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Background: Previously, management of gestational diabetes (GDM) has focused largely on glycaemic control, with a view to reduce the occurrence of large‐for‐gestational‐age (LGA) infants. However, tight glycaemic control in GDM is associated with a higher incidence of small‐for‐gestational‐age (SGA) infants, which has been linked to higher rates of adverse outcomes. Aim: The aim was to characterise risk factors associated with having an SGA infant in women being treated for GDM. Methods: This was a retrospective observational cohort study of 308 women with GDM. Women were split into groups based on their infant's size at delivery (SGA, appropriate‐for‐gestational‐age (AGA) or LGA). Literature review and expert opinion helped to determine several predictors of women with GDM delivering an SGA infant, and statistical analysis was used to produce odds ratios (OR) for these predictors. Results: The sample included primiparous women with a mean pre‐pregnancy body mass index (BMI) of 25.72 (standard deviation: 5.75). Metabolic risk factors associated with delivering an SGA infant included a lower pre‐pregnancy BMI (adjusted OR 1.13, P = 0.04, 95% confidence interval (CI): 1.01–1.26), a lower fasting blood glucose level (BGL) (adjusted OR: 3.21, P = 0.01, 95% CI: 1.30–7.93) and growth that was high risk for SGA at baseline ultrasound scan (USS) (adjusted OR: 7.43, P < 0.001, 95% CI: 2.93–18.79). Conclusions: The combined clinical picture of lower pre‐pregnancy BMI, fasting BGL and baseline USS growth measurements may indicate a need for less aggressive glucose management in women with GDM to prevent SGA infants. [ABSTRACT FROM AUTHOR]

Objective: To review rates of and indications for late pregnancy feticide at a major Queensland tertiary perinatal centre over the past decade. Design: Retrospective cohort study. Setting, participants: The Centre for Advanced Prenatal Care at the Royal Brisbane and Women's Hospital, a tertiary perinatal centre; feticides of singleton pregnancies of at least 22 weeks' gestation, 1 January 2010 – 31 December 2020. Main outcome measures: Indications for feticide; median gestational age at feticide; referral source; time between referral, maternal–fetal medicine review, and feticide. Results: During 2010–2020, 305 feticides were undertaken at 22 weeks' gestation or later. The annual number of feticides increased from 20 in 2010 to 54 in 2020. The median gestational age at feticide was consistent across the decade (24+6 weeks; range, 17+0 to 37+1 weeks). The most frequent fetal indications for feticide were neurological abnormalities (110 of 305, 36%), aneuploidy or genetic syndromes (67, 22%), and cardiac malformations (59, 19%). Most women were seen for review within seven days of referral for feticide (154 of 197 for whom this information was available, 78%; median, five days; range, 0–34 days), and 136 of 197 feticides (69%) were undertaken within seven days of the initial maternal–fetal medicine review. Conclusions: Most late pregnancy feticides were performed because of fetal indications, primarily structural malformations or genetic abnormalities. Despite advances in prenatal imaging and diagnosis, late termination of pregnancy remains a necessary option in some pregnancies with maternal or fetal indications, and equitable access to late termination of pregnancy services is a vital component of reproductive health care. [ABSTRACT FROM AUTHOR]

Background: Consensus‐based recommendations guiding oral intake during labour are lacking. Aims: We surveyed women at a tertiary women's hospital about preferences for and experiences of oral intake during labour, gastrointestinal symptoms during labour and recalled advice about oral intake. Materials and methods: Women who experienced labour completed a postpartum survey with responses as free text, yes‐no questions and five‐point Likert scales. We identified demographic data and risk factors for surgical or anaesthetic intervention at delivery from medical records. We summarised free text comments using conventional content analysis. Results: One hundred and forty‐nine women completed the survey (47% response rate). Their mean (SD) age was 31 (four) years, birthing at median gestation of 39 weeks (interquartile range: 38‐40). One hundred and twenty‐two (83%) and 44 (30%) women strongly agreed or agreed they felt like drinking and eating respectively during labour. Ninety women (61%) reported nausea and 47 women (32%) reported vomiting in labour. Forty‐one women (28%) did not receive advice on oral intake during labour. Maternal risk factors for surgical intervention were identified in 72 (48%) women and fetal risk factors in 27 (18%) women. Thirty‐one women (21%) delivered by emergency caesarean section. Conclusion: Pregnant women received variable advice regarding oral intake during labour, from variable sources. Most women felt like drinking but not eating during labour. Guidelines on oral intake in labour may be beneficial to women, balancing the preferences of women with risks of surgical intervention. [ABSTRACT FROM AUTHOR]

