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

{"title":"Examining Interpregnancy Weight Change Across a Birthing Population in Aotearoa, New Zealand.","authors":"Emma Le Lievre, Per Kempe, Robin Cronin, Alice Hyun Min Kim, Rosemary Hall","doi":"10.1111/ajo.70037","DOIUrl":"https://doi.org/10.1111/ajo.70037","url":null,"abstract":"<p><strong>Introduction: </strong>Inter-pregnancy weight change (IPWC) has been linked to adverse outcomes in subsequent pregnancies. No studies have examined IPWC in Aotearoa New Zealand (AoNZ). This study aims to 1. Examine the distribution of IPWC in a birthing population in AoNZ and 2. Investigate IPWC across priority populations identified by the Perinatal and Maternal Mortality Review Committee (PMMRC).</p><p><strong>Methods: </strong>This retrospective cohort study in AoNZ, included people who birthed their first two singleton pregnancies between 2016 and 2021. IPWC was calculated as the difference in pre-pregnancy body mass index (BMI) and divided into four categories: 1. Interpregnancy weight loss (IPWL) (BMI reduction of > 1 kg/m²) no change in weight (NC) (BMI change -1-0.9 kg/m²); moderate interpregnancy weight gain: (BMI increase 1-3 kg/m²) and increased IPWG (BMI increase > 3 kg/m²).</p><p><strong>Results: </strong>The study cohort (n = 856) had a mean IPWC of 1.13 kg/m² (SD 3.5). 49.9% (n = 427) experienced a BMI increase (> 1 kg/m²). IPWC rates observed across categories: IPWL: 167 (19.5%); NC 262 (30.6%); IPWG: 427 (49.9%) (moderate IPWG: 235 [27.5%] and increased IPWG: 192 [22.4%]). IPWC varied by ethnicity, socioeconomic deprivation, age, and BMI in the index pregnancy; in a multiple regression model with these variables, increasing age and BMI in the index pregnancy were associated with lower IPWC.</p><p><strong>Discussion: </strong>22.4% of the cohort experienced IPWG at a level associated with adverse perinatal outcomes. Elevated rates of increased IPWG were observed in priority birthing populations, consistent with populations highlighted by the PMMRC. Further research is required to understand the impact of IPWC in AoNZ birthing populations.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136617","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":"Subjective Assessment of Adnexal Masses Using Various Ultrasonographic Diagnostic Models: An Analysis of Interobserver Variability.","authors":"Ivana Rizzuto, Shohreh Rezai, Annah Lane, Marita Prior, Kristy P Robledo, Andreas Obermair","doi":"10.1111/ajo.70036","DOIUrl":"https://doi.org/10.1111/ajo.70036","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the interobserver agreement of the International Ovarian Tumour Analysis (IOTA) ultrasound-based simple rules risk (SRRisk) score, the logistic regression model 2 (LR2), the Assessment of Different NEoplasias in the adneXa (ADNEX) model and the Ovarian-Adnexal Reporting and Data System (O-RADS) in an Australian, population-based context.</p><p><strong>Methods: </strong>A retrospective multi-centre study was performed between January 2020 and January 2021. The study included 198 women with adnexal masses examined with transvaginal grey scale and power Doppler ultrasound. Participants were recruited from the multidisciplinary oncology meetings (MDT) of two tertiary cancer centres. Two independent radiologists described the adnexal masses according to the SRR, LR2 scores, ADNEX model, and O-RADS. Values > 30 units different were considered differential and > 50 units were considered highly differential.</p><p><strong>Results: </strong>From 198 patients, 128 were diagnosed with benign ovarian masses, 53 with malignant and 17 patients with borderline tumours. There was strong agreement (Cohen's kappa 0.8) for intra-tumour blood flow, number of cysts locules, and presence of blood flow within solid projections. Interobserver agreement was moderate (Cohen's kappa 0.60-0.79) for the presence of free pelvic fluid/ascites, solid components, unilocular cysts and acoustic shadows. Of the 198 cases, 10 (5%) cases were highly differential and (38/198) 19% were differential for SRRisk, (20/198) 10% highly differential and (36/198) 18% differential for LR2, and (10/198) 5% and (24/198) 12% for ADNEXA model, respectively. Comparison of O-RADS scores between the two observers showed a moderate agreement with a kappa of 0.65. In 7/198 (4%) cases, the difference between observers was for 2 or more categories when using the O-RADS score.</p><p><strong>Conclusions: </strong>Our results suggested that interobserver variation was present in evaluating adnexal masses using well established ultrasonographic diagnostic models. Implementation of sonographic ovarian cancer risk prediction models will need to consider this issue and ensure examiners have adequate training in the technique, and standard operating procedures are in place to reduce interobserver variability.