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

Objective: High participation rates in the National Cervical Screening Program (NCSP) by all groups of women are required to ensure the equitable elimination of cervical cancer in Australia. In this study, we examine screening participation of overseas-born women compared to Australian-born women who gave birth.

Design: Population-based retrospective cohort study using linked health datasets.

Setting and participants: Women who gave birth in New South Wales between January 1, 2000 and June 30, 2017.

Main outcome measures: Participation in the NCSP (≥ 1 cytology test) in the 3- and 5-year periods prior to delivery by place of maternal birth, adjusted for multiple socio-demographic and health characteristics.

Results: Among the 1 332 669 mothers who gave birth over the study period, overall cervical screening participation in the 3- and 5-year periods prior to delivery was 67.0% and 75.7%, respectively. Participation was lower for overseas-born mothers compared to Australian-born mothers for both the 3-year (57.8% vs. 71.7%; adjusted odds ratio [aOR]: 0.51, 95% confidence interval [CI]: 0.50-0.51) and 5-year (64.9% vs. 81.2%; aOR: 0.40, 95% CI: 0.40-0.40) participation periods. All groups of overseas-born women had substantially lower screening participation compared to Australian-born women, with the lowest relative 3-year participation in mothers born in Southern/Central Asia (aOR: 0.30, 95% CI: 0.30-0.31), Oceania (aOR: 0.31, 95% CI: 0.30-0.32), North-East Asia (aOR: 0.49, 95% CI: 0.48-0.50), and New Zealand (aOR: 0.49, 95% CI: 0.48-0.51).

Conclusions: Overseas-born women had around half the cervical screening participation in the period prior to birth compared to Australian-born women. It is likely that opportunities to screen these under-screened groups during the antenatal period, typically a time of repeated health services contact, are missed.

The Australasian CREI (Certificate of Reproductive Endocrinology and Infertility) Consensus Expert Panel on Trial Evidence (ACCEPT) group recently published an evidence-based guideline on the investigation and management of recurrent pregnancy loss (RPL). This position paper is a brief summary of the freely accessible two-part guideline and can be found with digital object identifier (DOI) 10.1111/ajo.13821 and DOI 10.1111/ajo.13820.

Background: Birth in the operating theatre is increasing in prevalence and includes elective and emergency caesarean section and instrumental vaginal births. Birth in the operating theatre is a well-documented risk factor for negative subjective patient outcomes. Despite this, there has been little research into women's experiences of birth in theatre or staff perspectives on how they may create and contribute to a more positive theatre birth environment.

Aim: To explore both the women and caregiver's experiences of birth in the operative theatre and to identify ways to deliver and optimise woman-centred care.

Materials and methods: This qualitative prospective study used experience based co-design principles and enrolled both women who gave birth in the operating theatre and staff who cared for them. All participants underwent semi-structured interviews to discuss their birth experiences. Thematic analysis was then undertaken to identify key themes from both the caregiver and patient perspective.

Results: Key themes centered around communication and maintaining an empowering birth environment. Participants acknowledged the need for clear and respectful communication between women, their support person, and the multidisciplinary team, particularly within emergency situations. Supporting and maintaining an empowering birth environment was achieved through advocacy, autonomy, and inclusion of a support person at all stages of the theatre journey.

Conclusions: Communication and an empowering birth environment significantly influenced the subjective experience of birth within the operating theatre. Results from this study may be used to identify system adaptations and improvements to support more positive birth experiences in the operating theatre.

Background: In the late 2000s, mid-urethral slings (MUS) emerged globally as the preferred surgical treatment for stress urinary incontinence (SUI). Despite their high safety and efficacy, through the late 2000s and 2010s, MUS became embroiled in widely publicised controversy surrounding mesh products used for pelvic organ prolapse.

Aims: To review recent trends in the surgical management of SUI in Australia in the context of recent medicolegal and media attention on transvaginal mesh devices.

