The Australian & New Zealand journal of obstetrics & gynaecology最新文献

{"title":"Understanding Australian Women's Attitudes Towards Menstrual Leave: One Small Piece of a Complex Puzzle.","authors":"Michelle O'Shea","doi":"10.1111/ajo.70045","DOIUrl":"https://doi.org/10.1111/ajo.70045","url":null,"abstract":"","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometrial thickness threshold and management of asymptomatic postmenopausal patients.","authors":"Christos Iavazzo, Alexandros Fotiou, Nikolaos Vrachnis","doi":"10.1111/ajo.13517","DOIUrl":"https://doi.org/10.1111/ajo.13517","url":null,"abstract":"With a great deal of interest, we read the article entitled ‘Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review’ by Li et al.1 As we know, there is a lack of consensus regarding the endometrial thickness threshold of asymptomatic postmenopausal women. According to the systematic review, postmenopausal women with endometrial thickness of less than 10 mm can be observed without any surgical intervention. Although we do agree with these author’s statement, several parameters of such a proposal should be considered for clinical practice. Several recent published articles have raised several questions regarding the endometrial thickness in postmenopausal women that should be evaluated with biopsy. In a recent retrospective cohort study based on the SEER national cancer registry, the authors found a racial discrepancy in endometrial cancer diagnosis when endometrial biopsy was based on endometrial thickness threshold of more than 3 or more than 5 mm. Such a discrepancy can be explained either by the fact that Black women have a greater prevalence of fibroids that can lead to misdiagnosis of endometrial thickness or by the higher prevalence of such women to nonendometrioid histologictype endometrial cancer that does not combine with increased endometrial thickness.2 Similarly, another study concluded that for Black patients the recommended threshold of more than 4 mm led to 50% of newly diagnosed endometrial cancer patients to be missed and to an eightfold higher frequency of falsenegative results compared to the general population.3 For such reasons, some authors suggest that the decision whether a patient must be surgically investigated by endometrial biopsy should be based on a casebycase basis after examining any predisposing factors for endometrial pathology, such as obesity or unopposed oestrogen exposure.4 Of course, a new consensus regarding the endometrial thickness threshold of such patients is essential to avoid unnecessary endometrial biopsies, but definitely racial characteristics should be considered to avert any racial inequity in the provided medical services and in the health outcome. Moreover, several questions could be raised under the prisma of either resourcesdependent action in every national health system or potential medicolegal consequences. Once again, we thank the authors for their excellent contribution.","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":"E9"},"PeriodicalIF":1.7,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40417950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should we stop using the term 'hysterectomy', if yes then why?","authors":"Pathirajage Deepthi Madushan Pathiraja, Ashwita Siri Vanga, Premala Paramanathan, Meninda Kieser","doi":"10.1111/ajo.13554","DOIUrl":"https://doi.org/10.1111/ajo.13554","url":null,"abstract":"Historically, hysterectomy (the Greek term ‘hystera’ plus the Latin ‘ectomy’) was first used in the literature 150 years ago when Charles Clay (1843) performed the first documented procedure.1,2 However, hysterectomies were once part of the treatment protocol for hysteria, and this begs the question: Can it be represented with a better term? The word ‘Hystera’, denotes the womb, which caused the mental health condition called hysteria. The etymology of hysteria has been dynamic since it was coined in the early 19th century. This error, prejudice and offensive practice persisted for hundreds of years as evidenced by the history books. Even the archaic Greek and Egyptian periods reference the concept of a ‘wandering’ or ‘moving womb’.3 Hippocrates, Plato and Aretaeus continued this belief that the ‘hystera’ is migrating in the woman's body causing spasmodic disease. Hysteria was believed to be solely attributable to women, characterised by extreme excitability and emotional overflow. Sigmund Freud spent time studying patients with hysteria. Modern psychiatry has fragmented the blanket diagnosis of hysteria into numerous psychological disorders.4 Given how hysteria has formed the basis of modern terminology with varying connotations and undertones, one topic remains prevalent – its connection to women's health and mental health.5 The use of the word ‘hysterectomy’ involuntarily establishes and confirms the old belief that women are susceptible to mental illness due to the hypothesis of having a moving or spasmodic uterus. Today when