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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: For parents who experience stillbirth, knowing the cause of their baby's death is important. A post mortem examination is the gold standard investigation, but little is known about what may influence parents' decisions to accept or decline. Aim: We aimed to identify factors influencing maternal decision‐making about post mortem examination after late stillbirth. Methods: In the New Zealand Multicentre Stillbirth Study, 169 women with singleton pregnancies, no known abnormality at recruitment, and late stillbirth (≥28weeks gestation), from seven health regions were interviewed within six weeks of birth. The purpose of this paper was to explore factors related to post mortem examination decision‐making and the reasons for declining. We asked women if they would make the same decision again. Results: Maternal decision to decline a post mortem (70/169, 41.4%) was more common among women of Māori (adjusted odds ratio (aOR) 4.99 95% confidence interval (CI) 1.70–14.64) and Pacific (aOR 3.94 95% CI 1.47–10.54) ethnicity compared to European, and parity two or more (aOR 2.95 95% CI 1.14–7.62) compared to primiparous. The main reason for declining was that women 'did not want baby to be cut'. Ten percent (7/70) who declined said they would not make this decision again. No woman who consented regretted her decision. Conclusion: Ethnic differences observed in women's post mortem decision‐making should be further explored in future studies. Providing information of the effect of post mortem on the baby's body and the possible emotional benefits of a post mortem may assist women faced with this decision in the future. [ABSTRACT FROM AUTHOR]

It is recognised that urogynaecological symptoms can have a significant impact on patient quality of life (QoL). Many of the QoL questionnaires are long and provide a burden to patients. The aim of this study was to compare patients' responses to utilising equivalent QoL questionnaires in different formats. The electronic personal assessment questionnaire, ePAQ- PF, was compared to the paper-based Queensland questionnaire. ePAQ- PF appeared to be of greater value but not more burdensome. However, women were more likely to complete the sexual function section using the Queensland questionnaire. [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]

Background: Preterm birth (PTB) is one of the leading causes of neonatal mortality and morbidity worldwide. A shortened cervix is a recognised risk factor for PTB, and amniotic fluid sludge (AFS) diagnosed on ultrasound may be suggestive of underlying inflammation or infection. Aims: The aim is to determine if azithromycin, administered in cases of a shortened cervix, results in prolongation of gestation with improvements in neonatal outcomes. Materials and Methods: We performed a retrospective cohort study at three tertiary maternity services in Melbourne, Australia, between 2015 and 2020. Women with a singleton pregnancy were included if they had a cervical length of 15 mm or less at 13–24 weeks' gestation, with or without AFS. Exclusion criteria comprised multiple pregnancy, major fetal congenital anomaly, placenta praevia, prelabour premature rupture of membranes, vaginal bleeding and/or clinical signs suggestive of chorioamnionitis at the time of diagnosis of the short cervix. The results of antibiotic treatment with azithromycin were compared to those of no antibiotic treatment. The outcomes of interest were PTB, prelabour premature rupture of membranes (PPROM), chorioamnionitis and neonatal morbidity. Results: A total of 374 women were included in the study, of whom 129 received azithromycin and 245 received no antibiotics. When adjusting for potential confounders, the adjusted risk of PTB overall was higher in the treatment group (adjusted hazard ratio 1.36 (95% confidence interval 1.04–1.77) P = 0.023) with no differences found for PPROM, chorioamnionitis or neonatal morbidity. Conclusion: These data do not support the routine use of azithromycin in women with a short cervix, including those with AFS detected on ultrasound. [ABSTRACT FROM AUTHOR]

Background: Placenta accreta spectrum (PAS) is a rare but serious complication of pregnancy. Aims: The aim of this study was to determine maternal and neonatal outcomes following a combined surgical and interventional radiology (IR) approach to managing PAS, and the risks associated with this technique. Methods and Materials: Retrospective cohort study of all cases of PAS in a tertiary maternity centre between January 2001 and July 2020. Women who underwent caesarean hysterectomy for histologically confirmed PAS with a staged surgical and IR approach were compared with those who underwent caesarean hysterectomy without IR. Maternal, neonatal outcomes, surgical and radiological complications were assessed. Results: Forty‐six women were included in the study, and 30/46 (65.2%) underwent the staged surgical and IR approach. Women in the staged group had less overall blood loss (1794 mL vs 3713 mL; P < 0.001), less requirement for blood transfusion (40% vs 75%; P < 0.001), and a lower mean volume of packed red cells transfused (2.5 vs 6.1 units). Anaesthetic and operative times were longer for the staged group (468 vs 189 min: 272 vs 141 min P < 0.001), respectively. There were no differences in rates of neonatal or maternal complications between the two groups. Conclusion: This study demonstrates that a staged procedure combining surgery and IR for PAS results in a considerable reduction in blood loss, need for transfusion, and units of packed red cells transfused compared with surgery alone. The staged procedure required significantly longer anaesthetic and operative times; however, there were no differences in maternal and neonatal morbidity. [ABSTRACT FROM AUTHOR]

Background: Peripartum antibiotics are commonly administered. Little is known of the attitudes of pregnant women toward peripartum antibiotics. Aim: We aimed to assess the awareness of and attitudes toward peripartum antibiotic use in Australian women. Materials and Methods: We surveyed post‐partum women at three hospitals over six months. Women reported if they received antibiotics 48 h either side of delivery and responded to statements assessing attitudes to peripartum antibiotic use. Administered antibiotics were recorded. We reported the proportion receiving antibiotics and the proportion aware of receiving them. Participants responded on five‐point Likert scales and selected side effects of concern. Results: Participants responding were 248 of 299 (83%, Royal Brisbane and Women's Hospital), 56 of 106 (53%, Caboolture Hospital) and 17 (Redcliffe Hospital, denominator not recorded). Of 183 (57%) receiving antibiotics, 134 (73%) received them pre‐delivery only, 18 (10%) post‐delivery only and 31 (17%) pre‐ and post‐delivery. Pre‐delivery, the most common indication was pre‐incisional prophylaxis for caesarean delivery (93 of 160 responses, 58%). Seventy‐nine (51%, 156 responses) of those receiving pre‐delivery antibiotics were aware. Of 49 women receiving post‐delivery antibiotics, 36 (73%) were aware. Most agreed they were worried that pre‐delivery antibiotics would affect their baby (198, 62%) and 160 (50%) were concerned about effects on their own microbiome. Most (204, 65%) agreed they would rather not take antibiotics while breastfeeding. Conclusion: Many women were unaware of receiving pre‐delivery antibiotics. Most had concerns about side effects. Improved communication regarding peripartum antibiotic use would improve patient‐centred care. [ABSTRACT FROM AUTHOR]

Background: Cross‐border surrogacy and egg donor arrangements are an increasingly common means to family building. Establishing patterns of use has always been difficult in relation to Australian patients. Accurate data is stymied by lack of documentation of international third‐party reproductive care available to Australian authorities. When international travel bans came into effect, it is hypothesised that those planning to use cross‐border reproductive care had to rely significantly more on local in vitro fertilisation (IVF) clinics for services such as sperm freezing, embryo creation and gamete release procedures. Aim: To quantify and characterise the impact of the Covid‐19‐related travel ban on international and interstate gamete shipping by Australian IVF clinics. Materials and methods: Thirty‐one Australian and New Zealand IVF clinics were invited to provide de‐identified data on interstate and international gamete export applications from two 12 month time periods pre‐ and during Covid‐19‐related international travel lockdowns. Seven IVF organisations provided data on: patient age; type of gametes exported; destination country/state; and date gamete release approved. Results: Most gametes (78%) were shipped to another Australian IVF clinic and 22% internationally. Patient‐initiated shipping domestically and internationally both showed significant increases when comparing pre‐ and post‐Covid datasets. Of the 21 destination countries reported for international shipments, the US was the commonest (39%), followed by Ukraine (21%) and Canada (9%). Conclusions: The inability of involuntarily infertile patients to travel internationally, rather than halt cross‐border reproductive care, has led to a significant increase in the uptake of gamete shipping. The high proportion of internationally shipped gametes going to the US and Ukraine is likely a reflection of the availability of surrogates and donors and more amenable legal frameworks. [ABSTRACT FROM AUTHOR]

