Editor-in-Chief's introduction to ANZJOG 64 (3)

IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Scott W. White
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The authors identify contributors such as higher levels of female education and employment and extended educational and career development pathways coinciding with peak fertility ages. In suggesting areas for public policy changes which could address the fertility decline, the authors make a call for this to become part of the political agenda.</p><p>The issue continues with a wide-ranging selection of papers from across our specialty.</p><p>Endometriosis continues to be topical. Fang <i>et al</i><span><sup>2</sup></span> present a systematic review of multidisciplinary teams for the care of people with endometriosis. They find the models studied varied in professional composition, with little clear evidence to demonstrate which is the superior model in terms of clinical and important non-clinical outcomes. They speculate that multidisciplinary teams are likely to be valuable but that further research is required to show which models are most effective. Frayne <i>et al</i><span><sup>3</sup></span> present a mixed methods study of the acceptability of using the Raising Awareness Tool for Endometriosis (RATE) in a general practice setting. They found that general practitioners found RATE valuable, particularly in facilitating discussion about symptoms and their management, but identified uncertainty about the identification and management of people with chronic pain syndromes. Pelvic pain was highly prevalent, with a significant impact on quality of life in a substantial proportion of those participants. Paterson <i>et al</i><span><sup>4</sup></span> present the first published data on endometriosis surgery in Aotearoa New Zealand. This retrospective review of over 400 surgeries performed for known or suspected endometriosis found pain to be the most common indication for surgery, with 68% of surgeries confirming this condition. These findings are broadly comparable to international data, but the authors call for further research into endometriosis in a New Zealand-specific context.</p><p>McGinn <i>et al</i><span><sup>5</sup></span> present their study of sexual and reproductive health services in New Zealand. They report that these services are fragmented without an overarching strategic framework, limiting their capacity to deliver on the Women's Health Strategy, and conclude that a suite of community-based programs should be developed and evaluated, with consumer co-design being a fundamental component of such work. Also in the sexual health sphere, Nyakio <i>et al</i><span><sup>6</sup></span> present their study of sexual violence in the Democratic Republic of Congo. They found that victims of sexual violence were more likely to be from poorer socioeconomic backgrounds, to be younger, and to have had younger age at menarche and first sexual intercourse. They propose that targeted interventions are required to reduce the high prevalence of sexual violence in these communities, including educational and reproductive health resources, incorporated in both public health and societal contexts.</p><p>Hohmann-Marriott <i>et al</i><span><sup>7</sup></span> present their survey of consumers and healthcare providers regarding the role of menstrual cycle tracking apps in fertility and infertility. Both groups reported beliefs in a role for such apps, but with discordant values placed on the different functions by consumers and by health professionals. Sakas <i>et al</i>.<span><sup>8</sup></span> present their study on the use of testicular fine needle aspiration (TEFNA) for absolute non-obstructive azoospermia in terms of successful mature sperm retrieval and fertilisation and pregnancy outcomes. They conclude the TEFNA is a simple and safe technique, effective in sperm retrieval and that the fertilisation outcomes were proportional to the number of sperm retrieved. Mitchell and Bennett's<span><sup>9</sup></span> opinion piece addresses infertility in Pacific Island nations. They argue that infertility is underacknowledged as a public health issue in these countries despite its relatively high prevalence and being of particular cultural importance. They advocate for further context-specific research into locally appropriate reproductive health service provision and education and identify potential areas for synergistic public and reproductive health messaging. They call for infertility to be recognised as a public health and social rights issue to be considered in national and regional policy planning.</p><p>Foster <i>et al</i><span><sup>10</sup></span> present their single-institution review of the use of intraperitoneal chemotherapy as adjuvant treatment for advanced epithelial ovarian cancer. They found that outcomes were comparable to published international data in terms of completion rate and survival, and that ten-year survival was greater than for those who received intravenous chemotherapy. Also in gynaecological oncology, McInerny <i>et al</i><span><sup>11</sup></span> present their retrospective review of low-risk gestational trophoblastic neoplasia cases from a prospectively maintained registry. They found good rates of response to methotrexate monotherapy in participants with low World Health Organisation scores but lower rates of success in those with higher scores or higher baseline human chorionic gonadotropin levels. They conclude that methotrexate monotherapy is an excellent treatment for low-risk disease and that further investigation is required to determine optimal therapy for higher-risk cases.</p><p>Cron <i>et al</i><span><sup>12</sup></span> present their systematic review of clinical practice guidelines for medication use in pregnancy. They found significant variation in quality and recommendations between 39 clinical guidelines regarding medication use for specific conditions in pregnancy across Australian jurisdictions. Using antibiotics for premature rupture of membranes (PROM) at term, metformin for gestational diabetes mellitus, and antidepressants for depression and anxiety as specific examples, they conclude that such variation in clinical guidance may explain observed variation in clinical practice around medication use in maternity care. Jardine Cameron <i>et al</i><span><sup>13</sup></span> also evaluated variation in clinical practice in their study of the management of PROM over a 14-year period. They observed an increase in elective caesarean section and induction of labour compared to expectant management in women with preterm PROM across the course of the study, concluding that research is needed to determine the drivers of this increase in intervention.</p><p>Han <i>et al</i><span><sup>14</sup></span> present a retrospective review of their single-centre experience of pregnancy outcomes in women with prior kidney transplantation. They found high rates of pre-existing hypertension and subsequent pre-eclampsia and gestational hypertension. Preterm birth was common, occurring in 60%, including very preterm birth at or prior to 32 weeks in around one-quarter of cases. Neonatal intensive care admission occurred in half of the neonates. Obstetric intervention was also very common, with 62% of cases undergoing caesarean section. These outcomes highlight the high rate of obstetric and neonatal complications in such pregnancies, requiring multidisciplinary management in experienced centres to optimise outcomes.</p><p>Zheng <i>et al</i><span><sup>15</sup></span> present their case–control study of obesity and birth outcomes. They found a 43% increase in unplanned caesarean section in women with body mass index (BMI) above 40 kg/m<sup>2</sup> compared to those of BMI below 25 kg/m<sup>2</sup>, and higher rates of intrapartum interventions including fetal scalp electrode, intrauterine pressure monitoring, epidural analgesia, and fetal blood sampling. Facchetti <i>et al</i> present their study of vaginal birth after caesarean (VBAC) in relation to model of maternity care. Continuity of care models were associated with the rate of attempting VBAC and the rate of vaginal birth, with midwifery models having higher rates and private obstetrician models having lower rates. The authors conclude that continuity of care can improve rates of attempted VBAC and vaginal birth, possibly mediated through increased counselling and provision of birth choices. However, it is less clear to what extent women choose various models of care due to predetermined plans for VBAC or planned repeat caesarean section.</p><p>I trust that you will find these and the remaining articles in this issue interesting. Thank you for your ongoing interest in and support of <i>ANZJOG</i>.</p><p>The author reports no conflicts of interest.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13863","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Australian & New Zealand Journal of Obstetrics & Gynaecology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ajo.13863","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Welcome to the June issue of the Australian and New Zealand Journal of Obstetrics and Gynaecology.