The article focuses on study conducted to evaluate the rate of subsequent spontaneous preterm birth in patients with previous induction of labour at term compared to women with previous spontaneous labour at term. Topics discussed include accomplishing birth prior to the onset of spontaneous labour via Induction of labour (IOL); methodology used in the study using birth data from the Royal Brisbane and Women's Hospital (RBWH); and Risk of subsequent sPTB risk among different gestational age.

Objective: To evaluate the use of transvaginal (TV) sonographic cervical length (CL) measurement alone in predicting time of delivery in women who present in threatened preterm labor. Methods: A retrospective cohort study at Royal Brisbane and Women's Hospital of all women who presented between 22 weeks and 0 days and 35 weeks and six-day gestation in threatened preterm labor and were admitted for ongoing management including a TV sonographic CL measure. The accuracy of CL for predicting time of delivery was compared between women with a short cervix (CL <25mm) and those with a normal cervix (CL -25mm). The predictive accuracy of CL for spontaneous preterm delivery was analyzed with different outcome-specific thresholds. Results: One hundred and forty-six women with threatened preterm labor met the inclusion criteria; of which 74 (50.7%) had a short cervix and 72 (49.3%) had a normal cervix. The group with short cervix were more likely to deliver prematurely before 37-week gestation, as well as a shorter time interval between initial presentation and delivery and delivery within 14 days from presentation (p=.0002, p=.0001, and p=.0001, respectively). Similarly, with respect to the area under the receiver operator characteristic curves, CL measurement was found to be significant for time of delivery before or after 37 weeks (p<.0001), preterm delivery before 34 (p= .0003) and 31 (p< .0001) weeks; and preterm delivery within 14 days from presentation (p<.0001). Cervical length measurement has a high negative predictive value ranging from 94.9 to 97.1% depending on the different CL threshold used. Conclusions: Cervical length measurement at the time of presentation was significantly associated with the risk of preterm delivery in women presenting with threatened preterm labor and a short cervix. Cervical length measurement was also helpful in predicting time of delivery within 14 days from presentation. The negative predictive value and predictive accuracy of CL as a single measure were of significance. [ABSTRACT FROM AUTHOR]