Background: Internationally, placental growth factor (PlGF)‐based tests are used as prognostic markers in suspected preeclampsia. However, Ministry of Health guidelines do not currently endorse PlGF‐based tests in New Zealand (NZ). Aims: To investigate the predictive value of soluble fms‐like tyrosine kinase 1 (sFlt‐1)/PlGF ratio in suspected preeclampsia in a NZ population. Materials and Methods: A prospective cohort study of singleton pregnancies at 20+0–36+6 weeks gestation with suspected preeclampsia as defined by Society of Obstetric Medicine Australia and NZ (SOMANZ) criteria. Primary objective: to evaluate a sFlt‐1/PlGF ratio >38 at ≤35+0 weeks gestation to predict birth ≤14 days. Secondary objectives: to assess a sFlt‐1/PlGF ratio cut‐off of 38 at ≤37+0 weeks gestation, to rule out preeclampsia ≤1 week, rule in preeclampsia ≤4 weeks, and to predict perinatal outcome. Clinicians were blinded to sFlt‐1/PlGF ratio results. Results: Included were 222 participants, 19.4% Māori and 10.4% Pasifika. A sFlt‐1/PlGF >38 predicted birth ≤14 days, positive predictive value (PPV) 51.4% (95% CI, 39.6–63.0) and negative predictive value (NPV) 95.9% (95% CI, 91.4–98.1), median (interquartile range) days to birth 14 (2–27) vs 49 (33–70), P < 0.000. A sFlt‐1/PlGF cut‐off of 38 ruled out preeclampsia ≤1 week (NPV 96.2% (95% CI, 92.3–98.2)) and ruled in preeclampsia ≤4 weeks (PPV 75.0% (95% CI, 65.0–82.9)). A sFlt‐1/PlGF >38 was associated with greater perinatal morbidity. Conclusions: The predictive value of the sFlt‐1/PlGF ratio in NZ is comparable to that reported in international trials. Used in clinical practice the sFlt‐1/PlGF ratio may aid risk stratification in suspected preeclampsia, directing limited resources to those pregnancies at highest risk. [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: Rates of homebirth in Australia remain low, at less than 0.3% of all births. Aims: To report maternal and neonatal outcomes of ten years of a publicly funded homebirth service, 2009–2019. Method: Retrospective analysis of clinical outcome data including neonatal outcomes of women who requested a homebirth at a large metropolitan health service in Victoria, Australia. The primary outcomes included: maternal outcomes (mortality, transfer to hospital, place and mode of birth, perineal status, type of third stage of labour, postpartum haemorrhage), and neonatal outcomes (mortality, Apgar score at five minutes, birthweight, breastfeeding initiation, significant morbidity, transfer to hospital). Results: Referrals for 827 women were reviewed; 633 remained eligible at 36 weeks gestation, and 473 (57%) birthed at home. Compared to women who did not, women who had a homebirth were significantly more likely to be multiparous, have a normal vaginal birth and an intact perineum, less likely to require suturing and less likely to have blood loss of more than 500 mL. Compared to infants not born at home, infants born at home were significantly less likely to require resuscitation, more likely to be of normal birthweight and exclusively receive breastmilk on discharge. There were no maternal deaths and one neonatal death of a baby born at home before the arrival of a midwife. Conclusions: The outcomes for women accepted into the publicly funded homebirth program suggest appropriate triaging and case selection. A publicly funded homebirth program, with appropriate governance and clinical guidelines, appears to be a safe option for women experiencing low‐risk pregnancies. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has necessitated alterations in provision of health care and how patients access it. Telehealth has replaced traditional face‐to‐face outpatient clinics in an unprecedented manner. This study aimed to assess overall patient and clinician satisfaction with telehealth consultations, to establish acceptability of telehealth during pandemic and non‐pandemic times, and document feedback. Materials and Methods: A prospective observational study involving women presenting to a general gynaecology outpatient department was performed. Women who attended for consultation between 13 July and 4 September 2020 were invited to participate in a questionnaire following their telehealth appointment. Clinicians consulting in the outpatient department were invited to complete a questionnaire at the end of the eight‐week study period. Satisfaction, utility and acceptability data were obtained using visual analogue scales (VAS). Results: Twenty‐six out of 56 (46.4%) clinicians and 124/870 (14.3%) patients completed the questionnaire. Patients who responded were older and more likely to have been born in Australia than women who did not (P = 0.0355 and P = 0.005, respectively). Overall patient satisfaction with telehealth was high (median VAS (interquartile range), 8.6 (5.6–9.8)). More women found telehealth to be acceptable during a pandemic than afterward (8.9 vs 6.6, P < 0.0001). Clinicians were less satisfied with telehealth than patients (7.1 vs 8.6, P = 0.02); however, most would be happy to continue using telehealth in non‐pandemic times (7.0 (6.2–9.8)). Conclusion: Telehealth consultations allow provision of gynaecological care at a time when reducing risk of infection to patients and staff is paramount. Telehealth gynaecology consultations are efficient and convenient without significant detriment to patient or clinician satisfaction. [ABSTRACT FROM AUTHOR]

Background: Raspberry leaf tea (RLT) is a traditional herb purported to help with many pregnancy‐related outcomes including reducing the duration of labour. No experimental data exist to support these claims. Aims: This study aims to determine how common use and knowledge of RLT are during pregnancy. It also aims to explore whether it would be possible to recruit women for a trial of raspberry leaf in the future. Materials and Methods: Postnatal women were asked to fill in a survey about their use of RLT during pregnancy, and their knowledge of its purported benefits. They were asked whether they would consider being part of a randomised controlled trial of raspberry leaf in the future. Results: One hundred and twenty‐one women completed the survey. Of these, 88 (73%) were aware of herbal tea use in pregnancy and 46 (38%) reported using raspberry leaf during pregnancy. Of all women surveyed, 79% indicated they would be happy to participate in a trial of RLT in pregnancy if they were asked. Conclusions: Despite no scientific evidence of the efficacy of RLT in pregnancy, 38% of women surveyed used it during pregnancy. Further studies are required to determine whether the claims made about RLT are correct. Clinicians should base their advice on available evidence. [ABSTRACT FROM AUTHOR]

