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Aims: The combined oral contraceptive (COC) is the most commonly used hormonal contraceptive in Aotearoa New Zealand (Aotearoa/NZ). Currently there is limited data available on who uses COC in Aotearoa/NZ. The aims were to (i) define the population of reproductive‐aged females in Aotearoa/NZ in 2018 and identify the rate of COC use among this group and (ii) describe the sociodemographic and geographic characteristics of the population of COC users compared to the general population of reproductive‐aged females in 2018. Methods: This whole‐of‐population cross‐sectional study used the Integrated Data Infrastructure, a large research database managed by Statistics New Zealand. Females aged 16–50 years with complete sociodemographic and geographic information in 2018 from Aotearoa/NZ's estimated resident population were included. COC dispensing records to this cohort were identified from the national Pharmaceutical Collection. This paper reports descriptive counts of COC use and employs generalised linear regression with a binomial distribution and a log link to estimate adjusted risk ratios (aRR) of COC use for key sociodemographic and geographic subgroups. Results: Of 1 113 750 individuals in the study, 159 789 (14.3%) were dispensed as COC in 2018. European/other individuals were most likely to use COC (aRR: 2.72, 2.67–2.78), and Pacific Peoples were least likely (aRR: 0.56, 0.55–0.58) to use COC. Individuals residing in the most deprived quintile had less COC use than individuals in the least deprived quintile (aRR: 0.73, 0.72–0.74). Conclusion: Our study is able to highlight significant disparities in use by ethnicity, area‐level deprivation, and geographic factors. [ABSTRACT FROM AUTHOR]

Background: Endometrial carcinoma (EC) is increasing in incidence, attributed largely to the obesity epidemic. Ethnic differences in New Zealand have long been recognised, with Pacific women bearing the greater burden of disease. We hypothesise that the pooled national incidence rates underestimate the true burden of EC in our high‐risk community. Aims: We aimed to: (1) determine the incidence, trends and outcome of EC in the high‐risk community served by our hospital, relative to national data; and (2) examine associated demographic, and clinicopathological features with reference to risk factors, to identify potential clinical and population intervention points. Materials and Methods: All area‐resident women treated for EC at Middlemore Hospital from 2000 to 2014 were identified from records, and clinicopathological data obtained. Incidence and time trend analyses were performed with reference to tumour type, age and ethnicity. Results: The study included 588 women. Pacific, followed by Māori, women had the highest incidence of EC (relative risk = 5.11 and 2.47, respectively, relative to 'Other' women). The incidence increased for all ethnicities (annual percentage change (APC) of 7.3; 95% CI 3.6–11.1), most marked in women aged below 50 years (APC of 12.2; 95% CI 5.2–19.7). This occurred predominantly in Pacific women, who had a high prevalence of potentially reversible risk factors. Disease‐specific survival was worse in Pacific, and to a lesser extent, Māori women. Conclusions: Prompt investigation of symptomatic, high‐risk women regardless of age may detect endometrial abnormalities at an early, potentially reversible stage. The prevention and management of identifiable high‐risk factors would help mitigate the risk of EC and associated diseases. [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: Growth charts customised for maternal height, weight, ethnicity and parity have been proposed as more effective at detecting infants who are small for gestational age (SGA) than routine screening with symphysio‐fundal height measurement alone. Our non‐randomised, prospective cohort study assessed antenatal SGA detection rates in a general maternity cohort following the introduction of the Perinatal Institute's Growth Assessment Protocol (GAP) program (consisting of customised growth chart software for plotting symphysio‐fundal height, staff training and serial auditing). Methods: The GAP program was implemented into the routine antenatal schedule of 882 women who delivered at The Royal Women's Hospital, Melbourne, during our study period. SGA detection was compared to 936 women from the same team who delivered prior to the intervention. Secondary outcomes assessed were infant gestation at birth and method of delivery, neonatal Apgar scores and admission to the Neonatal Intensive and Special Care nursery (NISC). Results: Identification of SGA infants increased from 21% to 41% with the introduction of the GAP program (OR 2.6, 95% CI 1.3–4.9, P < 0.05). This was not associated with an increase in false‐positive rates. Following the introduction of the GAP Program, SGA babies were more likely to be born by vaginal delivery (OR 2.7; 95% CI 1.4–5.1, P < 0.005). There was no overall increase in the induction of labour or caesarean delivery rates. Overall rates of admission to NISC were reduced. Conclusions: In our increasingly culturally heterogenous society, the use of the GAP program is a safe and potentially more sensitive tool for detecting in utero growth restriction. [ABSTRACT FROM AUTHOR]