This issue begins with a thought-provoking editorial by Boothroyd et al1 which explores the declining fertility rate in the Australian population and its implications for society. Australia is not alone among similar countries in this situation, it being a common challenge faced by virtually all high-income countries. While we have been able to maintain population growth due to net immigration, this is unlikely to remain the case in the longer term, and at some point we are likely to find ourselves in the situation where supporting the growing elderly population is reliant upon a shrinking working age population. This is clearly economically unsustainable. The authors identify contributors such as higher levels of female education and employment and extended educational and career development pathways coinciding with peak fertility ages. In suggesting areas for public policy changes which could address the fertility decline, the authors make a call for this to become part of the political agenda.

The issue continues with a wide-ranging selection of papers from across our specialty.

Endometriosis continues to be topical. Fang et al2 present a systematic review of multidisciplinary teams for the care of people with endometriosis. They find the models studied varied in professional composition, with little clear evidence to demonstrate which is the superior model in terms of clinical and important non-clinical outcomes. They speculate that multidisciplinary teams are likely to be valuable but that further research is required to show which models are most effective. Frayne et al3 present a mixed methods study of the acceptability of using the Raising Awareness Tool for Endometriosis (RATE) in a general practice setting. They found that general practitioners found RATE valuable, particularly in facilitating discussion about symptoms and their management, but identified uncertainty about the identification and management of people with chronic pain syndromes. Pelvic pain was highly prevalent, with a significant impact on quality of life in a substantial proportion of those participants. Paterson et al4 present the first published data on endometriosis surgery in Aotearoa New Zealand. This retrospective review of over 400 surgeries performed for known or suspected endometriosis found pain to be the most common indication for surgery, with 68% of surgeries confirming this condition. These findings are broadly comparable to international data, but the authors call for further research into endometriosis in a New Zealand-specific context.