Objective: Routine cervical length measurement in asymptomatic pregnant women to prevent preterm birth has not been universally adopted due to poor predictive accuracy. The purpose of our study was to evaluate the risk of preterm delivery and pregnancy outcomes in women with asymptomatic short cervix and examine the implications of gestational age at presentation on these outcomes.Study Design: This was a retrospective cohort study of women with singleton pregnancies who presented prior to or at 32 + 0 weeks with an asymptomatic short cervix (≤25 mm) between April 2014 to March 2018 at a single tertiary maternity center. Women with cervical length ≤25 mm were grouped into four cohorts according to gestational age at presentation: Obstetric outcomes were compared between the cohorts and the general cohort of women delivering during the same period. Outcomes were compared using Mann-Whitney U, chi-square tests, and logistic regression. Survival analysis was carried out to compare the probability of delivery for each subgroup.Results: The rate of spontaneous preterm birth <37 weeks was highest in the cohort presenting at 25 + 0-27 + 6 weeks, and lowest in the first cohort presenting at <22 + 0 (60.0 versus 22.2%, p < .05). When compared with the general cohort, the rate of spontaneous preterm birth at <37-week gestation was significantly higher in the asymptomatic short cervix cohort (40.4 versus 8.7%, p < .001), with a 7.1-fold increase in the relative risk of spontaneous PTB.Conclusions: In asymptomatic women, cervical shortening showed significant increase in the risk of preterm birth. Our study findings suggest that routine cervical screening may be helpful in predicting risk of preterm birth even in women who are considered low-risk for preterm birth. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the role of prolonged second stage of labour and second stage caesarean section on the risk of spontaneous preterm birth (sPTB) in a subsequent pregnancy. This was a retrospective cohort study of nulliparous women with two consecutive singleton deliveries between 2014 and 2017 at a tertiary centre. In the vaginal delivery cohort, subsequent pregnancy outcomes for women with a prolonged second stage (>2 h) were compared with those with a normal second stage (≤2 h). In the caesarean delivery cohort, women with a first stage or a second stage were compared with the vaginal delivery cohort. The primary outcome was subsequent sPTB. A total of 821 women met inclusion criteria, of which 74.8% (614/821) delivered vaginally and 25.2% (207/821) delivered by caesarean section. There was no association between a prolonged second stage in the index pregnancy and subsequent sPTB (aOR 0.70, 95% CI 0.13–3.83, p=0.7). The risk of subsequent sPTB was threefold for those with a second stage caesarean section; however this did not reach statistical significance. A prolonged second stage of labour in the index pregnancy is not associated with an increased risk of subsequent sPTB. A second stage caesarean section in the index pregnancy may be associated with an increased risk of subsequent sPTB, however there was no statistically significant difference. These findings are important for counseling and suggest that the effects of these factors are not clinically significant to justify additional interventions in the subsequent pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the use of transvaginal (TV) sonographic cervical length (CL) measurement alone in predicting time of delivery in women who present in threatened preterm labor.Methods: A retrospective cohort study at Royal Brisbane and Women's Hospital of all women who presented between 22 weeks and 0 days and 35 weeks and six-day gestation in threatened preterm labor and were admitted for ongoing management including a TV sonographic CL measure. The accuracy of CL for predicting time of delivery was compared between women with a short cervix (CL  < 25 mm) and those with a normal cervix (CL ≥25 mm). The predictive accuracy of CL for spontaneous preterm delivery was analyzed with different outcome-specific thresholds.Results: One hundred and forty-six women with threatened preterm labor met the inclusion criteria; of which 74 (50.7%) had a short cervix and 72 (49.3%) had a normal cervix. The group with short cervix were more likely to deliver prematurely before 37-week gestation, as well as a shorter time interval between initial presentation and delivery and delivery within 14 days from presentation (p = .0002, p = .0001, and p = .0001, respectively). Similarly, with respect to the area under the receiver operator characteristic curves, CL measurement was found to be significant for time of delivery before or after 37 weeks (p < .0001), preterm delivery before 34 (p =  .0003) and 31 (p <  .0001) weeks; and preterm delivery within 14 days from presentation (p < .0001). Cervical length measurement has a high negative predictive value ranging from 94.9 to 97.1% depending on the different CL threshold used.Conclusions: Cervical length measurement at the time of presentation was significantly associated with the risk of preterm delivery in women presenting with threatened preterm labor and a short cervix. Cervical length measurement was also helpful in predicting time of delivery within 14 days from presentation. The negative predictive value and predictive accuracy of CL as a single measure were of significance. [ABSTRACT FROM AUTHOR]

Background: Recent data suggest that quantitative measurements of fetal fibronectin can be used accurately to predict increased risk of preterm birth. Aim: The purpose of this study was to demonstrate that the quantification of fetal fibronectin improves diagnostic accuracy in women who present with symptoms suggestive of threatened preterm labour (TPL) using a quantitative fetal fibronectin (qfFN) bedside analyser. Study design: This was a retrospective cohort study of pregnant women who presented between 22+6 and 32+6 weeks gestation with symptoms of TPL who had qfFN measured using the Rapid fFN Q10 system. The ability to predict spontaneous preterm birth (sPTB) within 48 h, 14 days and <34 weeks gestation at qfFN thresholds of 10, 50 and 200 ng/mL was assessed. Results: The overall rate of sPTB <34 weeks was 4.1% (n = 373). For deliveries within 48 h, within 14 days and <34 weeks, a qfFN threshold of 200 ng/mL had positive predictive values of 26.7%, 42.9% and 46.7%, respectively, when compared to patients with qfFN values of 0–9 ng/mL. The corresponding relative risks were 68.5, 53.8 and 38.0, respectively Conclusion: Quantitative fetal fibronectin testing with thresholds of 10, 50 and 200 ng/mL allows for more accurate prediction of preterm birth in symptomatic women. This higher degree of discrimination allows for more directed interventions for high‐risk patients and reduces the cost and burden of unnecessary treatment for low‐risk patients. [ABSTRACT FROM AUTHOR]

