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Sequential real-time ultrasound examinations were performed in 174 neonates to determine the time of occurrence of cerebroventricular haemorrhage (CVH). Of the 47 infants in whom CVH was detected, in 36 (77%) CVH was present at the first examination. Of the 34 infants with CVH who were examined first within 6 hours of birth, 24 (71%) already had haemorrhage demonstrable at the initial scan. Extension of a CVH after its initial detection occurred in only 3 infants. Of 124 consecutive infants of birthweights less than 1500 g, 38 (31%) developed CVH, 56% of the outborn and 27% of the inborn babies. Our results indicate that most infants who develop CVH have done so within 6 hours of birth. [ABSTRACT FROM AUTHOR]

Despite abortion being decriminalised in Victoria, Australia, access remains difficult, especially at later gestations. Institutions (i.e. health services) place restrictions on the availability of late abortions and/or require additional requirements to be satisfied (e.g. Hospital Termination Review Committee approval), as a consequence of local regulation (i.e. policies and processes determined at the institutional level). This paper reports on the results of 27 interviews with Victorian health professionals about late abortion processes and the operation of Termination Review Committees in Victorian health services, which were analysed thematically. The results reveal the operation of an 'institutional lottery' whereby patients' experiences in seeking late abortion services were variable and largely shaped by the institution(s) they found themselves in., Competing Interests: One author, LDC, was involved in the Case discussed in this paper. He was not involved in the collection or analysis of the data. JS is a Partner Investigator on an Australian Research Council (grant number LP190100841) which involves industry partnership from Illumina. He does not personally receive any funds from Illumina. JS is a Bioethics Committee consultant for Bayer., (Crown Copyright © 2023 Published by Elsevier Ltd.)

Background: Termination of pregnancy (TOP) is not an uncommon procedure. Availability varies greatly between jurisdictions; however, additional institutional processes beyond legislation can also impact care and service delivery. This study serves to examine the role institutional processes can play in the delivery of TOP services, in a jurisdiction where TOP is lawful at all gestations (Victoria, Australia). As per the Abortion Law Reform Act 2008, TOPs post-24 weeks require the approval of two medical practitioners. However, in Victoria, hospitals that offer post-24 week TOPs generally require these cases to additionally go before a termination review committee for assessment prior to the service being provided. These committees are not stipulated in legislation. Information about these committees and how they operate is scarce and there is minimal information available to the public., Methods: To trace the history, function, and decision-making processes of these committees, we conducted a qualitative interview study. We interviewed 27 healthcare professionals involved with these committees. We used purposive sampling to gain perspectives from a range of professions across 10 hospitals. Interviews were transcribed verbatim, identifying details removed and inductive thematic analysis was performed., Results: Here, we report the three main functions of the committees as described by participants. The functions were to protect: (1) outward appearances; (2) inward functionality; and/or, (3) service users. Function (1) could mean protecting the hospital's reputation, with the "Herald Sun test"-whether the TOP would be acceptable to readers of the Herald Sun, a tabloid newspaper-used as a heuristic. Function (2) related to logistics within the hospital and protecting the psychological wellbeing and personal reputation of healthcare professionals. The final function (3) related to ensuring patients received a high standard of care., Conclusions: The primary functions of these committees appear to be about protecting hospitals and clinicians within a context where these procedures are controversial and stigmatized. The results of this study provide further clarity on the processes involved in the provision of TOPs at later gestations from the perspectives of the healthcare professionals involved. Institutional processes beyond those required by legislation are put in place by hospitals. These findings highlight the additional challenges faced by patients and their providers when seeking TOP at later gestations., (© 2023. The Author(s).)

The actions of pregnant women can cause harm to their future children. However, even if the possible harm is serious and likely to occur, the law will generally not intervene. A pregnant woman is an autonomous person who is entitled to make her own decisions. A fetus in-utero has no legal right to protection. In striking contrast, the child, if born alive, may sue for injury in-utero; and the child is entitled to be protected by being removed from her parents if necessary for her protection. Indeed, there is a legal obligation for health professionals to report suspected harm, and for authorities to protect the child's wellbeing. We ask whether such contradictory responses are justified. Should the law intervene where a pregnant woman's actions risk serious and preventable fetal injury? The argument for legal intervention to protect a fetus is sometimes linked to the concept of 'fetal personhood' and the moral status of the fetus. In this article we will suggest that even if the fetus is not regarded as a separate person, and does not have the legal or moral status of a child, indeed, even if the fetus is regarded as having no legal or moral status, there is an ethical and legal case for intervening to prevent serious harm to a future child. We examine the arguments for and against intervention on behalf of the future child, drawing on the example of excessive maternal alcohol intake., (© 2016 The Authors. Bioethics Published by John Wiley & Sons Ltd.)

