Australian & New Zealand Journal of Obstetrics & Gynaecology最新文献

{"title":"The Demographics and Outcomes of Women With Stage II Endometrial Cancer Diagnosed in Australia 2005-2007.","authors":"Jonathan Sandeford, Pearl Tong, Selvan Pather","doi":"10.1111/ajo.70006","DOIUrl":"https://doi.org/10.1111/ajo.70006","url":null,"abstract":"<p><strong>Background: </strong>Stage II endometrial cancer comprises 5% to 10% of cases and is pathologically diverse. Retrospective data guides recommendations which suggest surgical staging with adjuvant therapy, but the role of radical surgery and lymphadenectomy is uncertain, due to conflicting outcomes. Treatment decisions are influenced by histopathology, yet a definitive standard of care is still elusive.</p><p><strong>Objectives: </strong>To identify prognostic factors affecting stage II endometrial cancer survival and assess the 2009 FIGO staging changes using data from the Australian National Endometrial Cancer Study (ANECS).</p><p><strong>Materials and methods: </strong>Ninety patients were identified between July 2005 and December 2007. Survival data was analysed using Kaplan-Meier estimates and Cox regression models, with ethics approval from QIMR.</p><p><strong>Results: </strong>Ninety patients were identified with an average age of 60 and mean body mass index (BMI) of 30. Positive cytology (HR 5.4 [CI: 1.32-22.15]) and chemotherapy alone (HR 17.3) [CI: 2.65-112.6] were identified overall survival (OS) predictors in univariate and age (HR 1.81; [CI: 1.13-2.91]) in multivariate analyses. LVSI was a significant progression free survival (PFS) predictor (HR 4.29; [CI: 1.13-16.26]). There was no significant difference in OS (p = 0.9) and PFS (p = 0.6) when cases were re-stratified into the 1988 stage IIA and IIB groups.</p><p><strong>Conclusions: </strong>The study supports contemporary management of simple hysterectomy with lymph node assessment and the refined 2009 stage II definition. Current treatment paradigms could also be refined based upon prognostic factors like age and LVSI.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Causes of Stillbirths Following Disruption to Antenatal Care During Implementation of COVID-19 Mitigation Measures.","authors":"Jasmine Donaghey, Sandy Chu, Shivadharshini Sridhar, Atul Malhotra, Kirsten R Palmer, Daniel L Rolnik, Ben W Mol","doi":"10.1111/ajo.70008","DOIUrl":"https://doi.org/10.1111/ajo.70008","url":null,"abstract":"<p><strong>Background and aim: </strong>Restrictions to mitigate COVID-19 transmission during the pandemic led to the disruption of routine antenatal care. We aimed to assess if those disruptions impacted the rates and types of stillbirths that occurred during that time.</p><p><strong>Material and methods: </strong>We performed a retrospective cohort study of the types and causes of stillbirths occurring in women attending three maternity hospitals in Melbourne, Australia, to understand if COVID-19 mitigation measures altered them. Stillborn babies conceived between November 2019 and February 2020 (restriction exposed cohort) were compared with stillborn babies conceived between November 2017 and February 2018 or November 2018 and February 2019 (control cohort). Stillbirths were classified according to the Perinatal Society of Australia and New Zealand classification system (2018).</p><p><strong>Results: </strong>In the exposed cohort, 29/2511 foetuses were stillborn (11.55 per 1000 births), compared to 53/5171 (10.25 per 1000 births) in the non-exposed cohort. No statistical difference in rates of stillbirth was found between the two groups (odds ratio [OR] 1.13, 95% CI 0.72 to 1.78, p = 0.603). The rate of pregnancy terminations was significantly lower in the exposed cohort (7.1% vs. 34.0%, p = 0.007), while the antepartum stillbirth rate was significantly higher (82.8% vs. 49.1%, p = 0.003), particularly for unexplained stillbirths (51.7% vs. 17.0%, p < 0.001). The rate of congenital abnormalities was lower in the exposed cohort (24.1% vs. 45.3%, p = 0.059), however, not significant.</p><p><strong>Conclusions: </strong>Changes in routine antenatal care during the COVID-19 pandemic may have resulted in a decreased diagnosis of congenital abnormalities, subsequent decreased terminations of pregnancy and a significant increase in unexplained antepartum foetal deaths.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No Clarity on Parity After Twin Birth: A Clinical Survey of Maternity Care Providers.","authors":"Abdullah Mohammad Mian","doi":"10.1111/ajo.70009","DOIUrl":"https://doi.org/10.1111/ajo.70009","url":null,"abstract":"<p><p>Parity describes a key component of a woman's reproductive history. It constitutes an essential part of clinical handover between maternity care providers. Despite this, there is no consensus on how parity should be defined after twin birth. We surveyed 93 midwives and doctors of various specialties working in a regional obstetric unit in Queensland, Australia. 