Editor-in-chief's introduction to ANZJOG 64 (4)

Abstract

Welcome to the August issue of the Australian and New Zealand Journal of Obstetrics and Gynaecology.

This issue begins with an editorial by Calvert, Janssens, and Symonds introducing the new initiative of the RANZCOG Academy of Clinician Educators (ACE).¹ 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 Framework² upon which the revised RANZCOG Curriculum is founded.

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.

The issue continues with a wide-ranging selection of papers from across our specialty.

Harrison et al.³ 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 et al.⁴ 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.

Wade et al.⁵ present their study of the clinical utility of maternal infectious serology in the evaluation of fetal growth restriction. They found that serological screening in the setting of isolated fetal growth restriction was of no clinical utility and resulted in substantial expenditure for no clinical benefit, and concluded that, unless there are additional clinical indications, this practice should be abandoned in keeping with most recent evidence and international clinical guidance.

Boland et al.⁶ present the latest in their outstanding series of papers regarding clinicians' counselling around outcomes of preterm infants born at periviable gestations. In this article, the authors describe the effect of the ‘NIC-PREDICT’ mobile device application in informing clinicians about the true outcome data for such infants. This simple yet helpful tool allows maternity care providers, often the first to provide counselling to parents during acute obstetric presentations at extremely preterm gestations, to provide accurate information to guide parental decision-making and therefore obstetric interventions such as antenatal corticosteroids, tertiary transfer, fetal surveillance and operative birth.

From a gynaecology perspective, this issue has a preponderance of fertility-related articles. Lo et al.⁷ present their case series of ultrasound-guided lipiodol hysterosalpingography. These data add to the growing literature of the safety and efficacy of this technique, with technical and subsequent pregnancy-related outcomes comparable to existing studies. Of important note, and in keeping with previous studies, was the high rate of subsequent subclinical hypothyroidism of which those requesting and performing this technique should be aware. Deans et al.⁸ present their study of perfusion magnetic resonance imaging (MRI) for the assessment of intrauterine adhesions. They found that uterine perfusion assessed at MRI was correlated with more severe adhesions, with the authors suggesting a role in the presurgical evaluation of women with known adhesions to aid prognostication and determine suitability for surgery. This pilot study was unable to determine whether perfusion MRI plays a role in determining the presence of milder Asherman's syndrome.

Pittman et al.⁹ present the protocol for their recently established uterine transplantation trial. This is a collaborative effort between three New South Wales centres and the Swedish pioneers of this treatment for absolute uterine factor infertility. It is reassuring to see that this potentially life-changing but highly invasive technique is being introduced in the context of a clinical trial to allow rigorous assessment of clinical outcomes and safety prior to more widespread adoption.

Maunder et al.¹⁰ present the findings of a survey of Australian and New Zealand women regarding the health needs and experience of traditional complementary and integrative medicine (TCIM) for diminished ovarian reserve. They found that a high proportion of respondents had used TCIM, with many reporting benefits from such treatments. On a similar theme, Proudfoot et al.¹¹ assessed Australian women's use of cannabis products as treatment for endometriosis symptoms. They report that such products are being extensively used by Australian women for this reason but that cost is often prohibitive, leading to dose reduction or use of illicit products.

Two studies report on colposcopy in clinical practice. Ormandy et al.¹² present an evaluation of wāhine (women's) experiences of marae-based colposcopy clinics. They found that prioritising local, culturally appropriate care enhanced the experience of wāhine attending for colposcopic evaluation and that such initiatives were likely to be useful in reducing inequity of access to colposcopy as part of an HPV-based cervical cancer screening program in Aotearoa New Zealand. Also relating to providing effective colposcopy in an HPV-based screening program, Tan et al.¹³ present their study of colposcopic performance to determine indicators for competency. Of the potential indicators assessed, early detection rate of CIN2+ within six months of first assessment was found to be the most reliable measure of competency.

I trust that readers will find these and the other articles in this issue informative and clinically impactful.

Thank you for your ongoing support of ANZJOG.