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

{"title":"Adoption of vaginally assisted natural orifice transluminal endoscopic surgery for hysterectomy: A single tertiary experience.","authors":"Supuni Kapurubandara, Jan Baekelandt, Patrick Laws, Jenny King","doi":"10.1111/ajo.13862","DOIUrl":"https://doi.org/10.1111/ajo.13862","url":null,"abstract":"<p><strong>Background: </strong>Vaginal hysterectomy (VH) rate is declining despite being considered as the optimal minimally invasive option for hysterectomy with reduced operative time and length of stay compared with laparoscopic hysterectomy (LH). Vaginal assisted natural orifice transluminal endoscopic surgery hysterectomy (VANH) combines the advantages of both vaginal and endoscopic approach to surgery.</p><p><strong>Aims: </strong>To report feasibility and early experience of a single surgeon adopting VANH at a tertiary Australian hospital.</p><p><strong>Materials and methods: </strong>Prospective review of the first 20 VANH cases with complete data set collected retrospectively including patient demographics, indication for surgery and perioperative outcomes.</p><p><strong>Results: </strong>The median age of the first 20 participants was 51.5 years (47-57 years of age) and the median body mass index was 33.5 kg/m² (27.8-38.3 kg/m²). The predominant indication was complex hyperplasia with atypia (12/20, 60%). The median parity was two (1-3) where four patients were nulliparous. The median blood loss was 125 mL (100-200 mL) with an operative time of 149 min (138-198 min) and median weight of the specimen of 181.5 g (66.5-219 g). The mean length of stay was 1.4 days (1-2 days). Five cases had conversion to laparoscopy and the majority (80%) occurred within the first ten cases.</p><p><strong>Conclusions: </strong>VANH is feasible but there is a learning curve to achieve competence in this technique, which requires adequate training in the early stages of adoption with careful case selection. Until further robust data is available to determine the clinical benefit and safety profile of VANH, patients should be carefully counselled and the decision on mode of hysterectomy be individualised.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617706","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":"Methoxyflurane analgesia for outpatient hysteroscopy: A double-blind, randomised, controlled trial.","authors":"Emily K Twidale, Sofie Neutens, Lyn Hynt, Narena Dudley, Catherine Streeton","doi":"10.1111/ajo.13861","DOIUrl":"https://doi.org/10.1111/ajo.13861","url":null,"abstract":"<p><strong>Background: </strong>Despite clinical and economic benefits, pain during outpatient hysteroscopy (OPH) remains a barrier to use. There is a lack of evidence to support routine use of one analgesic over another versus no analgesic.</p><p><strong>Aims: </strong>To study the efficacy and safety of methoxyflurane analgesia during OPH.</p><p><strong>Materials and methods: </strong>A single-centre, randomised, double-blind, placebo-controlled experiment was performed; 90 patients were randomly assigned (1:1). Participants allocated to the treatment group (cases) received 3 mL of methoxyflurane through an inhaler. The control group received a placebo. The primary outcome was a mean difference in pain, via a change in Visual Analog Scale (VAS) score from baseline at diagnostic hysteroscopy. Secondary outcomes were a mean difference in VAS score with any subsequent operative procedures; a mean difference in VAS score at 15 min post-procedure; participant and clinician-reported adverse effects and events; and participant-reported procedure acceptability, adjuvant nitrous oxide (N₂O₂) use and a composite of 'distress'.</p><p><strong>Results: </strong>During diagnostic hysteroscopy, there was a mean difference of 11.5 mm/100 (95% confidence interval (CI) 0.08-22.95), P = 0.05, with the lower score in the cases, compared with controls. During subsequent operative procedures, there was a mean difference of 15 mm/100 (95% CI 2.71-28.22), P = 0.02, with the lower pain score in the cases, compared with controls. There was no significant difference in pain 15 min post-procedure, participant- and clinician- reported adverse effects and events, procedure acceptability and the 'distress' composite.</p><p><strong>Conclusions: </strong>Methoxyflurane significantly reduced pain during OPH compared with placebo, for diagnostic as well as operative procedures. Furthermore, methoxyflurane was well tolerated, with no adverse events.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617707","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 64 (3)","authors":"Scott W. White","doi":"10.1111/ajo.13863","DOIUrl":"10.1111/ajo.13863","url":null,"abstract":"<p>Welcome to the June issue of the <i>Australian and New Zealand Journal of Obstetrics and Gynaecology</i>.