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Ambivalence in Australian thought on induction of labour, despite recent evidence, stands out in contrast to ever‐increasing rates of this intervention. As consent obligations on information provision have crystallised in maternity care, this article examines whether consumer‐led expectations and legal obligations may precipitate change to end the cultural stigma around induction of labour. [ABSTRACT FROM AUTHOR]

Background: Prioritising normal birth has led to harm in some instances in the United Kingdom. While Australian organisations also promote normal birth, its negative impact is less well understood here. Aims: This study explores the problems that may arise from the promotion of normal birth and the quality of clinical incident investigations. Materials and Methods: This study uses a survey‐based research design and has received 1278 responses. The main outcome measures include perceptions on bias against interventions, delays in interventions, systemic attempts to reduce caesarean rates, and clinical incident investigations. Results: The perception among both obstetric and midwifery cohorts is that the promotion of normal birth may sometimes or frequently lead to bias against intervention for women (93.8% vs 63.2%), bias against intervention for clinicians (81.1% vs 53.1%), delays in interventions (86.8% vs 37.4%), maternal request caesarean sections being discouraged (81.2% vs 66.9%), an increased emphasis on vaginal birth after caesarean (88.1% vs 69.3%), and a culture of vaginal births 'at all costs' leading to poor outcomes for mothers and babies (79.5% vs 24.7%). Respondents believe clinical incident investigations to be 'frequently' independent (48% vs 48.2%) but engagement of women in these processes is often missing or 'rarely' seen (46.6% vs 51.7%). Conclusions: This study finds that Australian maternity healthcare providers believe institutional encouragement of normal birth has created work practices in maternity care that compromise patient safety and reduce the agency of the woman in the choices she makes. Current regulatory standards must change to reflect core ethical and legal obligations around informed consent. [ABSTRACT FROM AUTHOR]

Background: Despite being an efficacious means of pain relief, there is a broad range of usage rates of epidural analgesia among countries worldwide. Australia sits between common usage in North America and more conservative usage in the UK. The reason for this is unclear, raising the question of whether there is a difference between Australia and other Western countries in pregnant women's attitudes toward epidural use, or the hospital context. Aim: To explore predictors for epidural analgesia request among pregnant women in Townsville, Australia. Materials and Methods: A three‐phase mixed methods exploratory study design, with Phase One involving 12 one‐on‐one interviews with pregnant and post‐partum women regarding attitudes toward labour analgesia decision‐making and epidural preferences. Interview data were analysed thematically to develop a survey distributed to 265 third‐trimester women in Phase Two. Phase Three involved a chart review of survey participants to record delivery mode, epidural request and indication. Bivariate and logistic regression analysis of Phases Two and Three data were used to develop predictive models for epidural decision‐making. Results: Interviews revealed several themes influencing analgesia preferences in Townsville women: concerns regarding personal safety, trust in health professionals, and previous experiences with labour. The logistic regression identified epidural request in labour to be predicted by: primiparity, epidural experience, induction or augmentation of labour, and perceived sense of control associated with epidural use. Conclusions: This study suggests that the most significant influencers on Townsville women's epidural decision‐making were parity, induction or augmentation of labour, previous experience of epidurals and attitude toward epidurals. [ABSTRACT FROM AUTHOR]

Rising rates of caesarean section (CS) have been attributed, in part, to maternal‐choice CS (MCCS). There are few published data regarding maternal and perinatal risks comparing MCCS with planned vaginal birth (VB) in uncomplicated first pregnancies to inform choice. We report the results of a pragmatic patient‐preference cohort study of private patients in Australia: 64 women planning MCCS and 113 women planning VB. There were few differences in outcome between the two groups. The study highlighted the well‐recognised difficulties in undertaking prospective research into MCCS. [ABSTRACT FROM AUTHOR]

Background Pelvic floor dysfunction ( PFD) is the most common complication of childbirth. Assumptions have been made that perineal trauma increases the risk of PFD compared to an intact perineum, however the evidence for this is lacking. The aim of this study was to explore the relationship between perineal outcome and postpartum PFD. Materials and Methods Prospective cohort study design, with a self-reported quality of life ( QOL) questionnaire mailed to all primiparous women with a non-instrumental delivery at The Townsville Hospital between 2011 and 2012 ( n = 766). ANOVA was used to compare how the symptoms of PFD affect QOL in women with an intact perineum, episiotomy or spontaneous tear. Results Seventy-nine percent of the population had perineal injury; 60% had a spontaneous tear and 19% had an episiotomy. Ninety-seven percent of women who completed the questionnaire ( n = 196) complained of PFD symptoms. Women with episiotomy had the best QOL, reporting the lowest levels of urinary dysfunction (statistically significant). No differences between the groups were found for symptoms of bowel, prolapse or sexual dysfunction. Conclusions This study shows a relationship between perineal outcome and PFD and suggests that an episiotomy is associated with the least morbidity due to symptoms of urinary incontinence. Additional large-scale prospective research is required to further investigate and delineate the impact of childbirth on PFD. [ABSTRACT FROM AUTHOR]

