Editor-In-Chief's Introduction to ANZJOG 64(6)

Welcome to the final issue of ANZJOG for 2024.

This has been another busy year for the Journal with a significant increase in the number of submissions. While this is welcome, it does come with increased burden upon the voluntary workforce that maintains the academic rigour of the publication, specifically the Associate Editors and Peer Reviewers. These generally thankless roles are vital to the ongoing viability of a local scientific journal for our field, and I am immensely grateful to those clinicians and academics who make these contributions—ANZJOG would literally not exist without you. I wish to acknowledge the dedication and support of the Editorial Board who give so generously of their time and expertise. Thank you.

ANZJOG is proud to provide a forum for the dissemination of locally relevant obstetrics and gynaecology research. It is through the support of authors choosing ANZJOG as the home for their work that allows the Journal to continue and to grow. Ultimately, this can only advance the science behind the work that us clinicians do, to the benefit of the communities that we serve. Without authors submitting their high-quality manuscripts, this would not be possible. I am aware that journal submissions and the peer review process can be at times tedious, frustrating and delayed. RANZCOG are please to have reappointed Wiley as the publisher for ANZJOG, and I am excited to be able to work with Wiley in implementing several new initiatives in the coming year, which promise to improve the author and reader experience of the Journal.

This issue features an editorial by Kirsten Connan [1] discussing the progress in gender-equitable representation in obstetrics and gynaecology leadership in Australia and Aotearoa New Zealand. Contrasting the findings of her earlier work [2] with that of Holmes, Ibiebele, and Nippita [3] more recently, Connan describes the commendable improvements in gender equity in RANZCOG and clinical departmental leadership positions over a relatively short period of time. This change goes beyond the ‘pipeline’ effect of an increasingly female RANZCOG Fellowship and reflects the deliberate efforts of senior College representatives and staff in identifying and removing barriers to gender equity in college bodies. RANZCOG has dual roles in representing it members as a member-based organisation and also in advocating for the community which we serve, unique among all medical colleges in being heavily gender-specific, making gender diversity particularly relevant. Connan also highlights the other important diversity considerations, which are also worthy of addressing, particularly those such as First Nations, Māori, migrant, other culturally and linguistically diverse communities, and the LGBTQIA+ community, as these groups often face disproportionately poor health outcomes in our field. RANZCOG's progress so far and commitment to ongoing improvement is worthy of such recognition.

Endometriosis and pelvic pain continue to be topical, with several related articles included in this issue. Ellis and Wood importantly bring insight into endometriosis from a consumer perspective. The first of their two articles discusses the ‘decade to wait’, or the delay between symptom onset and endometriosis diagnosis of, on average, 9.7 years in New Zealand, and identifies the contributors to this delay and potential strategies to reduce it [4]. Their second article describes the findings of a survey of endometriosis patients and their support networks regarding their views on what should be the research priorities for endometriosis research in New Zealand [5]. Such information allows for consumer-driven research and consumer codesign as mechanisms to ensure that research meets the needs of the affected community. Schofield et al. [6] explore the role of language in identifying which women presenting with dysmenorrhoea-related pelvic pain have a component of bladder pathology underlying their presentation. This study exploits Sir William Osler's adage, perhaps with a specialty-appropriate modification: ‘listen to your patient, [s]he will tell you the diagnosis’, in what is perhaps the first time that an academic linguist has published in ANZJOG, finding that certain words—bloating, pressure, pounding, tingling, stabbing, burning and cramping—are used more commonly in women experiencing pelvic pain with bladder-related pathology than by those with other pathologies. The authors conclude that careful assessment of a patient's language may assist clinicians, particularly those in primary care, to direct referrals and investigations towards specific conditions and treatments.

In other gynaecological topics, Preston et al. [7] present their study of sentinel lymph node biopsy (SLNB) in FIGO Stage 1 cervical cancer. Using either indocyanine green or patent blue dye, or both, bilateral and side-specific sentinel node detection rates were high and comparable to previous studies. The authors conclude that SLNB with either dye is feasible. Sathiyaselvan et al. [8] undertook a review of adverse events during gynaecological admissions in a single health service in Auckland. A gynaecology morbidity and mortality review committee was formed to systematically evaluate adverse events in order to identify contributory factors and potential avoidability, in the belief that this could identify areas for quality improvement. Of 153 cases of adverse events, half were considered to have had contributory factors including organisational, personnel and patient factors, and 42% were considered to have been potentially avoidable, providing valuable information for health service improvement. Seymour et al. [9] present their study of the implementation of a direct-to-patient telehealth early medical abortion service. This study is a valuable contribution to the growing body of evidence supporting expanded access to early medical abortion through novel methods such as telehealth. The authors found a shift away from surgical abortion towards medical abortion, particularly in women living in rural and remote areas, and although this may have been impacted by factors other than the telehealth service, this suggests that the service may have removed a barrier to women outside metropolitan areas accessing early medical abortion.

