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Background: It is estimated that up to one in three lesbian, bisexual or queer (LBQ) women in Australia have children. In the past decade, it has become common for LBQ women to pursue pregnancy using clinic‐acquired donor sperm. Aims: The aims of this paper are to explore pathways to parenthood among Australian LBQ women in the context of increased access to fertility clinics and identify the type of clinical fertility services being used. Materials and method: This paper reports on female LBQ parents and expectant/prospective parents who participated in a 2016/2017 online survey of Australian lesbian, gay, bisexual, transgender and queer (LGBTQ) adults exploring reproductive choices, pathways to parenthood, conception method and use of clinical fertility services. Results: More than half the children reported on by current parents (52%) had been conceived using clinical fertility services. When asked what factors influenced a parent respondent's decision to use fertility services: 80% indicated access to donor sperm, 41% indicated fertility problems. Of respondents who had accessed donor sperm, over half (57%) had used in vitro fertilisation (IVF) services. Conclusions: These findings indicate that use of fertility clinics to access donor sperm is common for LBQ women, including those with no known fertility problems, and that most women who access donor sperm conceive using IVF rather than intrauterine insemination. More needs to be known about the context and reasons for this, including factors that influence LBQ women's decision making on their pathway to parenthood. [ABSTRACT FROM AUTHOR]

Background: The probability of pregnancy after in vitro fertilisation (IVF) declines with age in parallel with a reduction in the ovarian reserve. However, there is considerable variation in the ovarian reserve in women of advanced reproductive age; so to give such women accurate advice about the prospects of treatment success, factors other than age must be considered. Anti-Müllerian hormone (AMH) has been shown to be a good indicator of ovarian reserve, and its utility is explored in this paper. Aims: To determine the utility of AMH serum levels for prediction of ovarian response to gonadotropin stimulation and outcome in IVF in women of advanced reproductive age. Methods: The material consists of 127 women with a median age of 42 years (range 39-46) having had their first cycle of IVF/intracytoplasmic sperm injection (ICSI) treatment from November 2006 to December 2008. During this period, a total of 772 oocyte retrievals and 715 embryo transfers were performed at the clinic (median age 36.4 years). AMH was analysed with the Beckman Coulter DSL ELISA. Agonist and antagonist protocols were used and monitored by ultrasound and oestradiol; embryo transfer was performed on day 2, 3 or 5 of culture. Results: The lower the AMH, the higher the risk of cycle cancellation, low oocyte yield and treatment failure. Women with a serum AMH above 8.6 pmol/L had a good chance of achieving live birth after IVF/ICSI treatment. Conclusions: Anti-Müllerian hormone is useful for identifying a good prognosis group in women of advanced reproductive age. [ABSTRACT FROM AUTHOR]

Background: The use of neuromodulation is growing and it is an established therapy for conditions such as bladder dysfunction. It is an increasingly used therapy for the management of chronic perineal pain but little research is currently available looking at its efficacy. Aim: We present a series of 52 patients who underwent placement of a neuromodulator, the majority of whom suffered from perineal pain, with most placements via the sacral hiatus. Method: Patients were asked to complete a survey recalling their symptoms prior to implantation and describing their symptoms and experience after. The majority had two leads placed via the sacral hiatus. Results: Fifty‐two patients had implantation of a permanent neuromodulator and 44 completed at least part of the survey. Forty‐eight had leads placed via the sacral hiatus, 29 of whom had these leads only. Forty patients had perineal pain as an indicator and 32 reported that their pain improved; this difference was statistically significant (95% CI: 2.60–4.27, P < 0.001). Bladder, bowel and sexual dysfunction were reported by about half the cohort with smaller numbers of improvement for each. Thirty‐five patients reported improved quality of life and 32 said they would have the procedure done again. Ten patients had the device removed. Conclusion: We present the largest published case series looking at the use of sacral neuromodulation as a treatment option for pelvic pain and the overall results of our audit are promising for the ongoing use and further development of this modality as a management option. [ABSTRACT FROM AUTHOR]

Objective To quantify late-pregnancy weight gain in women with and without gestational diabetes mellitus ( GDM) and to determine factors associated with gestational weight gain. Study design A prospective clinical audit of 212 women (115 GDM and 97 non- GDM) who were weighed at each antenatal visit from 24-32 weeks gestation until delivery. Women received routine antenatal clinical care. For women with GDM, this included a 2-h lifestyle counselling session, capillary blood glucose testing and frequent clinical review. Results Women with GDM gained less weight than nondiabetic women ( GDM: 1.18 kg (1.6%) [range, 3.8-7.1 kg]; non- GDM: 4.0 kg (4.8%) [range, 0.7-18.5 kg]; P < 0.0001). Weight gain was influenced by body mass index and country of birth. Women with GDM showed reduced weight gain at weeks 1-4 postrecruitment, relative to weeks 4-8 (0.04 kg/week vs 0.45 kg/week; P < 0.0001). Nondiabetic women gained weight at a constant rate. GDM status was the only independent predictor of postrecruitment weight gain. Conclusions Application of a model of care for GDM (lifestyle advice and regular clinical review, in addition to home glucose monitoring) may reduce weight gain in women with GDM. The potential for applying a modified version of this model to all women in pregnancy warrants further study. [ABSTRACT FROM AUTHOR]

