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

{"title":"Extending the new era of genomic testing into pregnancy management: A proposed model for Australian prenatal services","authors":"Alice Rogers, Lucas De Jong, Wendy Waters, Lesley H. Rawlings, Keryn Simons, Song Gao, Julien Soubrier, Rosalie Kenyon, Ming Lin, Rob King, David M. Lawrence, Peter Muller, Shannon Leblanc, Lesley McGregor, Suzanne C. E. H. Sallevelt, Jan Liebelt, Tristan S. E. Hardy, Janice M. Fletcher, Hamish S. Scott, Abhi Kulkarni, Christopher P. Barnett, Karin S. Kassahn","doi":"10.1111/ajo.13814","DOIUrl":"https://doi.org/10.1111/ajo.13814","url":null,"abstract":"BackgroundTrio exome sequencing can be used to investigate congenital abnormalities identified on pregnancy ultrasound, but its use in an Australian context has not been assessed.AimsAssess clinical outcomes and changes in management after expedited genomic testing in the prenatal period to guide the development of a model for widespread implementation.Materials and methodsForty‐three prospective referrals for whole exome sequencing, including 40 trios (parents and pregnancy), two singletons and one duo were assessed in a tertiary hospital setting with access to a state‐wide pathology laboratory. Diagnostic yield, turn‐around time (TAT), gestational age at reporting, pregnancy outcome, change in management and future pregnancy status were assessed for each family.ResultsA clinically significant genomic diagnosis was made in 15/43 pregnancies (35%), with an average TAT of 12 days. Gestational age at time of report ranged from 16 + 5 to 31 + 6 weeks (median 21 + 3 weeks). Molecular diagnoses included neuromuscular and skeletal disorders, RASopathies and a range of other rare Mendelian disorders. The majority of families actively used the results in pregnancy decision making as well as in management of future pregnancies.ConclusionsRapid second trimester prenatal genomic testing can be successfully delivered to investigate structural abnormalities in pregnancy, providing crucial guidance for current and future pregnancy management. The time‐sensitive nature of this testing requires close laboratory and clinical collaboration to ensure appropriate referral and result communication. We found the establishment of a prenatal coordinator role and dedicated reporting team to be important facilitators. We propose this as a model for genomic testing in other prenatal services.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140567467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient hysteroscopy: Suitable for all? A retrospective cohort study of safety, success and acceptability in Australia","authors":"Rebecca Nash, Samir Saidi","doi":"10.1111/ajo.13816","DOIUrl":"https://doi.org/10.1111/ajo.13816","url":null,"abstract":"BackgroundIn Australia, gynaecologists continue to assess and investigate abnormal uterine bleeding with inpatient hysteroscopy despite evidence validating outpatient hysteroscopy services.AimThis retrospective cohort study assessed the safety, success and acceptability of office hysteroscopy in a gynae‐oncology rapid‐access clinic over six years in Sydney, Australia, and included all women without an age or body mass index (BMI) cut‐off using a ‘see and treat’ concept.MethodsA database was created and analysed retrospectively for patients who attended office hysteroscopy service between January 2016 and March 2021 (63 months, 481 eligible). An anonymous modified PAT‐32 patient satisfaction questionnaire was also offered to an initial cohort after their procedure to gauge insightful feedback about acceptability.ResultsA total of 92% of patients had successful outpatient hysteroscopic access; 24% of cases required hysteroscopy under general anaesthesia (GA) despite pathology in over 50% of cases; 68% of the total were able to be managed with outpatient hysteroscopy and did not require a follow‐up GA hysteroscopy. This paper is also the first of its kind to our knowledge to incorporate patients >65 years, those with a BMI >35 and those with a history of cervical stenosis. This study suggests that age and BMI do not impact the success rate of the procedure.ConclusionThis study demonstrates that outpatient hysteroscopy is an acceptable, safe procedure that is well tolerated by patients. Considering our rapid‐access hysteroscopy service allowed 68% of the patient cohort to avoid hysteroscopy under GA, we estimate conservatively ~$63 million per year in Australia could be saved by performing office hysteroscopies.