Aims: Iodine supplements are recommended for women planning pregnancy, but their impact on thyroid function during controlled ovarian hyperstimulation (COH) and into pregnancy is unknown. The aim of this study was to assess the impact of iodine supplementation on thyroid function during COH. Methods: One‐hundred and six euthyroid women (thyroid stimulating hormone (TSH) 0.4–2.5 mIU/L) planning their first COH cycle were subdivided according to iodine supplementation (nil, <6 months, ≥6 months) and compared to levothyroxine (LT4)‐treated controls. Serial TSH, free thyroxine, free triiodothyronine and thyroglobulin (Tg) levels were recorded at four time points: (i) baseline, (ii) day 7 ovarian stimulation, (iii) ovulation trigger and (iv) two weeks post oocyte retrieval. Oocyte numbers, fertilisation rates and pregnancy outcome were recorded. Results: TSH increased during COH for those women taking iodine supplements for ≥6 months (P = 0.025). One quarter recorded a TSH level >2.5 mIU/L before embryo transfer. A similar increase in TSH was demonstrated by LT4‐dependent controls (P = 0.024) but not the remaining subgroups. Tg levels did not change during COH in any group but decreased significantly post oocyte retrieval if nil iodine (P < 0.0001) or supplemented for ≥6 months (P < 0.005). Iodine supplementation did not influence oocyte count, fertilisation or implantation rates. Women taking iodine for <6 months were four times more likely to achieve a live birth than women taking iodine for longer. Conclusions: Women taking iodine supplements for ≥6 months are less able to adapt to the thyroidal demands of COH, with responses comparable to LT4‐dependent patients. [ABSTRACT FROM AUTHOR]

Background: Papua‐New Guinea (PNG) has one of the highest maternal mortality rates in the world; complications due to unsafe abortion are an important cause. Abortion laws are restrictive, and safe, induced abortions are unavailable to the majority of women, while unsafe abortions are known to be practised throughout the country. The topic of abortion is stigmatised, for women and health professionals. Aim: To conduct a study of PNG health professionals' experience of induced abortion and their views on the provision of safe, accessible abortion services for PNG women. Materials and Methods: A questionnaire developed from similar surveys conducted in Australia and New Zealand was distributed in 2017 to doctors working in provincial hospitals of the public health system; in 2020, the questionnaire was distributed to doctors and nursing staff in Port Moresby General Hospital, and to medical, nursing and health sciences students in the University of Papua‐New Guinea. Results: Significant numbers of senior medical officers and nurses reported experience of women presenting following unsafe induced abortion. There was wide variation across all respondents with regard to accurate knowledge of PNG's abortion laws, and to views on the provision of safe accessible abortion services in the country's public health system. Conclusions: Abortion training for service providers and provision of primary care services are necessary to ensure that PNG women have equitable access to abortion care instead of seeking out untrained providers or attempting self‐abortion. Innovative approaches also need to be adopted to complement family planning efforts in PNG. [ABSTRACT FROM AUTHOR]

Background: The Australian Contraceptive ChOice pRoject (ACCORd) aimed to assess the impact of a complex general practice intervention on the uptake of long‐acting reversible contraceptives (LARC). Aims: Using survey data from enrolled women, we aimed to compare the ongoing use and satisfaction of women who chose one of the hormonal LARC methods including the levonorgestrel intrauterine system (LNG‐IUS) or levonorgestrel implant compared to the oral contraceptive pill (OCP). Materials and Methods: We used the data from participants' baseline, six and 12‐month surveys to identify new users of implants, LNG‐IUS or OCP. We included demographic information, ongoing use of the contraceptive method, reasons for dissatisfaction and discontinuation and experience of side‐effects. Proportions were compared using χ2 tests. Results: Of the 740 women enrolled in ACCORd, 176 started using a hormonal LARC or OCP in the study's first six months with 76 using the IUS (43%), 60 the implant (34%) and 40 (23%) the OCP. Twelve‐month continuation rates for the LNG‐IUS, implant and OCP were 93, 83 and 65% respectively (P < 0.001). Satisfaction was highest among the LNG‐IUS users; 86% were very/somewhat satisfied compared to 75% of implant users and 61% of OCP users (P < 0.001). Main reasons for method dissatisfaction were irregular bleeding and mood changes which were similar for all methods. Conclusions: This study provides further evidence that hormonal LARC methods have higher continuation and satisfaction rates compared to the OCP with similar side‐effects. Since hormonal LARC methods have the highest contraceptive efficacy, these should be offered first‐line to women. [ABSTRACT FROM AUTHOR]

Background: Placenta praevia (PP) is a rare obstetric condition associated with significant maternal and perinatal morbidity. Traditionally, the degree of PP has been classified into minor and major; however, there are very few robust studies that compare the maternal outcomes of these types of PP. Aims: To identify any significant differences in obstetric outcomes between major and minor PP, including antepartum, intraoperative and postpartum complications. Materials and Methods: A retrospective cohort study was conducted at the Royal Brisbane & Women's Hospital between 2009 and 2018; all women were diagnosed with PP. Results: Of the total of 368 women recruited, over half of the participants were diagnosed with major PP (57%), while the remaining had minor PP. Women with major PP, compared to women with minor PP, had an increased risk of antepartum haemorrhage (odds ratio (OR) 2.77, P < 0.001), delivery at an earlier gestational age (36.1 vs 37.4 weeks), general anaesthesia (OR 3.25, P < 0.001), greater proportion of emergency lower segment (51% vs 40%) and classical caesarean (7.7% vs 3.8%), increased number of uterotonics (incidence rate ratio (IRR) 1.17, P < 0.031), greater blood loss (IRR 1.32, P < 0.001) and higher frequency of blood transfusion (IRR 2.00, P < 0.027), and longer postpartum hospital stay (IRR 1.26, P < 0.001). Hysterectomy was performed for three women with major PP, compared to one with minor PP. Conclusions: The degree of PP significantly impacts obstetric outcomes, with major PP associated with worse maternal morbidity antenatally, intraoperatively and postpartum. Therefore, to optimise patient care, this study emphasises the importance of identifying and distinguishing between different types of PP. [ABSTRACT FROM AUTHOR]

Aim: To determine if a policy recommending administration of terbutaline prior to emergency caesarean section improved arterial umbilical cord pH. Materials and Methods: This was a prospective audit between February 2018 and June 2019 among women who underwent a category one or two caesarean section. Neonatal cord gas results and perinatal outcomes were compared before and after the introduction of a policy recommending subcutaneous terbutaline prior to emergency caesarean section. Results: Among 423 women in the pre‐policy change cohort and 253 post‐policy change, there was no difference in arterial cord pH (median pH = 7.24 before the policy and median pH = 7.24 after the policy was introduced, P = 0.88). There was no statistically significant difference in any perinatal outcome, apart from the median arterial cord lactate which was higher in the post‐treatment group (4.2 mmol/L vs 3.9 mmol/L, P = 0.006). Maternal heart rate was higher (median 110 vs 95, P < 0.0001) in the post‐treatment group. Breastfeeding was more common in the post‐treatment group (99% vs 95%, P = 0.005). There was no difference in estimated blood loss or rate of post‐partum haemorrhage. A post hoc analysis according to treatment received, limited to caesarean section when the indication was suspected fetal compromise, demonstrated that among women who received terbutaline the rate of low pH (<7.1) was 3.8% (5/130) when terbutaline was given, compared with 6.6% (18/272) when terbutaline was not given (χ21 = 1.3, P = 0.26). Conclusion: Changing our labour ward policy to recommending terbutaline prior to all category one and category two caesarean sections did not change arterial cord pH. [ABSTRACT FROM AUTHOR]

