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

{"title":"A Pilot Study of Capturing Patient Reported Outcome Measures in the Australasian Pelvic Floor Procedure Registry.","authors":"Rasa Ruseckaite, Randi Jayasinghe, Michelle Merenda, Chethana Mudunna, Helen E O'Connell, Elizabeth Gallagher, Jennifer King, James Keck, Jessica Yin, Susannah Ahern","doi":"10.1111/ajo.70030","DOIUrl":"https://doi.org/10.1111/ajo.70030","url":null,"abstract":"<p><strong>Background: </strong>Patient Reported Outcome Measures (PROMs) are increasingly being introduced in clinical registries. The Australasian Pelvic Floor Procedure Registry (APFPR) is a clinical quality registry which records information about procedures for stress urinary incontinence and pelvic organ prolapse. This study aimed to determine the feasibility of capturing PROMs in women with pelvic floor disorders (PFDs) identified via the APFPR, using various modes and methods of administration.</p><p><strong>Methods: </strong>We administered the Australian Pelvic Floor Questionnaire (APFQ) in women with PFDs prior to surgery (baseline) and 6 months post-surgery through a combination of email, postal mail, SMS and telephone. The study was carried out from July 2022 to May 2023. Results were reported descriptively, as number and proportion for PROMs response rates and data completeness, and as a mean and standard deviation (SD) for the APFQ scores.</p><p><strong>Results: </strong>The APFQ was administered to 140 patients at baseline and to 112 post-surgery. The baseline PROMs response rates were high (75%), but decreased to 56% at follow up. The overall APFQ completeness was ~98%. The APFQ dysfunction scores revealed a significant improvement at 6 months (mean [SD] score at baseline = 14.5 [5.7], 6 months = 11.4 [6.5], p ≤ 0.001). Significant improvement in the bladder and prolapse domains (p ≤ 0.001) were particularly observed.</p><p><strong>Conclusion: </strong>The results showed an overall improvement in quality of life scores at follow up. The APFQ data completeness was high and response rates were satisfactory, suggesting that the APFQ was a suitable instrument for the APFPR.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774929","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":"New Frontiers in Reproductive Health: Australians' Support for Uterus Transplantation.","authors":"Annabelle Law, Melissa Oxlad","doi":"10.1111/ajo.70035","DOIUrl":"10.1111/ajo.70035","url":null,"abstract":"<p><strong>Background: </strong>Infertility is a global public health concern, and as a result, fertility treatments continue to evolve. Uterus transplantation is a novel procedure where a healthy donor uterus is transplanted into an individual without a functioning uterus who desires pregnancy, allowing them to participate in the genetic, gestational and social components of parenthood. Previous studies in several countries have investigated their population's views regarding uterus transplants to aid in awareness and understanding. However, Australians' views have not been explored outside the absolute uterine factor infertility community.</p><p><strong>Aims: </strong>We aimed to examine Australians' support for uterus transplantation and the factors associated with higher support for the procedure's availability, Medicare subsidisation and ethical acceptance.</p><p><strong>Materials and methods: </strong>Participants (N = 349, aged 17-68) completed an online cross-sectional survey comprising demographics, fertility and transplant history and perceptions of uterus transplantation.</p><p><strong>Results: </strong>Most Australians supported uterus transplantation availability (84.5%), subsidisation (67.3%) and ethical acceptance (73.3%). Male gender, non-university education, younger age, high parenthood importance and higher beliefs that the procedure is safe for the recipient, donor and infant/child predicted higher support for availability. Higher beliefs in uterus transplantation being safe for the recipient predicted higher support for subsidisation. Male gender and increased parenthood importance predicted higher levels of ethical acceptance.</p><p><strong>Conclusions: </strong>Despite ethical complexities surrounding the procedure, Australians were generally supportive of uterus transplantation. While our findings may inform future policies about uterus transplantation, research examining public perceptions over time, with the birth of more children and health professionals' perceptions, would be beneficial.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755729","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":"Knowledge and Awareness of Cardiovascular Risk Factors Among Women With a History of Pregnancy Complications in Australia: A World Heart Federation Cross-Sectional Study.","authors":"Farnoosh Asghar Vahedi, Leila Gholizadeh, Marjan Khajehei","doi":"10.1111/ajo.70026","DOIUrl":"https://doi.org/10.1111/ajo.70026","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is the leading cause of death worldwide, and women who experience complications during pregnancy, such as pregnancy loss (miscarriage and stillbirth), hypertensive disorders of pregnancy and gestational diabetes, have a significantly higher risk of future CVD. Increasing awareness of CVD risk among these women is crucial for effective engagement in risk reduction programs.