people use the word hysteric or hysterical, they mean, ‘an uncontrollable outburst of emotion or fear, often characterized by irrationality, laughter, weeping, etc.’, according to Urban dictionary. ‘Hystera’, although having the meaning of ‘womb’ is still carrying the historic incorrect and offensive association with being the cause of mental illness. Medicine is beautiful in its development, not only scientifically but also ethically. With growing awareness at an individual and societal level, the medical fraternity is recognising gender diversity and their respective medical needs.6 Understandably, changing medical vocabulary is a laborious process, but history has shown that changing terminology is possible. In 1961, the diagnostic term Trisomy 21, which some called ‘Mongolism’, had misleading connotations, and the World Health Organization dropped the word in 1965 after a request from the Mongolian People's Republic.7 The surgical removal of an anatomical part of the body is indicated by the EnglishLatin postfix ‘ectomy’. Consistent with the Latin nomenclature for womb, is the term uterus. The logical combination yields ‘uterectomy’. In support of clear and understandable communication with patients, especially in the context of informed consent before surgery, one can ask the question why clinicians, after explaining the pathology of the uterus and the recommendation to surgically remove the uterus, then proceed wit","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":"E10-E11"},"PeriodicalIF":1.7,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40417951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The utility of routine screening for anaemia at 36 weeks gestation.","authors":"Samuel Purcell,&nbsp;Michael Beckmann","doi":"10.1111/ajo.13495","DOIUrl":"https://doi.org/10.1111/ajo.13495","url":null,"abstract":"<p><p>Anaemia is a global disease, affecting over 1 billion people worldwide; 12% of Australian women experience anaemia in pregnancy. Professional bodies/institutions recommend screening for and treating anaemia in pregnancy but there is inconsistency in recommendations for when to screen. A ten-year retrospective analysis was undertaken of 10 518 pregnancies where there was not a specific indication for repeat blood tests. Using a 28-week haemoglobin (Hb) threshold of ≥110 g/L, seven out of ten could safely forego a routine 36-week full blood count. Less than 2.5% would then be anaemic at 36 weeks, none of whom would have had a Hb < 90 g/L.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":"610-613"},"PeriodicalIF":1.7,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39803575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is normal birth, and why does it matter?","authors":"Scott W White","doi":"10.1111/ajo.13582","DOIUrl":"https://doi.org/10.1111/ajo.13582","url":null,"abstract":"","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":"463-465"},"PeriodicalIF":1.7,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40417955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender bias or patient preference for female practitioners in Obs/Gyn care.","authors":"Lukman Thalib","doi":"10.1111/ajo.13542","DOIUrl":"https://doi.org/10.1111/ajo.13542","url":null,"abstract":"We read the recent systematic review by Nguyen et al.1 published in your esteemed journal where they discussed the role of men in Obs/Gyn care. They argued that the decline of male doctors specialising in Obs/Gyn care is likely be due to gender bias and called for the attention of medical educators to create a genderinclusive working and training environment as a means of enhancing diversity in Obs/Gyn. It is not surprising that most of the studies that the authors included in their review indicated that women are more comfortable being seen and examined by women rather than men, be it specialists or medical students. Such a preference is manifested globally and not confined to a single ethnic or religious group as the authors found. Given the strong gender preference for women in Obs/Gyn settings, particularly when internal examinations are involved, I wonder if the call for medical educators to socially engineer to work against the wellmanifested women's preference is a healthy recommendation. I would like the authors to reconsider their recommendations in view of the modern evidencebased framework which value the patient's preference to be a key component in modern healthcare provision. Evidencebased medicine (EBM) is built upon three major pillars, namely best evidence, clinical expertise and patient's preference. Ever since David Sackett2 introduced the idea of EBM, the evidencebased community has been promoting the role of patient's preference in clinical practice. As articulated by Montori et al.,3 the patient preference includes patient perspectives, beliefs, expectations, goals for health and life and the processes that individuals use in considering the potential benefits, harms, costs and