ANZJOG in 2025

Welcome to Volume 65 of the Australian and New Zealand Journal of Obstetrics and Gynaecology. 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.

This year will bring some changes to authors and readers of ANZJOG. 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 ANZJOG and RANZCOG channels soon.

I am very grateful to the ANZJOG 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.

This first issue of the new volume contains many valuable articles. To open, Baalman et al. [1] 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.

Readman et al. [2] 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 complaint. They identify a range of contributors, including the increasing complexity of cases, the broadening of treatment options, and the increased expectations by patients of standards of care. As in many other areas of healthcare, the COVID-19 pandemic exacerbates pre-existing problems, and divided government priorities between various challenges in healthcare provision are also identified as contributors. The authors attempted a clinical trial of empiric hormone therapy for those facing extended waiting periods for specialist review but found patients were unwilling to be recruited, citing scepticism toward hormonal treatments, the desire to receive a definitive diagnosis as opposed to managing symptoms, and perceptions of the limitations of the role of general practitioners as barriers to participation. They propose a number of solutions, such as empowering GPs, utilising dedicated services such as endometriosis hubs, shared care models, and lifestyle interventions in order to ease the strain on public gynaecology services.

This issue features two excellent contributions to clinical guidance. First, Bowyer et al. [3] present the revised Society of Obstetric Medicine of Australia and New Zealand position statement on the investigation and management of sepsis in pregnancy. Sepsis remains a leading cause of maternal mortality and severe morbidity, often amenable to prevention through timely identification and aggressive management. This guideline is invaluable to clinicians in the maternity environment, outlining clear processes for the identification and management of sepsis, which should lead to improvements in outcomes in such cases. Second, Hui et al. [4] present a brief review of mitochondrial disease in pregnancy and its management. These conditions are rare but may negatively impact maternal and perinatal outcomes due to altered capacity to meet the metabolic demands of pregnancy. Of particular relevance, is the recently developed technology for mitochondrial donation as a method of reducing offspring inheritance of maternal mitochondrial disorders.

Lanzarone et al. [5] present a systematic review of diagnostic tests for the prediction of histological chorioamnionitis in women with preterm premature rupture of membranes. The authors found a disappointing lack of evidence and poor predictive capacity of maternal blood, amniotic fluid, and sonographic markers. The low sensitivity and specificity of these markers make the clinical detection of chorioamnionitis difficult, with none performing at a clinically useful standard. As such, we remain limited in our capacity to identify the fetus at risk of intrauterine inflammation and to time delivery to reduce its potential impact on neurodevelopment.

Long et al. [6] present their study of women's preferences around expanded non-invasive prenatal genetic screening tests and their willingness to pay for such testing. They found that women valued screening for a larger number of genetic conditions, test accuracy, risk of pregnancy loss, and screening earlier in pregnancy as important attributes of screening tests. There were significant differences between women by income and education level in regard to their willingness to pay for such testing. This provides further information around equity in prenatal screening options, lending weight to calls for public funding of such tests. In another evaluation of a prenatal screening program, Pedretti et al. [7] discuss the utility of routine mid-pregnancy screening for cervical length by transabdominal ultrasound. They found that transabdominally assessed cervical length (TACL) greater than 35 mm excluded transvaginally assessed cervical length less than 25 mm with a 99.7% negative predictive value. Using this TACL cut-off, transvaginal ultrasound was avoided in 86% of women. The authors conclude that TACL, using a cut-off value of 35 mm, is a reasonable method of screening for short cervix in mid-pregnancy in women without preterm birth risk factors, and that this is likely to be associated with significant cost savings over routine transvaginal assessment.

Liu et al. [8] present their analysis of the changes in preterm birth rates in relation to the COVID-19 pandemic. They found a borderline significant trend to a lower rate of preterm birth in women exposed to COVID-19 mitigation measures compared to the prior non-exposed cohort (8.1% vs. 9.4%, p = 0.051). The pattern of preterm births was different between the two groups, with more preterm labour with intact membranes in the exposed cohort, as opposed to more preterm premature rupture of membranes in the non-exposed cohort. This study adds to the literature describing variable impacts of the COVID-19 pandemic and lockdown measures on preterm birth outcomes.

Einarsson and Knowles [9] present their study of surgeon-administered transversus abdominis plane (TAP) blocks at emergency caesarean section. They found little to no impact of TAP blocks in terms of postoperative analgesia requirement compared to other methods of perioperative anaesthesia. The authors acknowledge the potential limitation of this study and call for further research into this potentially useful technique.

Three gynaecological oncology focussed articles are included in this issue. McBain et al. [10] present a 37-year single-centre series of borderline ovarian tumours. Of 549 cases, recurrence occurred in 5% and malignant transformation in 1.4%. They found that fertility-sparing surgery was associated with a higher risk of recurrence than bilateral oophorectomy for both serous and mucinous tumours. This study provides useful guidance as to the outcomes of borderline tumours according to management strategy. Williams et al. [11] studied the experience of endometrial cancer survivors in being offered nutrition and wellbeing advice. Important themes identified in this qualitative study included isolation, vulnerability, appropriate use of language, inconsistency of nutritional information and advice, competing priorities, and cultural safety. The authors conclude that survivorship after endometrial cancer is enhanced by culturally responsive care and appropriate communication around high weight. Naiqiso et al. [12] evaluated the first two years of a programme of universal endometrial cancer tumour testing for Lynch syndrome in New Zealand. Of 409 participants, 83% of tumours were tested in which 2.3% of participants were confirmed to have Lynch syndrome variants.

Twidale et al. [13] present a randomised, placebo-controlled trial of methoxyflurane analgesia during outpatient hysteroscopy. The authors found a significant reduction in pain reported when methoxyflurane was used, with a greater magnitude of reduction in operative compared to diagnostic hysteroscopy. There were no significant differences in adverse events. This provides justification for the use of methoxyflurane analgesia during outpatient hysteroscopy. Kapurubandaran et al. [14] studied the early experience of a single surgeon with vaginal assisted natural orifice transluminal endoscopic surgery hysterectomy (VANH). In a series of 20 cases, the authors found VANH to be feasible but noted a significant learning curve, with five conversions to laparoscopy, mostly among earlier cases. They conclude that until there are further robust data on the outcomes of VANH, patients should be carefully counselled and have individualised decisions around the mode of hysterectomy.

I trust that readers will find these and the remaining articles in this issue of interest.

I look forward to another busy year for ANZJOG in 2025 and thank you for your continued support.

The author declares no conflicts of interest.