Background: Over the last decade the incidence of obstetric anal sphincter injuries (OASIS) has been steadily increasing locally and internationally. Investigations into reducing rates, and the long‐term complications, of OASIS are required. Aims: To determine if applying a new method of perineal guarding at the time of delivery reduces the incidence of OASIS at an Australian tertiary hospital. Materials and Methods: A retrospective audit was performed for the three years prior to and following mandatory introduction of a new method of perineal guarding. The novel 'Please Squeeze' technique involved placement of the accoucheur's thumb and index finger just above the line of the posterior fourchette at crowning and bringing them firmly one centimetre postero‐medially to reduce tension. Demographic data were extracted from the unit's obstetric database (ObstetriX). Results: There were 9453 deliveries prior to, and 9805 deliveries following commencement of 'Please Squeeze', with no difference in the incidence of caesarean (30.4% vs 30.3% P = 0.87) or forceps (6.3% vs 5.8% P = 0.14) between groups. The incidence of primiparas (P = 0.005), ventouse (P < 0.001) and spontaneous vaginal deliveries (SVD) (P = 0.005) between groups. There was a clinically important 20% reduction in the incidence of OASIS across all vaginal deliveries from 3.5% to 2.8% (P = 0.006). In SVD, there was a 20% decrease in OASIS from 2.4% to 2.2% (P = 0.02), and a 14% decrease in OASIS with assisted vaginal delivery from 8% to 7.3% (P = 0.002). The incidence of episiotomy increased 16% (P < 0.001). Conclusions: The novel 'Please Squeeze' perineal guarding method contributed to a reduced incidence of OASIS in an Australian tertiary hospital. [ABSTRACT FROM AUTHOR]

Background: Multiple micronutrient supplement use in the Australian pregnant population is rising, despite little evidence of benefit in low‐risk women. While some supplement recommendations are grounded in high‐quality evidence, others warrant further investigation. This highlights a research gap regarding appropriate use of supplements during pregnancy in the Australian population. Aims: To describe micronutrient supplement use during pregnancy in the context of current evidence and national recommendations in a population of south‐east Queensland women. Material and Methods: A cross‐sectional observational design was used to examine data gathered from pregnant women aged 16–44 years residing in south‐east Queensland, Australia. Women were recruited to the study between 23 May 2016 and 30 September 2017. Results: Pregnancy multivitamin use was declared by 42% of the cohort, with 26.8% declaring multivitamins in combination with individual micronutrients and 9.8% declaring specific micronutrient supplement use. Nulliparous women were more likely to declare use of supplements than their multiparous peers (adjusted odds ratio (aOR) 1.938, 95% CI 1.053–3.571, P = 0.034); smoking (aOR 2.717, 95% CI 1.011–7.302, P = 0.047) and low socio‐economic status were associated with no supplement use (aOR 2.451, 95% CI 1.010–5.949, P = 0.048). Conclusions: Current recommendations regarding micronutrient supplements throughout pregnancy are based on varying degrees of evidence, resulting in supplement advice of poor cohesion and consistency. Adherence to micronutrient supplement recommendations in the peri‐conception period in this population was poor; second and third trimester supplement use was high. Contemporary empirical research is required to determine what constitutes appropriate supplementation in high‐income regions and the populations they will benefit most. [ABSTRACT FROM AUTHOR]

Background: Severe postpartum haemorrhage (PPH) is a serious clinical problem that is increasing in incidence. Aim: To identify risk factors for severe PPH. Materials and Methods: Population‐based retrospective cohort study of all women who gave birth in Victoria in 2009–2013 using the validated Victorian Perinatal Data Collection. Three multivariable logistic regression models estimated the adjusted risk of severe PPH. Adjusted odds ratios (aOR) and their 95% confidence intervals are reported. The primary outcome was severe PPH (estimated blood loss of ≥1500 mL). Results: Severe PPH occurred in 1.4% of all births (n = 5122). Maternal characteristics significantly associated with severe PPH included: multiple pregnancy; older maternal age; overweight/obesity; first births. Other risk factors included placental complications, macrosomia, instrumental vaginal birth, third and fourth degree perineal lacerations, in‐labour caesarean section, birth at a gestation other than 37–41 weeks, duration of labour 12 to <24 h, and use of oxytocin infusions in labour. Planned pre‐labour caesarean section was associated with reduced odds of severe PPH. Severe PPH also occurred in 0.7% (n = 104) of women with none of the identified risk factors. Conclusions: Numerous risk factors for severe PPH are identified but some cases are not modifiable or predictable. Limiting use of oxytocin infusions in labour to cases with clear indications, and strategies to prevent severe perineal lacerations would prevent some severe PPHs. Close surveillance of all women in the hours immediately following birth is crucial to detect and manage excessive blood loss and reduce severe PPH and associated morbidity. [ABSTRACT FROM AUTHOR]

Background: Excess gestational weight gain is associated with adverse pregnancy outcomes. Addressing barriers to the provision of best practice care that supports healthy pregnancy weight gain could assist staff in clinical care; however, little is known about changes to staff practices after ameliorating barriers. Aims: To evaluate if service initiatives to promote healthy pregnancy weight gain improve weight‐related documentation by antenatal staff throughout pregnancy care. Materials and Methods: Service initiatives including staff training, familiarisation with a pregnancy weight gain chart and placement of scales in clinic rooms were introduced. Pregnancy health records were audited for deliveries pre‐ (2014) and post‐implementation (2017) to obtain weight‐related measures. Measures assessed included the documentation of pre‐pregnancy weight, height, pre‐pregnancy body mass index (BMI), referral to dietetic services (if overweight) and the accuracy of pre‐pregnancy BMI calculation. The proportion of visits with weight recorded during pregnancy was also audited. Results: A total of 1003 and 1050 records were included from the pre‐ and post‐intervention groups respectively. Significant improvements over time were observed in the documentation of pre‐pregnancy weight (P < 0.001), BMI (P < 0.001), accuracy of BMI calculation (P < 0.001) and for obese women proportion of visits with weight recorded (P = 0.02). There was a non‐significant increase in the documentation of dietetic referral for overweight women (1.1% vs 2.2%, P = 0.27) and proportion of visits with weight recorded for women across all pre‐pregnancy BMI groups (49% vs 51%, P = 0.07). Conclusions: Addressing barriers to supporting healthy pregnancy weight gain through service‐wide initiatives may improve weight‐related documentation by antenatal staff. [ABSTRACT FROM AUTHOR]

Background: Amniotomy is a commonly used, inexpensive method of labour induction; however, the optimal timing of amniotomy during labour induction is debated. Aims: To investigate whether artificial rupture of membranes <4 cm dilation is associated with caesarean, severe maternal and neonatal morbidity, and labour induction duration. Materials and Methods: Retrospective cohort study of 228 438 deliveries at 19 US hospitals. Women with a viable, singleton gestation undergoing induction ≥37 weeks with cervical dilation <4 cm were included. Women were excluded if membranes spontaneously ruptured <4 cm. Women were compared by early amniotomy (<4 cm dilation) versus not early. The primary outcome was caesarean. Secondary outcomes included severe maternal and neonatal morbidity, and labour duration. Logistic and Cox proportional hazard regression estimated the association between early amniotomy and study outcomes. Results: Of 15 525 eligible women, 10 421 (67%) had early amniotomy. Early amniotomy was associated with higher adjusted odds of caesarean and severe maternal morbidity, but not neonatal morbidity. After accounting for interaction, early amniotomy was associated with increasingly higher odds of caesarean as body mass index increased. Early amniotomy was associated with lower odds of severe maternal morbidity among multiparas with mechanical ripening. Median labour induction was 2.5 h shorter with early amniotomy, significant in hazard regression. Conclusions: Early amniotomy was associated with increased odds of caesarean among obese women. The association between early amniotomy and severe maternal morbidity varied by maternal characteristics, but early amniotomy was not associated with neonatal morbidity. Early amniotomy in labour induction may be advantageous in certain populations, particularly non‐obese women requiring mechanical ripening. [ABSTRACT FROM AUTHOR]