Background and Aim Mesh reinforcement is considered an effective method for anterior compartment prolapse repair. Two common methods of mesh reinforcement involve either transobturator fixation (eg Perigee™) or lateral and apical anchoring (eg Anterior Elevate™). The aim of this study was to assess subjective and objective outcomes after Anterior Elevate and Perigee mesh kit surgery. Materials and Methods This was a surgical audit of patients after anterior colporrhaphy ( AC) with mesh reinforcement, undertaken at three tertiary urogynaecological centres. All patients were assessed for prolapse recurrence, which was defined as either (i) symptoms of prolapse (vaginal lump/dragging), (ii) ICS POPQ ≥ Stage 2, or (iii) bladder descent ≥10 mm below the symphysis pubis on transperineal ultrasound. Mesh co-ordinates and organ descent on Valsalva were determined relative to the inferior symphyseal margin. Results Two hundred and twenty-nine patients with anterior compartment mesh (138 Perigee, 91 Elevate) were assessed at a median follow-up of 1.09 years ( IQR 0.65-2.01). On assessment, 24% ( n = 55) had symptoms of prolapse recurrence, 46% ( n = 106) had a clinical recurrence, and 41% ( n = 95) a recurrent cystocele sonographically. All objective results favoured the Perigee group. The superiority of the Perigee kit remained highly significant ( P < 0.0001 for all clinical and ultrasound measures of prolapse recurrence) on multivariate analysis. Conclusions This retrospective analysis suggests that apical anchoring such as Anterior Elevate mesh system does not necessarily confer an advantage over the original transobturator mesh fixation technique for anterior compartment reconstruction. [ABSTRACT FROM AUTHOR]

Objectives: The Perigee transobturator cystocoele repair system (AMS) was designed and first used in Townsville, Australia. This prospective study evaluates the efficacy and safety of this device for the management of cystocoeles. Methods: Patients who underwent surgery with the Perigee system between March 2004 and December 2005 were reviewed. Patients who consecutively presented to our clinic with a stage 3 cystocoele or above were given information regarding the Perigee mesh surgery. Those who consented were included in our study. The study involved a questionnaire and POPQ assessment pre- and postoperatively at six weeks, three months, six months, 12 months and subsequently biannually. Results: A total of 70 patients underwent surgery with the Perigee system between March 2004 and December 2005. There were no life-threatening complications with the procedure. Five (7.1%) patients were found to have small mesh extrusion through the vagina, and three (4.28%) patients had recurrence of stage 2 cystocoele. Discussion/Conclusion: On medium-term evaluation (18 to 36 months) of the Perigee system the results seem very encouraging. The morbidity is minimal, as is the recurrence and mesh extrusion rate. [ABSTRACT FROM AUTHOR]

A prospective observational study of 96 patients undergoing insertion of the MONARC transobturator tape (American Medical Systems, Minnetonka, USA) for treatment of urodynamic stress incontinence was conducted to investigate its’ the safety and efficacy. Although there were no major intraoperative complications, sling protrusion was observed in 11/91 patients (12.1%) at early follow up visits. At these visits, 80 women (87.9%) were either completely or substantially continent and 74 women (81.3%) were satisfied with the operation. Objectively, 74 women (81.3%) were cured on urodynamic assessment and only one woman (1.1%) was found to have voiding dysfunction. As a conclusion, it would appear that this new technique is effective for the treatment of stress incontinence; but further studies are needed to investigate its long-term results and complications. [ABSTRACT FROM AUTHOR]

