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

Background: Obstetric ultrasound is an important tool, aiding in screening, diagnosis, and surveillance throughout pregnancy.

Aims: To explore obstetric doctors', midwives', and sonographers' experiences and views of obstetric ultrasound in Victoria, Australia. To investigate the increasing role of obstetric ultrasound for clinical management, and the adequacy of resources and training for appropriate use of ultrasound in clinical management.

Materials and methods: This cross-sectional study forms part of a multi-national CROss-Country Ultrasound Study (CROCUS) exploring the views of consumers and health professionals from high-, middle- and low-income countries. Qualitative studies conducted in several countries informed the construction of a quantitative survey. These quantitative surveys were distributed to 16 hospitals across regional and metropolitan Victoria, Australia. Descriptive statistics were analysed from the responses.

Results: There were 354 questionnaires returned from 106 doctors, 222 midwives, and 26 sonographers. Overall, 72% of respondents held concerns about the potential loss of focus on clinical skills with increasing ultrasound use. Midwives were more concerned about the contribution of ultrasound to medicalisation of pregnancy than were doctors (P < 0.001). Many respondents noted that geographical factors (71%), rather than income levels (53%) influenced access to obstetric ultrasound. Over 90% of doctors and midwives believed additional training for their respective professions in ultrasound would enhance its reach and effectiveness.

Conclusions: Our survey findings confirm that clinicians place high levels of trust in the diagnostic findings of obstetric ultrasound antenatal care in Australia. Access to routine ultrasound could be improved for women in rural and lower-income areas.

Background: Miscarriage is a common medical occurrence which can be associated with significant psychological distress. Patients and partners are frequently disappointed by aspects of their care, especially with regard to emotional support. Although most published studies investigated the experiences of patients and partners in emergency departments (EDs) of public hospitals, miscarriage is also frequently diagnosed in non-emergency settings, such as during sonography or antenatal appointments, and approximately 25% of Australian women receive maternity care in private hospitals.

Aim: Because the experience of miscarriage is known to be setting-dependent, it is important to understand how patients and partners experience care outside the ED. Here, we addressed this gap by investigating the experiences of patients and partners who attended a private maternity hospital for miscarriage using a mixed-methods approach.

Materials and methods: Eighteen patients and six partners who had recently experienced a miscarriage were recruited at a private maternity hospital to take part in both semi-structured interviews and online surveys.

Results: Overall, patients and partners were highly satisfied with the emotional care they received. Thematic analysis of semi-structured interviews allowed us to identify a total of ten themes that contributed to satisfaction with emotional care.

Conclusions: We provide the first specific insights into the experiences of women and partners who received care for miscarriage in an Australian private hospital setting, and the first example of a healthcare setting that achieves high satisfaction with emotional care around miscarriage. The ten themes we identify provide a framework for improving satisfaction with care also in other settings.

Aims: The aim was to explore Endometrial cancer (EC) survivors' experiences of being offered nutrition and well-being advice.

Methods: This qualitative study was conducted at two tertiary centres in Aotearoa New Zealand. Semi-structured conversations with people who had completed treatment for EC in the past 12 months were undertaken to explore how they were offered nutrition and well-being advice as part of standard follow-up care. Interviews were analysed using reflexive thematic analysis.

Results: Fifteen people of Pacific, Māori and European ethnicity participated. Five themes were derived: (i) isolation and vulnerability, (ii) importance of language, (iii) inconsistent availability and relevance of nutrition and well-being information, (iv) competing priorities and influences and (v) holistic and culturally responsive support. People often experienced judgement associated with their weight as part of their care, with limited understanding of their lived realities. Nutrition and well-being advice was not widely available or accessible, and people had to explicitly ask for it. Social and environmental factors were barriers to making changes to health behaviours. A need for culturally safe holistic care was identified.

Conclusion: Enhancing survivorship after EC is ultimately premised on providing culturally safe and responsive care. Expanding workforce training in communication around high weight as well as education and self-assessment of cultural safety could enable aspects of this. A holistic care program could facilitate wider access to nutrition and well-being advice and better meet the needs of this population.

Background: Women in leadership in obstetrics and gynaecology in Australia and Aotearoa New Zealand have historically been underrepresented, despite forming a significant portion of the workforce. This study extends prior research from 2017, examining shifts in gender representation, attitudes, and perceived leadership barriers within the specialty.

Aims: The study aims to evaluate changes in gender diversity among leadership positions in the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and accredited training hospitals since 2017. Additionally, it seeks to understand current attitudes toward leadership and identify perceived barriers among RANZCOG consultants and trainees.

