Search

Background Recent population-wide changes in perinatal risk factors may affect rates of breech presentation at birth, and have implications for the provision of breech services and training in breech management. Aims To investigate whether changes in maternal and pregnancy characteristics explain the observed trend in breech presentation at term. Materials and methods All singleton term (≥37 week) births in New South Wales during 2002-2012 were identified through birth and associated hospital records. Annual rates of breech presentation were determined. Logistic regression modelling was used to predict expected rates of breech presentation and these were compared with observed rates over time. A priori predictors included maternal age, country of birth, parity, smoking during pregnancy, diabetes, pregnancy hypertension, placenta praevia, previous singleton term breech, previous caesarean section, infant sex, gestational age, birthweight and congenital anomalies. Hospital and Medicare data were used to assess concomitant trends in external cephalic version. Results Among 914 147 singleton term births, 3.1% were breech at delivery. Rates of breech presentation declined from 3.6% in 2002 to 2.7% in 2012 (test for trend P < 0.001), but was predicted to increase from 3.6% in 2002 to 4.3% in 2012 because of increased maternal age, nulliparity, maternal diabetes, history of breech presentation and previous caesarean section. However, use of external cephalic version appears to have increased over time. Conclusions Breech presentation at delivery has decreased in New South Wales. Increased use of external cephalic version likely accounts for this decline, as changes in risk factors do not. [ABSTRACT FROM AUTHOR]

Background Hysterectomy remains one of the frequently used surgical operations on women in Australia despite new therapeutic approaches for most of the common conditions for which hysterectomy is indicated. Aims To determine whether the surgical approach to hysterectomy has changed in New South Wales ( NSW) over the period 1981 to 2010-2012. Data and methods De-identified individual records for hysterectomy patients during the three-year period (January 2010 to December 2012) provided by the NSW Ministry of Health were used. Robotic assistance with surgery was not recorded in the hysterectomy data. Analysis largely involved the method of indirect standardisation. Results The average annual hysterectomy rate during 2010-2012 was 3.07 per 1000 females per annum; the majority of patients stayed an average of four days in hospital. Total abdominal and vaginal hysterectomies were the two most frequently used procedures. One-in-four procedures involved the use of laparoscopes. Principal diagnoses (in descending order) were disorders of menstruation and other abnormal bleeding, genital prolapse, leiomyoma of uterus, malignant neoplasm of genital organs and endometriosis. While declining trends in hysterectomy rates were noted since 1981, an increasing trend in the use of laparoscopy was evident. Conclusions The 45% decrease in hysterectomy rates was indeed the most striking finding of our analysis. This is probably due to the development of alternative nonsurgical procedures such as oral hormone suppression of menstruation and the levonorgestrel-releasing intrauterine system. [ABSTRACT FROM AUTHOR]

Background: Selection of specialist trainees in obstetrics and gynaecology has traditionally been hospital based. Aims: To report the outcomes of a state-wide selection process and suggest possibilities for future trainee selection. Methods: Applicants were screened for interview using a standardised curriculum vitae (CV) and referee reports, and the highest-ranked applicants were offered an interview. Scores from CV, interview and references were collated to give an overall score for each candidate. The candidates were then ranked in order of merit and integrated training program (ITP) hospitals ranked their preferences for candidates. The candidates were then offered positions based on a preference-matching system. Scores for selection components were correlated. Selection matching and trainee retention rates are reported. Results: In a 4 year period, 155 unique applicants made 183 applications, 65% were interviewed and 43% offered a position; 76% of the successful candidates were preference matched to theirs and the ITP's first choice. The retention rate to date is 92%. Conclusion: A state-wide selection process offers a transparent and meritorious means of selection of trainees in obstetrics and gynaecology. It has significant advantages over an individual hospital-based selection process for both trainees and hospitals. Outcome data for the optimal trainee to be selected are difficult to define. Reporting and reviewing data with a national selection process are imperative. The current selection process does not address issues that may be important for selection such as manual dexterity or psychological preparedness for the speciality of obstetrics and gynaecology. [ABSTRACT FROM AUTHOR]

Many women with problems in early pregnancy such as vaginal bleeding or abdominal pain present to the emergency department (ED). To describe demographic, service delivery and diagnostic characteristics of women who presented to the ED with a problem in early pregnancy. Data were reviewed for all electronically available ED presentations in 2008 in NSW, Australia according to diagnostic codes related to problems in early pregnancy ( N = 12,061). Descriptive statistics were used to illustrate relevant characteristics, and adjusted odds ratios were used to highlight the predictors of key service delivery outcomes. Women who presented to the ED for a problem in early pregnancy accounted for 1.2% of all ED presentations for women. The average age of women who presented to the ED for a problem in early pregnancy was 29.3 years, with 25% aged 35 years or older. Over a fourth (28%) of women presented to the ED on a weekend and over a third (37%) presented after-hours. Most (70%) women were seen according to their triage category, and the median length of stay in the ED was just under 4 h. One-fourth of women were admitted to hospital, which was 3.8 times more likely among women with an ectopic pregnancy. The findings of this research may be useful for hospitals and clinicians to review and improve their current service delivery models for women who present to the ED with a problem in early pregnancy. [ABSTRACT FROM AUTHOR]

We assessed the RANZCOG Basic Surgical Skills Workshop (BSSW) with regards to trainees' basic knowledge and skill using a laparoscopic pelvi-trainer. First-year trainees answered a multiple choice questionnaire (MCQ) and performed timed simulated laparoscopic exercises with a pelvi-trainer before completing a 2-day workshop. Assessment was repeated following the workshop, at 6 months and 5 years. MCQ results improved immediately after the workshop (baseline 16/34 vs post-course 23/34; P = 0.0001) declined at 6 months (post-course 24/34 vs 6 months 20/34; P = 0.009) with no change at 5 years (20/34 at 5 years). The time to complete both the simple and the complex laparoscopic exercises improved significantly following the workshop (simple: baseline 30 s, post-course 23 s; P = 0.008, complex: baseline 219 s, post-course 145 s; P = 0.0001) and was maintained at 6 months (simple: post-course 22 s, 6 months 23 s; P = 0.644, complex: post-course 124 s, 6 months 125 s; P = 0.958), but the time to complete the simple exercise was no better at 5 years and the time to complete the complex exercise was increased at 5 years (6 months 115 s, 5 years 172 s, P = 0.023). First-year trainees' basic knowledge of electrosurgery, hysteroscopy and laparoscopy and the time to perform skills on a laparoscopic pelvi-trainer improved after a BSSW but there was no further improvement at 5 years. [ABSTRACT FROM AUTHOR]