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Background Metformin is increasingly accepted as an alternative to insulin therapy in gestational diabetes mellitus ( GDM). The Metformin in Gestational Diabetes (MiG) trial reported similar pregnancy outcomes for metformin versus insulin; however, supplemental insulin was required in 46% of women on metformin. Aims We aimed to identify predictors of response to metformin monotherapy in women with GDM attending a general hospital antenatal clinic. Methods We offered extended-release metformin to women diagnosed with GDM ( ADIPS 1998 criteria) at ≥24 weeks of gestation. If glucose targets were not achieved (≤5.0 mmol/L fasting, ≤6.7 mmol/L two-h post-meal), women were changed to insulin. We carried out an audit to determine characteristics of metformin responders versus nonresponders. Results Twenty-five women chose initial metformin therapy; 16 (64%) achieved satisfactory glycaemic control (responders). Nine women (36%) were changed to insulin: seven due to inadequate control (nonresponders) and two had metformin intolerance. Fasting glucose at oral glucose tolerance test ( OGTT) was significantly lower in metformin responders versus nonresponders; two-h glucose and BMI did not differ. Ninety-three percent of women with fasting glucose ≤5.2 mmol/L responded to metformin: conversely, at fasting glucose >5.2 mmol/L, 33% responded ( P = 0.005). Neonatal outcomes were similar in metformin responders and nonresponders, women who chose initial insulin therapy ( n = 25), or were diet-controlled ( n = 21). Conclusions In women with GDM, fasting glucose on OGTT predicted response to metformin: at fasting glucose ≤5.2 mmol/L, the probability of response was 93%. Antenatal clinics should determine locally relevant predictors of response to metformin in women with GDM. [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 Antepartum haemorrhage of unknown origin ( APHUO) is associated with preterm birth and perinatal mortality. Aim To determine whether smoking beyond the first trimester of pregnancy was an independent risk factor for APHUO. Methods Rates of APHUO were compared between non-smokers and smokers, and non-smokers and ceased smokers. Participants were healthy nulliparous women recruited to the Screening for Pregnancy Endpoints ( SCOPE) prospective cohort study in New Zealand, Australia, Ireland and United Kingdom. Logistic regression was used to compare adjusted odds ratio, 95% confidence intervals ( OR, 95% CI) of APHUO between continued smokers and non-smokers, adjusting for possible confounders. Results Of the 3513 participants, 77.9% ( n = 2737) were non-smokers, 10.6% ( n = 371) ceased in the first trimester and 11.5% ( n = 405) continued smoking beyond the first trimester. APHUO rates were higher in smokers than non-smokers (7.4%, n = 30 vs 4.5%, n = 122; P = 0.01), but there was no difference between ceased smokers and non-smokers (4.3%, n = 16 vs 4.5%, n = 122; P = 0.90). Smoking was no longer significantly associated with APHUO after adjustment for confounders (adjusted OR = 1.28, 95% CI 0.76-2.14), but vaginal bleeding in early pregnancy (adjusted OR = 2.98, 95% CI 2.12-4.18) and overweight/obesity (adjusted OR = 1.43, 95% CI 1.02-1.99) were independent risk factors. First trimester folic acid use was associated with a reduced risk (adjusted OR = 0.44, 95% CI 0.25-0.77). Conclusion Smoking is not an independent risk factor for APHUO after adjustment for confounders, but other risk and protective factors have been identified. [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]

Monash Medical Centre (MMC) is a university-affiliated tertiary referral hospital in Melbourne, Victoria, Australia. The hospital has a large obstetric service and is the only quarternary obstetric unit in Victoria. The intensive care unit (ICU) is a busy 21-bed general unit with a broad casemix. While there is no designated state service obstetric ICU in Victoria, MMC ICU has increasingly tried to accept all obstetric patients referred, from both MMC and externally. To provide a local perspective on obstetric intensive care in Australia. A retrospective audit of obstetric ICU admissions over 2 years. Sixty women were admitted, of whom 46 were postpartum. Twenty-nine women were transferred from external sites. Mean maternal age was 30.7 years, mean gestational age 34.5 weeks and mean Acute Physiology and Chronic Health Evaluation (APACHE) version IIIj score 33. Obstetric haemorrhage was the most common admission diagnosis, followed by hypertensive spectrum disorders. Three women were admitted for induction of labour. Median length of stay was 35 h. Twenty-seven women (45%) required mechanical ventilation. No woman died in the ICU, although one died in hospital post-ICU discharge. No data were collected on neonatal outcomes. Critically ill obstetric patients can be managed successfully in a general ICU with obstetric input. It may be sensible to cluster these patients into units that are best equipped to deal with them, especially in the ante- and peripartum period. [ABSTRACT FROM AUTHOR]