Materials and methods: Data were obtained from the Australian Government Department of Human Services database from January 2007 to December 2023. Total procedure numbers for females ≥ 25 years were retrieved for the following Medicare Benefits Schedule (MBS) item numbers: 35599 (MUS), 37044 (Burch colposuspension), 37043 (Stamey or similar), 37042 (autologous fascial sling) and 37339 (peri-/transurethral bulking agents).

Results: A total of 69 145 MUS, 5749 Burch, 711 Stamey, 3243 fascial sling and 10 798 bulking agent procedures were recorded during this period. Total procedures peaked at 6877 in 2010 and reached a low of 2627 in 2022, with a turning point in 2016. There was a 61.8% reduction in procedure numbers between these years. The decline in total SUI procedures directly reflects MUS numbers, which dropped by 80.4% between 2011 (5876 cases) and 2022 (1154 cases). This correlates with progressive restrictions and medicolegal events concerning transvaginal mesh during this time.

Conclusions: There is a significant downtrend in overall surgical SUI management, especially MUS, being performed in Australia in recent years. The impact on surgical training and patient access to treatment options must be addressed.

We investigated the value of measuring sFlt-1/PlGF in people with suspected fetal growth restriction (sFGR) without signs of preeclampsia at recruitment. Angiogenic biomarkers were considered positive when sFlt-1/PlGF > 38 or PlGF < 100 pg/mL. Clinicians were blinded to the sFlt-1/PlGF results. In sFGR presenting < 32 weeks, but not ≥ 32-37 weeks, positive angiogenic biomarkers vs. NZ FGR criteria had increased risk of preterm birth RR 5.32 [2.04-13.88] vs. 2.19 [0.89-5.37], respectively, and birthweight < 3rd centile RR 2.11 [1.24-3.58] vs. 1.83 [0.92-3.63], respectively. Larger studies are needed to establish whether routine testing of angiogenic biomarkers in sFGR is recommended for risk stratification.

Recurrent pregnancy loss (RPL) is when a woman experiences two or more pregnancy losses. Investigating for causes of RPL can provide an explanation and possible treatment options. This is a summary of Parts 1 and 2 of Australasian Recurrent Pregnancy Loss Clinical Management Guidelines in an easy-to-read patient friendly format. These original publications can be found with a digital object identifier (DOI) 10.1111/ajo.13821 and DOI 10.1111/ajo.13820.

Background: Systematic, multi-disciplinary review of Severe Acute Maternal Morbidity (SAMM) can improve maternal outcomes. Routinely collected data, collated into the Queensland SAMM Dashboard, may facilitate local case review. We wanted to understand how SAMMs are reviewed locally and how centrally collated data supports review processes.

Aims: The purpose of this survey was to assess local SAMM recording and review practices in Queensland.

Materials and methods: A cross-sectional online survey, using multiple choice and free-text response formats, sampled multi-disciplinary health care workers (HCW) involved in SAMM review in Queensland public maternity units. Responses were analysed for content, with thematic analysis performed on free-text comments.

Results: Twenty HCW responded from a mix of tertiary, regional and rural maternity facilities. HCW responses identified a lack of clarity around the terms 'maternal morbidity', 'SAMM' and 'Near-Miss'. HCW reported various approaches for recording and reviewing SAMM. The commonest structures were Root Cause Analysis and Human Error and Patient Safety incident analysis. Reviews commonly involved: patient safety teams (50%); staff involved in the case (45%); independent/external reviewers (40%) and hospital management (40%). Few responses (10%) indicated consumers were involved. 30%-80% reviewed the ACSQHC defined SAMM, 70% Near-Miss cases and up to 70% reviewed other severe maternal morbidity indicators. 20% of HCW stated lessons learned during reviews were shared with other hospitals.

Conclusions: In Queensland, we have found variability in: HCW understanding of SAMM definitions, how cases are recorded, reviewed and improvements facilitated. A standardised approach to SAMM review and collaboration to share lessons learned may benefit maternity care.