Materials and methods: A cross-sectional approach was employed, utilising publicly available information, a survey distributed to RANZCOG members, and data from accredited training hospitals. Gender representation in leadership positions was analysed, and survey responses were collected from consultants and trainees to evaluate attitudes and perceived barriers.

Results: The study reveals an increase in women's representation in RANZCOG leadership, particularly on the council and in clinical leadership positions. While the proportion of women trainees remained stable, there was a noteworthy increase in women specialists. Survey responses revealed shared perceptions on leadership qualities but diverged on barriers, with more women expressing concerns about skillsets, caring responsibilities, and mentorship support.

Conclusions: The findings underscore substantial progress in achieving gender equity in obstetrics and gynaecology leadership roles, attributed to RANZCOG initiatives, societal changes, and improved policies. Ongoing efforts, including structured mentorship and flexible arrangements, are recommended to sustain and further enhance gender representation and address specific barriers identified by women in the specialty.

Study objective: To investigate the aetiology of vaginal bleeding and discharge in prepubescent girls, and the utility of vaginoscopy for making a diagnosis.

Design: Retrospective observational study over 14 years.

Setting: Two major tertiary referral paediatric hospitals in Sydney, Australia.

Participants: All prepubescent girls (n = 104) who presented with vaginal bleeding and/or discharge and subsequently underwent a vaginoscopy. A total of 120 procedures were performed.

Main outcome measures: Surgical findings at vaginoscopy; number needed to investigate (NNI) to establish a diagnosis and to exclude malignancy.

Results: There were 52/120 (43.3%) vaginoscopies which provided a positive diagnosis, including 36/86 (41.8%) performed for bleeding and 16/34 (47.0%) for vaginal discharge. In the vaginal bleeding group, the causes found were a foreign body in 11/86 (12.7%), vulvovaginitis in 6/86 (6.9%), benign Mullerian papilloma in 5/86 (5.8%), trauma in 4/86 (4.6%), and malignant tumours in 2/86 (2.3%). To establish a diagnosis in girls presenting with vaginal bleeding, the NNI was 2.4; to detect a malignancy the NNI was 43.0. In girls presenting with vaginal discharge, vulvovaginitis was noted intraoperatively in 7/34 (20.6%) and a foreign body was found in 7/34 (20.6%). No malignant tumours were identified in the vaginal discharge group. To establish a diagnosis in girls presenting with vaginal discharge, the NNI was 2.1.

Conclusions: Vaginoscopy is an important diagnostic tool in the setting of vaginal bleeding in prepubescent girls, allowing the ability to confirm a diagnosis, and importantly, to exclude malignancy.

Correspondence and Opinion provide a 'human voice,' serving as the captivating elements that grab readers' attention and stimulate contemplation. The extent of ChatGPT's involvement in writing raises controversy. We tested ChatGPT's capability to generate readable Correspondence or Opinion, producing an English Opinion from a Japanese abstract. We also tasked ChatGPT with creating Correspondence and Reply for an English→German translated Opinion. Opinion, Correspondence, and Reply output here were found to be readable and reasonable. While preliminary, these results suggest that ChatGPT can generate such articles, prompting serious concern about AI taking over the 'human voice.' Some regulatory measures may be needed.

Background: Infection of the amniotic cavity is an important driver and/or consequence of preterm prelabour rupture of membranes (PPROM). Prediction of infection is challenging, limiting guidance for interventions during the antenatal period. Infection typically triggers a host inflammatory response, and non-invasive indirect markers of the maternal or fetal inflammatory response have been reported in the context of PPROM and intra-amniotic infection. Some of these markers have also been tested in amniotic fluid (AF) samples.

Aims: This study compared markers of the inflammatory response in women with PPROM against the outcome standard of histological chorioamnionitis (HCA) or funisitis (FUS).

Methods: Searches were conducted for studies reporting diagnostic test sensitivity and specificity for proven HCA or FUS in pregnant women with PPROM after 20 weeks' gestation. Weighted mean pooled sensitivity (Se), specificity (Sp), positive predictive value, negative predictive value, diagnostic odds ratio and 95% confidence intervals were calculated for each of the selected diagnostic tests.

Results: Except ultrasonographic detection of fetal thymic involution, almost all index tests analysed showed relatively low sensitivity. Maternal white cell count, interleukin-6 (IL-6) and AF IL-6 had credible specificity. Testing of AF markers, while more consistent than serum markers, showed no clear diagnostic accuracy improvement.

Conclusions: There is a clear lack of evidence for the reliability of any individual diagnostic test to assist in the detection of HCA or FUS in women with PPROM. Combining several markers into a predictive model for improved diagnosis may be worth investigating.

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.