McGinn et al5 present their study of sexual and reproductive health services in New Zealand. They report that these services are fragmented without an overarching strategic framework, limiting their capacity to deliver on the Women's Health Strategy, and conclude that a suite of community-based programs should be developed and evaluated, with consumer co-design being a fundamental component of such work. Also in the sexual health sphere, Nyakio et al6 present their study of sexual violence in the Democratic Republic of Congo. They found that victims of sexual violence were more likely to be from poorer socioeconomic backgrounds, to be younger, and to have had younger age at menarche and first sexual intercourse. They propose that targeted interventions are required to reduce the high prevalence of sexual violence in these communities, including educational and reproductive health resources, incorporated in both public health and societal contexts.

Hohmann-Marriott et al7 present their survey of consumers and healthcare providers regarding the role of menstrual cycle tracking apps in fertility and infertility. Both groups reported beliefs in a role for such apps, but with discordant values placed on the different functions by consumers and by health professionals. Sakas et al.8 present their study on the use of testicular fine needle aspiration (TEFNA) for absolute non-obstructive azoospermia in terms of successful mature sperm retrieval and fertilisation and pregnancy outcomes. They conclude the TEFNA is a simple and safe technique, effective in sperm retrieval and that the fertilisation outcomes were proportional to the number of sperm retrieved. Mitchell and Bennett's9 opinion piece addresses infertility in Pacific Island nations. They argue that infertility is underacknowledged as a public health issue in these countries despite its relatively high prevalence and being of particular cultural importance. They advocate for further context-specific research into locally appropriate reproductive health service provision and education and identify potential areas for synergistic public and reproductive health messaging. They call for infertility to be recognised as a public health and social rights issue to be considered in national and regional policy planning.

Foster et al10 present their single-institution review of the use of intraperitoneal chemotherapy as adjuvant treatment for advanced epithelial ovarian cancer. They found that outcomes were comparable to published international data in terms of completion rate and survival, and that ten-year survival was greater than for those who received intravenous chemotherapy. Also in gynaecological oncology, McInerny et al11 present their retrospective review of low-risk gestational trophoblastic neoplasia cases from a prospectively maintained registry. They found good rates of response to methotrexate monotherapy in participants with low World Health Organisation scores but lower rates of success in those with higher scores or higher baseline human chorionic gonadotropin levels. They conclude that methotrexate monotherapy is an excellent treatment for low-risk disease and that further investigation is required to determine optimal therapy for higher-risk cases.

Cron et al12 present their systematic review of clinical practice guidelines for medication use in pregnancy. They found significant variation in quality and recommendations between 39 clinical guidelines regarding medication use for specific conditions in pregnancy across Australian jurisdictions. Using antibiotics for premature rupture of membranes (PROM) at term, metformin for gestational diabetes mellitus, and antidepressants for depression and anxiety as specific examples, they conclude that such variation in clinical guidance may explain observed variation in clinical practice around medication use in maternity care. Jardine Cameron et al13 also evaluated variation in clinical practice in their study of the management of PROM over a 14-year period. They observed an increase in elective caesarean section and induction of labour compared to expectant management in women with preterm PROM across the course of the study, concluding that research is needed to determine the drivers of this increase in intervention.

Han et al14 present a retrospective review of their single-centre experience of pregnancy outcomes in women with prior kidney transplantation. They found high rates of pre-existing hypertension and subsequent pre-eclampsia and gestational hypertension. Preterm birth was common, occurring in 60%, including very preterm birth at or prior to 32 weeks in around one-quarter of cases. Neonatal intensive care admission occurred in half of the neonates. Obstetric intervention was also very common, with 62% of cases undergoing caesarean section. These outcomes highlight the high rate of obstetric and neonatal complications in such pregnancies, requiring multidisciplinary management in experienced centres to optimise outcomes.