Background: The widespread and rapid adoption of private payments for non-invasive prenatal testing (NIPT) in Australia has introduced complexities to the decision-making process for the public regarding prenatal screening. NIPT has the potential to be a useful screening tool, but concerns have been raised about its cost, the psychological consequences of testing and the information available to support informed decision-making.

Objective: To explore the attitudes, values and beliefs around prenatal screening in Australia, and how perspectives may differ between people living in metropolitan locations versus rural/regional locations.

Materials and methods: Three focus groups were conducted in New South Wales (NSW), Australia. Participants (N = 25) were recruited by a market research group. Focus groups took place face-to-face in metropolitan and rural/regional areas, and online via videoconference. Discussions were transcribed and analysed thematically.

Results: Participants generally expressed interest in undertaking prenatal screening but held misconceptions about the purpose of NIPT (i.e. screening, not diagnosis) and the conditions assessed. There were varied opinions among participants on expanding the scope of screening: some felt additional information provided reassurance, whilst others thought it would increase stress due to the decreased accuracy. People living in rural/regional areas had greater concerns over access to screening (cost, wait times and distance) than people living in metropolitan areas.

Conclusion: Our findings demonstrate different approaches are needed to improve understanding of NIPT (to ensure informed consent), and to improve access to NIPT for people living in rural/regional areas. The pre-test information needs to account for the range of perspectives observed across geographic locations.

Background: In Aotearoa New Zealand, there are limited data on ethnicity-specific prevalence and management of endometriosis and persistent pelvic pain. In the international literature, there appears to be a wide variation in both diagnosis and treatment access for these common conditions.

Aims: To explore ethnicity-specific referral data for people with symptoms of endometriosis and pelvic pain referred to two tertiary hospitals in Aotearoa New Zealand.

Materials and methods: Referrals to two gynaecology departments, in the North and South Islands of New Zealand, for women aged 16-52 during 2021 were screened and included if the primary referral reason was pelvic pain > 3 months, abdominal pain, dysmenorrhea, endometriosis or dyspareunia. Denominator data were obtained from Statistics NZ.

Results: There was a significantly lower referral rate at the North Island unit for Māori, Pacific and Asian people compared to European/MELAA; and a significantly lower referral rate in the South Island unit for Pacific and Asian people compared to European/MELAA and Māori, per 1000 women aged 16-52 years per year. Similar patterns occurred in the rates of waitlisting for surgery.

Conclusions: European women are privileged in Aotearoa compared to Māori, Pacific and Asian people in secondary referral and population waitlisting for surgery. This privilege was not evident in waitlisting for surgery from the gynaecology clinic. We suggest that a nationally consistent approach to the management of endometriosis and persistent pelvic pain is required.

Background: Low birth weight (LBW) is associated with adverse short-term and long-term health outcomes for neonates. The impact of maternal geographical location on rates of LBW in Australia is conflicted in existing literature.

Aims: The aim was to identify if a difference in rates of LBW exist between neonates born to rural versus metropolitan maternal residence. Secondary aim was to identify any associated factors influencing LBW.

Materials and methods: A secondary data analysis of retrospective health surveillance data from all births from 2018 to 2022 in the Hunter New England Local Health District (New South Wales, Australia) was performed. Logistic regression was used to determine odds ratio and adjusted odds ratio of LBW for rural versus metropolitan residence.

Results: A total of 39,579 neonates were included in this analysis, with 50.9% of the maternal cohort residing rurally. Median maternal was age 29.2 years. Rates of LBW were higher in rural maternal residence (5.7%) compared to metropolitan residence (5.2%). Odds of neonatal LBW did not differ between rural and maternal metropolitan residence after adjusting for confounders (adjusted Odds Ratio (aOR) = 0.90, 95% CI 0.79-1.01, p = 0.07). Socioeconomic disadvantage was significantly identified as an issue associated with LBW.

Conclusions: LBW neonates were more likely to be born to rural maternal residence and LBW risk factors disproportionately affected those living in rural locations. To reduce LBW in neonates, it is imperative that access to safe and affordable healthcare is available, and resources addressing LBW risk factors are specific to geographical locations.