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

{"title":"Educational programs for adolescents.","authors":"Felicity Roux","doi":"10.1111/ajo.13868","DOIUrl":"https://doi.org/10.1111/ajo.13868","url":null,"abstract":"","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890999","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 (4)","authors":"Scott W. White","doi":"10.1111/ajo.13860","DOIUrl":"10.1111/ajo.13860","url":null,"abstract":"<p>Welcome to the August issue of the <i>Australian and New Zealand Journal of Obstetrics and Gynaecology</i>.</p><p>This issue begins with an editorial by Calvert, Janssens, and Symonds introducing the new initiative of the RANZCOG Academy of Clinician Educators (ACE).<span><sup>1</sup></span> This program is born out of a recognition of the vast experience in the practical clinical education of RANZCOG trainees held by those who provide that training on the ground, be they Fellows of the College or the other health professionals with whom our trainees interact in the clinical environment. The ACE aims, notably ambitiously, “to foster excellence in medical education” and backs up this noble goal with further aims of how to support this. The ACE will bring together a group of clinician educators with varied expertise, including those with higher qualifications in medical education to those with long careers of supervising trainees at the bedside and those making the transition from trainee to trainer. The ACE is deliberately inclusive, recognising that teaching is a key component of the Scholar Role of the CanMEDS Physician Competency Framework<span><sup>2</sup></span> upon which the revised RANZCOG Curriculum is founded.</p><p>Calvert et al describe the key competencies of medical educators as only knowledge of such qualities will allow the ACE to foster and further develop the skills of clinicians as teachers. The ACE will provide a range of opportunities for clinician educators to develop these skills, including professional development workshops, resource sharing, educational collaboration, and networking between teachers across institutions and jurisdictions. To access these opportunities, I recommend you join the ACE via the dedicated website: www.ranzcog.edu.au/ace.</p><p>The issue continues with a wide-ranging selection of papers from across our specialty.</p><p>Harrison <i>et al</i>.<span><sup>3</sup></span> present a retrospective audit of a tertiary maternal medicine clinic with a particular focus on women with current or previous malignancy, accounting for 6% of the women receiving care in their service. As pregnancies in women with current and previous malignancies become more common due to increasing maternal age, improved cancer survival outcomes, attention to fertility preservation and confidence in continuing a pregnancy while offering cancer treatment, it is useful to have such data to provide reassurance that obstetric and perinatal outcomes are generally favourable. Stoinis <i>et al</i>.<span><sup>4</sup></span> present a series of cases of Cushing's syndrome in pregnancy. They describe the diverse presentations of this rare comorbidity and the challenges of making a diagnosis during pregnancy. Pregnancy outcomes are compromised by a delayed diagnosis, reminding maternity care providers of the particular importance of evaluating for secondary causes of hypertension when present in early pregnancy.</p><p>Wade <i>et al</i>.<span","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"64 4","pages":"303-304"},"PeriodicalIF":1.4,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13860","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891000","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":"Levothyroxine may not adequately prepare hypothyroid women for controlled ovarian hyperstimulation: Correspondence.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1111/ajo.13870","DOIUrl":"https://doi.org/10.1111/ajo.13870","url":null,"abstract":"","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861683","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":"Retrospective review of surgeon administered transversus abdominis plane blocks at emergency caesarean.","authors":"Rachel Einarsson, Joshua Knowles","doi":"10.1111/ajo.13871","DOIUrl":"https://doi.org/10.1111/ajo.13871","url":null,"abstract":"<p><strong>Background: </strong>Effective analgesics with minimal side effects are imperative for patient and neonate wellbeing postpartum. Post-caesarean section ultrasound-guided transversus abdominis plane (TAP) blocks have proven safety and efficacy. Surgical TAP blocks appear effective and require little time and equipment. No previous examination of surgical TAP blocks in patients having undergone emergency caesarean section has been undertaken.</p><p><strong>Aims: </strong>To investigate surgical TAP block and multimodal analgesic use during emergency caesarean section, the effect on surgical time, post-operative analgesia use, and admission length.</p><p><strong>Materials and methods: </strong>We performed a retrospective review of 250 patients who underwent emergency caesarean in 2022. Surgical TAP blocks were performed with 20 mL of 0.375% ropivacaine either side. Primary outcomes included surgical time, length of admission, time to first request of rescue opiate, opiate use in first post-operative 24 h, total dose used during admission, and opiates prescribed on discharge.