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Aims: Maternal overweight and obesity in pregnancy are known to increase the risk of a range of complications and adverse pregnancy outcomes. This study estimates the population‐level contribution of maternal overweight and obesity to adverse pregnancy outcomes. Methods: Data derived from the Australian Capital Territory (ACT) Maternal and Perinatal Data Collection were analysed. A total of 24 161 women who had a singleton birth in 2009–2015, with maternal weight and height information available, were included. In this study, the association between risk factors and outcomes was investigated using multilevel regression modelling. Based on model predictions under various hypothetical maternal weight scenarios, the number and proportion of adverse perinatal outcomes that could be potentially prevented were estimated. Results: Maternal overweight and obesity were associated with increased risks of gestational diabetes mellitus (GDM), pre‐eclampsia, caesarean delivery, preterm birth (PTB), large for gestational age (LGA) and admission to the special care nursery or neonatal intensive care unit (SCN/NICU). The estimated proportions of adverse pregnancy outcomes attributable to overweight and obesity in pregnancy are 29.3% for GDM, 36.2% for pre‐eclampsia, 15.5% for caesarean delivery, 21.6% for longer antenatal stay in hospital (≥2 days), 16.3% for extreme PTB, 25.2% for LGA and 6.5% for SCN/NICU admission. Conclusions: Maternal overweight and obesity contribute to a large proportion of obstetric complications and adverse outcomes in the ACT. Effective intervention strategies to reduce the prevalence of overweight and obesity in pregnant women could have significant beneficial effects on pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: As age is not modifiable, pregnancy risk information based on age alone is unhelpful for older women. Aim: To determine severe morbidity/mortality rates for women aged ≥35 years according to maternal profile based on parity, pre‐existing medical conditions and prior pregnancy complications, and to assess the independent contribution of age. Materials and methods: Population‐based record‐linkage study using NSW hospitalisation and birth records 2006–2012. Maternal and perinatal mortality/morbidity were assessed for non‐anomalous singleton births to women aged ≥35 years. Results: For 117 357 pregnancies among 99 375 women aged ≥35 years, the median age at delivery was 37 years (range 35–56 years), including: 35 652 (30.4%) multiparae without pre‐existing medical or obstetric complications, 33,058 (28.2%) nulliparae without pre‐existing medical conditions and 30 325 (25.8%) multiparae with prior pregnancy complications. Maternal and perinatal mortality/morbidity varied by maternal profile with ranges of 0.9–3.5% and 2.4–11.9%, respectively. For nulliparae, each five‐year increase in age did not contribute significantly to maternal risk after controlling for medical conditions (adjustedodds ratio 1.08, 95% CI 0.93–1.25), but did confer perinatal risk (1.14; 1.05–1.25). For multiparae, each five‐year increase in age beyond 35 years was independently associated with adverse maternal (1.23; 1.09–1.39) and perinatal outcomes (1.23; 1.09–1.39). Conclusions: For women aged ≥35 years, presence of medical conditions conferred a greater risk for morbidity/mortality than age itself. For multiparous women, the effects of medical and obstetric history were additive. The contribution of maternal age to adverse outcomes in pregnancies without significant medical and obstetric history is modest. [ABSTRACT FROM AUTHOR]

Background The diagnostic criteria for gestational diabetes ( GDM) have been controversial following the International Association for Pregnancy Study Groups ( IADPSG) 2010 recommendations to lower the diagnostic fasting blood sugar level threshold. Aim To assess the pregnancy-related outcomes of women according to the different diagnostic criteria for GDM adjusting for body mass index categories. Method A retrospective observational cohort study was conducted on 4081 pregnant women with positive 50 g glucose challenge test but without pre-gestational diabetes. Participants were grouped into four cohorts: no GDM (control group); GDM on Australasian Diabetes in Pregnancy ( ADIPS) 1998 criteria only (treated); GDM on IADPSG 2010 criteria only (untreated); and GDM on both criteria (treated). The association of each cohort with pregnancy outcome measures, including birthweight centile, delivery gestation, primary caesarean section, shoulder dystocia and stillbirth, together with the effect of obesity, were examined. Results Women diagnosed with GDM according to the IADPSG 2010 (untreated) but not the ADIPS 1998 criteria (treated) had an increased risk of being large for gestational age ( LGA) (odds ratio ( OR) = 2.45, 95% CI: 1.46-4.12, P = 0.001) and primary caesarean section ( OR = 2.03, 95% CI: 1.23-3.35, P = 0.006) compared to control women. Among the women in this untreated group and women without GDM, obese women had an increased risk of LGA ( OR = 3.82, 95% CI: 2.87-5.10, P < 0.001), shoulder dystocia ( OR = 1.50, 95% CI: 1.03-2.19, P = 0.04) and primary caesarean section ( OR = 1.63, 95% CI: 1.26-2.10, P < 0.001), compared to those women of normal weight. These associations remained significant on multivariate analysis. Conclusion Untreated women who would be diagnosed with GDM using the new criteria have an increased risk of pregnancy complications, with maternal obesity having an even greater risk. [ABSTRACT FROM AUTHOR]