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082236","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":"Editor-In-Chief's Introduction to ANZJOG 65(2)","authors":"Scott W. White","doi":"10.1111/ajo.70043","DOIUrl":"10.1111/ajo.70043","url":null,"abstract":"&lt;p&gt;Welcome to this issue of &lt;i&gt;ANZJOG&lt;/i&gt;. This issue contains a diverse array of articles covering many aspects of our specialty.&lt;/p&gt;&lt;p&gt;One of my aims for &lt;i&gt;ANZJOG&lt;/i&gt; is to publish articles which are of direct use to clinicians in their practice. The Australian Sickle Cell Disease Working Group position statement on the management of pregnancy in sickle cell disease (SCD) by Yue et al. is a fine example of such an article [&lt;span&gt;1&lt;/span&gt;]. This guideline provides clear and practical guidance for maternity care providers for the management of this relatively rare condition in Australia and New Zealand. SCD has significant implications for preconception, prenatal, intrapartum, and postnatal care for the mother and inheritance potential for the fetus and neonate which warrant specific consideration in order to minimise the risk of potentially serious complications. As migration patterns change the demographic of the pregnant population, we are likely to see an increase in pregnancies in women with SCD and this statement will be of benefit particularly to clinicians unfamiliar with its management before, during, and after pregnancy.&lt;/p&gt;&lt;p&gt;Jenkinson et al. present their evaluation of the implementation of a suite of resources for ‘partnering with the woman who declines recommended maternity care’ [&lt;span&gt;2&lt;/span&gt;]. This paper describes the rigorous development and refinement of clinical guidance for managing this difficult clinical situation. The situation where a woman declines recommended care presents her carers with a conflict between providing what they consider as optimal care for the clinical scenario and maintain respect for the woman's autonomy. The difficulty of these situations varies enormously, influenced by a variety of factors such as the chance of an adverse outcome, the severity of such an outcome, whether the risk is primarily to the mother, the fetus, or both, the existing relationship, or lack thereof, between the woman and the carer, the urgency of the clinical situation, and the numerous psychosociocultural factors that impact clinical communication. A defined and systematic approach such as that presented allows clinicians to navigate this space more effectively, aiming to maintain a therapeutic relationship such that a woman's rights are respected and that clinical outcomes can be optimised. Clinical Excellence Queensland have made this suite of resources freely publicly available, including for adaptation for other maternity services to fit their local needs.&lt;/p&gt;&lt;p&gt;Aboud et al. present a single-centre review of haemorrhagic and thromboembolic complications of pregnancies to women with mechanical heart valves [&lt;span&gt;3&lt;/span&gt;]. As long as Australia continues to struggle to reduce rheumatic heart disease in marginalised populations such as remote First Nations communities, and for decades following, we will continue to be faced with the challenge of peripartum anticoagulation management in this high-thromboembolic-risk situatio","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"65 2","pages":"181-182"},"PeriodicalIF":1.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of 360° VR Video, Educational Videos, and High-Fidelity Physical Models in Teaching Breech Birth - A Pilot Feasibility Study.","authors":"Lin Yang, Andrew Bisits","doi":"10.1111/ajo.70040","DOIUrl":"https://doi.org/10.1111/ajo.70040","url":null,"abstract":"<p><strong>Background: </strong>Although there is ongoing debate, the current consensus is that vaginal breech birth carries a marginal increase in perinatal morbidity and mortality. Due to these risks there have been decreasing numbers of vaginal breech births and subsequently clinical exposure to hands-on training has declined. However, to confidently care for women who plan a vaginal breech birth or those presenting in advanced labour with an unexpected breech presentation, education in vaginal breech birth remains necessary.</p><p><strong>Aims: </strong>This pilot study aimed to assess the ability of a multimodal teaching program consisting of high-fidelity physical models, educational videos and a 360° virtual reality video to increase the confidence of maternity staff in their theory and management skills regarding vaginal breech birth. A secondary aim was to determine whether the virtual reality video enhanced learning alongside established techniques.</p><p><strong>Materials and methodology: </strong>A multimodal teaching program was administered to 20 maternity health staff. They were given a self-reported pre- and post-intervention scales to assess changes in their confidence. They also provided feedback on the virtual reality video.