</p><p><strong>Results: </strong>Ninety-six patients received surgical TAP blocks, and 154 did not. There were no statistically significant differences in the primary outcomes. Subgroup analyses were performed in patients who did not receive intrathecal morphine, body mass index over 30 kg/m², for patients whom this was their first caesarean, and for TAP blocks versus local infiltration to the wound. There were no significant differences in the primary outcomes in these subgroups.</p><p><strong>Conclusions: </strong>Surgical TAP blocks did not prolong surgical time or decrease post-operative analgesia use or admission length in patients having undergone emergency caesarean. Patient-tailored multimodal analgesia is encouraged, although more research is needed.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861684","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 impact of the COVID-19 public health response on service demand and patient perceptions in a tertiary Australian gynaecology oncology unit.","authors":"Nooraishah Yasin, Michael Yu, Kristen Jones, Anne Woolfield, Ian Hughes, Marcelo Nascimento, Helen Green","doi":"10.1111/ajo.13867","DOIUrl":"https://doi.org/10.1111/ajo.13867","url":null,"abstract":"<p><strong>Introduction: </strong>The public health response (PHR) to the COVID-19 pandemic significantly disrupted healthcare services worldwide. Our hospital, a major tertiary centre, is a unique two-state service across Queensland and New South Wales (NSW).</p><p><strong>Objective: </strong>The primary objective is to describe changes in service demand and delivery in our hospital resulting from the COVID-19 PHR. The secondary objective is to investigate patient perceptions of this impact.</p><p><strong>Materials and methods: </strong>We performed a retrospective interrupted time series analysis and a population-based survey to examine patient perceptions of the impact of the COVID-19 PHR. The study periods were demarcated by the initiation of the COVID-19 PHR on 1 March 2020 with the 'pre' and 'during' COVID-19 periods defined as the 12 months before and after this date respectively.</p><p><strong>Results: </strong>More patients were seen during the COVID-19 PHR period. The number or stage of cancer diagnoses was not different (P > 0.05). There was evidence (P = 0.03) of an increase in overall occasions of service and fewer failed attendances (P = 0.005). Fewer surgeries were performed on NSW patients (P = 0.005). The survey response rate was 19.3% (n = 185) with 48% stating that COVID-19 had negatively affected their emotional wellbeing. More participants from NSW than Queensland identified border closures as the most significant impact of the COVID-19 PHR.</p><p><strong>Discussion: </strong>The COVID-19 PHR resulted in an unexpected increase in unit service demand and delivery. The necessary implementation of telephone appointments, while less preferred by patients, sustained service requirements. Cross-border tertiary healthcare services should consider the significant impact of border restrictions on patient wellbeing.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789883","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":"Worth waiting for?","authors":"Karen Joseph,&nbsp;Lauren Kite,&nbsp;Sonia Grover,&nbsp;Marilla Druitt","doi":"10.1111/ajo.13869","DOIUrl":"10.1111/ajo.13869","url":null,"abstract":"&lt;p&gt;The article by Ellis and Wood ‘A decade to wait’&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; has added to the focus of energies on identifying and reducing the delay in diagnosis of endometriosis for those suffering pelvic pain. Such anonymous, retrospective, self-report surveys have recognised limitations.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; These endeavours also have an a priori assumption that a shorter time to diagnosis of endometriosis improves outcomes and does not pose risks. Women's health has an unfortunate history of harms caused by assumptions based on ‘first principles’ without rigorous research.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The recently formed Endometriosis Initiative Group comprises experts from across the globe with the aim of considering ‘alternatives to the commonly accepted hypotheses … and common sense propositions’, noting that to do so ‘we may need to move away from our “comfort zone” and not become complacent’.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In this spirit we propose alternative viewpoints on the effects of reducing delays to diagnosis of endometriosis for women living with pelvic pain, which could be uncomfortable reading for some.&lt;/p&gt;&lt;p&gt;The Webster dictionary defines diagnosis as ‘the art or act of identifying a disease from its signs and symptoms’, yet it is well recognised that endometriosis – the presence of ectopic endometrial glands and stroma – cannot be reliably identified from clinical signs and symptoms.