The article offers information on the impact of assisted reproductive technology in treatment of women with a high body mass index (BMI). Topics discussed include women with a high BMI face greater risks procedurally and with pregnancy outcomes; rate of pregnanacy has been lower in womens with high BMI; and increase in rates of pre-eclampsia and gestational diabetes lead to induction of labour.

Background There are no contemporary cohorts examining pregnancy outcomes in women with type 2 diabetes (T2D) in Australia. Aim To compare pregnancy outcomes in women with and without T2D, and assess effects of body mass index ( BMI) and glycaemic control on outcomes. Materials and methods An historical cohort study was conducted of all singleton births > 20 weeks gestation at a specialist maternity network in Australia from 2010 to 2013. Data were extracted from the Birthing Outcomes System database. Multivariable logistic regression analysis was used to examine associations between presence of T2D and pregnancy outcomes. Results Outcomes for 138 pregnancies with T2D and 27 075 pregnancies in women without diabetes were compared (type 1 diabetes and gestational diabetes excluded). Women with T2D were older and more overweight compared to women without diabetes ( P < 0.01). Their babies were born earlier ( P < 0.01) with increased risk of large for gestational age (adjusted odds ratio 2.13 (95% CI 1.37-3.32)), hypoglycaemia (4.90 (2.79-8.61)), jaundice (2.58 (1.61-4.13)) and shoulder dystocia (2.72 (1.09-6.78)), but not congenital malformations or perinatal death. Women with T2D had a higher risk of induction (4.03 (2.71-5.99)), caesarean section (2.10 (1.44-3.04)), preterm birth (2.74 (1.78-4.24)) and pre-eclampsia (2.75 (1.49-5.10)). An HbA1c ≥ 6.0% (42 mmol/mol) was associated with increased preterm birth, special care nursery admission, hypoglycaemia and jaundice. Conclusions Despite availability of preconception care, good glycaemic control and specialist management, T2D remains associated with increased adverse obstetric and neonatal outcomes. Further research to examine predictors of adverse outcomes may assist in targeted antenatal surveillance and management. [ABSTRACT FROM AUTHOR]

Background Conception using assisted reproduction treatments ( ART) has been associated with an increased risk of pregnancy complications. It is uncertain if this is caused by ART directly, or is an association of the underlying factors causing infertility. Aims We assessed the relationship between assisted conception (AC) and maternal or fetal complications in a large retrospective cohort study. In a nested cohort of women receiving infertility treatment, we determined if such risk rests predominantly with certain causes of infertility. Materials and Methods Retrospective database analysis of 50 381 women delivering a singleton pregnancy in four public hospital obstetric units in western Sydney, and a nested cohort of 508 women receiving ART at a single fertility centre, in whom the cause of infertility was known. Results A total of 1727 pregnancies followed AC; 48 654 were spontaneous conceptions. Adjusted for age, body mass index and smoking, AC was associated with increased risk of preterm delivery ( OR 1.73, 95% CI 1.50-2.02), hypertension ( OR 1.55, 95% CI 1.34-1.82) and diabetes ( OR 1.51, 95% CI 1.30-1.75). In the nested cohort, ovulatory dysfunction was present in 145 women and 336 had infertility despite normal ovulatory function. Ovulatory dysfunction was associated with increased risk of diabetes ( OR 2.94, 95% CI 1.72-5.02) and hypertension ( OR 2.40, 95% CI 1.15-5.00) compared to women with normal ovulatory function. Conclusions Assisted conception is associated with increased risk of pregnancy complications. This risk appears greatest for women whose underlying infertility involves ovulatory dysfunction. Such disorders probably predispose towards diabetes and hypertension, which is then exacerbated by pregnancy. [ABSTRACT FROM AUTHOR]

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

The article discusses issues concerning planned vaginal breech birth focusing on the increased risks for the baby. It mentions the need to inform women about planning delivery for a breech baby and the risk of perinatal mortality with caesarean section. It also mentions that selection of appropriate pregnancies and skilled intrapartum care may allow planned vaginal breech birth to be as safe as planned vaginal cephalic birth.