Background: Germline BRCA1/2 mutations account for approximately 15% of invasive ovarian carcinomas. Referral of all women with non‐mucinous epithelial tubo‐ovarian and peritoneal cancer, especially high‐grade serous carcinoma (HGSC) to genetic services for genetic counselling and subsequent BRCA testing, has become standard of care in many countries. Publicly funded BRCA testing was restricted to women ≤70 years old with HGSC in New Zealand for most of our study period. Referral rates of women with HGSC for BRCA mutation testing in New Zealand have not previously been reported. Aims: To determine the proportion of eligible patients with tubo‐ovarian or peritoneal HGSC referred to Auckland Gynaecologic Oncology Centre who were referred for genetic counselling. To determine the number of patients who underwent BRCA1/2 genetic testing and the rate of germline BRCA mutations. Methods: Eligible cases were identified from Auckland Gynaecologic Oncology multidisciplinary meetings database from 1 January 2012 to 31 December 2014. Genetic referrals sent were checked against the genetic services database to ensure that referrals were received. Genetic counselling clinic attendance, uptake and results of genetic testing were also collected. Results: One hundred and four eligible patients were identified with 58 patients referred. Referral rates increased from 37.5% in 2012 to 64.3% in 2014. Of the 58 patients referred, 53 attended genetic counselling, and 49 underwent BRCA mutation testing, of whom 10 (20.4%) tested positive for a germline BRCA mutation. Conclusion: Overall, 55.8% of eligible patients were referred for genetic testing; however, referral rates increased with time. This BRCA mutation‐positive rate is comparable with current international data. [ABSTRACT FROM AUTHOR]

Babies born to mothers with gestational diabetes mellitus (GDM) are at a greater risk of developing respiratory complications and hypoglycaemia than those born to mothers without diabetes. However, there is currently insufficient evidence as to whether these risks are altered by antenatal corticosteroids after 37 weeks gestation. This retrospective study suggests that antenatal corticosteroids probably reduce respiratory admissions to the newborn intensive care unit with a mild increase in neonatal hypoglycaemia in women with GDM who deliver via caesarean section after 37 weeks gestation. Consequently, we recommend a randomised, controlled trial is required to determine the efficacy and safety of antenatal corticosteroids specifically in women with GDM. [ABSTRACT FROM AUTHOR]

Background: Recent guidelines suggest screening high‐risk women in early pregnancy for gestational diabetes (GDM); however, there is little evidence to support this. Aims: To compare pregnancy outcomes associated with diabetes for women with risk factors for GDM according to gestation of diagnosis. Early GDM was defined as a positive test before 20 weeks gestation, late GDM as a positive test at 20 or more weeks and no GDM when both tests were negative. Materials and methods: Retrospective analysis in an Australian tertiary hospital of women who underwent a glucose tolerance test in pregnancy prior to 20 weeks gestation, and a repeat test after 20 weeks gestation if the initial test was negative. Results were adjusted for maternal demographics. Results: Women with early GDM (n = 170) were no more likely to experience the obstetric composite outcome than women with late GDM (n = 171) or no GDM (n = 547) (early odds ratio (OR) 1.16, 95%CI 0.79–1.71; late OR 0.78, 95%CI 0.53–1.12). Infants of women with early GDM, but not late GDM, were more likely (early OR 1.8, 95%CI 1.15–2.92; late OR 1.4, 95%CI 0.90–2.23) to have the neonatal composite outcome than infants of women without GDM, predominantly due to an increase in neonatal hypoglycaemia. Conclusions: This result may be due to careful management of GDM, or because, after adjustment for maternal demographics, the early diagnosis of GDM does not substantially increase rates of adverse outcomes compared to GDM diagnosed in later pregnancy or no GDM in women with risk factors for GDM. [ABSTRACT FROM AUTHOR]