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140567575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID‐19 lockdowns affected birthing outcomes in a regional New South Wales Health District","authors":"Pierre Hofstee, Bridie Mulholland, Megan Kelly, Warren Davis, Kate Curtis","doi":"10.1111/ajo.13812","DOIUrl":"https://doi.org/10.1111/ajo.13812","url":null,"abstract":"IntroductionThe 400 000 residents of the Illawarra Shoalhaven Local Health District (ISLHD) experienced two distinct lockdowns aimed at mitigating the transmission of severe acute respiratory syndrome coronavirus 2 infection. Analysing effects of these lockdowns on maternal and neonatal outcomes presents a valuable opportunity to assess the impact of pandemic‐level restrictions on maternal and neonatal outcomes.AimEvaluate the impacts of restrictions from two lockdown periods on maternal, birthing, and neonatal outcomes within a regional local health district.Materials and MethodsThe study included 22 166 women who gave birth within ISLHD between 2017 and 2022. Groups included for analysis: Control Group – mothers pregnant before the pandemic (conception before 3 April 2019); Exposure Group 1 – mothers pregnant during the first lockdown (conception date 22 January 2020 to 5 May 2020); and Exposure Group 2 – mothers pregnant during the second lockdown (conception date 30 April 2021 to 13 Sep 2021).ResultsOdds of adverse birthing outcomes including non‐reassuring fetal status (odds ratio (OR) 1.34; 95% CI 1.14–1.56 and OR 1.20; 95% CI 1.03–1.40), and postpartum haemorrhage (OR 2.04; 95% CI 1.73–2.41 and OR 1.74; 95% CI 1.48–2.05) were substantially increased in Exposure Groups 1 and 2, respectively. Gestational diabetes, gestational hypertension, low birth weight and admission to neonatal intensive care rates improved.ConclusionsPregnant women exposed to pandemic restrictions within ISLHD had decreased odds of adverse antenatal and neonatal outcomes, but increased odds of poor peripartum outcomes.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140567476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal Editorial Board","authors":"","doi":"10.1111/ajo.13564","DOIUrl":"https://doi.org/10.1111/ajo.13564","url":null,"abstract":"","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84059457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal Editorial Board","authors":"","doi":"10.1111/ajo.13388","DOIUrl":"https://doi.org/10.1111/ajo.13388","url":null,"abstract":"","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85163714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal deaths in Australia from ruptured splenic artery aneurysms","authors":"G. Lawson","doi":"10.1111/ajo.13537","DOIUrl":"https://doi.org/10.1111/ajo.13537","url":null,"abstract":"The rupture of a splenic artery aneurysm (SAA) in pregnancy is a highly lethal condition, but so rare that most obstetricians would not encounter it during their career. In the seven official ‘Maternal Deaths in Australia’ reports, that covered 21 years from 1997 to 2017, among a total of 449 direct and indirect deaths, there were nine deaths (2%) from a ruptured SAA. These cases, and other cases from the literature and the Cochrane Library, are reviewed. The aim of the review is to raise awareness among clinicians of this potentially fatal condition.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80460332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of obesity on cost of total laparoscopic hysterectomy","authors":"V. A. Rajadurai, E. Nathan, J. Pontré, B. Mcelhinney, K. Karthigasu, R. Hart","doi":"10.1111/ajo.13520","DOIUrl":"https://doi.org/10.1111/ajo.13520","url":null,"abstract":"To test for the association between increasing patient body mass index (BMI) and the cost of total laparoscopic hysterectomy (TLH). Secondary outcomes include the relationship between increasing BMI and both peri‐ and post‐operative morbidity.