</p><p>This issue begins with a thought-provoking editorial by Boothroyd <i>et al</i><span>¹</span> which explores the declining fertility rate in the Australian population and its implications for society. Australia is not alone among similar countries in this situation, it being a common challenge faced by virtually all high-income countries. While we have been able to maintain population growth due to net immigration, this is unlikely to remain the case in the longer term, and at some point we are likely to find ourselves in the situation where supporting the growing elderly population is reliant upon a shrinking working age population. This is clearly economically unsustainable. The authors identify contributors such as higher levels of female education and employment and extended educational and career development pathways coinciding with peak fertility ages. In suggesting areas for public policy changes which could address the fertility decline, the authors make a call for this to become part of the political agenda.</p><p>The issue continues with a wide-ranging selection of papers from across our specialty.</p><p>Endometriosis continues to be topical. Fang <i>et al</i><span>²</span> present a systematic review of multidisciplinary teams for the care of people with endometriosis. They find the models studied varied in professional composition, with little clear evidence to demonstrate which is the superior model in terms of clinical and important non-clinical outcomes. They speculate that multidisciplinary teams are likely to be valuable but that further research is required to show which models are most effective. Frayne <i>et al</i><span>³</span> present a mixed methods study of the acceptability of using the Raising Awareness Tool for Endometriosis (RATE) in a general practice setting. They found that general practitioners found RATE valuable, particularly in facilitating discussion about symptoms and their management, but identified uncertainty about the identification and management of people with chronic pain syndromes. Pelvic pain was highly prevalent, with a significant impact on quality of life in a substantial proportion of those participants. Paterson <i>et al</i><span>⁴</span> present the first published data on endometriosis surgery in Aotearoa New Zealand. This retrospective review of over 400 surgeries performed for known or suspected endometriosis found pain to be the most common indication for surgery, with 68% of surgeries confirming this condition. These findings are broadly comparable to international data, but the authors call for further research into endometriosis in a New Zealand-specific context.</p><p>McGinn <i>et al</i><span>⁵</span> present their study of sexual and reproductive health services in New Zealand. They report that these services are fragmen","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13863","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617708","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":"Willingness to pay for expanded non-invasive prenatal screening - An online discrete choice experiment from the perspective of women living in Western Australia.","authors":"Sarah Long, Peter O'Leary, Richard Norman, Jan E Dickinson","doi":"10.1111/ajo.13858","DOIUrl":"https://doi.org/10.1111/ajo.13858","url":null,"abstract":"<p><strong>Introduction: </strong>Ongoing advances in genetic technology may soon provide prenatal screening for multiple genetic conditions.</p><p><strong>Aims: </strong>The aims were to investigate what prenatal screening test characteristics women prioritise and their willingness to pay for these tests.</p><p><strong>Methods: </strong>We designed an online survey incorporating a series of discrete choice scenarios. Dimensions and levels were selected based on existing prenatal tests and a hypothetical prenatal test that could non-invasively detect multiple genetic disorders in pregnancy. Participants were recruited from social media platforms. Data were analysed using conditional logistic regression and latent class analysis (LCA).</p><p><strong>Results: </strong>A total of 219 women completed the survey. Women with higher incomes and those with a tertiary education were willing to pay more than other groups. The maximum willingness to pay was AUD1870 (95% confidence interval: 1630, 2112) for a hypothetical non-invasive test to detect multiple genetic conditions in early pregnancy. An LCA demonstrated considerable heterogeneity in preferences, differing in both overall preference for testing and test characteristics considered most attractive. Among the participants, decision factors cited by 14.5% of participants were the risk of pregnancy loss, making them less likely to undergo testing; for 32.1% participants, accuracy was a major factor, and they were very likely to have testing; for 12.9%, test availability early in pregnancy was a decision factor.</p><p><strong>Conclusions: </strong>If a non-invasive test that could detect the greatest number of genetic disorders in pregnancy was available, the priorities were test accuracy, risk of pregnancy loss and a test available early in pregnancy.