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Background The COVID‐19 pandemic has led to multiple changes in maternity services worldwide. Systems rapidly adapted to meet public health requirements aimed at preventing transmission of SARS‐CoV‐2, including quarantine procedures, travel restrictions, border closures, physical distancing and “stay‐at‐home” orders. Although these changes have impacted all stakeholders in maternity services, arguably the women at the center of this care have been most affected. This study aimed to explore women's experiences of receiving maternity care during the COVID‐19 pandemic in Australia. Methods A national cross‐sectional online survey, including fixed choice and open‐ended questions, was conducted during the first wave of the COVID‐19 pandemic in Australia; pregnant and postnatal women were recruited through social media networks. Results The survey was completed by 3364 women. Women felt distressed and alone due to rapid changes to their maternity care. Limited face‐to‐face contact with health practitioners and altered models of care often required women to accommodate significant changes and to coordinate their own care. Women felt that they were often “doing it alone,” due to public health restrictions on support people and visitors, both within and outside health services. Women described some benefits of visitor restrictions, such as, more time for rest, breastfeeding establishment, and bonding with their baby. Conclusions This large nationwide Australian study provides unique data on women's experiences of receiving maternity care during the COVID‐19 pandemic. Lessons learned provide an opportunity to rebuild and reshape the maternity sector to best meet the needs of women and their families during current and future public health crises.

BACKGROUND Competency-based medical education (CBME) is increasingly employed by postgraduate training programs worldwide, including obstetrics and gynaecology. Focusing on assessment of outcomes rather than time-in-training, and utilising a well-defined curricular framework, CBME aims to train doctors capable of meeting the needs of modern society. When this study was undertaken, in 2019, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) had a time-based curriculum and was due to undergo a curriculum review starting in 2020. AIMS To explore Victorian RANZCOG Integrated Training Program (ITP) coordinators' understanding of the concept of competency and how it is taught and assessed within RANZCOG training. MATERIALS AND METHODS A qualitative, grounded theory design using semi-structured interviews was employed. Victorian RANZCOG ITP coordinators from inner and outer metropolitan, and regional sites, were approached to participate. Transcripts were coded and analysed using thematic analysis. RESULTS Themes identified were: Competence, Vision and Innovation, Structures, ITP Coordinator Role and Teaching and Learning. Competence was defined as a combination of independent practice and understanding of ones' own limits, in addition to required clinical skills and knowledge. Enablers and barriers to achieving competency were identified and associated with structures, human and logistical factors. Victorian ITP coordinators believed the current training program has positive elements but could be further improved. CONCLUSIONS Several areas for future research were identified regarding understanding of competency, relevant if RANZCOG is to introduce a CBME framework. Replicating this research across all RANZCOG jurisdictions in Australia and New Zealand would be prudent to determine if the themes are universal.

Contemporary clinical practice places a high demand on healthcare workforces due to complexity and rapid evolution of guidelines. We need embedded workplace practices such as clinical debriefing (CD) to support everyday learning and patient care. Debriefing, defined as a ‘guided reflective learning conversation’, is most often undertaken in small groups following simulation-based experiences. However, emerging evidence suggests that debriefing may also enhance learning in clinical environments where facilitators need to simultaneously balance psychological safety, learning goals and emotional well-being. This twelve tips article summarises international experience collated at the recent Association for Medical Education in Europe (AMEE) debriefing symposium. These tips encompass the benefits of CD, as well as suggested approach to facilitation. Successful CD programmes are frequently team focussed, interdisciplinary, implemented in stages and use a clear structure.

