australian Society for Colposcopy and Cervical Pathology survey, which they could return by post or internet on-line. There were 836 (49.0%) responses, with 35.6% of responders using 'Tuna' on-line. Results: 836 RANZCOG fellows, members and trainees responded to the survey. The gender of responders are 261 (43%) females and 470 (56%) males. Of the responders, 391 (46.8%) usually initiated discussion regarding the role of HPV vaccination with their patients. More than 93% encourage when recommending the HPV vaccines for female responders aged 12-26 years. This proportion decreased to 66% for women aged 27-45 years, with 15% strongly encouraging vaccination for this age group. The attitudes to HPV vaccination for the different age groups of females were similar for trainees, fellows and members, as well as for gender and age groups of the responders. However, those with lower level of knowledge are less likely to encourage HPV vaccination in all vaccination age groups and the association is statistically significant after adjusting for role, gender and age. Conclusions: The results show a strong support from gynaecologists in Australia for HPV vaccination. [ABSTRACT FROM AUTHOR]