</p><p><strong>Methods: </strong>A descriptive cross-sectional survey using a non-probability sampling method was adopted to explore the CVD knowledge and awareness of women with a history of complications of pregnancy. Distribution occurred from February to December 2021 via two tertiary hospitals in Australia and various groups in social media.</p><p><strong>Results: </strong>Of 364 survey responses received, a sample of 299 completed responses were considered for final analysis. The participants' mean knowledge score regarding CVD risk factors was 14.5 (SD ± 4.6; range 0-25). Among them, 50.2% had poor knowledge, 25.1% had moderate knowledge, and only 24.7% had good knowledge of CVD and its risk factors in women. Statistically significant differences in knowledge scores were observed based on ethnicity (p = 0.009) and education level (p = 0.007).</p><p><strong>Conclusion: </strong>This study revealed a significant gap in CVD knowledge among women with pregnancy complications, highlighting the need for targeted educational programs. Improving health literacy, particularly among high-risk and lower socioeconomic groups, is crucial for reducing CVD incidence.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765943","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":"Exploring Australian Women's Attitudes Towards Paid Menstrual Leave: A Mixed-Methods Study.","authors":"Amy Wong, Melissa Oxlad, Deborah Turnbull","doi":"10.1111/ajo.70031","DOIUrl":"https://doi.org/10.1111/ajo.70031","url":null,"abstract":"<p><strong>Background: </strong>Australian lawyers, researchers and unions are advocating for the implementation of national paid menstrual leave legislation. The scarce research in this emerging field has not thoroughly explored women's attitudes towards such leave.</p><p><strong>Aim: </strong>To explore Australian women's attitudes towards paid menstrual leave.</p><p><strong>Materials and methods: </strong>Participants (n = 923, female sex assigned at birth currently or previously menstruating; 18+ years; resident in Australia; fluent in English) primarily recruited via social media, including accounts of Australian women's health and menstruation support groups for conditions such as adenomyosis and endometriosis, using a passive snowball sampling frame, completed an online cross-sectional mixed-methods survey.</p><p><strong>Results: </strong>Most (85%) expressed being somewhat to definitely in favour of paid menstrual leave, 4% were unsure and 11% were somewhat to definitely not in favour. Younger age and history of missing work due to menstrual pain were significant independent predictors of support for paid menstrual leave. Women preferred menstrual leave to be paid (rather than unpaid or reimbursed as additional income if unused), available monthly, with a once-off doctor's approval required to access leave. Overall, 73% of participants reported positive impacts on employees in response to open-ended questions about potential impacts (positive, negative and unintended). The most common categories were better workplaces and productivity and improved work outcomes.</p><p><strong>Conclusion: </strong>Research such as this is essential for informing considerations about menstrual leave legislation. Further research investigating the attitudes of a wider range of stakeholders, such as men, colleagues, employers, employment lawyers and economists, is needed to develop an inclusive understanding of menstrual leave.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755707","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":"Consequences for Australian Recipients of Cross Border Oocyte Donation in South Africa: Double Embryo Transfer and Donor Anonymity.","authors":"Cal Volks, Karin Hammarberg, Andrea Whittaker","doi":"10.1111/ajo.70027","DOIUrl":"https://doi.org/10.1111/ajo.70027","url":null,"abstract":"<p><strong>Background: </strong>Due to the shortage of oocyte donors in Australia, Australian women increasingly travel overseas for oocyte donation. South Africa is a recognised 'repro-hub' due to the accessibility of relatively affordable, high-quality assisted reproductive technology services and the availability of donors. In contrast to Australia, where only known and identity release altruistic gamete donation is permitted, in South Africa, oocyte donors are anonymous and receive fixed compensation.</p><p><strong>Aims: </strong>To explore the consequences for Australian recipients of cross-border oocyte donation (CBOD) in South Africa.</p><p><strong>Materials and methods: </strong>Semi-structured interviews were conducted with 12 Australian recipients who had at least one live birth after oocyte donation in South Africa between 2012 and 2020. Interviews were transcribed and transcripts analysed thematically.