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602210","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":"Routine transabdominal cervical length screening in mid-pregnancy for the prevention of preterm birth: Is it good enough to use as a screening test?","authors":"Michelle K Pedretti, Jan E Dickinson, Dorota A Doherty, John P Newnham","doi":"10.1111/ajo.13859","DOIUrl":"https://doi.org/10.1111/ajo.13859","url":null,"abstract":"<p><strong>Background: </strong>Preterm birth (PTB) is a major pregnancy complication. There is evidence that a short cervical length in mid-pregnancy may predict women at increased risk of PTB.</p><p><strong>Aims: </strong>To evaluate the utility of population-based, transabdominal cervical length (TACL) measurement screening in mid-pregnancy for PTB prediction in women.</p><p><strong>Materials and methods: </strong>A transabdominal approach was initially performed, with a transvaginal (TVCL) approach offered when the TACL was <35 mm, could not be accurately measured, or the pregnancy had risk factors for PTB. TACL was compared to the directly related TVCL, when both were performed at the same assessment. Women with risk factors of PTB were included when they had both TACL and TVCL measurements performed at the same visit.</p><p><strong>Results: </strong>Data were provided for 9355 singleton pregnancies from 13 participating imaging centres. A transabdominal approach was used in 9006 (96.3%), including 682 (7.3%) TVCL combined with TACL. There were 349 (3.7%) women who had TVCL only. The median TACL was longer (40 mm) than the TVCL (38 mm). In 682 paired TACL and TVCL measurements, TACL <35 mm correctly identified 96.2% of pregnancies with TVCL <25 mm, compared with 65.4% of cases when using a TACL <30 mm. A TVCL <25 mm occurred in 59 (0.6%) women. A TACL <35 mm was associated with birth <37 weeks of gestation in 12.1% of women and birth <32 weeks of gestation in 3.9%.</p><p><strong>Conclusions: </strong>Universal TACL is a feasible option for population screening of cervical length in a low-risk population, progressing to TVCL if the TACL is <35 mm or the cervix cannot be transabdominally accurately measured.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565192","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 of preterm births during COVID-19 mitigation measures.","authors":"Yizhen Amy Liu, Alexia Matheson, Rochelle Sleaby, Brendan Mulcahy, Kirsten R Palmer, Ryan J Hodges, Ben W Mol, Atul Malhotra, Daniel L Rolnik","doi":"10.1111/ajo.13853","DOIUrl":"https://doi.org/10.1111/ajo.13853","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, mitigation measures were associated with a reduction in preterm birth rates; while not clearly proven, this observation has sparked significant interest.</p><p><strong>Aim: </strong>To understand the cause of this reduction by exploring the characteristics of preterm birth cohorts.</p><p><strong>Material and methods: </strong>We performed a retrospective cohort study where we compared women who delivered preterm in three Melbourne maternity hospitals and conceived between November 2019 and February 2020 (mitigation measures-exposed cohort) to women who delivered preterm and conceived between November 2018 and February 2019 (non-exposed cohort). We compared maternal characteristics, pregnancy complications, antenatal interventions, intrapartum care, and indications for delivery.</p><p><strong>Results: </strong>In the exposed cohort, 252/3129 women delivered preterm (8.1%), vs 298/3154 (9.4%) in the non-exposed cohort (odds ratio (OR) 0.84, 95% CI 0.70-1.00, P = 0.051). The baseline characteristic of two cohorts were comparable. Rates of spontaneous preterm labour (sPTL) without preterm pre-labour rupture of membranes (PPROM) were lower in the exposed cohort (13.1% vs 24.2%, OR 0.47, P = 0.001) while PPROM occurred more often (48.0% vs 35.6%, OR 1.67, P = 0.003). With a non-statistically significant prolongation of pregnancy in the cohort exposed to mitigation measures for both sPTL without PPROM (35.4 vs 34.9 weeks, P = 0.703) and PPROM (35.6 vs 34.9 weeks, P = 0.184). The rate of spontaneous labour after PPROM was higher in the exposed cohort compared to the non-exposed cohort (40.1% vs 24.1%, OR 2.09, P < 0.001).</p><p><strong>Conclusion: </strong>The reduction in preterm delivery during mitigation measures may have been driven by a reduction in spontaneous labour without PPROM, which seemed to result in more PPROM later in pregnancy.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472845","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 survey of obstetric and gynaecology doctors at an Australian metropolitan tertiary hospital to understand their views, training and confidence in abortion care.","authors":"Laura C Phung, Joanne M Said, Aekta Neel","doi":"10.1111/ajo.13852","DOIUrl":"https://doi.org/10.1111/ajo.13852","url":null,"abstract":"<p><strong>Background: </strong>The barriers to comprehensive abortion care in Australian metropolitan tertiary hospitals are under-researched. Previous work has suggested that negative practitioner attitudes and lack of training may play a large role; however, this remains poorly understood.</p><p><strong>Aim: </strong>The aim was to survey doctors practicing obstetrics and gynaecology to better understand their views, training experience and confidence in abortion care.