Background: Ultrasound‐guided manual vacuum aspiration (USG‐MVA) is an effective but underutilised alternative to medical or surgical evacuation of the uterus following first trimester miscarriage. Aims: To evaluate the efficacy, feasibility and patient acceptability of USG‐MVA for treating early pregnancy loss. Material and Methods: We invited patients with early pregnancy losses to participate in this prospective cohort study. We reviewed the medical records of the participants and their visual analogue pain score during MVA. Primary outcomes were efficacy, feasibility and patient acceptability of USG‐MVA. Secondary outcomes included the success rate of culture of chorionic villi for chromosomal analysis and complications from the USG‐MVA procedure. Results: We included a consecutive series of 35 women who underwent the USG‐MVA procedure. The efficacy of USG‐MVA in achieving complete evacuation was 97.1%. The procedure was well tolerated and the mean procedure‐related pain score was 6.25 out of 10 (SD 1.55). Overall, all patients were satisfied with the procedure. The successful culture rate of chromosomal analysis was 94.3%. There were no major complications. Conclusion: USG‐MVA is an effective treatment for the management of early pregnancy loss in an out‐patient setting. It is an alternative to surgical evacuation under general anaesthesia, particularly for women desiring chromosomal analysis of products of conception. Further studies are required to investigate its health‐related and economic benefits in hospital service provision. [ABSTRACT FROM AUTHOR]

Background High-quality, evidence-based guidelines can improve the quality of health care and facilitate standardisation of practice within and across healthcare organisations. Limited information is known regarding existing antenatal corticosteroid ( ACS) guideline practices within organisations across Australia and New Zealand. Aims To assess existing ACS clinical practice guidelines ( CPG). To describe current organisational practice related to the production, implementation and renewal of CPG. Design A cross-sectional survey of hospital practice using an online questionnaire. Methods Clinical Managers at 27 secondary and 25 tertiary maternity hospitals, that contribute data to the Australia and New Zealand Neonatal Network, were approached from May to September 2015 and completed the questionnaire on behalf of their organisation. Results Of the hospitals surveyed, 93% reported having a CPG or protocol. Of these, 89% of CPG included recommendations on a single course of ACS, 37% on the use of repeat course/s and 41% on use prior to elective caesarean section at term. Variation in the recommendations provided existed between countries and depending on the level of neonatal care provided. A guideline development group existed in 85% of hospitals. The preferred tools to facilitate implementation of a CPG include: email with a link to the hospital intranet, education sessions and an opinion leader. Only 28% of respondents reported auditing the use of ACS administration. Conclusions There is significant variation in the recommendations provided by current ACS CPGs. Utilisation of a single ACS CPG reflective of the current available evidence base may limit this variation. [ABSTRACT FROM AUTHOR]

Objective To assess the gastrointestinal functional outcomes and symptoms of low anterior resection syndrome after disc resection for deeply infiltrative endometriosis ( DIE) using a validated scoring system. Design Retrospective study to assess the gastrointestinal functional outcomes after rectal disc resection for DIE using a validated scoring system. Setting University tertiary referral centre. Patients Women who underwent disc resection for endometriosis at Royal Hospital for Women and Prince of Wales Private Hospital between January 2012 and December 2013 were included. Main outcome measure Low anterior resection syndrome ( LARS) score using a validated questionnaire. Results Forty-one women met the inclusion criteria. The mean age was 40 ± 10 years (range 22-75 years). All procedures were performed laparoscopically. Eleven women (27%) underwent a hysterectomy in addition to rectal disc resection and endometriosis surgery. Mean operative time for the entire cohort was 158 ± 64 minutes, and mean length of hospital stay was 5 ± 2 days. Completed questionnaires were received from 31 women, a response rate of 76%. The mean length of follow-up was 17 ± 10 months (range 3-34 months). The LARS scores ranged from 0 to 34 (median 15, interquartile range 0-24). Eight women (26%) had a LARS score of 0. Nineteen women (61%) had a LARS score less than 21 (the threshold for LARS). Conclusion Conservative treatment of DIE with rectal disc resection is safe and feasible and is associated with mild gastrointestinal dysfunction in the medium to long term. [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 Knowledge about expected insulin requirements during pregnancy, in women with pre-existing diabetes may assist clinicians to effectively respond to gestation-specific changes in glycemic pattern. Few studies have examined differences between type 1 (T1 DM) and type 2 diabetes (T2 DM). Aims To compare patterns of insulin requirements in pregnancy for women with pre-existing T1 DM and T2 DM. Material and Methods A retrospective cohort study of 222 pregnancies was conducted in women with pre-existing diabetes, (67 with T1 DM, 155 with T2 DM). Total daily insulin dose ( TID) at the end of each trimester, recorded as units and units per kilogram (median, 25th-75th percentile) as well as percentage increase in insulin dose per trimester were compared. Results Women with T1 DM had higher insulin requirements in the first two trimesters than those with T2 DM (0.69 (0.58-0.85) vs 0.36 (0.0-0.7) units/kg in first trimester; 0.80 (0.62-0.95) vs 0.61 (0.27-0.95) units/kg, P < 0.005) in second trimester), but requirements in late pregnancy were similar (0.97 (0.69-1.29) vs 0.95 (0.53-1.32) units/kg, P = 0.54). Women with T2 DM needed much greater increases in insulin per trimester compared to T1 DM ( P < 0.001). Women with T1 DM had a net fall in insulin requirements (3.7% in the first trimester and 4.1% in the late third trimester) while those with T2 DM did not. Conclusions This is the largest comparison study of insulin requirements in women with pre-existing diabetes, highlighting important trimester-specific differences between T1 DM and T2 DM to guide insulin titration during pregnancy. Our findings suggest a differential effect of pregnancy-mediated insulin resistance by type of diabetes. [ABSTRACT FROM AUTHOR]