62.4% of respondents defined parity as two after twin birth; the remainder defined it as one. Differences in the interpretation of parity may cause inter-clinician miscommunication and patient harm. We call upon Australian national bodies to publish a consensus definition of parity in relation to twin birth.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Low Fertility Rates in Australia and New Zealand.","authors":"Clare Boothroyd, Katharine Bassett, Stephen Robson","doi":"10.1111/ajo.70007","DOIUrl":"https://doi.org/10.1111/ajo.70007","url":null,"abstract":"","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender Bias in Pain Management: The Case for Updating Analgesia Guidelines for Intrauterine Device Insertion Procedures.","authors":"Lauren Tarrant, Richard Grills, Kathryn McLeod","doi":"10.1111/ajo.70010","DOIUrl":"https://doi.org/10.1111/ajo.70010","url":null,"abstract":"<p><p>Gender bias in pain management represents a significant challenge in healthcare resulting in the underestimation of women's pain during procedures including intrauterine device insertions. In this setting, the gender pain gap perpetuates the inadequate use of procedural analgesia and negatively impacts the experiences and outcomes for women. This opinion piece reflects on current standards for pain management during intrauterine device insertions and calls for a review of clinical practice guidelines to ensure adequate analgesia is accessible for all patients, minimising the harmful effect of gender bias in women's healthcare.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To Bleed or Not to Bleed (At Work)-Why has Fostering a Safe Workplace Menstrual Hygiene Culture Been out of the Question?","authors":"Haddijatou Hughes","doi":"10.1111/ajo.70012","DOIUrl":"https://doi.org/10.1111/ajo.70012","url":null,"abstract":"","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Participation in the National Cervical Screening Program Among Women Who Gave Birth in New South Wales, Australia by Place of Maternal Birth: A Data Linkage Analysis.","authors":"Susan Yuill, Megan A Smith, Louiza S Velentzis, Monjura Nisha, Marion Saville, Erich V Kliewer, Deborah Bateson, Karen Canfell","doi":"10.1111/ajo.13939","DOIUrl":"https://doi.org/10.1111/ajo.13939","url":null,"abstract":"<p><strong>Objective: </strong>High participation rates in the National Cervical Screening Program (NCSP) by all groups of women are required to ensure the equitable elimination of cervical cancer in Australia. In this study, we examine screening participation of overseas-born women compared to Australian-born women who gave birth.</p><p><strong>Design: </strong>Population-based retrospective cohort study using linked health datasets.</p><p><strong>Setting and participants: </strong>Women who gave birth in New South Wales between January 1, 2000 and June 30, 2017.</p><p><strong>Main outcome measures: </strong>Participation in the NCSP (≥ 1 cytology test) in the 3- and 5-year periods prior to delivery by place of maternal birth, adjusted for multiple socio-demographic and health characteristics.</p><p><strong>Results: </strong>Among the 1 332 669 mothers who gave birth over the study period, overall cervical screening participation in the 3- and 5-year periods prior to delivery was 67.0% and 75.7%, respectively. Participation was lower for overseas-born mothers compared to Australian-born mothers for both the 3-year (57.8% vs. 71.7%; adjusted odds ratio [aOR]: 0.51, 95% confidence interval [CI]: 0.50-0.51) and 5-year (64.9% vs. 81.2%; aOR: 0.40, 95% CI: 0.40-0.40) participation periods. All groups of overseas-born women had substantially lower screening participation compared to Australian-born women, with the lowest relative 3-year participation in mothers born in Southern/Central Asia (aOR: 0.30, 95% CI: 0.30-0.31), Oceania (aOR: 0.31, 95% CI: 0.30-0.32), North-East Asia (aOR: 0.49, 95% CI: 0.48-0.50), and New Zealand (aOR: 0.49, 95% CI: 0.48-0.51).</p><p><strong>Conclusions: </strong>Overseas-born women had around half the cervical screening participation in the period prior to birth compared to Australian-born women. It is likely that opportunities to screen these under-screened groups during the antenatal period, typically a time of repeated health services contact, are missed.