Introduction: Early pregnancy body mass index (BMI) is known to predict adverse pregnancy outcomes but does not account for body fat distribution. This study aimed to determine prospectively whether maternal abdominal subcutaneous fat thickness (SCFT) measured by ultrasound at the fetal morphology scan is a better predictor than BMI of mode of delivery and other pregnancy outcomes.Material and Methods: This was a prospective cohort study of women delivering singleton neonates at a tertiary public hospital. Women were included if they had appropriate images at the routine fetal anomaly ultrasound scan and delivered in the facility. The primary outcome was mode of delivery categorized as cesarean section or vaginal delivery. The relation between maternal SCFT and BMI was described using the Pearson correlation coefficient. The association of maternal abdominal SCFT BMI at booking-in was compared with pregnancy outcomes using univariate linear and logistic regression.Results: SCFT and BMI were obtained for 997 women. The median (interquartile range) SCFT was 15.3 mm (12.8-19.6) and median (interquartile range) BMI 24.3 kg/m2 (21.7-28.3). Maternal abdominal SCFT and BMI were highly correlated (R2  = 0.55). Both were significantly associated with cesarean delivery: SCFT per 5 mm (odds ratio [OR] 1.32, 95% confidence interval (CI) 1.18-1.48; BMI per 5 kg/m2 OR 1.29, 95% CI 1.15-1.44.Conclusions: Maternal abdominal SCFT and BMI were both significantly associated with cesarean delivery and other outcomes. More research is needed to define the strengths of maternal SCFT in predicting pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: The stillbirth rate in Australia is 7 per 1000 births (Australia's Mothers and Babies 2014—in brief. Perinatal Statistics Series no. 32. Cat no. PER 87, Canberra, AIHW, 2016). The Perinatal Society of Australia and New Zealand (PSANZ) developed guidelines to standardise the investigations into stillbirth. Aims: To identify causes of stillbirths and stillbirth care using the National Perinatal Death Clinical Audit Tool (National Perinatal Death Clinical Audit Tool, Australian and New Zealand Stillbirth Alliance [ANZSA]/Perinatal Society of Australia and New Zealand [PSANZ]) and compare it to the PSANZ recommendations. Documentation of examination findings and follow‐up after stillbirth were also reviewed. Materials and Methods: From the total of 515 registered stillbirths at a Queensland hospital, 170 stillbirths were considered unexplained after chart review between July 2004 and September 2014. The National Perinatal Death Clinical Audit Tool was applied and resulting underlying causes of stillbirths were classified using the PSANZ perinatal mortality classification system. Results: The stillbirth rate for this centre was 11.2 per 1000 births. A cause of fetal death was established in 55.4% (93/168) and 75 cases (44.6%) remained unexplained corresponding to 14.6% of all registered stillbirths (75/515). Over half of the women (52.7%) were nulliparous. High rates of autopsy (47.3%), bereavement support (99.4%) and placental histopathology (98.8%) were noted. The general practitioner was notified in 98.7% of cases at the time of stillbirth; 34.1% of babies were small for gestational age at birth, 18.9% were growth‐restricted at birth and 21.4% of women were current smokers. Conclusion: The National Perinatal Death Clinical Audit Tool facilitates and streamlines stillbirth investigations and thus helps to identify underlying causes of stillbirth. [ABSTRACT FROM AUTHOR]