Zheng et al15 present their case–control study of obesity and birth outcomes. They found a 43% increase in unplanned caesarean section in women with body mass index (BMI) above 40 kg/m2 compared to those of BMI below 25 kg/m2, and higher rates of intrapartum interventions including fetal scalp electrode, intrauterine pressure monitoring, epidural analgesia, and fetal blood sampling. Facchetti et al present their study of vaginal birth after caesarean (VBAC) in relation to model of maternity care. Continuity of care models were associated with the rate of attempting VBAC and the rate of vaginal birth, with midwifery models having higher rates and private obstetrician models having lower rates. The authors conclude that continuity of care can improve rates of attempted VBAC and vaginal birth, possibly mediated through increased counselling and provision of birth choices. However, it is less clear to what extent women choose various models of care due to predetermined plans for VBAC or planned repeat caesarean section.

I trust that you will find these and the remaining articles in this issue interesting. Thank you for your ongoing interest in and support of ANZJOG.

The author reports no conflicts of interest.

ANZJOG 64 (3) 主编序言。
Foster 等人10 介绍了他们对腹腔内化疗作为晚期上皮性卵巢癌辅助治疗的单一机构回顾。他们发现,就完成率和存活率而言,结果与已公布的国际数据相当,而且十年存活率高于接受静脉化疗的患者。同样在妇科肿瘤学领域,McInerny 等人11 介绍了他们对前瞻性登记的低风险妊娠滋养细胞肿瘤病例的回顾性研究。他们发现,世界卫生组织评分较低的患者对甲氨蝶呤单一疗法的反应良好,但评分较高或基线人类绒毛膜促性腺激素水平较高的患者成功率较低。他们的结论是,甲氨蝶呤单药治疗是低风险疾病的最佳治疗方法,需要进一步研究以确定高风险病例的最佳治疗方法。Cron 等人12 对妊娠期用药临床实践指南进行了系统回顾。Cron 等人12 对妊娠期用药的临床实践指南进行了系统回顾。他们发现,澳大利亚各辖区的 39 份有关妊娠期特定病症用药的临床指南在质量和建议方面存在很大差异。以治疗临产胎膜早破(PROM)的抗生素、治疗妊娠糖尿病的二甲双胍以及治疗抑郁和焦虑的抗抑郁药为例,他们得出结论认为,临床指南中的这种差异可能解释了在孕产妇护理用药方面观察到的临床实践差异。Jardine Cameron 等人13 在对 14 年间 PROM 的管理进行研究时,也对临床实践中的差异进行了评估。他们观察到,在整个研究过程中,与预产期管理相比,对早产 PROM 妇女进行选择性剖腹产和引产的情况有所增加,并得出结论:需要开展研究以确定干预措施增加的驱动因素。他们发现,原有高血压以及随后的先兆子痫和妊娠高血压的发生率很高。早产很常见,发生率为 60%,其中约四分之一的病例在 32 周或 32 周之前发生极早产。半数新生儿需要接受新生儿重症监护。产科干预也很常见,62%的病例进行了剖腹产。这些结果凸显了此类妊娠中产科和新生儿并发症的高发率,需要在经验丰富的中心进行多学科管理,以优化结果。他们发现,与体重指数低于 25 kg/m2 的妇女相比,体重指数超过 40 kg/m2 的妇女计划外剖腹产的比例增加了 43%,而且产前干预的比例也更高,包括胎儿头皮电极、宫内压监测、硬膜外镇痛和胎儿血液采样。Facchetti 等人对剖腹产后阴道分娩(VBAC)与产妇护理模式的关系进行了研究。连续性护理模式与尝试 VBAC 的比率和阴道分娩的比率有关,助产模式的比率较高,而私人产科模式的比率较低。作者得出结论,连续性护理可提高尝试 VBAC 和阴道分娩的比率,这可能是通过增加咨询和提供分娩选择来实现的。然而,目前尚不清楚妇女选择各种护理模式的原因在多大程度上是由于预先确定的 VBAC 计划或计划中的重复剖腹产。感谢您一直以来对 ANZJOG 的关注和支持。
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来源期刊
CiteScore
3.40
自引率
11.80%
发文量
165
审稿时长
4-8 weeks
期刊介绍: The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.
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