To compare blood loss and need for blood transfusions in women who underwent abdominal myomectomies after receiving vasopressin or combined vasopressin and tourniquet. A retrospective chart review was performed reviewing abdominal myomectomies that took place at our institution. Subjects were divided into three groups: no intervention, vasopressin, or combined vasopressin and tourniquet. Blood loss, need for blood transfusion, and drop in hemoglobin and hematocrit were compared across all groups. One-hundred and thirty-two subjects were included in the study. No statistically significant difference was found between groups in blood loss, drop in hemoglobin or hematocrit, or blood transfusions. Combined vasopressin and tourniquets was not associated with a statistically significant decrease in blood loss or need for blood transfusion. [ABSTRACT FROM AUTHOR]

Many couples do not complete IVF treatment. There is little published data regarding this issue and also what changes might lead to better compliance rates. To investigate what proportion of patients discontinue IVF prematurely, why they stop treatment, and what factors are important for them to restart. Survey of 1310 patients undergoing IVF treatment over a 3-year period at a single IVF provider. Information was collection on demographics and the outcomes of treatment. For those who discontinued treatment two further questions were completed: reasons why treatment was discontinued (primary outcome measure) and factors required to reactivate fertility treatment (secondary outcome measure). 40.2% response rate. 15.0% of patients discontinued IVF prematurely; 77.0% had a live birth or were currently pregnant. Those who discontinued treatment were more likely to be older and have a trade qualification. Of those who discontinued treatment; failing to become pregnant, cost, and stress were identified as factors. Less expensive treatment and a guaranteed baby were important factors for patients to restart treatment. Numerous comments were made regarding having readily available counselling services and continuity of care. Reasons for stopping treatment are multifactorial. Our data set is limited by a low response rate. Further research is needed to into this issue, including differences between private and public cessation rates are barriers to completion of treatment. The majority of patients having IVF achieve either a live birth or fall pregnant through IVF. Service may be improved by decreasing cost, optimising outcomes and increasing availability of counselling services. [ABSTRACT FROM AUTHOR]

Serum anti-Mullerian hormone (AMH) is an established marker of the number of oocytes left within a woman's ovaries (quantitative ovarian reserve). However, it is presently unclear if serum AMH also measures oocyte quality and therefore the chances of successful live-birth pregnancy. The aim of this study was to determine if serum AMH assessed ovarian reserve correlates with chances of live birth (LB) and miscarriage following intra-uterine insemination (IUI) treatment. In this retrospective study, serum AMH percentile charts were developed using AMH measurements from 1032 women undergoing routine infertility investigation. A total of 244 women undergoing IUI treatments were classified according to whether they had low (first quartile), normal (second and third quartiles) or high (fourth quartile) serum AMH concentrations relative to their age, and the subsequent pregnancy outcomes were analysed. Serum AMH concentration fell with advancing maternal age and serum AMH concentrations were well correlated with quantitative ovarian reserve (antral follicle counts, AFC). The LB and miscarriage rates in each of the four AMH quartiles did not differ significantly from one another. Serum AMH is a useful marker of quantitative but not qualitative ovarian reserve as it correlates well with AFC, yet bears no relation to chances of live-birth or miscarriage. [ABSTRACT FROM AUTHOR]

Nausea and vomiting in pregnancy (NVP) is the most common pregnancy complication affecting women during the first trimester of pregnancy. The cause of NVP remains unknown and factors associated with the occurrence of NVP are contradictory. There is currently little information on its effects of NVP in general and specifically in the Chinese population. To assess the prevalence of NVP with different degree of severity and identify their relationship with health-related quality of life (HRQoL) and to determine its association with the sociodemographic and obstetric factors. In a prospective cross-sectional study, 396 women who attended the antenatal clinic between 10 and 14 weeks of gestation were invited to complete a structured questionnaire covering maternal characteristics, severity of NVP and their HRQoL. The status of NVP and HRQoL was measured by the frequency of symptoms and the Medical Outcomes Study Short-Form-36 (SF-36) respectively. Logistic regression analysis was performed to delineate the factors associated with NVP. The prevalence of NVP was 90.9%. Almost all domains and dimensions of SF-36 were affected by the presence of NVP and its severity. Factors associated with the presence and severity of NVP were non-smoking, younger age and history of NVP in previous pregnancy. The various degrees of severity of NVP significantly impair both physical and mental HRQoL in Hong Kong Chinese women. Awareness and care should be given to women with symptoms of nausea or retching alone, as well as vomiting. [ABSTRACT FROM AUTHOR]