Background: Preterm breech delivery is associated with a higher perinatal mortality rate compared with preterm vertex delivery, and some studies suggest caesarean section leads to lower mortality rates. Few studies include infants delivered less than 26 weeks gestation, and where included, results are often not stratified by gestational age. There is also a lack of consistent reporting on neonatal and maternal morbidity outcome measures. Aims: To determine if mode of delivery for singleton extreme preterm breech fetuses is associated with a difference in perinatal mortality, neonatal and maternal morbidity. Materials and Methods: Retrospective cohort study of breech deliveries from 23 + 0 to 27 + 6 weeks gestation (extreme preterm) between 2005 and 2014 at a tertiary obstetric facility. Results: One hundred and fifty deliveries met the selection criteria. Perinatal mortality was reduced in the caesarean section group (20% vs 55.5% P < 0.001). Apgar scores ≥ 7 (P = 0.008) and cord pH ≥7.1 (P = 0.025) were more likely for neonates delivered by caesarean section, with lower rates of birth trauma (P = 0.003). Caesarean section was associated with higher nursery admission rates (P < 0.001), longer intensive care nursery admission (P = 0.006), continuous positive airway pressure times (P = 0.008) and increased use of surfactant (P < 0.001). Maternal morbidity was increased with caesarean section including longer hospital stay (P < 0.001), higher postpartum haemorrhage (P < 0.001) and wound infection rates (P = 0.034). Conclusion: Caesarean section for singleton extreme preterm breech delivery is associated with reduced perinatal mortality, improved neonatal condition at delivery, and increased short‐term maternal morbidity. [ABSTRACT FROM AUTHOR]

Background Peripartum hysterectomy is commonly performed for catastrophic postpartum haemorrhage uncontrolled by conservative medical and surgical therapies. Currently, information about the incidence and indications for peripartum hysterectomy are not well defined in Australia. Aims Evaluate the incidence and indications of peripartum hysterectomy in the Royal Brisbane and Women's Hospital ( RBWH) between 2000 and 2014. Materials and Methods A 15-year retrospective cohort study of peripartum hysterectomies at RBWH was conducted. The incidence of this event was calculated. Risk factors for abnormal placentation were explored using univariate analyses. Statistical significance was declared at α < 0.05. Results A total of 83 cases of peripartum hysterectomy were reviewed. The incidence of peripartum hysterectomy was 0.60 per 1000 births after discounting the 44 (53%) cases of peripheral regional hospital referrals. Abnormal placentation and uterine atony constituted the majority of the indications for peripartum hysterectomy. Abnormal placentation included placenta praevia, accrete, increta and percreta. In this cohort with peripartum hysterectomy, previous caesarean section was strongly associated with abnormal placentation ( P < 0.001, OR 11.4, 95% CI 3.6-35.8). No maternal mortality was recorded, although 63% of patients encountered complications. A planned peripartum hysterectomy resulted in significantly fewer red blood cell ( P = 0.011) and platelet transfusions ( P = 0.001). Conclusions The incidence of peripartum hysterectomy recorded in our tertiary institution between 2000 and 2014 is 0.60 per 1000 births. Abnormal placentation is the commonest indication leading to severe postpartum haemorrhage requiring peripartum hysterectomy. [ABSTRACT FROM AUTHOR]

Objective: To estimate the risk of stillbirth in apparently uncomplicated monochorionic-diamniotic twin pregnancies by systematic review and meta-analysis and compare it with that in uncomplicated dichorionic pregnancies.Data Sources: We performed an electronic search (January 1985 to April 2012) of Medline, PubMed, Embase, and ClinicalTrials.gov databases.Methods Of Study Selection: Studies detailing gestational-age specific stillbirth rates after 24 weeks of gestation in monochorionic-diamniotic twin pregnancies uncomplicated by twin-twin transfusion syndrome, growth restriction, or major anomalies. The rate and risk of stillbirth were calculated in 2-week gestational age blocks and compared in controlled studies with dichorionic pregnancies.Tabulation, Integration, and Results: We evaluated 361 studies to include nine informative studies, four after additional data from the investigators. The rate of stillbirth per 1,000 uncomplicated monochorionic-diamniotic pregnancies at 32-33, 34-35, and 36-37 weeks of gestation was 5.1, 6.8, and 6.2, respectively. The risk of stillbirth per pregnancy at 32, 34, and 36 weeks of gestation was 1.6%, 1.3% and 0.9%, respectively. Compared with uncomplicated dichorionic pregnancies, the odds ratio for stillbirth per pregnancy at 32, 34, and 36 weeks of gestation was 4.2 (95% confidence interval [CI] 1.4-12.6), 3.7 (CI 1.1-12.0), and 8.5 (CI 1.6-44.7), respectively.Conclusion: Uncomplicated monochorionic twin pregnancies are at substantial risk of stillbirth throughout the third trimester, which is severalfold higher than in dichorionic twin pregnancies. Given the risk of fetal death to the cotwin, these data should inform decisions around timing of delivery in seemingly normal monochorionic twin pregnancies. [ABSTRACT FROM AUTHOR]

