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

{"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}

{"title":"The Patient Is Dying of Drug Poisoning-Let's Increase the Dosage!","authors":"Hans Peter Dietz, Susanne Langer, Ka Lai Shek, John Pardey","doi":"10.1111/ajo.13898","DOIUrl":"https://doi.org/10.1111/ajo.13898","url":null,"abstract":"<p><p>The recently completed Select Committee of the NSW Upper House into Birth Trauma has caused consternation amongst colleagues and triggered a controversial response from the NSW Government. It is high time that our college started to fight back.</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":"143702150","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":"A 2-Min Cytomegalovirus (CMV) Awareness Video Improves Pregnant Women's Knowledge and Planned Adherence to Hygiene Precautions.","authors":"Tanya Tripathi, Jotara Watson, Hayley Smithers-Sheedy, Kath Swinburn, Natalia Rode, Emma Waight, Annabel Webb, Natasha E Holmes, Hanako Stump, Antonia Shand, Lisa Hui","doi":"10.1111/ajo.70016","DOIUrl":"https://doi.org/10.1111/ajo.70016","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital cytomegalovirus (cCMV) is a leading infectious cause of life-long neurodevelopmental disabilities, but public awareness of CMV is low. This study evaluated a short educational video on cCMV for its acceptability and impact on pregnant women's knowledge and planned hygiene adherence.</p><p><strong>Materials and methods: </strong>Participants were pregnant women recruited from an Australian tertiary maternity hospital clinic and social media (May 2023 to May 2024). Participants completed online surveys: before the video (T1), immediately after (T2), and 8 weeks later (T3). Linear mixed effects models assessed changes in knowledge and intended adherence to CMV precautions, adjusting for previous CMV education, and parity.</p><p><strong>Results: </strong>A total of n = 296 eligible pregnant women were recruited, n = 270 completed the T1 survey and watched the video. Participants (n = 270) had a median age of 33 years (range: 18-43 years), 21% were multiparous and 30% had received previous CMV education. Of the 270 participants who completed the T1 survey and viewed the video, 202 (75%) and 109 (40%) completed surveys at T2 and T3 respectively. Adjusted total mean CMV knowledge scores increased significantly between T1 and T2 (+2.38; p < 0.001) and remained higher at T3 (+2.14; p < 0.001). Self-reported adherence to hygiene precautions improved from T1 to T2 (p < 0.001) and were maintained for four out of five key behaviours at T3. Participants (99%) found the content valuable, and 91% agreed that CMV precautions were \"easy\" to follow.</p><p><strong>Conclusion: </strong>A CMV education video is a simple, effective method to improve pregnant women's knowledge and planned adherence to hygiene precautions.</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":"143702144","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":"The PreGen Research Program: Implementing Prenatal Genomic Testing in Australia-A Commentary.","authors":"Sarah Long, Deborah Schofield, Josh Kraindler, Rebecca Vink, Kate Ross, Natalie Hart, Holly Evans, Alyssa Wilson, Jon Hyett, Claire E Wakefield, Lauren Kelada, Hamish Scott, Sebastian Lunke, Meaghan Wall, Michael F Buckley, Gemma Fernihough, George McGillivray, Tony Roscioli","doi":"10.1111/ajo.13936","DOIUrl":"https://doi.org/10.1111/ajo.13936","url":null,"abstract":"<p><p>Prenatal genomic sequencing, which can provide a significantly increased diagnostic rate for fetal structural anomaly (FSA) compared with karyotype and microarray, is not available uniformly across Australia. PreGen, a 5-year translational research program, has identified significant barriers to implementation including access to funding, the availability of genomic testing, access to termination of pregnancy services and the availability of specialist genomic centres. A federal item number for prenatal genomic testing would increase equitable test availability and reduce delays to diagnoses by making them in pregnancy whilst removing the need for low-yield diagnostic interventions and enabling personalised patient management and family support.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694573","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":"Postprandial Hyperglycaemia Screening and Pregnancy Outcomes-Lessons From COVID -19.","authors":"Beenu Bastian, Lisa Gaye Smithers, Ansar Kunjunju, Alexia Pape, Monique Francois","doi":"10.1111/ajo.70014","DOIUrl":"https://doi.org/10.1111/ajo.70014","url":null,"abstract":"<p><strong>Background: </strong>During COVID-19, the diagnosis and treatment of GDM differed from conventional criteria. In Australia, during the alternative testing period, women with fasting glucose < 4.7 mmol/L were not diagnosed with GDM.</p><p><strong>Aim: </strong>To describe the maternal and neonatal outcomes of pregnant women with fasting blood glucose < 4.7 mmol/L for whom the diagnosis and treatment pathways differed before and during COVID-19.