This issue features two articles evaluating the potential use of online information platforms to deliver patient education. Gow et al. [10] studied via survey the preferences of postpartum women for health information delivery via social media platforms. The authors found that postpartum women wanted to access information in this way, with a preference for it to be delivered via the social networking sites of trusted health institutions from either clinicians or researchers. They conclude that use of such an approach, in collaboration with health promotion experts, could be a cost-effective way of improving postpartum women's physical and psychological health. Willburger, Chen, and Mansfield [11] undertook an assessment of online educational material for pelvic floor exercises to manage stress urinary incontinence. They found numerous websites and videos providing relevant information, with videos providing a higher degree of understandability and actionability than written websites. The authors conclude that web-based resources, particularly videos, can be of value to patients seeking information, particularly those of lower health literacy.

Lowen et al. [12] present a pilot randomised controlled trial of intrapartum intravenous fluid management. Observational data are conflicting, with studies suggesting variable associations between intravenous fluid administration and prolonged labour and caesarean section. This trial recruited a convenience sample of 200 participants, aiming to inform the design of a larger clinical trial, randomised to receive either liberal (250 mL/h) or restrictive (40 mL/h) intravenous fluid in labour. The authors observed no significant differences between the two groups in important clinical outcomes but concluded a nonsignificant trend to shorter labour duration in women receiving restrictive fluid volumes warrants further exploration in a larger clinical trial.

Borbolla Foster et al. [13] present their study of implementing a strategy of population-based multidisciplinary first trimester screening, assessment and prevention of later pregnancy complications. The authors developed, with stakeholder consultation and identification of barriers to change, a model of early hospital antenatal review, with the average gestation at first hospital review falling from 20 to 13 weeks. This permitted first trimester evaluation of risk, such as by combined screening for preeclampsia, aneuploidy and fetal structural anomalies, as well as evaluation of maternal medical comorbidities and relevant obstetric history, such that interventions such as low-dose aspirin could be initiated and ongoing care could be streamed into appropriate models of care. Such strategies are imperative if early pregnancy screening and interventions are to be effectively rolled out at population level, as recently recommended by RANZCOG in their ‘Early pregnancy screening and prevention of preterm preeclampsia and related pregnancy complications’ clinical guideline.

Two articles in this issue address the importance of epidemiological methods in assessing the impact of First Nations ethnicity on pregnancy and perinatal outcomes. Berman et al. [14] present their study of different methods of identification of First Nations mothers in routinely collected and specifically linked Western Australian data. The authors found that, although specific data linkage to develop an Indigenous Status Flag identified more women as First Nations than the routinely collected Midwives Notification System did, and that these two methods gave different demographic criteria to the populations, that this did not have a significant impact on the assessed associations between First Nations status and perinatal outcomes. They conclude that, for the purposes of their analyses at least, the use of routinely collected First Nations status data was sufficient to allow accurate perinatal epidemiological studies in the Western Australian population.

Pervin et al. [15] evaluated the association of First Nations status with low birthweight in Queensland. This study found that, although there was a significantly greater chance of First Nations babies having low birthweight compared with non-Indigenous babies, this association was mediated entirely by modifiable risk factors, which are differentially present in First Nations individuals and that First Nations status itself was not a risk factor for low birthweight. This study, importantly, lends weight to the concept that identification of at-risk individuals should focus on the underlying risk factors that contribute to health disparity in First Nations populations, rather than considering ethnicity as a risk factor in itself. Further, the authors conclude that strategies to improve delivery of culturally safe maternity care to First Nations women, allowing modifiable risk factors to be addressed, are required to ameliorate inequity in pregnancy and perinatal outcomes in First Nations populations.

This issue also includes an obituary to eminent and pioneering obstetric physician Professor Barry Walters, kindly written by his long-term colleague Professor Bill Hague. In a profession where we stand on the shoulders of giants, none was more giant than Barry. Barry undoubtably saved the life of many Western Australian mothers with his phenomenal intellect and clinical acumen. He was famously generous in his time and compassion, both for his patients and for his colleagues, junior and senior alike. Barry had a profound influence upon generations of Western Australian obstetricians, including me, and his legacy will continue through the knowledge that he imparted to us. Vale Barry Walters.

I trust that you will find these and the remaining articles in this issue interesting. Thank you for your support of ANZJOG in 2024 and best wishes for the festive season and the new year.

The author declares no conflicts of interest.