The article describes a case of a pregnant patient with metastases who was treated for invasive ductal carcinoma one year before pregnancy. The patient was treated with docetaxel and trastuzumab. According to the authors, trastuzumab is approved for first-line treatment for breast cancer in combination with docetaxel for stage 2 tumors positive for human epidermal growth factor receptor 2. They add treatment with trastuzumab during midgestation may be associated with anhydramnios.

Sesquizygotic multiple pregnancy is an exceptional intermediate between monozygotic and dizygotic twinning. We report a monochorionic twin pregnancy with fetal sex discordance. Genotyping of amniotic fluid from each sac showed that the twins were maternally identical but chimerically shared 78% of their paternal genome, which makes them genetically in between monozygotic and dizygotic; they are sesquizygotic. We observed no evidence of sesquizygosis in 968 dizygotic twin pairs whom we screened by means of pangenome single-nucleotide polymorphism genotyping. Data from published repositories also show that sesquizygosis is a rare event. Detailed genotyping implicates chimerism arising at the juncture of zygotic division, termed heterogonesis, as the likely initial step in the causation of sesquizygosis. [ABSTRACT FROM AUTHOR]

Pregnancies in women on dialysis remain rare but are increasing in numbers.Retrospective observational audit of seven cases from 1977 to 2022 of all women who conceived prior to dialysis or conceived whilst on dialysis.Of a total of seven women, three were referred from regional centres in Australia, between the 6 and 20 weeks of gestation, generally without any opportunity for pre-conception counselling. Five were managed with intensive haemodialysis aiming for six sessions per week; one patient continued peritoneal dialysis until birth by caesarean section. Five women out of seven had live births, two of which were conceived whilst on dialysis. Four were delivered prematurely between 27 and 31 weeks of gestation, and one at term via spontaneous vaginal delivery.Outcomes for women with pregnancies on dialysis benefit from intensive dialysis management however the practical implementation remains challenging. Our cases highlight the diversity of experience in our centre across two decades. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the role of prolonged second stage of labour and second stage caesarean section on the risk of spontaneous preterm birth (sPTB) in a subsequent pregnancy., Methods: This was a retrospective cohort study of nulliparous women with two consecutive singleton deliveries between 2014 and 2017 at a tertiary centre. In the vaginal delivery cohort, subsequent pregnancy outcomes for women with a prolonged second stage (>2 h) were compared with those with a normal second stage (≤2 h). In the caesarean delivery cohort, women with a first stage or a second stage were compared with the vaginal delivery cohort. The primary outcome was subsequent sPTB., Results: A total of 821 women met inclusion criteria, of which 74.8% (614/821) delivered vaginally and 25.2% (207/821) delivered by caesarean section. There was no association between a prolonged second stage in the index pregnancy and subsequent sPTB (aOR 0.70, 95% CI 0.13-3.83, p=0.7). The risk of subsequent sPTB was threefold for those with a second stage caesarean section; however this did not reach statistical significance., Conclusions: A prolonged second stage of labour in the index pregnancy is not associated with an increased risk of subsequent sPTB. A second stage caesarean section in the index pregnancy may be associated with an increased risk of subsequent sPTB, however there was no statistically significant difference. These findings are important for counseling and suggest that the effects of these factors are not clinically significant to justify additional interventions in the subsequent pregnancy., (© 2020 Cathy Z. Liu et al., published by De Gruyter, Berlin/Boston.)