</p><p><strong>Materials and methods: </strong>An Australian population-based data linkage study involving 3891 women with fasting blood glucose < 4.7 mmol/L between 24 and 32 weeks of gestation categorised into three groups: women diagnosed with GDM by postprandial hyperglycaemia (PPGDM; n = 226); normal glucose tolerance group (NGT; n = 3125) and women not tested for postprandial hyperglycaemia, mostly during COVID-19 (LFBG; n = 540). Perinatal outcomes were compared using generalised linear models.</p><p><strong>Results: </strong>There were no differences between PPGDM and NGT groups in the risk of large for gestational age infants (RR 0.98, 95% CI: 0.63-1.52) although the mean birth weight (MD -103.43, 95% CI: -175.46 to -31.40)) was lower in the PPGDM group. The maternal and neonatal outcomes in the LFBG group were mostly comparable to the NGT group.</p><p><strong>Conclusion: </strong>In our study, the Australian COVID-19 GDM screening protocol, which includes initial fasting glucose testing, reduced the need for an OGTT in 67% of pregnant women. Diagnosis and treatment for postprandial hyperglycaemia in women with lower FBG should consider the benefits, as well as the financial, logistical and psychological costs involved.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694561","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":"Barry Normand John Walters, FRACP, FRANZCOG ad eundem (1950–2024)","authors":"Bill Hague","doi":"10.1111/ajo.13919","DOIUrl":"https://doi.org/10.1111/ajo.13919","url":null,"abstract":"&lt;p&gt;Barry Walters, a legend of Australian Obstetric Medicine, has died after a long incapacitating illness and a much shorter battle with the COVID-19 virus.&lt;/p&gt;&lt;p&gt;The elder son of jewellers, Wallace and Lucille Walters, Barry was born at St Vincent's Hospital, Melbourne: his father used to say, ‘he was born there because he wanted to be close to his mother’! Within 2 years, the family moved to Perth, which then became his home for the rest of his life. After winning a scholarship to Scotch College, he excelled in every subject and eventually became Dux of the school in 1967. He studied Medicine at the University of Western Australia (UWA) and, for most of the time, was the top student, including his final year, graduating with the AMA Gold Medal in 1974. His widow, Tamara, recalls her first memory of him at the first lecture of the year in the first year of medical school, ‘sitting with his rowdy friends right behind me, making wisecracks as I was trying to listen to the lectures. We didn't think very much of each other in those days. But the more time we spent together, the more I realized that he was the smartest man I had ever met. He was funny and made me laugh, and most of all, he was kind’.&lt;/p&gt;&lt;p&gt;After first thinking that he would like to do neurology, he then changed his mind to a career in paediatrics, with an initial job in neonatology at King Edward Memorial Hospital (KEMH), Subiaco. There he realised that there were many medical problems in obstetric patients that were not being well addressed, and he saw a need for a specialist obstetric physician in Perth. So he and Tamara headed over to England, where he worked first in Oxford for a year with one of the then two doyens of obstetric medicine, (the late) Chris Redman, and then for 2 years with the other, Michael de Swiet, at Queen Charlotte's Hospital in West London, home of the Institute of Obstetrics. During this time, he obtained his FRACP.&lt;/p&gt;&lt;p&gt;Returning to Perth, he initiated the obstetric medicine unit at KEMH, where he became Physician to the Diabetes service, although his interests were much broader than diabetes. He was available for medical advice in many obstetric crises, and many mothers (and their babies) owe their lives to his wise advice. He would drop everything to see a sick patient, often left picnics and parties, and would then not be seen for hours. Like his mentor, Chris Redman, Barry wanted to cure pre-eclampsia and had endless ideas about studies and research, writing and lecturing extensively on this, as well as other subjects. He was a founding member of the Obstetric Medicine Group of Australasia (OMGA) from its first meeting in Leonard's Mill, SA in 1992, and attended almost all the annual meetings on both sides of the Tasman. In 1998, he was appointed Clinical Associate Professor at UWA, and in 2003, was appointed Clinical Professor of Medicine at the newly opened medical school of the University of Notre Dame in Fremantle. Later, after the 2005 amalgamati","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"65 2","pages":"305-306"},"PeriodicalIF":1.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13919","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118001","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":"ANZJOG in 2025","authors":"Scott W. White","doi":"10.1111/ajo.70017","DOIUrl":"10.1111/ajo.70017","url":null,"abstract":"&lt;p&gt;Welcome to Volume 65 of the &lt;i&gt;Australian and New Zealand Journal of Obstetrics and Gynaecology&lt;/i&gt;. It is my great pleasure to lead RANZCOG's scientific publication into another year. 2024 was a busy year for the Journal, seeing an increase in submissions and published articles. I am grateful to those who contribute to the Journal's success through submission of quality manuscripts and participation in the peer review process. This support for our local publication furthers our aim of providing high-quality evidence to guide clinical care and further research.