</p><p><strong>Results and conclusion: </strong>The teaching program significantly increased maternity staff's confidence in their knowledge and management skills whilst decreasing their anxiety surrounding vaginal breech birth. However, participants did not perceive the 360^o virtual reality being of added value. Further studies should examine whether this program leads to objective change in vaginal breech birth knowledge and management skills and ultimately improved clinical outcomes. Additional studies should explore which types of virtual reality technology benefit breech birth education.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043329","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":"Pregnancy After Bariatric Surgery: A Comparison of Antenatal Care Practices With the 2019 International Consensus Recommendations in Queensland, Australia.","authors":"Rachel Willims, Hayley Sullivan, Lynda Ross, Taylor Guthrie, Penny Wolski, Ann-Maree Craven, Christoph Lehner, Leonie Callaway, Victoria Eley, Helen L MacLaughlin, Susan D E Jersey","doi":"10.1111/ajo.70041","DOIUrl":"https://doi.org/10.1111/ajo.70041","url":null,"abstract":"<p><strong>Background: </strong>Clinical practice guidelines recommend additional monitoring in pregnancy for women post-bariatric surgery, to reduce the risk of maternal and infant complications.</p><p><strong>Aim: </strong>To examine if pregnancy care post-bariatric surgery at an Australian quaternary public hospital is consistent with guidelines and to report on perinatal outcomes.</p><p><strong>Materials and methods: </strong>A retrospective audit of medical records and perinatal outcomes from post-bariatric surgery pregnancies from June 2016 to February 2021 was completed. Micronutrient monitoring and supplementation practices, gestational diabetes mellitus (GDM) screening, gestational weight gain (GWG) and fetal growth (FG) monitoring were compared with guidelines. Perinatal outcomes were compared with Queensland and Australian population data.</p><p><strong>Results: </strong>Eighty-three women meeting the inclusion criteria delivered 86 infants. Twenty percent (n = 16) had recommended GDM screening, 86% (n = 71) recommended FG monitoring at 12-weeks and 98% (n = 81) at 20-weeks, but only 24% (n = 20) had monthly monitoring from viability. GWG monitoring was 95% (n = 79) in the second trimester and 94% (n = 78) in the third trimester. Monitoring rates were highest for iron, and lowest for copper and selenium. Adverse infant outcomes for length of stay, neonatal intensive and special care admissions and caesarean section were significantly higher than the Queensland and Australian populations (all p < 0.05).</p><p><strong>Conclusion: </strong>Adherence with consensus recommendations aligning to standard antenatal monitoring for the general population was high, but additional monitoring for post-bariatric surgery specific care was lower. The evidence suggesting increased rates of adverse perinatal outcomes highlights the importance of consistency and adherence with post-bariatric surgery specific care for this group during pregnancy.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057529","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":"Pre-Pregnancy Diet and/or Physical Activity Interventions for the Prevention of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis.","authors":"Amanda J Poprzeczny, Megan Mitchell, Andrea R Deussen, Nahal Habibi, Tin Oi Cheung, Jessica A Grieger","doi":"10.1111/ajo.70032","DOIUrl":"https://doi.org/10.1111/ajo.70032","url":null,"abstract":"<p><strong>Background: </strong>Gestational diabetes mellitus (GDM) is associated with short- and long-term adverse health outcomes for women and their infants. Antenatal diet and/or physical activity interventions have not been effective at preventing GDM, and currently, it is not clear whether intervening similarly prior to pregnancy is beneficial.</p><p><strong>Aims: </strong>This review aims to evaluate the impact of pre-pregnancy diet and/or physical activity interventions on rates of GDM and other maternal and infant health outcomes.</p><p><strong>Methods: </strong>A systematic literature search of the online databases Embase, Pubmed, Cochrane Central Register of Controlled Trials, Ovid MEDLINE and CINAHL was conducted from inception to 7 February 2023. All randomised controlled trials comparing pre-pregnancy diet and/or physical activity interventions with standard care or control were included. Data were extracted by two reviewers independently, and meta-analysis was performed using random-effects models to calculate summary effect estimates and 95% confidence intervals. The primary outcome was GDM. Five randomised trials assessing pre-pregnancy diet and/or physical activity interventions (n = 1924 women) were included.</p><p><strong>Results: </strong>Pre-pregnancy diet and/or physical activity interventions were not associated with a significant difference in rates of GDM (2 studies; n = 214; RR 1.19, 95% CI 0.81, 1.75). There were no statistically significant differences for any of the secondary maternal or infant outcomes reported. There was significant heterogeneity between studies with regard to type, duration and intensity of the pre-pregnancy diet and/or physical activity interventions.