Debate around homebirth typically focuses on the risk of maternal and perinatal mortality and morbidity--the primary focus is on deaths. There is little discussion on the risk of long-term disability to the future child. We argue that maternal and perinatal mortality are truly tragic outcomes, but focusing disproportionately on them overshadows the importance of harm to a future child created by avoidable, foreseeable disability. The interests of future children are of great moral importance. Both professionals and pregnant women have an ethical obligation to minimize risk of long-term harm to the future child; harm to people who will exist is a clear and uncontroversial morally relevant harm. The medical literature does not currently adequately address the risk of long-term disability, which is at least as relevant as other outcomes. The choice of place of elective birth (home, hospital or other) may only be justified if it does not expose the future child to an unreasonable increased risk of avoidable disability. Doctors' duty of care for the life of the pregnant woman and her fetus may be overridden by the woman's choices. But further research is required to document the prevalence of long term avoidable disability associated with different birth place choices. Couples should be informed of this risk and doctors should attempt to dissuade couples when they elect a place of birth that puts the health and well-being of the future child at risk., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

In clinical practice, and in the medical literature, severe congenital malformations such as trisomy 18, anencephaly, and renal agenesis are frequently referred to as 'lethal' or as 'incompatible with life'. However, there is no agreement about a definition of lethal malformations, nor which conditions should be included in this category. Review of outcomes for malformations commonly designated 'lethal' reveals that prolonged survival is possible, even if rare. This article analyses the concept of lethal malformations and compares it to the problematic concept of 'futility'. We recommend avoiding the term 'lethal' and suggest that counseling should focus on salient prognostic features instead. For conditions with a high chance of early death or profound impairment in survivors despite treatment, perinatal and neonatal palliative care would be ethical. However, active obstetric and neonatal management, if desired, may also sometimes be appropriate., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Prenatally diagnosed abnormalities that are associated with death in the newborn period are often referred to as 'lethal malformations'. Yet, for many of the commonly described lethal malformations long-term survival is possible if supportive interventions are provided. In this paper we analyse and review fetal or congenital lethal abnormalities. The designation 'lethal' overlaps with the concept of 'medical futility'. The term is used for a heterogenous group of conditions, and hinders clear communication and counselling. We argue that the term should be avoided, and propose in its place a set of key questions that should be addressed by counselling., (© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.)

The amount of information available to couples about the health of their fetus is increasing. An important question in prenatal diagnosis is what information should be given to couples, and how best to present it. It has been argued elsewhere that, in the absence of economic constraints on testing, there is no place for limiting the information available to couples about their fetus. However, not every couple wants all available information, and it is not always clear what couples do want to know. Providing unwanted information about the health of a fetus may be harmful in a number of ways. Herein, the potential harms of being given unwanted information about one's fetus are illustrated by using case studies drawn from clinical practice, and a new approach to prenatal diagnosis is suggested. If the harms of being given unwanted information about one's fetus are to be avoided, then couples need an opportunity to limit the data gathered about their fetus at prenatal diagnosis.

The best interests of our patients are served by using language that both supports patient autonomy and is neutral. While it remains a "tentative" pregnancy (ie, before the completion of normal prenatal tests), the term "fetus" should be used. After normal prenatal testing, only in rare situations will the pregnant woman request an abortion. In such cases, it is appropriate that the term "fetal patient" or the lay terms "child" or "baby" be used. To be a "mother," however, one must have borne a child. Our language should support the autonomous views of the pregnant woman. The language proposed is not intended to be rigidly adhered to in all situations but rather is an appropriate starting point after which one needs to be responsive to the position of the pregnant woman. It is important to individualize language to cater to the views of individual patients. It is, however, time for doctors to acknowledge that their language can influence reality, particularly because they are frequently considered experts not only in prenatal diagnosis but also in morality. Doctor's language has a powerful influence over the way patients think.

Transvaginal ultrasound of the cervix is increasingly used to estimate cervical length during pregnancy. Initially used to determine a possible need for cervical suture, the technique has been shown to be of value in the prediction of preterm delivery In addition, bacterial vaginosis has been shown to be associated with an increased risk of preterm delivery. We hypothesised that shortening of the cervix and potential cervical pathogens, in particular the presence of bacterial vaginosis, act synergistically in the pathogenesis of premature labour. Three hundred and sixteen women were recruited for prospective longitudinal follow-up, with both transvaginal ultrasound and cervical bacteriology performed at approximately 18 and 28 weeks gestation. A strong correlation was found between a shortened cervix and preterm delivery (p<0.02 at 18 weeks; p<0.001 at 28 weeks). Women with both a short cervix and cervical pathogens had the highest risk of preterm delivery (43%), although not significantly greater than a short cervix with normal cervical flora (31% preterm delivery). In the presence of a normal cervical length, preterm delivery rates in the presence of normal flora and potential cervical pathogens were much lower (9% and 5% respectively).