The article discusses a study wherein the Term Breech Trial (TBT) showed that a policy of planned caesarean delivery that is safer than a policy of planned vaginal birth for the term fetus in the breech presentation. It discusses debate surrounding the safety of vaginal breech birth. It also mentions that in multiparous women, perinatal mortality and morbidity remained higher after planned vaginal birth compared with planned caesarean section.

Objective We examined the immediate and long-term health outcomes of hospitalised pregnancy-related assault. Methods A retrospective review of hospital records was conducted using data from the New Zealand Ministry of Health's National Minimum Data Set of hospital discharges. The hospital records of pregnant women admitted to a public hospital in New Zealand between 2001 and 2006 were included in this investigation. Unique identifiers were used to identify the index pregnancy event, subsequent discharge events and mortality for five years after the index event. Discharge records were grouped as follows: pregnancy-related hospital admission, but no associated or subsequent assault recorded (pregnant only); an assault-related hospital admission event after the pregnancy, but within five years of the index pregnancy (assault after pregnancy); an assault recorded within the same hospital admission event as the pregnancy (assault during pregnancy). Generalised linear models for the binomial family were conducted to explore increased risk ratios of adverse maternal, fetal and subsequent injury outcomes depending on group assignment. Results Compared with the pregnancy-only group, the assault after pregnancy and assault during pregnancy groups had increased risk ratios for death, preterm labour, antepartum haemorrhage, infectious complication, spontaneous abortion and stillbirth. Conclusion Assault during pregnancy substantially increased the risks for a number of adverse maternal and fetal outcomes. The identification of women who live in a violent relationship and the provision of adequate social support to these women may reduce the risks of subsequent injury and adverse maternal and fetal outcomes. [ABSTRACT FROM AUTHOR]

Background The widespread use of assisted reproductive technologies has led to an increase in the prevalence of monozygotic twins. Twinning after blastocyst transfer results in monochorionic placentation; a form of placentation that is associated with higher risks of mortality and morbidity. Aims This study describes complication rates of monochorionic diamniotic ( MCDA) twin pregnancies and examines whether they differ between spontaneous and assisted conceptions. Methods A five-year retrospective review of 294 MCDA twin pregnancies that had no evidence of structural abnormality on ultrasound at 12 weeks' gestation. Outcomes of spontaneous and assisted conceptions Day 3 ( D3) cleavage stage embryo or Day 5 ( D5) blastocyst transfer) pregnancies were compared. Results Two hundred and eighteen (74.1%) MCDA twin pregnancies were conceived spontaneously, whilst 14 (4.8%) resulted from D3 cleavage stage embryo and 62 (21.1%) resulted from D5 blastocyst transfer. Fetal and whole pregnancy loss rates were high, affecting 11.4% and 8.8% of cases, respectively. 16.2% of pregnancies were delivered <32 weeks' and 66% <37 weeks' gestation. 36.2% of infants were small for gestational age and selective intrauterine growth restriction ( IUGR) affected 7.5% of pregnancies. There was no significant difference in the prevalence of complications between spontaneous and assisted conceptions. Conclusions Assisted conception with either D3 cleavage stage embryo or D5 blastocyst transfer does not increase the risk of complication in a MCDA twin pregnancy. Mortality in monochorionic twins remains high despite early recognition and heightened surveillance throughout pregnancy. Information describing the risks of monochorionic twinning and of subsequent complications may be of value to women undergoing assisted conception. [ABSTRACT FROM AUTHOR]