Background Substantial changes occurred in Australian healthcare provision during the COVID-19 pandemic to reduce the risk of infection transmission. Little is known about the impact of these changes on childbearing women. Aim To explore and describe childbearing women’s experiences of receiving maternity care during the COVID-19 pandemic in Australia. Methods A qualitative exploratory design using semi-structured interviews was used. Women were recruited through social media and self-nominated to participate in an interview. Maximum variation sampling was used. Twenty-seven interviews were conducted with women from across Australia. Data was analysed thematically. Findings Three primary themes and nine sub-themes emerged: ‘navigating a changing health system’ (coping with constant change, altered access to care, dealing with physical distancing restrictions, and missing care), ‘desiring choice and control’ (experiencing poor communication, making hard decisions, and considering alternate models of care), and ‘experiencing infection prevention measures’ (minimising the risk of exposure and changing care plans to minimise infection risk). Discussion The substantial changes in care delivery for pregnant and postpartum women during the pandemic appear to have reduced woman-centred care. In most cases, care was perceived as impersonal and incomplete, resulting in a very different experience than expected; consequences included missing care. The presence of a known care provider improved women’s sense of communication, choice, and control. Conclusion This study provides unique insight into the experiences of childbearing women across Australia. The importance of respectful woman-centred care cannot be forgotten during a pandemic. The findings may inform future service planning during pandemics and disaster situations.

The joint burden of cancer and menopause impacts millions of women globally. This review provides an approach to management of menopausal symptoms after cancer in all settings. This includes an overview of current evidence for both hormonal and non-hormonal treatments for vasomotor symptoms and vaginal dryness after cancer. Systemic menopausal hormone therapy provides symptom control and may be used after most cancers but should be avoided after estrogen receptor-positive breast cancer and after some other estrogen-dependent cancers. Non-hormonal therapies have been minimally studied in women after a cancer diagnosis and, where they have been studied, it is usually in women with breast cancer. Non-hormonal methods to manage vasomotor symptoms include cognitive behavioral therapy, hypnosis, selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, clonidine, and gabapentin. Vaginal estrogen may be useful to address vaginal dryness. However, safety data in breast cancer patients are still lacking and there is currently no consensus. Lubricants may also help with pain with sexual activity. Management of menopausal symptoms after cancer may be challenging and should include information about induced menopause and possible symptoms as well as available treatments. Management then requires a holistic and multidisciplinary approach with individualized care.

Paragangliomas are rare neuroendocrine neoplasms which are often catecholamine-secreting and associated with familial syndromes. Described here are three women with a variety of pathology: isolated secretory paraganglioma diagnosed in pregnancy, secretory metastatic paraganglioma in pregnancy and non-secretory metastatic paraganglioma in pregnancy. Whilst paragangliomas are associated with morbidity and mortality during pregnancy, good maternal and fetal outcomes can be achieved through individualised care within the context of a multidisciplinary team. Although paragangliomas are associated with morbidity and mortality in pregnancy, good maternal and fetal outcomes can be achieved through individualised care within the context of a multidisciplinary team.

BACKGROUND: Substantial public health measures occurred in Australian society during the COVID-19 pandemic to reduce the risk of community transmission. Little was known about the impact of these changes on childbearing women. AIM: To describe childbearing women's experiences of becoming a mother during the COVID-19 pandemic in Australia. METHODS: A qualitative exploratory design using semi-structured interviews was used. Women were recruited through social media and self-nominated to participate in an interview. Maximum variation sampling was used. A total of 27 interviews were conducted with women across Australia. Data were analysed thematically. FINDINGS: The thematic analysis resulted in four primary themes and ten sub-themes. The themes were 'going it alone - having a baby was an isolating experience' ('receiving maternity care alone', 'dealing with government restrictions', and 'desiring social support'), 'advocating for self or others' ('seeking reliable information', 'valuing peersupport', and 'having to be resourceful'), 'finding a way through' ('a changed experience for all', 'managing stress and anxiety', 'requiring constant adjustments', and 'managing fear mongering'), and 'keeping safe'. CONCLUSION: Becoming a mother during the COVID-19 pandemic in Australia was a profound experience for the women. Following the public health initiatives which resulted in physical distancing restrictions, isolation, and the need to provide and receive social and peer support were common experiences. Whilst public health initiatives are implemented to keep people safe, the social and emotional toll on childbearing women should be considered by healthcare professionals. Childbearing women need to be safe but also require support and reassurance.