&lt;/p&gt;&lt;p&gt;Endometriosis lesions are neither necessary nor sufficient for pelvic pain. Women with extensive lesion burden can be completely pain free, yet many others who suffer severe pain have very minimal (or no) visible abnormalities. A drive to reduce delay in diagnosis of endometriosis could be extended to include making the diagnosis in those without symptoms.&lt;/p&gt;&lt;p&gt;Lesions have been demonstrated in up to 45% of pain-free women; it is possible that with wide peritoneal excision microscopic lesions could be found in most, if not all, women.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Identification of such asymptomatic lesions moves from early diagnosis to screening.&lt;/p&gt;&lt;p&gt;Calls for an earlier diagnosis or screening for a condition are grounded in the presumption of disease progression over time and that the outcome of the disease process could be improved by earlier intervention. This approach is the cornerstone for many cancers. The early detection of cervical dysplasia, and intervention to treat this (and now even prevent this with vaccination) is an excellent example.&lt;/p&gt;&lt;p&gt;However, unlike cervical cancer, endometriosis does not fulfil the World Health Organization/Wilson &amp; Jungner criteria for screening. The natural history is poorly understood, not predictably progressive or with a recognised latent stage, there are no predictors of which asymptomatic lesions will progress to a symptomatic state, and there are no treatments proven to prevent such progression to nervous system upregulation and development of persistent pain.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"64 5","pages":"423-426"},"PeriodicalIF":1.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13869","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762851","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":"Launching the ACE","authors":"Katrina Calvert,&nbsp;Sarah Janssens,&nbsp;Ian Symonds","doi":"10.1111/ajo.13866","DOIUrl":"10.1111/ajo.13866","url":null,"abstract":"&lt;p&gt;Much focus has been placed on optimising training in obstetrics and gynaecology, with redesign of accreditation standards, expansion of training sites, curriculum reviews and the ever-present dilemma around appropriate surgical numbers for trainee logbooks. However, the time has come to consider the role of the unsung heroes of the training experience – the trainers. At the 2023 Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Annual Scientific Meeting in Perth, a group of interested Fellows, Proceduralists, Trainees and College staff met to workshop what a RANZCOG Community of Practice for educators might look like. The discussion centred around the potential aims of such a group, its purpose, and of course – its name. Thus was born the RANZCOG Academy of Clinician Educators – the ACE. The ACE was formally launched by RANZCOG President Dr Gillian Gibson at the RANZCOG Symposium in the Sunshine Coast in July 2024, and will be hosting its opening webinar on the subject of ‘What makes a good medical teacher?’ on 22 August.&lt;/p&gt;&lt;p&gt;The aims of the ACE born out of that first meeting in Perth are fourfold: (1) to foster excellence in medical education; (2) to provide professional development opportunities for medical educators through RANZCOG; (3) to promote sharing of resources and collaboration between education providers and the College; and (4) to create networking and support opportunities for current medical educators and for those with an interest in the area (Fig. 1).&lt;/p&gt;&lt;p&gt;To foster excellence in education we need to know what that looks like: what are the essential competencies for a medical educator in our speciality? The literature identifies multiple competency domains, with good concordance between different authors on the subject.&lt;span&gt;&lt;sup&gt;1-3&lt;/sup&gt;&lt;/span&gt; The consensus is that excellence in medical education comprises skills or attributes in the following five areas: teaching and facilitating learning, designing and planning learning, assessment and feedback, educational research and scholarship, and educational leadership. If the ACE are to accept and promote those five competencies, we must first understand them, including understanding how they are applicable to clinician educators in our own speciality of obstetrics and gynaecology. Let us consider them in turn, starting with the most obvious competency area for an educator – that of teaching and facilitating learning.&lt;/p&gt;&lt;p&gt;How to define competency in teaching is surprisingly difficult within the medical field, as there seem to be opposing views on whether clinical expertise is more important than the non-clinical skills associated with teaching when it comes to medical education. In 2008, Sutkin &lt;i&gt;et al&lt;/i&gt; published a literature review on the subject ‘What makes a good clinical teacher in medicine?’.