To compare the safety and efficacy of three types of suburethral slings for the treatment of urodynamic stress incontinence.Following ethics approval, 195 (3 × 65) patients with urodynamic stress incontinence were randomly assigned to undergo suburethral slingplasty with the Tension-free Vaginal Tape (TVT; Gynecare, Ethicon, Somerville, NJ, USA), Intravaginal Sling (IVS; Tyco Healthcare, Mansfield, MA, USA), or Suprapubic Arc Sling (SPARC; American Medical Systems, Minnetonka, MN, USA). The patients were blinded to the type of sling implanted.(1) operative and short-term complications; (2) pre- and postoperative symptomatology; and (3) pre- and postoperative urodynamic findings.There was a statistically significant increased rate of sling protrusion (13.1% vs. 3.3% and 1.7%;P = 0.04) in the SPARC group when compared to TVT and IVS. Otherwise, there were no significant differences between the groups with respect to the incidences of other operative complications, patients’ main subjective outcomes, satisfaction rates, or postoperative urodynamic findings. The overall objective stress incontinence cure rates were 87.9%, 81.5% and 72.4% for the TVT, IVS, SPARC groups respectively (P = 0.11).All three slings appear quite successful for the treatment of stress incontinence. The SPARC tapes showed more sling protrusion complications and a trend towards lower objective cure rates; probably as a result of the insertion method used in this study which favoured a loose SPARC sling placement. The authors recommend that the SPARC slings be left tighter than TVT, or for the cough test to be carried out. [ABSTRACT FROM AUTHOR]

To compare the vaginal configuration on magnetic resonance imaging following transvaginal sacrospinous fixation (SSF), posterior intravaginal slingplasty (PIVS) (infracoccygeal sacropexy) and sacrocolpopexy (SCP). Twenty-one patients with vault prolapse requiring surgical treatment were randomly assigned in a balanced way to undergo SSF ( n = 7), PIVS ( n = 7) or SCP ( n = 7). The magnetic resonance imaging of the pelvis were performed preoperatively and at 6–12 weeks postoperatively to assess the vaginal configuration using the method described previously. The two main angles measured were: (i) the angle between the lower vagina and pubococcygeal line ‘d-angle’ (normal: 53 ± 15°); and (ii) the angle between the lower and upper vagina planes ‘e-angle’ (normal: 145 ± 7°). The mean preoperative/postoperatively measured d-angles were 69°/62°, 58°/70°, and 49°/52° for SSF, PIVS and SCP, respectively. The corresponding means for the e-angle were 173°/215°, 189°/146°, and 205°/149°. The changes of the e-angles proved to be statistically significant ( P < 0.05) in each surgical group, while no significant change in the d-angle could be found in any of the three groups. Significant improvements in the restoration of vaginal configuration were achieved in patients who underwent PIVS or SCP. Sacrospinous fixation in contrast seems to increase anatomical distortion of the vaginal configuration. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 62 year old woman with a history of two normal vaginal deliveries who presented to physicians with vaginal prolapse and worsening stress urinary incontinence, despite the use of topical oestrogen cream and pelvic floor exercises and had surgery to repair her vaginal prolapse and incontinence. A discussion of a systemic allergic reaction which the patient had to a mid urethral sling that had been implanted during her surgery is presented.

Aim: To study the incidence of erosions and tape infections following the use of intravaginal slingplasty (IVS) treatment for stress urinary incontinence after the SUSPEND trial period of 30 months. This subanalysis was carried out because of concerns regarding high percentage of delayed sling erosions and infections during follow up of the patients who participated in the trial. Materials and methods: The subanalysis patient group consisted of all IVS patients drawn from the SUSPEND randomised control trial that compared the safety and efficacy of three types of suburethral slings, TVT, SPARC and IVS, for the treatment of urodynamic stress incontinence. Results: A total of 62 patients were reviewed during this study conducted from April 2002 to May 2003. Continence was achieved in 88% the patients. A total of eight (13%) sling erosions were found requiring sling removal. Forty-eight (77.4%) patients were followed up at 12 months with one case of erosion (1.7%). Twenty-nine (46.8%) of the 62 patients were followed up between 12 and 34 months, and seven cases of sling erosions were diagnosed. One patient had purulent suprapubic sinus, five patients had foul-smelling discharge, and one had recurrent urinary tract infection associated with pain and discharge. After the slings were removed the patients had no further symptoms. However, three of them had recurrent stress urinary incontinence. Discussion/conclusion: The delayed presentation of the sling erosion from this subanalysis is a concern, and pelvic reconstructive surgeons using IVS need to be aware of the delayed presentations we found in our cohort of patients. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 43 year old woman who presented to physicians with progressively worsening stress urinary incontinence and prolapse. A discussion of Miniarc surgery which was conducted on the patient and which resulted in a pelvic haematoma is presented. Successful treatment which the woman received for the haematoma is discussed.