Background: Obstetric anal sphincter injuries (OASIs) are associated with maternal morbidity; however, it is uncertain whether gestational diabetes (GDM) is an independent risk factor when considering birthweight mode of birth and episiotomy. Aims: To compare rates of OASIs between women with GDM and women without GDM by mode of birth and birthweight. To investigate the association between episiotomy, mode of birth and the risk of OASIs. Methods: A population‐based cohort study of women who gave birth vaginally in NSW, from 2007 to 2013. Rates of OASIs were compared between women with and without GDM, stratified by mode of birth, birthweight and a multi‐categorical variable of mode of birth and episiotomy. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated by multivariable logistic regression. Results: The rate of OASIs was 3.6% (95% CI: 2.6–2.7) vs 2.6% (95% CI: 3.4–2.8; P < 0.001) among women with and without GDM, respectively. Women with GDM and a macrosomic baby (birthweight ≥ 4000 g) had a higher risk of OASIs with forceps (aOR 1.76, 95% CI: 1.08–2.86, P = 0.02) or vacuum (aOR 1.89, 95% CI: 1.17–3.04, P = 0.01), compared with those without GDM. For primiparous women with GDM and all women without GDM, an episiotomy with forceps was associated with lower odds of OASIs than forceps only (primiparous GDM, forceps‐episiotomy aOR 2.49, 95% CI: 2.00–3.11, forceps aOR 5.30, 95% CI: 3.72–7.54), (primiparous without GDM, forceps‐episiotomy aOR 2.71, 95% CI: 2.55–2.89, forceps aOR 5.95, 95% CI: 5.41–6.55) and (multiparous without GDM, forceps‐episiotomy aOR 3.75, 95% CI: 3.12–4.50, forceps aOR 6.20, 95% CI: 4.96–7.74). Conclusion: Women with GDM and a macrosomic baby should be counselled about the increased risk of OASIs with both vacuum and forceps. With forceps birth, this risk can be partially mitigated by performing a concomitant episiotomy. [ABSTRACT FROM AUTHOR]

Background: While pelvic floor ultrasound is commonly utilised in high‐resource locations, our understanding of pelvic floor characteristics in women suffering with obstetric fistula and unrepaired fourth degree obstetric tears in low‐resource areas is limited. Aims: This study aimed to assess the pelvic floor ultrasound characteristics of Ugandan women suffering with obstetric fistula, unrepaired fourth degree obstetric tears and pelvic organ prolapse, and determine whether obstructed labour resulting in obstetric fistula causes more levator muscle defects compared to parous women without a history of obstructed labour. Materials and Methods: This was a prospective study in western Uganda assessing 82 women with obstetric fistula, unrepaired fourth degree obstetric tears and pelvic organ prolapse with a pelvic floor ultrasound scan. Results: Demographic characteristics were significantly different, with women suffering pelvic organ prolapse being older and more parous. Hiatal area on Valsalva was significantly smaller in the obstetric fistula group (mean 21.45 cm2) compared to non‐obstetric fistula group (unrepaired fourth degree obstetric tears and pelvic organ prolapse; mean 30.44 cm2); a mean difference of 9.0 cm2 (95% CI: 5.4–12.6 cm2, P < 0.001). Overall, levator muscle defects were significantly more common in women with obstetric fistula (66.7%) compared to the non‐obstetric fistula group (44.7%) with P = 0.048; however, there were no significant differences in complete levator muscle defects between obstetric fistula (28.6%) and non‐obstetric fistula (23.7%). Conclusions: Increased hiatal area on Valsalva was noted in the non‐obstetric fistula group compared to women with obstetric fistula; however, there were no differences in proportions of complete levator muscle defects. [ABSTRACT FROM AUTHOR]

Introduction: Placenta accreta spectrum (PAS) covers a spectrum of placental adherence abnormalities: placenta accreta, increta and percreta. PAS is associated with significant maternal morbidity and mortality. Studies have shown the importance of multidisciplinary teamwork in the management of PAS. Aim: This study was designed to describe the maternal and neonatal morbidity and mortality associated with PAS in our centre over a ten‐year period. Methods: A retrospective cohort study was conducted of pregnancies complicated by PAS between February 2006 and January 2016 at Flinders Medical Centre (FMC), South Australia. Electronic and medical records were examined to obtain patient demographics, antenatal and surgical, findings and postnatal outcomes. Results: There were 67 PAS cases with an overall incidence of 2.3 per 1000 deliveries. Three cases were excluded due to incomplete information. Of the remaining 64 cases, 56 women were antenatally diagnosed. Sixty cases were confirmed to be invasive at delivery; 28 accreta (superficial) and 32 increta/percreta (deep) cases. The four cases with no invasion at delivery were suspected antenatally to have PAS. The median (Q1, Q3) number of caesarean sections in this cohort was 2 (1, 3). Deep invasion is significantly associated with increased bleeding, intensive care unit admission, surgical complications and an extended postpartum stay. Conclusion: The incidence of PAS at FMC is high as it is the state's tertiary referral centre. While PAS is associated with increased morbidity, thorough perioperative planning by a multidisciplinary team is crucial for excellent patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Preterm birth is associated with significant perinatal morbidity and mortality. The fetal fibronectin test (fFN) is used to manage women presenting with threatened preterm labour (TPTL). Aim: To evaluate the use of fFN in women presenting with TPTL with regard to hospital admission, tertiary hospital transfer and use of tocolytics and steroids in our hospital, against recommended guidelines. The ability of fFN <10 ng/mL, 10–49 ng/mL, 50–199 ng/mL and >200 ng/mL to predict outcome was also examined. Material and Methods: This was a single‐centre retrospective study from January 2015 to June 2017. All women who presented to Ipswich hospital, a level two facility for births at >32 weeks of gestation, between 23 and 346 weeks of gestation with TPTL and who had fFN tests were included in the study. Results: Fetal fibronectin <50 ng/mL had a negative predictive value of 93.5% (95% CI 86.5–97.1). Despite this assurance, one in four presentations resulted in hospital admission and nearly one in ten in steroids and tocolysis administration. Birth <34 weeks was 0% for fFN <10 and 2% for women with fFN levels <200 ng/mL compared to nearly 30% for levels >200 ng/mL. Conclusion: There is noncompliance with use of fFN to its full potential. This small study also provides support for the use of a 200 ng/mL cut‐off fFN level for birth <34 weeks. This would avoid the need to transfer to a tertiary facility many women who present with TPTL. [ABSTRACT FROM AUTHOR]