</p><p><strong>Results: </strong>Most participants had failed assisted reproductive treatment in Australia before travelling to South Africa. Inability to secure an Australian donor led to CBOD. Ten recipients had at least one double embryo transfer (DET). Of the 15 pregnancies, participants reported one third were twin pregnancies. Some had more than one double embryo transfer cycle. Donors were anonymous, creating disparity around access to genetic information between children conceived with an Australian donor and those conceived with a South African donor. Some Australian recipients used sleuthing methods to locate donor siblings whose recipient parents had used the same donor.</p><p><strong>Conclusions: </strong>Double embryo transfers increase the possibility of multiple pregnancy and its associated risks of poorer obstetric outcomes, and donor anonymity prevents donor conceived children's ability to officially access information about the donor through donor registers. Strategies to address the shortage of Australian oocyte donors could alleviate the need for CBOD. Education about the consequences of DET and donor anonymity is needed.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755704","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":"Pathogens Causing Surgical Site Infections After Lower Uterine Caesarean Sections and Recommendations for Antibiotic Guidelines.","authors":"Brendon Yeo, Penelope Clohessy, Andrew Walczak, Henco Nel, Rebecca McCann","doi":"10.1111/ajo.70034","DOIUrl":"https://doi.org/10.1111/ajo.70034","url":null,"abstract":"<p><strong>Background: </strong>Caesarean section surgical site infections (SSIs) have the potential to cause major complications however there remains a paucity of data on its microbiology and causative organisms.</p><p><strong>Aims: </strong>The aim of this study was to identify the organisms causing SSIs in hospitalised patients after lower uterine caesarean section (LUCS). Secondary aims included investigating the differences in organisms isolated from elective versus emergency caesarean sections, and to compare the microbiology of superficial and deep SSIs.</p><p><strong>Materials and methods: </strong>This was a large retrospective study reviewing all SSIs after LUCS in Western Australian (WA) public hospitals from 2001 to 2021 with data obtained from the Healthcare Infection Surveillance of Western Australia (HISWA).</p><p><strong>Results: </strong>There were 687 patients identified with an SSI following LUCS over this twenty-year period. The five most common organisms or organism groups isolated were methicillin-susceptible Staphylococcus aureus (MSSA) (30.4%), methicillin-resistant Staphylococcus aureus (MRSA) (14.7%), Enterobacterales (9.5%), Pseudomonas aeruginosa (9.3%), Staphylococcus lugdunensis (5.7%). Group A and B Streptococcus were isolated cumulatively in more than 5% of cases. There were a significantly higher number of superficial SSIs than deep SSIs, and SSIs were significantly more common post emergency LUCS.</p><p><strong>Conclusions: </strong>Current Australian guidelines may not be appropriate in a considerable proportion of patients with LUCS SSIs, and patients with systemic features of infection should receive antibiotics with activity against P. aeruginosa and MRSA. Critically ill patients with features of sepsis or septic shock should be administered a carbapenem agent which has activity against AmpC/ESBL producing Enterobacterales, instead of piperacillin/tazobactam. Staphylococcus lugdunensis may be an under recognised pathogen in LUCS SSIs. This study also highlighted the importance of wound site sampling in SSIs to establish appropriate directed antimicrobial therapy.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755732","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":"Patient Satisfaction With Rapid Access Hysteroscopy Clinics for Postmenopausal Bleeding-A Single Centre Observational Study.","authors":"Sanskruti Patel, Charlotte Oyston, Katherine Sowden, Julia Coffey, Catherine Askew","doi":"10.1111/ajo.70025","DOIUrl":"https://doi.org/10.1111/ajo.70025","url":null,"abstract":"<p><strong>Background: </strong>Endometrial cancer (EC) is the leading gynaecological cancer and is increasing in incidence. The Counties Manukau area has higher rates of EC than the rest of New Zealand. Hysteroscopy is the gold standard for the investigation of those with risk factors for EC. To reduce time to diagnosis, our service developed a rapid access clinic (RAC) where hysteroscopy occurs at the first specialist clinic (FSA) visit.</p><p><strong>Aim: </strong>To describe patient experience and satisfaction with the RAC.</p><p><strong>Methods: </strong>Postmenopausal patients referred to the RAC were invited to participate in a survey about their experience. Survey responses were summarised, with patient satisfaction, acceptability of FSA and procedure in the same appointment, and pain scores considered as primary outcomes.</p><p><strong>Results: </strong>The RAC had 194 attendances over 6 months and 74/112 approached patients consented to participate in the survey (approached response rate 66%). All patients surveyed reported high satisfaction with their care, and all were comfortable having the FSA and procedure in the same appointment. 