</p><p><strong>Conclusions: </strong>There was no evidence that pre-pregnancy diet and/or physical activity interventions reduced the risk for GDM or other adverse maternal and infant outcomes.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046770","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":"Levonorgestrel-Releasing Intrauterine Device: An Effective Treatment for Symptoms of Persistent Pelvic Pain.","authors":"Renee M Cocks, Samantha S Mooney, Sonia R Grover","doi":"10.1111/ajo.70042","DOIUrl":"https://doi.org/10.1111/ajo.70042","url":null,"abstract":"<p><strong>Background: </strong>Persistent pelvic pain (PPP) affects 5%-27% of women of reproductive age. The calls for earlier and improved access to surgery to diagnose endometriosis do not address the requirement for symptom management and exclude the 50% of women who undergo a laparoscopy for identical pain symptoms but do not have endometriosis identified. Moreover, current evidence for the management of pelvic pain almost exclusively focuses on patients diagnosed with endometriosis.</p><p><strong>Aims: </strong>To investigate the pain scores and overall satisfaction with symptom control in participants with PPP who utilised the levonorgestrel-intrauterine device 52 mg (LNG-IUD), to explore the association between time since last menstrual period (LMP) and other potential factors, including the impact of surgery and surgical findings, on pain outcomes.</p><p><strong>Materials and methods: </strong>This prospective cohort study recruited participants between February 2015 and December 2017 following outpatient clinic referral for pelvic pain symptoms (dysmenorrhea, non-cyclic pelvic pain, dysuria, dyspareunia or dyschezia). Over 18 months, 72 participants had an LNG-IUD (52 mg) inserted, with 51 completing a follow-up questionnaire 6-18 months after insertion to assess pain outcomes.</p><p><strong>Results: </strong>Dysmenorrhoea (coefficient = -0.142, p < 0.001) and overall satisfaction with symptom control (coefficient = 0.079, p = 0.020) scores improved linearly with increased months since LMP in LNG-IUD users. In multivariate analysis, the age of onset of symptoms, laparoscopies prior to study entry or during the study period, and a histological diagnosis of endometriosis did not have a significant relationship with pain outcome or overall satisfaction with symptom control.</p><p><strong>Conclusions: </strong>This study demonstrates that menstrual suppression with the LNG-IUD, regardless of a diagnosis of endometriosis, significantly improves a woman's overall satisfaction with PPP management. The LNG-IUD is an effective first-line medical management option for patients presenting with PPP.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052993","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":"Clinician's Approach to Antibiotic Treatment and Management of Preterm Prelabour Rupture of Membranes (PPROM) in Australia and Aotearoa New Zealand-A Survey.","authors":"Sonia Kua, Amanda Poprzeczny, Katie Groom, Matthew Payne, John Newnham, Brett Manley, Clare L Whitehead","doi":"10.1111/ajo.70039","DOIUrl":"https://doi.org/10.1111/ajo.70039","url":null,"abstract":"<p><strong>Background: </strong>Preterm prelabour rupture of membranes (PPROM) is a common obstetric complication with significant maternal and foetal consequences. There is a lack of contemporary evidence regarding the optimal management of PPROM, including the best antibiotic regimen and management at previable gestations.</p><p><strong>Aims: </strong>To understand the contemporary management of PPROM among clinicians in Australia and Aotearoa New Zealand.</p><p><strong>Materials and methods: </strong>An anonymous web-based survey was designed and distributed, consisting of 31 questions about individual clinicians' routine management of PPROM across a range of different gestations.</p><p><strong>Results: </strong>The survey was completed by 235 clinicians from across Australia and Aotearoa New Zealand. The majority (225/232, 97%) routinely prescribed prophylactic antibiotics after PPROM, with 90 different antibiotic regimens documented. The most commonly prescribed prophylactic antibiotics were erythromycin (198/225, 88%) and penicillins (103/225, 46%). There was variation in practice regarding the timing of birth after PPROM, with 62% (147/235) routinely delaying birth until after 37 weeks of gestation, and 61% (143/235) expediting birth after 34 weeks of gestation if Group B Streptococcus was cultured antenatally. For previable PPROM (< 22 weeks of gestation), 74% (171/232) of women were routinely admitted to hospital at the time of diagnosis and 77% (173/225) were routinely offered antibiotics. There was significant variation in the earliest gestational ages at which antenatal corticosteroids and resuscitation are offered.