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89678637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse perinatal outcomes in the Australian Indigenous population, the role of asthma","authors":"Bronwyn K Brew","doi":"10.1111/ajo.13468","DOIUrl":"https://doi.org/10.1111/ajo.13468","url":null,"abstract":"Asthma in pregnancy has been shown in a number of studies to be associated with adverse perinatal outcomes including low birth weight and perinatal death.1– 4 However, the majority of studies in this area have been in general populations in the US, Europe and Australia. It is therefore of interest that Clifton et al.5 recently published a study on perinatal outcomes in an Australian Indigenous population, especially as adverse perinatal outcomes in this population remain high, (although declining), with mortality and low birth weight rates double that of nonIndigenous rates.6 However, I do have some concerns about the results presented and their interpretation, namely around the choices of control group and confounders. In the abstract and results section the authors have stated they observed a twofold increase in neonatal deaths in Indigenous babies whose mothers had asthma compared to nonIndigenous women who did not have asthma. However, in Table 2 where odds ratios of Indigenous women with asthma have been presented the reference group is referred to as being ‘nonIndigenous women without asthma’. Given the existing risk of adverse perinatal outcomes in the Australian Indigenous population it is therefore not possible to tell what role asthma plays in these findings or whether the reported associations are in fact driven by Indigenous status (or rather, the risk factors and behaviours as a results of colonisation and racism that continue to drive Indigenous health outcomes). Further, the findings in Table 2 that asthma does not show any added effect on perinatal outcomes in nonIndigenous women supports the argument, that at least in this dataset, asthma may not be making a difference on perinatal outcomes. The other possible source of confounding is socioeconomic status. The authors have stated that the inclusion of confounders was determined by the univariate associations between covariates and outcomes. Table 1 shows that socioeconomic status measured as attained education level was significantly different between Indigenous and nonIndigenous mothers, P < 0.001. Given these findings and that it is well recognised that socioeconomic determinants are a strong driver of health,7 it is unclear then why the multivariate associations were not adjusted for education level. Although no other similar studies exist for Indigenous groups, studies comparing Black, Hispanic and White American women found that although Black women had a higher prevalence of asthma and were more likely to have lower socioeconomic determinants, asthma was not able to explain the increase in adverse perinatal outcomes in Black populations.8 These authors concluded that asthma does not contribute to racial disparities in obstetric and neonatal complications. It is therefore my suspicion that the results from Clifton et al. are driven in large part by Indigenous status and socioeconomic differences rather than by asthma. It may be that asthma is an effect modifier of the impact","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74372046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to make some noise about a quiet revolution","authors":"Katrina Calvert, S. Leathersich, P. Howat, Sarah Van Der Wal","doi":"10.1111/ajo.13530","DOIUrl":"https://doi.org/10.1111/ajo.13530","url":null,"abstract":"‘Tomorrow belongs to those who can hear it coming’ David Bowie. Language is a living entity that moves and changes. Use of gender‐neutral language in medical literature is increasingly common. It is time for obstetricians and gynaecologists in Australia and New Zealand to interrogate their own bias and desire to maintain the status quo, and to consider reasons for change.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79212445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter to the Editor ‘Adverse perinatal outcomes in the Australian Indigenous population, the role of asthma’","authors":"Vicki L. Clifton, J. Das, V. Flenady, Kym Rae","doi":"10.1111/ajo.13480","DOIUrl":"https://doi.org/10.1111/ajo.13480","url":null,"abstract":"6. Australian Institute of Health and Welfare & National Indigenous Australians Agency. Aboriginal and Torres Strait Islander Health Performance Framework; 2020. Available from URL: https://www. indig enous hpf.gov.au/. Accessed 16/08/2021. 7. Marmot M. The Health Gap. London: Bloomsbury Publishing, 2016. 8. Flores KF, Robledo CA, Hwang BS et al. Does maternal asthma contribute to racial/ethnic disparities in obstetrical and neonatal complications? Ann Epidemiol 2015; 25: 392– 397.e1.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80491434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}