Background: Congenital diaphragmatic hernia (CDH) is a potentially correctable anatomical defect that continues to represent a significant cause of stillbirth and neonatal death. Aims: To describe the outcomes of fetuses diagnosed antenatally with CDH. Methods: A retrospective cohort study of fetuses with CDH detected antenatally at our fetal medicine unit between January 1996 and December 2008. The study analyses factors associated with mortality in a setting where no fetal intervention for this condition is performed. Results: Eighty-six cases were identified and 75.5% of infants were born alive. Mortality prior to corrective surgery was 7%. The survival rate for babies born at term with isolated CDH was 83%. Presence of an additional anomaly, herniated liver and preterm delivery were associated with increased mortality. Seventy-four percent of liveborn infants with either isolated CDH or other anomalies survived to discharge. Conclusions: Although the overall mortality rate for this condition remains high, fetuses with isolated CDH born at term have relatively high survival rates. This study provides data for counselling parents in tertiary centres with advanced neonatal care but where antenatal intervention for this condition has not been introduced. [ABSTRACT FROM AUTHOR]

Background Women who experience unexpected labour and birth interventions describe feeling distressed and have an increased risk of postnatal depression. Primigravidae who have an unrealistic expectation of labour and birth may be at higher risk of these outcomes. Aims To determine whether primigravidae and their carers have a realistic expectation of uncomplicated labour and birth. Methods One hundered and ninety-five primigravidae, 32 obstetricians, 76 midwives, 198 medical students prior to their obstetric term and 131 medical students after their obstetric term completed a short questionnaire about the likelihood of primigravid women undergoing spontaneous onset of labour, no augmentation of labour and a cephalic vaginal birth without instrumental assistance, defined as birth without intervention. This number was compared to the local published data. Results Overall, the study subjects believed that women had a 48% chance of birth without intervention, and a 26% chance of birth without intervention or perineal sutures. The statewide published figures for these two outcomes are 21 and 8%, respectively. Staff, both obstetric and midwifery, were more accurate than medical students who were in turn more accurate than pregnant women. Attendance at antenatal education classes by pregnant women did not improve accuracy. Level of experience did not improve accuracy by medical staff. Medical students were more accurate after teaching than before teaching. Conclusion Primigravidae in late pregnancy and maternity staff do not have a realistic expectation of a labour and birth that is free from medical intervention. This may impact on choices women make about care in pregnancy and labour. [ABSTRACT FROM AUTHOR]

Background: Several population-based and clinical studies report that stress incontinence has less impact on quality of life (QoL) than urge incontinence and overactive bladder. Aims: This research aimed to determine if this relationship held true for urodynamic diagnoses. Methods: Quality of life was evaluated by the King's Health Questionnaire prior to urodynamic testing in 326 women presenting with lower urinary tract symptoms and who completed a 48-h frequency volume chart. Urodynamic results were categorised as 'normal', 'sensory abnormalities only', 'idiopathic detrusor overactivity (IDO) only', 'urodynamic stress incontinence (USI) only' or 'mixed (IDO and USI)'. QoL data were compared using these diagnostic categories. Results: Women in mixed, USI and IDO categories had significantly worse QoL scores in the domain Severity Measures than women in sensory or normal categories ( P < 0.0001). Incontinence Impact was significantly worse in mixed and IDO categories compared with normal ( P = 0.006) but not compared with women with USI. Sleep/Energy scores were significantly worse for women in mixed and IDO categories compared with women with USI ( P = 0.003). Significant differences between urodynamic categories were also observed in the domains Role Limitations, Social Limitations and General Health. Conclusions: Mixed incontinence had the greatest adverse effect on QoL; however, any abnormal urodynamic diagnosis was associated with a significantly adverse effect. Although a normal urodynamic result was associated with less impact on QoL than an abnormal result, there was still an effect present. The optimal management (eg conservative vs surgical management) of women with a normal urodynamic result is yet to be established. [ABSTRACT FROM AUTHOR]

Background: High pre-operative CA125 levels in women with endometrial cancer may be related to lymph node metastases and poor prognosis. Aim: To evaluate whether pre-operative cancer antigen 125 (CA125) levels are associated with lymph node metastases and prognosis in endometrial cancer. Methods: One hundred and twenty women with endometrial cancer were retrospectively reviewed for pre-operative CA125 levels. The results were then correlated with the clinicopathological outcome. Results: An elevated CA125 (>40 U/mL) was significantly correlated with higher stage, higher grade, increased depth of myometrial invasion, lymph node metastases and the presence of lympho-vascular space involvement in endometrial cancer. Five-year overall survival (OS) and recurrence-free survival (RFS) rates were significantly higher in women with endometrial cancer with CA125 ≤ 40 U/mL than those with CA125 > 40 U/mL ( P < 0.001). When women were further stratified according to CA125 levels and lymph node status, OS and RFS were highest for those with CA125 ≤ 40 U/mL and without lymph node metastases, and lowest for those with lymph node metastases and CA125 > 40 U/mL ( P < 0.001). Conclusion: The testing of pre-operative CA125 levels may a useful prognostic tool in endometrial cancer 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]