</p><p><strong>Conclusions: </strong>We observed wide variation in clinical practice of management of PPROM. With a lack of national consensus regarding optimal management of this common pregnancy complication, contemporary clinical trials to define best practices are required.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996113","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":"Proactive Insulin Escalation for Antenatal Betamethasone-Induced Hyperglycaemia in Women With Diabetes: A Prospective Cohort Study.","authors":"Annabel Jones, Joanna Y Gong, I-Lynn Lee, Dev Kevat, Manjri Raval, Joanne Said, Christopher Yates","doi":"10.1111/ajo.70029","DOIUrl":"https://doi.org/10.1111/ajo.70029","url":null,"abstract":"<p><strong>Background: </strong>In patients with diabetes, antenatal glucocorticoids can induce transient maternal hyperglycaemia for approximately 72 h. This may be associated with adverse outcomes, including neonatal hypoglycaemia, prompting recommendations for prophylactic increases in insulin by some expert groups; however, there are no validated protocols. A review of our institutional practice of empiric dose escalation (Day 1:25%, Day 2-3:40%, Day 4:20%, Day 5:10%) determined it was inadequate to prevent hyperglycaemia.</p><p><strong>Aim: </strong>To investigate the efficacy of an intensified insulin escalation protocol in achieving time in target range (3.9-7.8 mmol/L) following antenatal betamethasone.</p><p><strong>Materials and methods: </strong>Following implementation of the intensified insulin escalation protocol at Western Health (Day 1 and 2: 50% increase, Day 3:30% increase), a prospective cohort study was conducted for women with gestational diabetes or type 2 diabetes managed with insulin requiring betamethasone. Data was collected from the electronic medical record and expressed as mean ± SD or median (IQR).</p><p><strong>Results: </strong>29 women (82.8% GDM, 17.2% T2DM) were included with median gestation 33 + 2 (31-34⁺⁴) weeks and median BMI 30 kg/m² (27-38IQR). In the 72 h post first-dose betamethasone, the proportion of readings in target range (< 5.1 mmol/L fasting and < 6.8 mmol/L post prandial) was 35.3%. There was no maternal hypoglycaemia. Median increase in insulin requirement was 50% (22.6%-100% IQR) on Day 1, 106% on Day 2 (33%-297% IQR) and 133% on Day 3 (23%-543% IQR).</p><p><strong>Conclusions: </strong>A significant increase in insulin requirement, exceeding current guideline recommendations, occurs following antenatal betamethasone in women with diabetes, and further prospective evaluation of optimal dosing is required.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046772","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":"Induced Abortion After Previous Caesarean Section: A Scoping Review.","authors":"Natalie Drever, Vinay Gangathimmaiah, Brittany van Der Lugt, Cecelia O'Brien, Catriona Melville, Kirsten Black, Caroline de Costa","doi":"10.1111/ajo.70013","DOIUrl":"https://doi.org/10.1111/ajo.70013","url":null,"abstract":"<p><strong>Background: </strong>Previous caesarean section (CS) is increasingly common among women undergoing induced abortion.</p><p><strong>Aims: </strong>To map and analyse existing literature on abortion safety, outcomes and management in those with previous CS.</p><p><strong>Materials and methods: </strong>Four databases were systematically searched from inception to July 2024. Primary human studies in English reporting on outcomes, safety or management of first- or second-trimester medical (MToP) or surgical (SToP) abortion in women with previous CS were included. Uterine rupture incidence was analysed cumulatively in the first and secondtrimesters by the number of CS and the type of prostaglandin used. Data on the efficacy and safety of MToP and SToP, including studies reporting on the management of abortion in the setting of abnormal placentation, were collected and analysed by theme.</p><p><strong>Results: </strong>In total, 164 articles met inclusion criteria. Incidence of uterine rupture in first-trimester MToP was 0 of 2194 cases, in second-trimester misoprostol MToP in those with 1 previous CS was 0.5% (10/1910) and 2.2% (18/835) in women with ≥ 2 CS (p < 0.001). Mifepristone priming did not increase the rupture rate in second-trimester MToP (p = 0.77). Previous CS was a modest risk factor for retained products after MToP across both trimesters (OR 1.48, CI 1.29-1.70).</p><p><strong>Conclusion: </strong>Medical and surgical abortion in the first and second trimester appears safe in women with prior CS; however, risks include uterine rupture, need for surgical intervention and haemorrhage from undiagnosed placenta accreta. Further research and guidance are needed on managing abortion after previous classical CS, ≥ 3 previous CS and those with abnormally invasive placenta.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058191","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}