Background The Australasian Diabetes in Pregnancy Society ( ADIPS) has recently endorsed the World Health Organization ( WHO) terminology and classification of hyperglycaemia in pregnancy. The prevalence is likely to increase, but no prospective data are available for a representative Australian population. Aims To determine the prevalence of hyperglycaemia in pregnancy ( HIP) using results from both the public and private sectors in a population that has a similar ethnicity to the overall Australian population. Material and Methods The results of all pregnancy oral glucose tolerance tests ( POGTT) in the public sector and by a dominant private pathology provider in a major city have been prospectively collected for a three-year period and analysed using the ADIPS ( WHO) criteria. Results The prevalence of hyperglycaemia in pregnancy ( HIP) was 13.1% with diabetes mellitus in pregnancy ( DIP) being 0.4% and gestational diabetes mellitus ( GDM) being 12.7%. Conclusion The new criteria will diagnose about one-third more women with GDM than the previous ADIPS criteria. This will have resource and health implications. Focussed local health economic data will be important. [ABSTRACT FROM AUTHOR]

Background Australian Fitness to Drive guidelines suggest that anyone who has had a seizure of any kind in the context of a 'metabolic' disorder should avoid driving for a period of 6 months. The special case of eclampsia is not mentioned. Aims In this study, we aimed to assess what advice healthcare professionals involved in the peripartum care of women provide to women who have an eclamptic seizure, what investigations they would conduct to exclude other causes of seizures and their level of awareness of whether eclampsia was addressed in the Australian Fitness to Drive guidelines. Materials and Methods A survey of 165 healthcare professionals attending the 2012 Society of Obstetric Medicine of Australia and New Zealand annual scientific meeting. Participants included registered nurses, midwives, consultant obstetricians, consultant physicians, doctors in training and others, interested in medical disorders of pregnancy. Results One hundred and nine conference attendees completed the survey (response rate 66.1%). 58 respondents (53.2%) had cared for 5 or more women with peripartum seizures, and 23 respondents (21.1%) had cared for 10 or more women with peripartum seizures. 46 respondents (42.2%) had never considered the issue of driving after an eclamptic seizure. For those who had considered the issue, advice ranged from no restriction ( n = 5, 4.6%), no driving for 1-2 weeks ( n = 14, 12.8%), no driving for 3 months ( n = 20, 18.4%) or no driving for 6 months ( n = 6, 5.5%). Conclusions Many healthcare professionals caring for women with peripartum seizures have not considered issues relating to fitness to drive after an eclamptic seizure. There is a wide range of advice provided. Better prospective data are required regarding the risk of subsequent seizure after eclampsia, to inform clear fitness to drive guidelines. [ABSTRACT FROM AUTHOR]