</p><p><strong>Method: </strong>The method involved a cross-sectional study via an anonymous survey at a single metropolitan tertiary hospital not providing substantive abortion services in Melbourne, Australia. Inclusion criterion was obstetric and gynaecology medical staff working at that hospital. Data were collected regarding views, training experiences and confidence in first-trimester medical and surgical abortion, and second-trimester surgical abortion. Data were analysed according to levels of training, categorised as RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) Fellows, prevocational/vocational trainees and general practitioner specialists.</p><p><strong>Results: </strong>Sixty-one valid responses were received from 90 eligible participants (response rate 68%). An overwhelming majority (96%) supported abortion services. The majority of RANZCOG Fellows felt confident performing first-trimester surgical abortion (89%) and first-trimester medical abortion (71%); however, only half felt confident performing second-trimester surgical abortion (50%). Prevocational/vocational trainees were overall less confident but overwhelmingly expressed interest in gaining further experience in abortion.</p><p><strong>Conclusion: </strong>Doctors are generally confident in providing first-trimester abortion services (medical or surgical) in the metropolitan tertiary setting. However, further work is required to understand ongoing barriers to comprehensive abortion care. There may also be a skills shortage for second-trimester surgical abortion, requiring significant improvements in abortion training.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460810","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":"Australasian Recurrent Pregnancy Loss Clinical Management Guideline 2024 Part I.","authors":"Adriana Suker, Ying Li, Danielle Robson, Anthony Marren","doi":"10.1111/ajo.13821","DOIUrl":"https://doi.org/10.1111/ajo.13821","url":null,"abstract":"<p><p>Guidelines for the investigation and management of recurrent pregnancy loss (RPL) have been developed in Europe, USA and UK, but there is currently no Australasian guideline. The Australasian Certificate of Reproductive Endocrinology and Infertility Consensus Expert Panel on Trial Evidence group has prepared a two-part guideline to provide guidance on the management of RPL. In Part I chromosomal, anatomical, and endocrine factors are outlined along with relevant recommendations for clinical management, levels of evidence and grades of consensus. In Part II thrombophilia, autoimmune factors, infective, inflammatory, and endometrial causes, environmental and lifestyle factors, male factor and unexplained causes will be outlined.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460811","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":"Australasian recurrent pregnancy loss clinical management guideline 2024, part II.","authors":"Adriana Suker, Ying Li, Danielle Robson, Anthony Marren","doi":"10.1111/ajo.13820","DOIUrl":"https://doi.org/10.1111/ajo.13820","url":null,"abstract":"<p><p>Part II of the Australasian guideline for the investigation and management of recurrent pregnancy loss (RPL) provides evidence-based guidance on the management of RPL provided. The implications of inherited and acquired thrombophilia with respect to RPL and suggestions for clinical management are provided. Autoimmune factors, including human leukocyte antigen, cytokines, antinuclear antibodies and coeliac antibodies, and guidance for management are discussed. Infective, inflammatory and endometrial causes of RPL are discussed in detail. Environmental and lifestyle factors, male factor and unexplained causes are outlined. Levels of evidence and grades of consensus are provided for all evidence-based statements.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460812","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":"Pelvic pain education - A short review on pelvic pain and endometriosis educational programs for adolescents.","authors":"Hui Ping Adeline Thong, Amelia Kate Mardon, Susan Evans","doi":"10.1111/ajo.13856","DOIUrl":"https://doi.org/10.1111/ajo.13856","url":null,"abstract":"<p><p>Persistent pelvic pain is a significant healthcare concern among adolescents; however adolescents often have poor health literacy regarding their pain. Current school curricula fail to specifically address pelvic pain and management strategies. This review aims to summarise current pelvic pain education programs in Australian and New Zealand schools. These programs have successfully strengthened the understanding of the psychosocial impact of periods and pelvic pain, instilled greater confidence in managing persistent pain and have allowed for prompt detection and treatment of pelvic pain in adolescents. An outcomes-driven, collaborative, and coordinated approach is needed to improve pelvic health educational interventions for adolescents.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460832","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}