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACCEPT Group Condensed Position Paper on the Management of Recurrent Pregnancy Loss.","authors":"Adriana Suker, Ying Li, Anthony Marren, Danielle Robson","doi":"10.1111/ajo.70001","DOIUrl":"https://doi.org/10.1111/ajo.70001","url":null,"abstract":"<p><p>The Australasian CREI (Certificate of Reproductive Endocrinology and Infertility) Consensus Expert Panel on Trial Evidence (ACCEPT) group recently published an evidence-based guideline on the investigation and management of recurrent pregnancy loss (RPL). This position paper is a brief summary of the freely accessible two-part guideline and can be found with digital object identifier (DOI) 10.1111/ajo.13821 and DOI 10.1111/ajo.13820.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking Experiences of Birth in Our Operating Theatre (REBOOT): A Qualitative Study of Patient and Staff Experiences of Birth in the Operating Theatre.","authors":"M McKimmie-Doherty, L Sweet, B Blackman, R O'Donohoe, N Sheridan, E Coghlan","doi":"10.1111/ajo.70004","DOIUrl":"https://doi.org/10.1111/ajo.70004","url":null,"abstract":"<p><strong>Background: </strong>Birth in the operating theatre is increasing in prevalence and includes elective and emergency caesarean section and instrumental vaginal births. Birth in the operating theatre is a well-documented risk factor for negative subjective patient outcomes. Despite this, there has been little research into women's experiences of birth in theatre or staff perspectives on how they may create and contribute to a more positive theatre birth environment.</p><p><strong>Aim: </strong>To explore both the women and caregiver's experiences of birth in the operative theatre and to identify ways to deliver and optimise woman-centred care.</p><p><strong>Materials and methods: </strong>This qualitative prospective study used experience based co-design principles and enrolled both women who gave birth in the operating theatre and staff who cared for them. All participants underwent semi-structured interviews to discuss their birth experiences. Thematic analysis was then undertaken to identify key themes from both the caregiver and patient perspective.</p><p><strong>Results: </strong>Key themes centered around communication and maintaining an empowering birth environment. Participants acknowledged the need for clear and respectful communication between women, their support person, and the multidisciplinary team, particularly within emergency situations. Supporting and maintaining an empowering birth environment was achieved through advocacy, autonomy, and inclusion of a support person at all stages of the theatre journey.</p><p><strong>Conclusions: </strong>Communication and an empowering birth environment significantly influenced the subjective experience of birth within the operating theatre. Results from this study may be used to identify system adaptations and improvements to support more positive birth experiences in the operating theatre.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing Trends in the Surgical Management of Stress Urinary Incontinence in Australia.","authors":"Charlotte Rook, Alan Lam","doi":"10.1111/ajo.70005","DOIUrl":"https://doi.org/10.1111/ajo.70005","url":null,"abstract":"<p><strong>Background: </strong>In the late 2000s, mid-urethral slings (MUS) emerged globally as the preferred surgical treatment for stress urinary incontinence (SUI). Despite their high safety and efficacy, through the late 2000s and 2010s, MUS became embroiled in widely publicised controversy surrounding mesh products used for pelvic organ prolapse.</p><p><strong>Aims: </strong>To review recent trends in the surgical management of SUI in Australia in the context of recent medicolegal and media attention on transvaginal mesh devices.</p><p><strong>Materials and methods: </strong>Data were obtained from the Australian Government Department of Human Services database from January 2007 to December 2023. Total procedure numbers for females ≥ 25 years were retrieved for the following Medicare Benefits Schedule (MBS) item numbers: 35599 (MUS), 37044 (Burch colposuspension), 37043 (Stamey or similar), 37042 (autologous fascial sling) and 37339 (peri-/transurethral bulking agents).</p><p><strong>Results: </strong>A total of 69 145 MUS, 5749 Burch, 711 Stamey, 3243 fascial sling and 10 798 bulking agent procedures were recorded during this period. Total procedures peaked at 6877 in 2010 and reached a low of 2627 in 2022, with a turning point in 2016. There was a 61.8% reduction in procedure numbers between these years. The decline in total SUI procedures directly reflects MUS numbers, which dropped by 80.4% between 2011 (5876 cases) and 2022 (1154 cases). This correlates with progressive restrictions and medicolegal events concerning transvaginal mesh during this time.</p><p><strong>Conclusions: </strong>There is a significant downtrend in overall surgical SUI management, especially MUS, being performed in Australia in recent years. The impact on surgical training and patient access to treatment options must be addressed.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}