Objectives To study the association between maternal vitamin B12 levels and fetal growth restriction. Methods In this nested case-control study, a cohort of low-risk women attending the antenatal clinic had their blood samples taken and stored at 28-31 weeks gestation. They were followed until delivery. Fifty-eight women delivering babies less than 2500 g were taken as cases and an equal number of controls delivering babies more than 2500 g were taken from the same cohort. Their B12 levels were assayed and studied for statistical significance. Results The baseline characteristics of both groups were similar. The number of women with serum B12 levels less than 200 pg/mL were similar in both groups: 33% versus 29% ( P = 0.84). Type of kitchen fuel used was taken as a surrogate marker for socioeconomic status. More women in the cases used non- LPG (liquid petroleum gas) kitchen fuels such as kerosene and wood than in controls, 35% versus 19% ( P = 0.06). Conclusions No association between maternal vitamin B12 levels and fetal growth restriction was found in this study. Low birth weight babies were more common in women of low socioeconomic status. [ABSTRACT FROM AUTHOR]

Background While weight gain during pregnancy is regarded as important, there has not been a prospective study of measured weight gain in pregnancy in Australia. This study aimed to prospectively evaluate pregnancy-related weight gain against the Institute of Medicine ( IOM) recommendations in women receiving antenatal care in a setting where ongoing weight monitoring is not part of routine clinical practice, to describe women's knowledge of weight gain recommendations and to describe the health professional advice received relating to gestational weight gain ( GWG). Methods Pregnant women were recruited ≤20 weeks of gestation ( n = 664) from a tertiary obstetric hospital between August 2010 to July 2011 for this prospective observational study. Outcome measures were weight gain from pre-pregnancy to 36 weeks of gestation, weight gain knowledge and health professional advice received. Results Thirty-six percent of women gained weight according to guidelines. Twenty-six percent gained inadequate weight, and 38% gained excess weight. Fifty-six percent of overweight women gained weight in excess of the IOM guidelines compared with 30% of those who started with a healthy weight ( P < 0.001). At 16 weeks, 47% of participants were unsure of the weight gain recommendations for them. Sixty-two percent of women reported that the health professionals caring for them during this pregnancy 'never' or 'rarely' offered advice about how much weight to gain. Conclusions The prevalence of inappropriate gestational weight gain in this study was high. The majority of women do not know their recommended weight gain. The advice women received from health professionals relating to healthy weight gain in pregnancy could be improved. [ABSTRACT FROM AUTHOR]

Aims: We performed an age-matched case-control study to compare the clinical and pathology outcomes between histologically diagnosed primary malignant mixed műllerian tumour (MMMT) of the uterus and endometrial carcinoma. Methods: Thirty-two women were treated for primary MMMT at seven tertiary medical centres in Korea from 2000 to 2006. For each woman with MMMT, four women with endometrioid and two with non-endometrioid endometrial carcinoma were selected as age-matched controls for analysis. Medical records were retrospectively reviewed to obtain outcome data. Results: The incidence of MMMT was 2.57% (32/1244). In comparison with women with endometrioid endometrial cancer, those with MMMT were characterised by large tumour size, higher incidence of adnexal involvement and lymph node metastases, leading to advanced disease stage. Despite the frequent use of adjuvant treatment, the 5-year survival rate of women with MMMT was significantly poorer than those with endometrioid endometrial cancer. However, women with MMMT were not significantly different from those with non-endometrioid endometrial cancer in terms of important pathologic variables, apart from larger tumour size. In addition, the 5-year survival rate of women MMMT was poorer than that those with non-endometrioid endometrial cancer, but the difference was not statistically significant. Conclusions: Malignant mixed műllerian tumour is characterised by a high incidence of lymph node metastases and advanced stage at diagnosis, leading to poorer overall survival than other subtypes of endometrial carcinoma. Clinical trials for MMMT are critical for improving treatment strategies. [ABSTRACT FROM AUTHOR]

Obesity worsens and modest weight loss improves female fertility. Overweight women were randomised to lifestyle or standard treatment pre- in vitro fertilisation with treatment cessation at embryo transfer. There was a greater reduction in weight ( P < 0.001) for lifestyle treatment (−3.8 ± 3.0 kg, P < 0.001) compared with no changes for standard treatment (−0.5 ± 1.2 kg, P = 0.092). Both the intervention (−5.3 ± 4.6 cm) and control (−3.5 ± 3.5 cm) group had reductions in waist circumference ( P < 0.001) with no differences between the two groups ( P = 0.215). The overall pregnancy rate was 53% (20/38) for the intervention and control group combined. [ABSTRACT FROM AUTHOR]