Background: Antenatal corticosteroids (ANC) reduce mortality and morbidity in preterm babies, but prescription practices vary. Aims: To assess obstetricians' compliance with the recommendations of the Australian and New Zealand clinical practice guidelines on use of ANC. Materials and Methods: An anonymous online questionnaire was distributed to Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Results: All respondents reported prescribing an initial course of ANC according to the guidelines if preterm birth at 28 weeks' gestation was expected within 24 or 72 h. However, 22% reported prescribing ANC even if birth was not expected within seven days. This was reported more often by practitioners not using adjunct tests to predict preterm birth (14% vs 69%; P < 0.001). An initial course of ANC at ≥35 weeks was prescribed by 52% of respondents. However, 93% reported prescribing ANC at ≥35 weeks prior to elective caesarean section. Repeat courses of ANC were prescribed by 76% of respondents. Of these, 89% reported prescribing repeat courses beyond the guideline recommendations at ≥33 weeks and 29% exceeded the recommendations on number of repeat courses. Conclusions: For infants born at <35 weeks, current ANC prescribing patterns in Australia and New Zealand are consistent with the guideline recommendations and result in high rates of administration in this group. However, administration of ANC to groups where benefits have not been demonstrated is commonly reported. Adherence to the guideline recommendations would decrease ANC exposure to babies for whom there is no strong evidence of benefit. [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: The incidence of both sexually transmitted infection (STI) and preterm birth is high among Indigenous women in the Northern Territory, Australia. It was hypothesised that these factors are linked. Aims: To analyse whether antenatal STI is associated with preterm birth among Northern Territory Indigenous women. Materials and Methods: A retrospective case–control study was conducted at a tertiary maternity hospital in the Northern Territory. Rates of STI among pregnant Indigenous women were compared between cases (singleton births at <37 weeks gestation) and controls (singleton births at 37 or greater weeks gestation). The association between the composite of any STI (chlamydia, gonorrhoea, trichomonas or syphilis) and preterm birth was evaluated by logistic regression analysis, adjusting for confounders. Secondary endpoints were the associations between each of these infections and preterm birth. Results: There were 380 cases and 380 controls. Diagnosis of any sexually transmitted infection (composite) in pregnancy was not associated with preterm birth (adjusted odds ratio (aOR) 0.9, 95%CI 0.58–1.39). Women were at increased risk of preterm birth if they had gonorrhoea in pregnancy (aOR 2.92, 95%CI 1.07–7.97); there was no association with chlamydia (aOR 1.38, 95%CI 0.63–3.04) or trichomonas (aOR 0.66, 95%CI 0.39–1.12). There were three syphilis diagnoses among controls and none among cases. Conclusions: Sexually transmitted infection (considered overall) in pregnancy did not affect preterm birth risk among Northern Territory Indigenous women. An association with preterm birth was observed for gonorrhoea in pregnancy but not with chlamydia, trichomonas or syphilis. [ABSTRACT FROM AUTHOR]

The records of women attending a large Australian regional hospital for antenatal care were retrospectively analysed to determine what proportion had undergone or been offered first trimester screening for fetal abnormalities; only 609 (54%) of 1114 women had undergone or been offered screening. Younger women, multiparous women and women living in rural Australia were less likely to be offered screening. Barriers to screening and solutions for overcoming these need to be identified to improve access and equality in antenatal screening for all women. [ABSTRACT FROM AUTHOR]

Objective: To compare current practice in the management of female pelvic organ prolapse in Australia and New Zealand with that in 2007, and assess the impact on practice of the withdrawal of Prolift® and Prosima® mesh kits in 2015. Materials and Methods: In early 2015, two invitations to participate in a survey, including a link to Surveymonkey, were emailed to 2506 Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees and fellows. The online survey closely resembled a printed survey that was posted to RANZCOG trainees and fellows in 2007 and had additional questions relating to the impact of withdrawal of Prolift® and Prosima® products. Results: Four‐hundred‐and‐three doctors participated, giving a response rate of 16%. Native tissue repair was the procedure of choice for primary and recurrent prolapse of the anterior and posterior vaginal wall. An implant was used to treat 45% of anterior recurrences and 25% of posterior recurrences. Vaginal hysterectomy and repair were the procedures of choice for uterovaginal prolapse. Sacrospinous hysteropexy was the uterine preservation procedure of choice, preferred by 41%. For post‐hysterectomy vault prolapse, sacrospinous colpopexy and vaginal repair was preferred by 65% of respondents. Between 2007 and 2015, there was a substantial decrease in respondents' usage of implants across all indications except for midurethral slings and sacrocolpo/hysteropexy. Forty‐two percent of respondents changed their practice as a result of Prolift® and Prosima® being withdrawn. Conclusion: There is a trend toward increasing use of various native tissue prolapse repair procedures and midurethral slings, and less utilisation of transvaginal mesh for prolapse. [ABSTRACT FROM AUTHOR]

Background: Recurrent implantation failure (RIF) is repeated unsuccessful embryo transfers (ETs). Aims: To identify predictive embryonic markers of implantation in RIF, following pre‐implantation genetic screening (PGS) of cleavage stage embryos, after accounting for male and female factors. Materials and Methods: Retrospective analysis of RIF patients undergoing PGS after correction of modifiable causes. Results: Eighty‐four patients underwent 140 in vitro ferilisation cycles. Forty‐one cycles were excluded: 12 (no embryo for transfer), four (double ETs) and 25 (no biopsy). Sixty‐three patients underwent 99 single euploid ETs (48 fresh, 51 frozen) resulting in 11 biochemical pregnancies, 36 clinical pregnancies (CP), and six miscarriages and 30 live births (LB). Frozen ET was more successful than fresh; respective live birth rate (LBR) and clinical pregnancy rate (CPR), 39.2% versus 20.8%, (P = 0.02), 45.1% versus 27.1% (P = 0.04). LBR and CPR were lower when 5–6 blastomeres were present at embryo biopsy, compared to embryos with ≥7 blastomeres: 15.4% versus 32.6% (P = 0.185) and 15.4% versus 39.5% (P = 0.074) respectively. Serum β human chorionic gonadotropin (βhCG) concentration was greater when a more developed embryo was biopsied (r = 0.448, P = 0.017 and r = 0.476, P = 0.118, fresh and frozen transfers, respectively). Embryo morphokinetic analysis demonstrated faster development to blastocyst stage when more cells were present at biopsy: mean 103.3, 102.2 and 96.0 h for biopsy at the 5–6, 7–8 or ≥9 cell stage respectively (P = 0.040 for difference between 7–8 cells vs ≥9). Conclusions: After cleavage stage biopsy, frozen ET was more successful than fresh ET. Chance of conception and serum βhCG concentration correlated with number of cells present at time of biopsy. [ABSTRACT FROM AUTHOR]

Background: Severe fetal growth restriction (FGR) is a leading cause of adverse perinatal morbidity and mortality; however, in Victoria, 35% of severely growth‐restricted infants are undelivered by 40 weeks gestation. Aims: We aimed to identify factors associated with failure to deliver severely growth‐restricted fetuses by 40 weeks gestation. Methods: We conducted a retrospective case‐control study of term singletons born <3rd centile for gestation at a single tertiary centre (2010–2017). Infants with a planned delivery for FGR between 37.0–39.6 weeks gestation ('planned birth' group; n = 187) were compared with those undelivered by 40.0 weeks ('undelivered' group; n = 233). Variables assessed included the presence of risk factors for FGR, model of care, symphyseal‐fundal height measurements and third trimester ultrasounds. Results: An equivalent proportion of women were 'high‐risk' for FGR on history (31.3% vs 38.0%, P = 0.187) in the planned and undelivered groups. Women booked under low‐risk models (shared care and midwifery‐led care) were significantly more likely to be in the undelivered group compared to those booked under traditional collaborative models (79.8% vs 37.4%, P < 0.001). Women in the undelivered group were less likely to have received a third trimester ultrasound (93.0% vs 40.3%, P < 0.001); however, they were more likely to have had a reassuring ultrasound with an estimation of fetal weight or abdominal circumference >10th centile (78.7% vs 16.1%, P < 0.001). Conclusions: Failure to deliver the severely growth‐restricted fetus before 40.0 weeks is more likely to occur in the following situations: (i) failure to receive an indicated third trimester ultrasound; (ii) the presence of falsely reassuring third trimester ultrasound scan; and (iii) booking under a low‐risk rather than traditional collaborative models of care. [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]