Five fetuses, each with a sacrococcygeal teratoma (SCT) were delivered at the Royal Women's Hospital while 2 fetuses, each with a SCT were delivered at Monash Medical Centre in 1998. The number of cases reported in this series is higher than expected but it most likely occurred due to chance. The diagnosis was made prenatally in all cases. Three of the SCT were entirely external while the remaining 4 were external with intrapelvic extension. Rapid growth of the SCT occurred in 3 fetuses. This was associated with polyhydramnios in 2 fetuses. No fetus developed nonimmune hydrops. Six infants were liveborn (perinatal mortality rate of 14%), 3 of whom were delivered prior to 37 weeks' gestation. Two infants were delivered by classical Caesarean section. The remaining 4 infants were delivered by lower uterine segment Caesarean section. There was 1 perinatal death. This stillborn infant was delivered vaginally. The 6 surgical resections were performed between the 4th and 10th postnatal days. Histological examination confirmed the diagnosis of benign SCT in each. One infant developed a recurrence at 2 months of age and required chemotherapy.

We surveyed obstetricians who are members of the Australian Association of Obstetrical and Gynaecological Ultrasonologists for details of actions in which they had been asked to give an expert opinion between 1993 and 1998. We uncovered 50 cases, most of which involved missed fetal anomalies. Our findings suggest there is considerable medicolegal activity in obstetrical and gynaecological ultrasound in Australia.

Seventeen fetuses were diagnosed with isolated congenital talipes equinovarus (CTEV) on mid-trimester ultrasound at the Royal Women's Hospital, Melbourne, between January, 1992 and December 1995. Sixteen of the 17 cases had an amniocentesis performed and all karyotypes were normal. The remaining case was phenotypically normal, except for a clubfoot. None of the pregnancies was complicated by any of the recognized intrauterine environmental causes of CTEV. Four of the babies were delivered prematurely and all survived the neonatal period. Six (35%) infants did not have CTEV at birth, although 2 had postural varus feet. Nine of the 11 infants who did have CTEV at birth were treated within days of birth with plaster of Paris for periods of 6 to 12 weeks. Two infants required no further treatment, 5 required orthotics and 2 required surgery. The other 2 infants with CTEV at birth were treated with orthotics at 8 weeks of age. All infants were considered to have an excellent result at the 2 year follow-up. Seven (41%) of the prospective parents received antenatal counselling by an orthopaedic surgeon and the lack of study on outcome following an ultrasound diagnosis of CTEV was the impetus for our work.

Saline infusion sonohysterography (SIS) is an important gynaecological diagnostic tool which is little used in Australia. We herein report the findings in 60 women referred for SIS, the procedure being uneventfully performed in 55. Forty-nine of the 60 referrals were for investigation of abnormal uterine bleeding. The technique described allows examination of the uterine cavity and the Fallopian tubes. In 26 of the patients information was obtained which improved or altered the diagnosis made on B mode and colour Doppler ultrasound. Unlike hysteroscopy, SIS is always performed as an outpatient procedure, appropriate disinfection procedures are relatively simple to implement (1), and vasovagal reactions are rare. Hysteroscopy was avoided in 11 patients, there were other benefits in 4 patients, and in only 1 of 16 patients did the hysteroscopy findings differ with SIS. If diagnostic pitfalls are avoided by careful attention to detail, SIS offers a powerful new gynaecological investigative tool in the investigation of bleeding disorders (including menorrhagia, intermenstrual and postmenopausal bleeding), uncertain endometrial findings on vaginal ultrasound, infertility, and in the investigation of congenital and acquired uterine abnormalities.

The use of anti-D immunoglobulin has dramatically reduced the incidence of rhesus isoimmunization arising from pregnancy. A critical shortage of anti-D has developed and consumption must be reduced, preferably without increasing the risk of isoimmunization. The standard dosage of anti-D currently given at all gestational ages is 1 ampoule containing 125 micrograms of anti-D. Of the anti-D administered half is during the first trimester when a much lower dose could be used; 30 micrograms would remove from the maternal circulation the entire fetoplacental blood volume (3 ml) of a 12 week's pregnancy. A dose of 30 micrograms would also be adequate for most fetomaternal transfusions after 12 weeks but prior to the third trimester. A larger dose could be administered if maternal Kleihauer testing suggests the need for a supplementary dose. In the third trimester, the current regimen is appropriate - a dose of 125 micrograms of anti-D supplemented when needed on the basis of maternal Kleihauer testing. A lower dose ampoule of anti-D should be available. In addition, existing protocols for anti-D administration should be modified so that smaller more appropriate doses are given, better utilizing the limited supply of anti-D.