57% described pain of hysteroscopy equal to or less than a menstrual period.</p><p><strong>Conclusion: </strong>The results indicate that the RAC is well received by our postmenopausal patients, including higher risk ethnicities, and aligns with existing literature. These findings support the continuation of the outpatient hysteroscopy service and can aid in providing accurate counselling, patient expectations and reproduction of similar service models across other gynaecology units.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744463","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":"Insights and Experiences From the 'Gatekeepers': A Qualitative Study Exploring Clinician Perspectives on Providing Publicly Funded Prenatal Exome Sequencing.","authors":"Samantha Dayman, Melissa Graetz, Lisa Hui, Lilian Downie","doi":"10.1111/ajo.70028","DOIUrl":"https://doi.org/10.1111/ajo.70028","url":null,"abstract":"<p><strong>Background: </strong>Genomics has improved etiological diagnosis for foetal structural anomalies. It is being increasingly utilised in prenatal investigation both in Australia and internationally. To date, literature reporting diagnostic yield according to indication has been available. There is limited literature around the challenges of implementation and other aspects of utility.</p><p><strong>Aims: </strong>We aimed to explore the experiences and perspectives of clinicians involved with the delivery of a state-wide public prenatal exome sequencing (pES) service in Australia.</p><p><strong>Materials and methods: </strong>This qualitative study was developed using a pragmatism framework. A multidisciplinary cohort of clinicians across all tertiary foetal medicine units in Victoria was interviewed. Inductive content analysis was used to understand the experiences, impact, and utility of pES.</p><p><strong>Results: </strong>Eight clinician interviews were analysed. The impact of pES on clinicians included: increased pressure, higher emotional toll, and balancing the benefits with resource limitations. PES was most useful when it provided prognostic information. The clinicians felt that pES had the most utility for patients when the result informed their decision about whether or not to continue a pregnancy. Clinicians acknowledged their 'gatekeeper' role and valued a collaborative, multidisciplinary approach. The main perceived harm for patients was the anxiety associated with waiting times for results.</p><p><strong>Conclusions: </strong>This study provides insights into the delivery of a publicly funded pES program. Our findings highlight the importance of the multidisciplinary team in the successful implementation of genomic technologies in reproductive health.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712235","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":"It's Time to Stop Excluding Early Pregnancy (Losses).","authors":"Miranda Aalderink","doi":"10.1111/ajo.70033","DOIUrl":"https://doi.org/10.1111/ajo.70033","url":null,"abstract":"<p><p>Current guidelines for the care of recurrent pregnancy loss patients in New Zealand typically limit the definition to clinical pregnancies. This approach is not supported by the available evidence, which shows that very early losses are just as prognostically important as clinical losses. Clinical pregnancy is a biologically meaningless construct and is not a suitable method for determining whether a loss is 'valid' or not. The exclusion extends to clinical trials, where treatment is often not initiated until clinical pregnancy has been established. Treatment opportunities are being missed as a result. This exclusion of early pregnancy needs to stop.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712236","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":"Maternal Deaths in Australia, 1964-2020. A Review.","authors":"Gerald Wightman Lawson","doi":"10.1111/ajo.70011","DOIUrl":"https://doi.org/10.1111/ajo.70011","url":null,"abstract":"<p><strong>Background: </strong>The overall number of maternal deaths in Australia has significantly declined over the last six decades. However, there has not been a decline in certain types of maternal deaths.</p><p><strong>Aims: </strong>The aim is to highlight the types of maternal death where the decline has not occurred.</p><p><strong>Materials and methods: </strong>Data was analysed from the 19 Australian maternal mortality reports that covered the years 1964-2020. Further information was obtained from searches in the medical literature on the Australian experience of maternal mortality.</p><p><strong>Results and conclusions: </strong>The previous 'traditional' causes of maternal death-haemorrhage, hypertension, pulmonary emboli and sepsis-are very much reduced. However, deaths following psychiatric and medical causes persist, often beyond the standard postnatal definition of 42 days.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702146","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}