The impact of COVID-19 on midwifery students is anticipated to be multi-faceted. Our aim was to explore Australian midwifery students’ experiences of providing maternity care during the COVID-19 pandemic. In a cross-sectional study 147 students were recruited through social media. Data were collected through an online survey and semi-structured interviews. Surveys were analysed using descriptive statistics; interviews and open text responses were interpreted through qualitative analysis. Findings revealed students found communication from hospitals and universities to be confusing, inconsistent and they relied on mass media and each other to remain updated. Moving to online learning and being isolated from peers made learning difficult. During clinical placements, students felt expendable in terms of their value and contribution, reflected in essential equipment such as personal protective equipment not always being available to them. Witnessing perceived compromised midwifery care increased students’ emotional burden, while personal household responsibilities and financial concerns were problematic. One silver lining witnessed was women’s appreciation of an improved ‘babymoon’, with fewer visitors, allowing uninterrupted time to establish breastfeeding and connection with their baby. Findings may guide management of midwifery education during future pandemics or health crises for universities and hospitals..

Introduction Vaccination against COVID-19 is a key global public health strategy. Health professionals including midwives and doctors support and influence vaccination uptake by childbearing women. There is currently no evidence regarding the COVID-19 vaccination perceptions and intentions of those who receive or provide maternity care in Australia. The aim of this study was to address this gap in knowledge and explore the perceptions and intentions regarding COVID-19 vaccination from consumers and providers of maternity care in Australia. Methods A national cross-sectional online study conducted in early 2021 in Australia, a country that has had a very low number of COVID-19 cases and deaths. Recruitment was undertaken through parenting and health professional social media sites and professional college distribution lists. A total of 853 completed responses, from women (n = 326), maternity care providers including doctors (n = 58), midwives (n = 391) and midwifery students (n = 78). Findings Personal intention to be vaccinated ranged from 48–89% with doctors most likely and women least likely. Doctors and midwifery students were significantly more likely to recommend the vaccine to pregnant women in their care than midwives (p Conclusion This is the first study to explore the perceptions and intentions regarding COVID-19 vaccination from the perspective of those who receive and provide maternity care in Australia. Findings have utility to support targeted public health messaging for these and other cohorts.

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BackgroundIn Australia, the provision of maternity care during the COVID-19 pandemic was significantly altered to limit transmission of the virus. Many hospitals limited face-to-face appointments to only the pregnant woman and restricted the number of support people present during labour, birth, and postnatal visits to one person. How these restrictions were experienced by partners and support persons of childbearing women are unknown.AimTo explore the experiences of partners and support persons of women receiving maternity care during the COVID-19 pandemic.MethodsA two-phased qualitative study including an online survey and interviews. Analysis was undertaken using content analysis.FindingsPartners and support persons experienced a sense of 'missing out' from the pregnancy and maternity care experience because of changes in the provision of care during the pandemic. They reported feelings of isolation, psychological distress, and reduced bonding time with babies. Conflicting information and processes within and across maternity services contributed to feelings of uncertainty and a perceived reduction in the quality of care. Partners and support persons were negatively impacted by restrictions on maternity wards, however they also perceived these to be of benefit to women.DiscussionMany partners and support persons were negatively impacted by restrictions in maternity services during the pandemic; strategies to ensure their active involvement in maternity care are needed.ConclusionThis study offers insights from the unique perspective of partners and support people of women receiving maternity care during the pandemic. Policies and processes that exclude partners and support persons need to be reconsidered.