inconveniences of the management options.4 As such, in the context of Obs/Gyn care, we should consider gender preference for female doctors as a component that promotes better patient satisfaction and not as gender bias that somehow needs to be rectified.","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":"E12"},"PeriodicalIF":1.7,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40417953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telehealth for gynaecology outpatients during the COVID-19 pandemic: Patient and clinician experiences.","authors":"Emma Jane Mclaughlin,&nbsp;Lenore Caroline Ellett,&nbsp;Emma Readman,&nbsp;Samantha Mooney","doi":"10.1111/ajo.13510","DOIUrl":"https://doi.org/10.1111/ajo.13510","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic has necessitated alterations in provision of health care and how patients access it. Telehealth has replaced traditional face-to-face outpatient clinics in an unprecedented manner. This study aimed to assess overall patient and clinician satisfaction with telehealth consultations, to establish acceptability of telehealth during pandemic and non-pandemic times, and document feedback.</p><p><strong>Materials and methods: </strong>A prospective observational study involving women presenting to a general gynaecology outpatient department was performed. Women who attended for consultation between 13 July and 4 September 2020 were invited to participate in a questionnaire following their telehealth appointment. Clinicians consulting in the outpatient department were invited to complete a questionnaire at the end of the eight-week study period. Satisfaction, utility and acceptability data were obtained using visual analogue scales (VAS).</p><p><strong>Results: </strong>Twenty-six out of 56 (46.4%) clinicians and 124/870 (14.3%) patients completed the questionnaire. Patients who responded were older and more likely to have been born in Australia than women who did not (P = 0.0355 and P = 0.005, respectively). Overall patient satisfaction with telehealth was high (median VAS (interquartile range), 8.6 (5.6-9.8)). More women found telehealth to be acceptable during a pandemic than afterward (8.9 vs 6.6, P < 0.0001). Clinicians were less satisfied with telehealth than patients (7.1 vs 8.6, P = 0.02); however, most would be happy to continue using telehealth in non-pandemic times (7.0 (6.2-9.8)).</p><p><strong>Conclusion: </strong>Telehealth consultations allow provision of gynaecological care at a time when reducing risk of infection to patients and staff is paramount. Telehealth gynaecology consultations are efficient and convenient without significant detriment to patient or clinician satisfaction.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":"553-559"},"PeriodicalIF":1.7,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9111195/pdf/AJO-62-553.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40317743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of recurrent preterm birth in Western Australia: A 36-year state-wide population-based study.","authors":"Akilew A Adane,&nbsp;Carrington C J Shepherd,&nbsp;Brad M Farrant,&nbsp;Scott W White,&nbsp;Helen D Bailey","doi":"10.1111/ajo.13492","DOIUrl":"https://doi.org/10.1111/ajo.13492","url":null,"abstract":"<p><strong>Background: </strong>It is known that a previous preterm birth increases the risk of a subsequent preterm birth, but a limited number of studies have examined this beyond two consecutive pregnancies.</p><p><strong>Aims: </strong>This study aimed to assess the risk and patterns of (recurrent) preterm birth up to the fourth pregnancy.</p><p><strong>Materials and methods: </strong>We used Western Australian routinely linked population health datasets to identify women who had two or more consecutive singleton births (≥20 weeks gestation) from 1980 to 2015. A log-binomial model was used to calculate risk ratios (RRs) and 95% confidence interval (CIs) for preterm birth risk in the third and fourth deliveries by the combined outcomes of previous pregnancies.</p><p><strong>Results: </strong>We analysed 255 435 women with 651 726 births. About 7% of women had a preterm birth in the first delivery, and the rate of continuous preterm birth recurrence was 22.9% (second), 44.9% (third) and 58.5% (fourth) deliveries. The risk of preterm birth at the third delivery was highest for women with two prior indicated preterm births (RR 12.5, 95% CI: 11.3, 13.9) and for those whose first pregnancy was 32-36 weeks gestation, and second pregnancy was less than 32 weeks gestation (RR 11.8, 95% CI: 10.3, 13.5). There were similar findings for the second and fourth deliveries.</p><p><strong>Conclusions: </strong>Our findings demonstrate that women with any prior preterm birth were at greater risk of preterm birth in subsequent pregnancies compared with women with only term births, and the risk increased with shorter gestational length, and the number of previous preterm deliveries, especially sequential ones.