Background: Opiate and amphetamine use during pregnancy is frequently associated with cigarette smoking. The negative effects on fetal growth from nicotine combined with opiates or amphetamines during pregnancy are not well documented. Aims: To investigate the relationship between maternal opiate or amphetamine use and smoking on fetal growth. Methods: A retrospective study was performed comparing pregnancies affected with either opiates or amphetamines with individually matched controls. All mothers smoked cigarettes during pregnancy. The outcome measures included changes in fetal abdominal circumference, head circumference and femur length during the second half of pregnancy and weight, length and head circumference at birth. Results: There were 91 opiate- and 37 amphetamine-affected pregnancies. Deviations from normative data only became apparent from the third trimester. The proportion of infants with a gestation-adjusted birthweight below the 10th percentile was not significantly different in the opiate group compared to their controls 35 (38%). However, there was a significant difference in proportions in the amphetamine group and their controls ( P < 0.001). We then compared antenatal growth patterns between the amphetamine group and their controls. Amphetamine-exposed fetuses showed comparable growth parameters in the second trimester but significantly larger head and abdominal circumferences and longer femoral lengths in the third trimester than their respective controls ( P < 0.05 for all). Conclusions: When combined with cigarette smoking, opiates had no observed independent effect on birth parameters. Unexpectedly, in the amphetamine group, the negative effects of smoking on growth were altered in late pregnancy. [ABSTRACT FROM AUTHOR]

Background: Intrapartum chemoprophylaxis for group B streptococcus (GBS) carriers reduces the risk of early-onset neonatal GBS infection. For women with β-lactam allergy, either erythromycin or clindamycin are administered. Recent reports worldwide suggest that GBS resistance to these antibiotics is increasing. Aims: To compare erythromycin and clindamycin resistance phenotypes in invasive neonatal GBS isolates across New Zealand and Australia over the past two decades and to determine whether regional variation in resistance patterns exist. Method: Invasive neonatal GBS isolates were collected from laboratories across New Zealand ( n = 107) and Australia ( n = 74) over two time periods (1992-1994 and 2002-2004 in New Zealand; 1982-2001 and 2002-2006 in Australia) and subjected to standard antibiotic susceptibility testing. A nested sub-study in New Zealand examined antibiotic susceptibilities of 112 maternal colonising GBS isolates during 2003-2004. Results: Erythromycin resistance among invasive neonatal GBS isolates increased across both countries over the past decade, with similar rates of resistance in New Zealand (9%) and Australia (6%) in recent years. New Zealand erythromycin-resistant GBS isolates commonly displayed cross-resistance to clindamycin. Also, there were significantly higher rates of isolated clindamycin resistance in GBS isolates from New Zealand than Australia ( P = 0.034). Maternal GBS isolates from New Zealand showed similar resistance patterns to neonatal isolates. Conclusion: Erythromycin and clindamycin resistance among invasive neonatal GBS isolates has emerged in both New Zealand and Australia over the past decade and is consistent with global trends in GBS resistance patterns. Although regional variations exist, these findings should be considered when implementing intrapartum GBS prevention strategies. [ABSTRACT FROM AUTHOR]

Aim: Inherited thrombophilic polymorphisms have been linked to pregnancy-related thromboembolism and other adverse pregnancy outcomes. As there are limited data on the prevalence of these polymorphisms in Australian populations, we aimed to assess this in an antenatal population. Methods: Healthy nulliparous women ( n = 2031) were recruited to this study. The women had no past or family history of venous thromboembolism. Women were excluded if they or a family member was known to be a carrier of any thrombophilic marker. Genotyping from venous blood for the factor V Leiden, prothrombin 20210A, MTHFR 677 and 1298 and thrombomodulin C1418T polymorphisms was undertaken. Results: Key findings were that 107 of 2019 (5.30, 95% confidence interval 4.36–6.37%) women tested were heterozygous carriers of factor V Leiden and one was homozygous (0.05, 0–0.27%); 2.43% of women were heterozygous carriers of the prothrombin gene mutation (1.80–3.20%) while no women were homozygous for this mutation; 11.62% (10.22–13.02%) and 9.98% (8.67–11.29%) were homozygous for the MTHFR 677 and 1298 polymorphisms, respectively, and 3.43% (2.63–4.22%) of women were homozygous for the thrombomodulin polymorphism. Conclusions: The prevalence of these polymorphisms is consistent with previously published data in Caucasian populations. These data will provide the basis for further assessment of the relationship between poor pregnancy outcome and these inherited thrombophilic polymorphisms in an asymptomatic antenatal population. [ABSTRACT FROM AUTHOR]