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: Polycystic ovarian syndrome (PCOS) is the most common condition among reproductive‐aged women. However, its exact prevalence is unknown. Aims: To determine the prevalence of PCOS in Australian women aged 16–29 years using the National Institutes of Health (NIH) criteria compared to self‐reported PCOS, to compare co‐morbidities between the groups and to determine the most distressing aspect of a diagnosis of PCOS for these young women. Materials and Methods: Participants were recruited from the Young Female Health Initiative (YFHI) and Safe‐D studies. Participants completed questionnaires, physical examinations and blood tests from 2012 to 2016. In March 2016, two supplementary questionnaires were distributed: the first, comprising questions on reproductive health and impact of diagnosis, was sent to participants who self‐reported having PCOS in the original studies. The second, comprising general reproductive health questions, was sent to the remainder. Results: The prevalence of PCOS, according to the NIH criteria, was 12% (31/254), while the prevalence of self‐reported PCOS was 8% (23/300). Only 35% (8/23) of those with self‐reported PCOS actually fulfilled the NIH criteria for PCOS. Comorbidities were relatively similar among groups. Finally, approximately 65% (15/23) were unhappy or worried about their initial PCOS diagnosis, with 72% (13/18) stating fertility concerns were the most distressing aspect of their diagnosis. Conclusions: The lack of consistent and accurate diagnosis of PCOS in young women potentially leads to over‐diagnosis. This creates unnecessary fears of health complications, particularly infertility. Therefore, we recommend the development of standardised criteria with set parameters that allow for better diagnosis of PCOS. [ABSTRACT FROM AUTHOR]

Background: Intravenous iron polymaltose (IPM) is commonly utilised in pregnancy when oral treatment is not tolerated or where rapid replenishment of iron stores is required, but data on use in pregnancy is scarce. Aim: To examine the use, safety and efficacy of intravenous IPM in pregnancy. Methods: Retrospective cohort study of pregnant women administered intravenous IPM between January 2014 and January 2016 at a Tertiary teaching hospital in Adelaide, Australia. Data on maternal characteristics, intravenous iron infusion details, and haematological parameters were collected from case notes and electronic records. Main outcome measures included indication for intravenous iron infusion, prevalence of infusion reactions, change in haemoglobin and correction of anaemia prior to delivery. Results: Intravenous IPM was administered in 213 pregnancies, 62.0% of women with iron deficiency anaemia (IDA) and the remainder (38.0%) with non‐anaemic iron deficiency. Adverse drug reactions (ADRs) occurred in 24% of women, of which 32% required infusion cessation. Anaemia was still present at delivery among 7%, and 17% of women with mild, and moderate/severe anaemia respectively. Approximately one in five anaemic women received an intravenous IPM dose below that recommended by the local guideline, particularly in women with a body mass index ≥ 25 kg/m2 compared with <25 kg/m2 (30.9% vs 6.3%; P < 0.001). Doses ‘at recommended’ resulted in a greater increase in haemoglobin from treatment until delivery than doses ‘below recommended’ (adjusted beta coefficient 8.4 g/L; 95% CI 2.7–14.1 g/L). Conclusion: Intravenous IPM is effective in treating IDA in pregnancy but is associated with a high prevalence of ADRs and treatment cessation. [ABSTRACT FROM AUTHOR]

Introduction: Asthma is one of the most prevalent chronic medical conditions to complicate pregnancy. Similarly, active management strategies that prioritise asthma control in this vulnerable population can have a far‐reaching impact. Aim: To describe lung function parameters and results of the Control of Allergic Rhinitis and Asthma Test (CARAT) questionnaire in pregnant asthmatics and to analyse correlations between lung function tests and CARAT results. Methods: All pregnant asthmatics who performed spirometry and CARAT between September 2014 and August 2015 were included. A medical records review was performed and data regarding demographics, sensitisation and medical prescriptions were recorded. Control of asthma and rhinitis was defined by CARAT total score (CARAT (T)) ≥ 24; upper airways (U) control if CARAT (U) > 8; lower airways (L) control if CARAT (L) > 15. Results: Forty‐two pregnant asthmatics were included, with a median age (interquartile range)of 32 (27–34) years; all had a previous medical diagnosis of asthma and rhinitis, 76% were atopic, 94% sensitised to dust mites and 43% were polissensitised. More than 80% presented poor control (CARAT (T) < 24) in the first assessment and 15% had a percentage forced expiratory volume in the first second < 80%. There were significant negative correlations between CARAT (L) and CARAT (T) scores and step‐up of controller medication, (correlation coefficients  = −0.453 and −0.392, respectively). Conclusion: The use of tools such as spirometry and validated questionnaires to objectively assess asthma control during pregnancy should be routinely applied to assist in the management of these patients. These data reinforce the importance of close monitoring of pregnant asthmatics to achieve and maintain better disease control. [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 There are few published data about the incidence of diagnoses or treatment outcomes, for chronic vulval pain. Aims To document diagnoses and treatment outcomes in a cohort of chronic vulval pain presentations. Materials and methods A retrospective case review of the patient database of a private vulval clinic between January 2011 and March 2015. Results Five hundred and twenty-five out of 3360 patients (15.6%) met the criterion of vulval pain alone. Mean age was 47.1 years (range 17-86). Average duration of symptoms was 60 months (range 3-432). Overall, 277/525 (52.7%) patients had satisfactory responses to appropriate treatment and 90/525 (17%) had partial improvement. A dermatosis was identified in 322/525 (61.3%) patients and of these, 211/322 (65.5%) had satisfactory responses to appropriate dermatological treatment. In the remaining 203/525 (38.7%) the skin was normal. These patients were questioned around the possibility of a neuromuscular cause for their pain, including pre-existing dysfunction, trauma or previous operations involving the spine, hips or lower limbs. There were 181/203 (89%) patients considered to have a neuromuscular cause for their pain and considered suitable for physiotherapy and/or neuromodulating medications. Of these patients, 63/182 (34.6%) had satisfactory responses to this treatment. One hundred and sixty-six out of 525 (31.6%) described vulval pain only during sexual intercourse. There was no statistically significant difference between different diagnoses and responses to treatment between patients reporting dyspareunia only and those sexually active women who did not experience dysparenunia (29/525, 5.5%). Conclusions The majority of this cohort with chronic vulval pain had a dermatological disease with a smaller proportion caused by neuromuscular dysfunction. Both groups are potentially treatable. [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 Childhood obesity is a growing concern internationally and a top priority for the World Health Organization. Preconception overweight, obesity and excess gestational weight gain significantly increase childhood obesity risk. Optimising preconception weight is a key preventative measure toward reducing childhood obesity. In 2014, the New Zealand ( NZ) Ministry of Health released guidance for health practitioners on healthy weight gain in pregnancy in an effort to reduce the burden of childhood obesity. Aim To explore the knowledge and practice of NZ general practitioners ( GPs) regarding preconception and gestational weight management. Materials and methods A nationwide survey was conducted on a randomly selected sample of NZ GPs using a mixed methods approach. Descriptive statistics were used for survey responses and a general inductive approach was applied to the free text data. Results A total of 200 GPs (42.5%) responded. The majority of GPs were aware of the risks of obesity in pregnancy. Over 50% of GPs reported practice that was not consistent with recommended standards of care. Ministry of Health guidance was known to only 12% of participants. Themes emerging from the free text data included: lack of opportunity for, and awareness of, preconception care; recognition of the importance of this area; and need for further learning. Conclusions General practitioners in NZ are not providing optimal preconception care. This research highlights the need for a public health message encouraging preconception counselling and better education of GPs on the topic. This should start with promotion of the Ministry of Health guidance. [ABSTRACT FROM AUTHOR]