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":"494-499"},"PeriodicalIF":1.7,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39916626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fertility preservation in gynaecology oncology patients: Experience from an Australian tertiary oncology centre.","authors":"Danielle Robson,&nbsp;Bradley de Vries,&nbsp;Selvan Pather,&nbsp;Anthony Marren","doi":"10.1111/ajo.13498","DOIUrl":"https://doi.org/10.1111/ajo.13498","url":null,"abstract":"<p><strong>Background: </strong>Management for gynaecological cancers often includes removal of the reproductive organs and/or the use of gonadotoxic therapies resulting in sub-fertility. Oncofertility and discussion of fertility preservation in these patients is critical.</p><p><strong>Aim: </strong>To determine the rate of fertility preservation discussion among a cohort of patients with a gynaecological cancer and what determinants impact likelihood of a discussion.</p><p><strong>Materials and methods: </strong>A seven-year quantitative retrospective study was conducted at a single oncology centre, including 15-45 year old patients with a gynaecological cancer. The primary outcome was if a fertility preservation discussion occurred during a consultation. Secondary outcomes included if a referral was made and what fertility preservation services were undertaken. Determinants that impacted the likelihood of a fertility preservation discussion were analysed.</p><p><strong>Results: </strong>One hundred and twenty-one patients were analysed. There were 84 (69%) patients who had a documented fertility preservation discussion, and 46% were referred to a fertility specialist for consultation. Age was a significant determinant, with patients aged 30-39 years of age more commonly having a fertility preservation discussion. Patients with a high-grade cancer compared to patients with a lower-grade cancer (grade one or two) were only a third as likely to have a discussion surrounding their fertility (odds ratio: 0.33, 95% CI: 0.13-0.86; P = 0.02).</p><p><strong>Conclusion: </strong>We conclude that rates of discussion around fertility options for patients with cancer are lower than the recommended guidelines. Oncofertility is an important discipline which we believe needs to be emphasised within the gynaecology oncology community and management of patients should include a multi-disciplinary team.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":"542-547"},"PeriodicalIF":1.7,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39924443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of praevia and non-praevia outcomes in placenta accreta spectrum cases: A single centre analysis.","authors":"Rhiannon Heading,&nbsp;Laura Slade,&nbsp;Sue Kennedy-Andrews,&nbsp;Elinor Atkinson,&nbsp;Rosalie Grivell","doi":"10.1111/ajo.13491","DOIUrl":"https://doi.org/10.1111/ajo.13491","url":null,"abstract":"<p><strong>Background: </strong>Placenta accreta spectrum (PAS) causes severe maternal morbidity and mortality. Antenatal diagnosis can optimise maternal outcomes and reduce the risk of complications. PAS cases where the placenta is not low lying are suggested to be more difficult to diagnose antenatally and are potentially associated with different outcomes.</p><p><strong>Aim: </strong>The aim was to compare factors associated with births in PAS pregnancies with and without placenta praevia at a single tertiary centre over 15 years.</p><p><strong>Materials and methods: </strong>A retrospective review of all births complicated by PAS was conducted from a site-specific database. Cases with and without a placenta praevia were analysed to compare differences in maternal risk factors, outcomes and histological diagnosis.</p><p><strong>Results: </strong>Between June 2006 and July 2020 there were 134 cases of PAS, 106 with placenta praevia. Cases without praevia were less likely to have a history of previous caesarean section and to be admitted for delivery planning or with antepartum haemorrhage. A higher proportion of cases without praevia were delivered at term, with no overall difference in emergency or elective deliveries. There was a significantly lower rate of hysterectomy in the non-praevia group. The overall estimated blood loss was significantly lower in those without praevia.</p><p><strong>Conclusion: </strong>Suspected PAS without placenta praevia is at lower risk of hysterectomy and massive blood loss. The management approach can be tailored accordingly, with good operative outcomes with transverse abdominal and uterine incisions. Antenatal diagnosis can be difficult to accurately predict the degree of invasion, and a higher level of suspicion is required.</p>","PeriodicalId":520788,"journal":{"name":"The Australian & New Zealand journal of obstetrics & gynaecology","volume":" ","pages":"487-493"},"PeriodicalIF":1.7,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39637884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}