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Sutkin identified 49 separate themes arising from analysis of the literature. The dominant theme was ‘Medical/clini","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"64 4","pages":"305-307"},"PeriodicalIF":1.4,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13866","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753452","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":"Management of potassium-wasting syndrome in the antepartum, intrapartum and postpartum period.","authors":"Connor McPhail, Hannah Szewczyk, Ana McCarthy, Tayla Wark, Anupam Parange, Shilpanjali Jesudason","doi":"10.1111/ajo.13865","DOIUrl":"https://doi.org/10.1111/ajo.13865","url":null,"abstract":"<p><p>Potassium-wasting syndromes, including Gitelman or Bartter syndrome, require close medical and biochemical review during pregnancy to reduce potentially severe complications, morbidity and mortality. We report a case of severe potassium-wasting syndrome managed successfully in pregnancy with extremely high oral potassium intake.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731670","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":"Universal screening for Lynch syndrome in endometrial cancer diagnoses in Auckland, New Zealand: The initial experience.","authors":"Silipa Lock Sam Naiqiso, Jo Moses, Ai Ling Tan, Lois Eva","doi":"10.1111/ajo.13857","DOIUrl":"https://doi.org/10.1111/ajo.13857","url":null,"abstract":"<p><strong>Background: </strong>Universal mismatch repair immunohistochemistry (MMR IHC) tumour testing in endometrial cancer (EC) for Lynch syndrome (LS) was introduced in Auckland, New Zealand, in January 2017. Identifying patients with LS allows them and their families to access risk reduction strategies. Universal MMR IHC testing aids in the molecular classification of EC and has prognostic and therapeutic implications.</p><p><strong>Aim: </strong>We aimed to determine the incidence of LS in women with EC in Auckland, New Zealand, following the introduction of MMR testing and the impact of universal screening on local genetic services.</p><p><strong>Materials and methods: </strong>This is a retrospective clinicopathological evaluation of women with a new EC diagnosis referred to the Auckland Gynaecological Oncology Unit from 1/1/17 to 31/12/18. Patient data were extracted from the Gynaecological Oncology Unit database and electronic records, and analysed using descriptive statistics.</p><p><strong>Results: </strong>During the study period, 409 patients were diagnosed with EC, with an over-representation of Pacific Islanders (32.5%). Of these, 82.6% underwent MMR IHC testing, 20% were MMR-deficient (MMRd), and 71% had somatic hypermethylation. The Pacific Islander population had a 64% (odds ratio 0.36, P = 0.005) reduction in the odds of having MMRd tumours compared with Europeans. Of the patients who underwent MMR IHC testing, 5.5% were referred to a genetic clinic for germline testing. LS was confirmed in eight patients (2.3%).</p><p><strong>Conclusion: </strong>LS was diagnosed in 2.3% of patients. There was an over-representation of Pacific Islanders in the EC group but not among those diagnosed with LS.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629336","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":"Temporal and external validation of the algorithm predicting first trimester outcome of a viable pregnancy.","authors":"Nicole Stamatopoulos, Donna Ngo, Chuan Lu, Mercedes Espada Vaquero, Mathew Leonardi, George Condous","doi":"10.1111/ajo.13855","DOIUrl":"https://doi.org/10.1111/ajo.13855","url":null,"abstract":"<p><strong>Background: </strong>Symptoms like vaginal bleeding or abdominal pain in early pregnancy can create anxiety about potential miscarriage. Previous studies have demonstrated ultrasonographic variables at the first trimester transvaginal scan (TVS) which can assist in predicting outcomes by 12 weeks gestation.</p><p><strong>Aim: </strong>To validate the miscarriage risk prediction model (MRP) in women who present with a viable intrauterine pregnancy (IUP) at the primary ultrasound.</p><p><strong>Materials and methods: </strong>A multi-centre diagnostic study of 1490 patients was performed between 2011 and 2019 for retrospective external and 2017-2019 for prospective temporal validation. The reference standard was a viable pregnancy at 12 + 6 weeks. The MRP model is a multinomial logistic regression model based on maternal age, embryonic heart rate, logarithm (gestational sac volume/crown-rump length (CRL)) ratio, CRL and presence or absence of clots.</p><p><strong>Results: </strong>Temporal validation data from 290 viable IUPs were collected: 225 were viable at the end of the first trimester, 31 had miscarried and 34 were lost to follow-up. External validation data from 1203 viable IUPs were collected at two other ultrasound units: 1062 were viable, 69 had miscarried and 72 were lost to follow-up. Temporal validation with a cut-off of 0.1 demonstrated: area under the curve (AUC) of 0.8 (0.7-0.9), sensitivity 66.7%, specificity 83.9%, positive predictive value (PPV) 35.7%, negative predictive value (NPV) 94.9%, positive likelihood ration (LR+) 4.1 and negative LR (LR-) 0.4. External validation demonstrated: AUC 0.7 (0.7-0.8), sensitivity 44.9%, specificity 90.4%, PPV 23.3%, NPV 96.2%, LR+ 4.6 and LR- 0.6 (0.4-0.7).</p><p><strong>Conclusion: </strong>The MRP model is not able to be used in real time for counselling, and management should be individualised.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635874","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}