Problem The COVID-19 pandemic has required rapid and radical changes to the way maternity care is provided in many nations across the world. Background Midwives provide care to childbearing women across the continuum and are key members of the maternity workforce in Australia. Aim To explore and describe midwives’ experiences of providing maternity care during the COVID-19 pandemic in Australia. Methods A two-phased cross-sectional descriptive study was conducted. Data were collected through an online survey and semi-structured interviews between May-June 2020. Findings Six hundred and twenty midwives responded to the online survey. Many reported a move to telehealth appointments. For labour care, 70% of midwives reported women had limited support; 77% indicated postnatal visiting was impacted. Five main themes were derived from the qualitative data including: coping with rapid and radical changes, challenges to woman-centred care, managing professional resilience, addressing personal and professional challenges, and looking ahead. Discussion Restrictions applied to women’s choices, impacted midwives’ ability to provide woman-centred care, which resulted in stress and anxiety for midwives. Professional resilience was supported through collaborative relationships and working in continuity models. Midwives revealed ‘silver linings’ experienced in providing care during the pandemic. Conclusion Findings provide valuable evidence to understand the impact on midwives who have provided care during the COVID-19 pandemic. Knowledge will be useful for health leaders and policy makers as they consider ways to continue care during the pandemic and support the essential midwifery workforce. Recommendations are presented to improve preparedness for future pandemics.

Introduction The global COVID-19 pandemic has radically changed the way health care is delivered in many countries around the world. Evidence on the experience of those receiving or providing maternity care is important to guide practice through this challenging time. Methods A cross-sectional study was conducted in Australia. Five key stakeholder cohorts were included to explore and compare the experiences of those receiving or providing care during the COVID-19 pandemic. Women, their partners, midwives, medical practitioners and midwifery students who had received or provided maternity care from March 2020 onwards in Australia were recruited via social media and invited to participate in an online survey released between 13th May and 24th June 2020; a total of 3701 completed responses were received. Findings While anxiety related to COVID-19 was high among all five cohorts, there were statistically significant differences between the responses from each cohort for most survey items. Women were more likely to indicate concern about their own and family’s health and safety in relation to COVID-19 whereas midwives, doctors and midwifery students were more likely to be concerned about occupational exposure to COVID-19 through working in a health setting than those receiving care through attending these environments. Midwifery students and women’s partners were more likely to respond that they felt isolated because of the changes to the way care was provided. Despite concerns about care received or provided not meeting expectations, most respondents were satisfied with the quality of care provided, although midwives and midwifery students were less likely to agree. Conclusion This paper provides a unique exploration and comparison of experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia. Findings are useful to support further service changes and future service redesign. New evidence provided offers unique insight into key stakeholders’ experiences of the rapid changes to health services.

Intravenous leiomyomatosis (IVL) is an uncommon benign smooth-muscle tumour of the uterus which invades into uterine and systemic veins. Although benign, this tumour may grow in the absence of, or beyond the confines of a uterine leiomyoma or fibroid, and has the potential to behave aggressively via extension of growth in the venous vasculature, upwards into the inferior vena cava (IVC) and into the right cardiac chambers. This can lead to serious cardiac and pulmonary sequelae. Rarer neurological sequelae and fatal cases have also been reported. Unless there is obvious IVC or intracardiac spread on preoperative imaging, IVL poses a diagnostic challenge. IVL has been reported in the literature as a rare event and is postulated to be more common than previously reported. Potentially this change is related to increased histopathological diagnosis following hysterectomy or fibroid excision. The prognosis of the cases is unknown but requires follow up as recurrence is possible. This paper presents a case series of 12 patients who were diagnosed on post-operative histopathology with IVL in a 20-month period at The Royal Women's Hospital, Victoria, Australia and a literature review of the current management of this unusual disease.

