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

Background: Endometriosis is a chronic condition that affects around 10% of New Zealand women and people presumed female at birth, however, limitations in diagnosis and management mean patients wait a decade on average from symptom onset to diagnosis.

Aims: The purpose of this article is to highlight recurrent themes in the experiences of four independent cohorts of endometriosis patients with surgically confirmed or clinically suspected endometriosis in New Zealand.

Methods and materials: Four cohorts of patients (n = 111), one with mixed ethnicities, gender and sexual identities (n = 50), one with Māori participants (n = 27), one with Pasifika participants (n = 10) and one with LGBTQIA+ participants (n = 28) were recruited in 2022 and 2023 to participate in online, asynchronous, text-based discussion groups about their journeys with endometriosis.

Results: Throughout each cohort, there were strong themes of normalisation of pain and dismissal, the value and difficulty of endometriosis diagnosis and the power of the practitioner over the lives of patients.

Discussion: There are key issues in the journeys of endometriosis that occur regardless of ethnicity, gender identity or sexuality. Many of these issues are tied up in societal attitudes that dismiss and downplay menstrual distress. When these attitudes are shared by the medical practitioners caring for endometriosis patients, this has been shown to severely harm patient's journeys to diagnosis, sense of self and capacity to manage the disease.

Background: Patient Reported Outcome Measures (PROMs) are increasingly being introduced in clinical registries. The Australasian Pelvic Floor Procedure Registry (APFPR) is a clinical quality registry which records information about procedures for stress urinary incontinence and pelvic organ prolapse. This study aimed to determine the feasibility of capturing PROMs in women with pelvic floor disorders (PFDs) identified via the APFPR, using various modes and methods of administration.

Methods: We administered the Australian Pelvic Floor Questionnaire (APFQ) in women with PFDs prior to surgery (baseline) and 6 months post-surgery through a combination of email, postal mail, SMS and telephone. The study was carried out from July 2022 to May 2023. Results were reported descriptively, as number and proportion for PROMs response rates and data completeness, and as a mean and standard deviation (SD) for the APFQ scores.

Results: The APFQ was administered to 140 patients at baseline and to 112 post-surgery. The baseline PROMs response rates were high (75%), but decreased to 56% at follow up. The overall APFQ completeness was ~98%. The APFQ dysfunction scores revealed a significant improvement at 6 months (mean [SD] score at baseline = 14.5 [5.7], 6 months = 11.4 [6.5], p ≤ 0.001). Significant improvement in the bladder and prolapse domains (p ≤ 0.001) were particularly observed.

Conclusion: The results showed an overall improvement in quality of life scores at follow up. The APFQ data completeness was high and response rates were satisfactory, suggesting that the APFQ was a suitable instrument for the APFPR.

Introduction: Inter-pregnancy weight change (IPWC) has been linked to adverse outcomes in subsequent pregnancies. No studies have examined IPWC in Aotearoa New Zealand (AoNZ). This study aims to 1. Examine the distribution of IPWC in a birthing population in AoNZ and 2. Investigate IPWC across priority populations identified by the Perinatal and Maternal Mortality Review Committee (PMMRC).

Methods: This retrospective cohort study in AoNZ, included people who birthed their first two singleton pregnancies between 2016 and 2021. IPWC was calculated as the difference in pre-pregnancy body mass index (BMI) and divided into four categories: 1. Interpregnancy weight loss (IPWL) (BMI reduction of > 1 kg/m²) no change in weight (NC) (BMI change -1-0.9 kg/m²); moderate interpregnancy weight gain: (BMI increase 1-3 kg/m²) and increased IPWG (BMI increase > 3 kg/m²).

Results: The study cohort (n = 856) had a mean IPWC of 1.13 kg/m² (SD 3.5). 49.9% (n = 427) experienced a BMI increase (> 1 kg/m²). IPWC rates observed across categories: IPWL: 167 (19.5%); NC 262 (30.6%); IPWG: 427 (49.9%) (moderate IPWG: 235 [27.5%] and increased IPWG: 192 [22.4%]). IPWC varied by ethnicity, socioeconomic deprivation, age, and BMI in the index pregnancy; in a multiple regression model with these variables, increasing age and BMI in the index pregnancy were associated with lower IPWC.

Discussion: 22.4% of the cohort experienced IPWG at a level associated with adverse perinatal outcomes. Elevated rates of increased IPWG were observed in priority birthing populations, consistent with populations highlighted by the PMMRC. Further research is required to understand the impact of IPWC in AoNZ birthing populations.

Current guidelines for the care of recurrent pregnancy loss patients in New Zealand typically limit the definition to clinical pregnancies. This approach is not supported by the available evidence, which shows that very early losses are just as prognostically important as clinical losses. Clinical pregnancy is a biologically meaningless construct and is not a suitable method for determining whether a loss is 'valid' or not. The exclusion extends to clinical trials, where treatment is often not initiated until clinical pregnancy has been established. Treatment opportunities are being missed as a result. This exclusion of early pregnancy needs to stop.

Objective: To investigate the interobserver agreement of the International Ovarian Tumour Analysis (IOTA) ultrasound-based simple rules risk (SRRisk) score, the logistic regression model 2 (LR2), the Assessment of Different NEoplasias in the adneXa (ADNEX) model and the Ovarian-Adnexal Reporting and Data System (O-RADS) in an Australian, population-based context.

Methods: A retrospective multi-centre study was performed between January 2020 and January 2021. The study included 198 women with adnexal masses examined with transvaginal grey scale and power Doppler ultrasound. Participants were recruited from the multidisciplinary oncology meetings (MDT) of two tertiary cancer centres. Two independent radiologists described the adnexal masses according to the SRR, LR2 scores, ADNEX model, and O-RADS. Values > 30 units different were considered differential and > 50 units were considered highly differential.

Results: From 198 patients, 128 were diagnosed with benign ovarian masses, 53 with malignant and 17 patients with borderline tumours. There was strong agreement (Cohen's kappa 0.8) for intra-tumour blood flow, number of cysts locules, and presence of blood flow within solid projections. Interobserver agreement was moderate (Cohen's kappa 0.60-0.79) for the presence of free pelvic fluid/ascites, solid components, unilocular cysts and acoustic shadows. Of the 198 cases, 10 (5%) cases were highly differential and (38/198) 19% were differential for SRRisk, (20/198) 10% highly differential and (36/198) 18% differential for LR2, and (10/198) 5% and (24/198) 12% for ADNEXA model, respectively. Comparison of O-RADS scores between the two observers showed a moderate agreement with a kappa of 0.65. In 7/198 (4%) cases, the difference between observers was for 2 or more categories when using the O-RADS score.

Conclusions: Our results suggested that interobserver variation was present in evaluating adnexal masses using well established ultrasonographic diagnostic models. Implementation of sonographic ovarian cancer risk prediction models will need to consider this issue and ensure examiners have adequate training in the technique, and standard operating procedures are in place to reduce interobserver variability.