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

Background: Non-invasive prenatal testing (NIPT) does not receive any Medicare rebate. This study investigated the views of Australian healthcare providers and consumers on public funding of NIPT.

Materials and methods: Two anonymous online, cross-sectional surveys were conducted from September 2022 to January 2023. Surveys targeted maternity healthcare professionals ('providers'), and individuals who had recently conceived a pregnancy ('consumers'). Quantitative data were analysed using χ² test. Free-text responses were analysed by inductive content analysis.

Results: Responses from 381 providers and 630 consumers were analysed. The overwhelming majority of providers (96.8%) identified financial cost as a consumer barrier to NIPT access. Public funding for NIPT was supported by 86.4% of providers and 90.4% of consumers, with free-text responses citing equity, clinical, health economic, reproductive autonomy, and ethical justifications. Of the 145 consumers who did not use NIPT in a recent pregnancy, 63.1% rated cost as an 'important/very important' factor in foregoing NIPT. NIPT non-users were younger, had lower household income and education, and were more likely to live in a rural or remote area than consumers who used NIPT.

Conclusion: Maternity healthcare providers and consumers are highly supportive of public funding for NIPT as a first-line screening test on clinical, equity, health economic, and ethical grounds. Our results confirm the presence of significant socioeconomic disparities between NIPT users and non-users, with cost being the most important factor impeding equitable access to best practice in prenatal screening. Further research and advocacy are needed to achieve equitable access to best practice in antenatal care.

Background: There are no published Australian population-based data on serious COVID-19-associated maternal morbidity before and after widespread vaccination.

Aims: To compare COVID-19 infection rates, intensive care unit (ICU) admissions, and length of stay in hospitalised pregnant patients before and after achieving 70% state-wide maternal COVID-19 vaccination coverage.

Material and methods: Population-based retrospective cohort study involving all hospital-admitted episodes for pregnant patients over 15-years-old with COVID-19 in Victoria from 1 March 2020 to 31 March 2022. Phase 1 was defined as March 2020-October 2021 when maternal vaccination coverage < 70%; Phase 2 was defined as November 2021-March 2022 when maternal vaccination coverage ≥ 70%. Primary outcomes include COVID-19 rates, ICU admission rates, and length of stay. A p-value of < 0.05 was considered statistically significant.

Results: We analysed 215,363 hospital admissions, among which 2,128 (0.99%) had COVID-19. The percentage of admitted pregnant patients with COVID-19 was higher in Phase 2 than Phase 1 (3.27% vs. 0.41% respectively, p < 0.001). However, Phase 2 was associated with lower maternal ICU admission rates (2.02% vs. 5.39%, p < 0.001) and lower median length of stay (2.19 vs. 3.11 days, p < 0.001) compared with Phase 1. The risk of COVID-19 was significantly lower in socioeconomically advantaged pregnant patients (aRR = 0.83 [95% CI, 0.76-0.90], p < 0.001) and pregnant patients ≥ 30-years-old (aRR = 0.81 [95% CI, 0.74-0.88], p < 0.001).

Conclusions: Maternal ICU admission risk and length of stay were significantly lower among pregnant patients with COVID-19 during Phase 2, which is likely due to the combined effects of high maternal COVID-19 vaccination coverage and changes in SARS-CoV-2 variants.

Background: Placenta praevia (PP) is a significant obstetric complication associated with antepartum haemorrhage (APH) and adverse maternal and fetal outcomes. Identifying risk factors for APH in women with PP is important for guiding management decisions.

Aims: This study aimed to identify risk factors associated with APH amongst women admitted to a single tertiary hospital with PP.

Materials and methods: A retrospective cohort study was undertaken, utilising data from the hospital's maternity dataset (2007-2021) and included publicly funded women with PP after 24 weeks gestation. Exclusions comprised multiple pregnancies, fetal abnormalities, intra-uterine fetal death and deliveries at other hospitals. Baseline characteristics, outcomes and potential risk factors for APH were analysed through bivariate and stepwise logistic regression.

Results: Of the 430 cases with PP, 112 (26%) were admitted with APH. Of these, 45 had two or more admissions with APH, constituting 40% of the APH cohort. Those requiring admission were more likely to deliver at an early gestation, and their baby required nursery admission. Factors independently associated with APH included a higher number of previous caesarean sections, parity, Caucasian ethnicity and major PP.

Conclusions: Most women with PP will not require an admission with APH. In considering inpatient versus outpatient management, multiparous Caucasian women with a major PP appear more likely to be at risk of APH admission and premature delivery. These findings underscore the importance of tailoring clinical decision-making.

Background: Chronic pelvic pain (CPP) is a common and debilitating presentation for adolescent and young adult females. Medical management is often utilised as first line therapy with surgical management considered if medical treatment has been unsuccessful. Laparoscopy in this young population remains controversial due to the high recurrence rate of pain, requirement for repeat surgeries and surgical risks. There is a need for prospective, longitudinal studies comparing medical and surgical management to guide management of young patients with CPP.

Aims: To determine the effect of the first laparoscopy in an adolescent and young adult female population and assess its association with CPP.

Materials and methods: Patients aged 16-25 will be recruited from the gynaecological service at the study sites. Consented participants will be randomised to the surgical or non-surgical arms. Those in the surgical arm will have a laparoscopy performed and those in the non-surgical arm will be medically managed. At recruitment and at 6 weeks, 6 months, 12 months and 24 months follow-up, patients will complete a number of validated questionnaires assessing pain and quality of life. An amendment was made to methodology to include patients who will choose their management pathway for CPP.

Results: An independent t-test or Mann-Whitney U test will be used to compare the questionnaire scores between the surgical and non-surgical groups. For questionnaire scores at baseline and follow-up within the same arm, a paired t-test or Wilcoxon signed-rank test will be used. A p-value of < 0.05 will be statistically significant.

Background: Anecdotal experience suggests that WHO Safer Surgery Checklist has become a 'tickbox' exercise, resulting in variable team engagement and efficacy.

Aims: To observe the quality and completeness of 'Time Out', together with the level of team engagement during obstetrics and gynaecology procedures.

Materials and methods: Observational study where the following data were collected during 'Time Out': % of the 19 items correctly responded to after 'challenge'. Type and duration of distractions. Level of team engagement. Authority gradient and likelihood of speaking up (Visual Analogue Score).

Results: Data from 70 obstetrics and gynaecology cases were collected over 8 weeks. 'Time Out' was clearly announced in 91.4% and was performed in all cases but not all items were communicated in the correct 'challenge and response' manner. Mean percentage of questions appropriately 'challenged' and 'responded' to was 92% ± 6.86%. Mean duration of 'Time Out' was 92.01 ± 86.9 s and observed distractions were auditory (61%), visual (26%), irrelevant chatter (22.5%) and theatre traffic (13%). In 92.8%, at least two team members were not engaged and were performing non-essential tasks. The likelihood of a team member being able to 'speak up' was 8.78/10 (±0.71) and this appeared independent of whether it was led by nurses, doctors, operating department practitioners or healthcare support workers.

Conclusion: Although performed in all cases, 'Time Out' is often not clearly announced or completed in the correct 'challenge and response' manner. It is plagued by avoidable distractions and suboptimal team engagement. Greater awareness is crucial to ensure more complete team involvement.