What you need to know Menopause is a normal event, and most women do not seek medical intervention. Of those who do, some will require only information and advice, but around 25% have problematic symptoms that may need treatment. Vasomotor symptoms are the main reason that women seek treatment. Hormone replacement therapy is effective for vasomotor symptoms, but for some it is unsuitable (due to preference or contraindications) and non-hormonal treatments can be considered. This update provides an overview of the evidence supporting non-hormonal treatments for vasomotor and vaginal symptoms, and translates this into practical guidance on managing these symptoms in clinical practice. The menopause is the final menstrual period. The “perimenopause” or “menopause transition” is the time from the onset of menstrual cycle changes until one year after the final menstrual period.1 Changes in vaginal bleeding patterns and vasomotor symptoms characterise the menopause transition, but the overall experience is highly variable and may be influenced by psychological, social, and cultural factors.2 Common symptoms include hot flushes and night sweats (vasomotor symptoms) and genital symptoms (vaginal dryness, dyspareunia), which may be accompanied by mood and sleep disturbance.3 …

Background: Fast track surgery is a concept that utilises a variety of techniques to reduce the surgical stress response,allowing a shortened length of stay, improved outcomes and decreased time to full recovery.Aims: To evaluate a peri-operative Fast Track Surgical Protocol (FTSP) in patients referred for abdominal surgery.Methods: All patients undergoing a laparotomy over a 12-month period were entered prospectively on a clinical database.Data were retrospectively analysed.Results: Over the study period, 72 patients underwent a laparotomy. Average patient age was 54 years and averageweight and BMI were 67.2 kg and 26 respectively. Sixty three (88%) patients had a vertical midline incision (VMI).There were no intraoperative blood transfusions. The median length of stay (LOS) was 3.0 days. Thirty eight patients(53%) were discharged on or before post op day 3, seven (10%) of whom were discharged on postoperative day 2. Onstepwise regression analysis, the following were found to be independently associated with reduced LOS: able to tolerateearly enteral nutrition, good performance status, use of COX inhibitor and transverse incision. In comparison with col-leagues at the SGOG not undertaking FTS for their patients, the authors’ LOS was lower and the RANZCOG modifiedQuality Indicators (QI’s) did not demonstrate excess morbidity.Conclusions: Patients undergoing fast track surgery can be discharged from hospital with a reduced LOS, without anincreased readmission rate and with comparative outcomes to non-fast tracked patients.Key words : fast track surgery, gynaecological oncology.

Summary Aims Hidradenoma papilliferum (HP) of the anogenital region, which was previously thought to be an apocrine tumour, is now believed to be derived from anogenital mammary-like glands (MLG) and is more accurately termed MLG adenoma. We sought to explore any ramifications that may have resulted from the perceived change in histogenesis of this tumour. Methods We performed a clinicopathological audit of 46 cases. Results The mean age was 52 years and the range 31–90 years. Symptoms occurred in 23%, comprising nodules of increasing size 9%, pruritus 9% and bleeding 6%. Tumours occurred in the known distribution of mammary-like glands. The labia minora accounted for 50%, labia majora 40%, fourchette 7% and clitoris 3%. Tumours were described clinically as cystic in 42%, ulcerated 33% and solid 25%. Histologically, adjacent normal MLG were often present. There was striking diversity in histology. Tubular, papillary, cystic and solid areas were seen in various combinations. Two cell types, epithelial and myoepithelial, were present. The most common epithelial cell, the ductal cell, was seen alone in 43% or associated with apocrine metaplasia (57%) and/or foam cells (13%) and/or squamous cells (13%). Myoepithelial cells were usually flattened, but were prominent and clear cell in type in 11%. Stroma was variable in amount and either desmoplastic or sclerotic. Inflammatory cells were particularly associated with tumours involving the surface. Unusual architectural patterns resembled breast lesions such as erosive adenomatosis, sclerosing adenosis and ductal adenoma. No recurrence or association with malignancy was recorded. Conclusions MLG adenomas demonstrate a marked diversity in histological pattern and cell morphology. The ductal cell and a site compatible with and/or the presence of adjacent normal MLG are the most characteristic features. Unusual vulvar tumours, which have been previously reported as erosive adenomatosis, sclerosing adenosis, papillary adenofibroma, syringocystadenoma papilliferans, etc., are variants of MLG adenomas.