Background Cord prolapse is an uncommon obstetric emergency, with potentially fatal consequences for the baby if prompt action is not taken. Simulation training provides a means by which uncommon emergencies can be practised, with the aim of improving teamwork and clinical outcomes. Aims This study aimed to determine if the introduction of a simulation-based training course was associated with an improvement in the management of cord prolapse, in particular the diagnosis to delivery interval. We also aimed to investigate if an improvement in perinatal outcomes could be demonstrated. Materials and methods A retrospective cohort study was performed. All cases of cord prolapse in the designated time period were identified and reviewed and a comparison of outcome measures pre- and post-training was undertaken. Results Thirty-one cases were identified in the pre-training period, and compared to 64 cases post-training. Documentation improved significantly post-training. There were non-significant improvements in use of spinal anaesthetic, and in the length of stay in the special care neonatal unit. There was a significant increase in the number of babies with Apgar scores less than seven at 5 min. There were no differences in the diagnosis to delivery interval, or in perinatal mortality rates. Conclusion Obstetric emergency training was associated with improved teamwork, as evidenced by the improved documentation post-training in this study, but not with improved diagnosis to delivery interval. Long-term follow-up studies are required to ascertain whether training has an impact on longer-term paediatric outcomes, such as cerebral palsy rates. [ABSTRACT FROM AUTHOR]

Background For many medicines, safe use during pregnancy is not established and adherence is often poor due to safety concerns. Therefore, it is important to identify consumers' medicines information needs during pregnancy. Materials and methods A retrospective, mixed methods analysis was conducted on eight years of pregnancy-related calls to an Australian national medicines call centre. The call profile of pregnancy and non-pregnancy-related questions were compared. Medicines involved in pregnancy calls were categorised by class (Anatomical Therapeutic Chemical (ATC)3 level), and Therapeutic Goods Administration pregnancy category. Questions in these calls were also themed by pregnancy stage. Results We identified 4573 pregnancy-related and 118 547 non-pregnancy-related calls. The caller profile for pregnancy-related calls was female (93.7%), asking for herself (83.0%), and while 70.1% of questions involved one medicine, 9.6% involved three or more medicines. Pregnancy enquiries were prompted more often by conflicting information, inadequate information or desire for a second opinion. For 1166 calls, where the stage of pregnancy was available, most questions concerned safety. Medication classified as 'safe' during pregnancy accounted for 34% of these questions. After antidepressants, most calls were made about over-the-counter (OTC) medicines (paracetamol, dexchlorpheniramine, codeine). Safe treatment for everyday conditions was of increasing concern as the pregnancy progressed. Conclusion Pregnant women are concerned about the safety of medication use in pregnancy and a significant proportion overestimate risk. Psychotropic medication and fertility are strong drivers to seek information during preconception. Everyday illnesses and self-medication with OTC medication are a common concern throughout pregnancy, even though many medicines are safe to use. [ABSTRACT FROM AUTHOR]

Background Obese pregnant women have an increased risk of antenatal, intra- and post-partum complications. At present, there is limited evidence to support specific nutritional management of obese women in pregnancy, and guidelines are infrequently translated into practice. Aims To implement an individually tailored nutrition program for obese pregnant women to reduce the rates of gestational diabetes mellitus ( GDM), improve diet quality, achieve weight gain targets, limit gestational weight gain ( GWG) and reduce complications for mother and child. Methods A prospective dietary intervention study was conducted at a hospital in Melbourne, Australia, using a parallel control group from the Birthing Outcomes System ( BOS) database. Obese pregnant women were included if they were ≤21 weeks gestation and aged ≥18 years. The intervention group received one face-to-face dietitian-delivered consultation, with reviews conducted over the phone. Results A total of 92 and 125 obese pregnant women were enrolled into the dietary intervention group and BOS control group, respectively. The diet quality of intervention participants improved, without significant differences in GWG across groups. In the control group, 19.3% of women developed GDM, compared to 6.5% in the diet group ( P 0.013). However, after adjusting for ethnicity and body mass index, the association between the diet group and GDM incidence was no longer significant. Conclusions This study demonstrates that a behavioural nutrition intervention, individually tailored for obese pregnant women can improve diet quality. A larger randomised controlled trial targeted at obese pregnant women, with comparable groups at baseline, is required to observe the effects of dietary improvement on GDM incidence, and other maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background Caesarean birth is one of the most frequently performed major obstetrical interventions. Although there is speculation that caesarean at term may have consequences for children's later health and development, longer-term studies are needed. Aim We aimed to evaluate risks to poor school achievement among children born by caesarean section compared with spontaneous vaginal birth. Materials and Methods This population-based observational study involved linkage of routinely collected perinatal data with children's school assessments. Perinatal data included all children born in South Australia from 1999 to 2005. Participants were children born by elective caesarean (exposed, n = 650) or vaginal birth (unexposed, n = 2959), to women who previously had a caesarean delivery. School assessments were reported via a standardised national assessment program for children attending grade three (at ~eight years of age). Assessments included reading, writing, spelling, grammar and numeracy and were categorised according to performing at above or ≤National Minimum Standards ( NMS). Statistical analyses involved augmented inverse probability weighting (apiw) and accounted for a range of maternal, perinatal and sociodemographic characteristics. Results Children performing ≤ NMS for vaginal birth versus caesarean section were as follows: reading 144/640 (23%) and 688/2921 (24%), writing 69/636(11%) and 351/2917 (12%), spelling 128/646 (20%) and 684/2937 (23%), grammar 132/646 (20%) and 655/2937 (22%), and numeracy 151/634 (24%) and 729/2922 (25%). Both the raw data and the aipw analyses suggested little differences in school achievement between children born by caesarean versus vaginal birth. Conclusion Analyses that carefully controlled for a wide range of confounders suggest that caesarean section does not increase the risk of poor school outcomes at age eight. [ABSTRACT FROM AUTHOR]

Background There is no consensus on the relationship between depressive symptoms ( DS) and pelvic organ prolapse ( POP) symptoms and quality of life (QoL). Our hypothesis was that women with DS and POP have worse symptoms and QoL than those without DS and POP. Aim Our aim was to compare two groups of POP patients, those with depressive symptoms and those without, and evaluate the association of symptoms and QoL. Materials and methods This planned report is part of a prospective study evaluating the impact of pessary use among symptomatic POP patients. Patients were evaluated by POP quantification ( POP-Q), pelvic ultrasound ( US), voiding diaries, stress test, pad test, Pelvic Floor Distress Inventory ( PFDI-20), Prolapse QoL (P-QoL) and the Goldberg Health Questionnaire ( GHQ-12) (psychological health screening for DS when score ≥5). A sample size of 78 patients was required to demonstrate a 50-point difference in the global PFDI-20 score with 80% power and 95% probability. Results Ninety-one women with POP were included. GHQ-12 was positive in 47 (51.6%) patients. No differences were found in POP-Q, pad and stress test between those with a positive GHQ-12 and those without. However, GHQ-12 was associated with higher PFDI-20 scores and higher scores in seven of nine P-QoL domains. GHQ-12 persisted as an independent risk factor for worse P-QoL scores after multivariable analysis. Conclusion A 'positive' screening for DS was associated with worse PFDI-20 and P-QoL scores despite no difference in objective measurements. It may be that depressed patients interpret their symptoms differently. [ABSTRACT FROM AUTHOR]