Background A low-lying placenta detected at the mid-pregnancy ultrasound is commonly reported to warn against potential morbidity associated with placenta praevia. There is no information on what distance away from the internal cervical os is safe. Aims We examined whether a low-lying placenta not overlapping the cervical os in the second trimester increases the risk of obstetric complications and whether there is a cut-off point at which that increase occurs. Methods Adverse perinatal outcomes were examined prospectively in a cohort of women with a placenta 0-30 mm from the internal cervical os ('low-lying') at the routine mid-trimester ultrasound and compared to those with a placenta further away. Two composite outcomes of 'major' and 'minor' adverse events were predefined as primary outcome measures, requiring a sample size of 480 women with a low-lying placenta. Chi-square and Fisher's exact tests were used for statistical analysis. Results In 1662 pregnancies ('low-lying': n = 484; 'normal': n = 1178), there was no increase in composite adverse outcomes with a low-lying placenta and no cut-off distance within 30 mm from the cervical os at which risks increased. Postpartum haemorrhage ≥1000 mL was more frequent with a low-lying placenta (7.6% vs 4.7%, P < 0.05). Conclusions Women with a low-lying placenta, not overlapping the cervical os, in mid-pregnancy are at no higher risk of adverse outcomes than those with a normally located placenta, except postpartum haemorrhage. This suggests that the high-risk label can be removed from pregnancies with a low-lying placenta not overlapping the cervical os in mid-pregnancy, reducing anxiety and resource utilisation. [ABSTRACT FROM AUTHOR]

Background: Papua New Guinea is a developing country with a population of six million, facing significant geographical, cultural and economic barriers to the provision of antenatal and intrapartum care. The maternal mortality ratio (MMR) is an internationally regarded index of the quality of a country’s maternity services; the most recently reported MMR for Papua New Guinea of 773 deaths per 100 000 births is one of the highest in the world. Aims: To review information about women who died from pregnancy-related causes, both direct and indirect, in the Goroka General Hospital (GGH) during the period 1st January 2005 to 31st May 2008. Methods: A retrospective review was undertaken of the charts of women recorded as dying in the Obstetrics and Gynecology (O&G) ward of GGH in the study period. Results: The charts of 21 women who died from pregnancy-related causes were reviewed and information collated. Puerperal sepsis and sepsis complicating unsafe abortion were the most common causes of maternal death accounting for 48% deaths. Other causes included ectopic pregnancy and postpartum haemorrhage. Contributing factors included residence in a rural area, geographical and transport difficulties accessing care, non-use of family planning services, non-booking for antenatal care and late presentation in pregnancy or labour, and under-resourcing of services at GGH. The socio-economic status of most of the women was low, and where educational attainments were recorded these were also low. 71% of women identified themselves as practising Christians. Conclusions: Better outreach services to provide health information and antenatal care, with specific counselling about the need for supervised delivery, are urgently required in the Eastern Highlands Province that GGH serves if numbers of maternal deaths are to be reduced. Working through churches in the region may be the most appropriate way to provide information and services to women because a majority of women adhere to Christianity and can be reached in this way. [ABSTRACT FROM AUTHOR]

Background: The major concern in gestational trophoblastic disease is management of persistent disease and malignant sequelae. However, prediction of response to treatment is difficult and methods used controversial. Aim and methods: To evaluate the usefulness of clinical presentation, methods of diagnosis and categorisation of risk in determining clinical outcomes, by analysis of a database of 705 registered patients collected over 30 years. Results: From the database, there were 97 patients who developed persistent disease and malignant sequelae on the basis of defined criteria – 80.4% had molar pregnancy and 19.6% non-molar pregnancy. Vaginal bleeding was not a common presentation; 59.8% had no clinical symptoms. According to protocol, monitoring by serial human chorion gonadotrophin (HCG) levels followed by imaging screen was used in all patients; histology was also available in 41.2% from hysterectomy and curettage specimens. There were 16 of 76 patients with persisting disease who had metastases (21.1%), and 2 of 20 patients with choriocarcinoma who had an antecedent molar pregnancy (10.0%). Based on five risk factors, 25 patients were categorised as ‘high risk’ and assigned to receive multi-drug chemotherapy. There were two deaths (2.1% for all malignant sequelae); both were from molar pregnancies. One patient failed to respond and the other suffered a complication of intensive chemotherapy. Conclusion: Serial HCG levels remain the best monitor to determine therapeutic response. Categorisation of ‘high risk’ by five factors is useful in treatment. Albeit a small series, clinical outcome is favourable with a five-year survival of 89.7%. [ABSTRACT FROM AUTHOR]

The article discusses the significance of patients, doctors, media and pharmaceutical companies in the prevention of multiple gestation in Australia and New Zealand. It highlights the importance of patient education on the accurate information of the risks and complications involved in multiple pregnancies. It mentions that media stories are unhelpful in offering information of grand multiple pregnancies by not showing the negative impact of premature children.

A letter to the editor in response to the article "Are 1st-trimester b-human chorionic gonadotrophin and pregnancy-associated plasma protein A levels predictive of intrapartum fetal compromise in a selected normal population?" by T. Prior in a 2014 issue is presented.