&lt;/p&gt;&lt;p&gt;This year will bring some changes to authors and readers of &lt;i&gt;ANZJOG&lt;/i&gt;. Authors will notice a change in submission processes which aim to streamline what has previously been a cumbersome process. We aim to provide new ways for readers to interact with the Journal's content, making our articles more visible to busy clinicians and researchers in this era of information overload and benefiting authors by raising the profile of and increasing the community's engagement with their publications. Please keep an eye out for these new features via &lt;i&gt;ANZJOG&lt;/i&gt; and RANZCOG channels soon.&lt;/p&gt;&lt;p&gt;I am very grateful to the &lt;i&gt;ANZJOG&lt;/i&gt; Editorial Board for their sustained efforts and support of the Journal's activity. I am very mindful of the delays that some authors have experienced in the peer review and decision processes, and this is something I am committed to improving upon in 2025. One mechanism for this will be to expand the Editorial Board, and a call for expressions of interest will soon be made, and I encourage anyone with an interest in research and publication to reach out. A diverse Editorial Board with a broad range of clinical and research experience makes for a more efficient and responsive Journal that will benefit authors and readers alike.&lt;/p&gt;&lt;p&gt;This first issue of the new volume contains many valuable articles. To open, Baalman et al. [&lt;span&gt;1&lt;/span&gt;] provide an overview of Prospective Structured Perinatal Audit using the Robson Ten Group Classification System. They identify a requirement for a cohesive strategy for the assessment of uniformly collected data, of outcomes relevant to clinicians, consumers, and health systems, to allow meaningful assessment of the quality of maternity care and benchmarking across jurisdictions and between models of care. Currently, there is no universally accepted consensus on maternity and newborn outcome data collection that allows such robust and insightful analysis. The authors highlight the difficulty in overcoming inertia in systematic audit and call upon health authorities and clinicians to make a strategic commitment to Prospective Structured Perinatal Audit with a view to improving outcomes for those under our care.&lt;/p&gt;&lt;p&gt;Readman et al. [&lt;span&gt;2&lt;/span&gt;] provide a commentary on the escalating problem of long waitlists for specialist gynaecology services, specifically in Victoria, and particularly for pelvic pain as the presenting ","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"65 1","pages":"3-5"},"PeriodicalIF":1.4,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627019","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":"Prevalence and Impact of Period and Pelvic Pain in Australian Adolescents: The PPEP Talk Schools Program.","authors":"Kate I Tomsett, Amelia K Mardon, Olivia W Gao, Annabelle K Simpson, Bridie C Squire, Indigo G Warner, Susan F Evans","doi":"10.1111/ajo.70015","DOIUrl":"https://doi.org/10.1111/ajo.70015","url":null,"abstract":"<p><strong>Background: </strong>In 2018 the Australian Government launched the world's first National Action Plan for Endometriosis (NAPE). Of its three priorities 'Priority 1' was 'Education and Awareness'. In response, the Pelvic Pain Foundation of Australia was funded to deliver their Periods, Pain and Endometriosis Program (PPEP) Talk to a proportion of Australian schools. Since then, PPEP Talk has been delivered to over 110,000 students.</p><p><strong>Aims: </strong>This retrospective cross-sectional study investigated students assigned female at birth (AFAB) and the prevalence and impact of period and pelvic pain, interaction with health care services and knowledge of endometriosis.</p><p><strong>Materials and methods: </strong>Multiple choice, pre and post PPEP Talk, paper survey responses between July 2022 and June 2023 were collected from 13,078 students AFAB.</p><p><strong>Results: </strong>52.6% of students reported regular severe period pain. 22.9% of students reported regularly missing school or work with their period. 21.5% of students had presented to a health professional for pain, and 5.7% had presented to an Emergency Department. 5.2% of students reported pelvic pain for more than 10 days per month. The prevalence and impact of period and pelvic pain varied across demographic variables. The proportion of students who knew what endometriosis was rose from 47.8% to 95.5% after the program.</p><p><strong>Conclusions: </strong>The NAPE's objective to enhance education and awareness of endometriosis and period/pelvic pain was met. 100% of schools who received PPEP Talk want it to return. Wide discrepancies in the prevalence of pain within different demographics were identified, providing previously unknown data to improve and direct services.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627033","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":"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}