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

Background: Previously it was recognised onset of Lactogenesis II was delayed in women with Type I diabetes compared to women without diabetes, but the effect of gestational diabetes was unclear. Some clinicians suggest pregnant women with diabetes express breastmilk in late pregnancy to hasten onset of Lactogenesis II.

Aims: To confirm if Lactogenesis II occurs later in women with diabetes in pregnancy, and test if advice to express antenatally hastens Lactogenesis II.

Materials and methods: Data from the DAME (Diabetes Antenatal Milk Expression) randomised controlled trial collected at recruitment and 2 weeks postpartum were compared with a concurrent purposively recruited cohort of women without diabetes in pregnancy. Timing of lactogenesis and adjusted percentage differences were calculated. Study sample was women from both studies with complete data for included measures to assess onset of Lactogenesis II (maternal perception).

Results: Delayed onset of lactation (≥ 72 h postpartum) was similar in DAME trial arms: standard care 58.6% (143/244); antenatal expressing 55.8% (148/265) but lower in comparison cohort 46.9% (90/192). Percentage difference between groups (adjusted for parity, delivery mode, BMI and gestation): DAME standard arm and comparison cohort 12.3% (95% CI 2.6%-22.0%; p = 0.01) DAME intervention arm and comparison cohort 8.3% (95% CI -1.2%-17.8%; p = 0.09) DAME standard care and intervention 4.0% (95% CI -4.5%-12.5%; p = 0.35).

Conclusions: Lactogenesis II occurs later for women with diabetes in pregnancy than women without diabetes. Our findings do not provide evidence that antenatal expressing hastens onset of lactation in women with diabetes in pregnancy.

Trial registration: ClinicalTrials.gov identifier: ACTRN12611000217909.

Background: Although consent has long been accepted as necessary in maternity care, the concept of informed consent for planned vaginal birth has polarised maternity politics. The publication of the NSW Consent Manual outlines new standards of informed consent, signalling the need for examination of current maternity consent practices.

Aims: To examine informed consent and disclosure of material risks in birth in a prospective qualitative study of midwives and obstetricians.

Materials and methods: Qualitative study using semi-structured interviews to examine practices and perspectives of obstetricians and midwives.

Results: Twenty-two telephone interviews were concluded. Five sub-themes were identified: (1) non-compliance with the NSW Consent Manual, (2) risk communication/informed consent in maternity care, (3) consent practices in instrumental birth, (4) who should deliver risk information and when (5) barriers to change in consent practice (obstetricians only).

Conclusions: One hundred per cent of participants (18 obstetricians, 4 midwives) described risk communication/informed consent practices that were non-complaint with the standards set out in the 2020 NSW Consent Manual. Eighty-three per cent (15/18) of obstetricians reported that current hospital-wide maternity care practices in risk communication/informed consent are inadequate. Sixty-one per cent (11/18) of obstetricians specifically singled out informed consent practices regarding instrumental birth to be inadequate. Ninety-four per cent (17/18) of obstetricians believe that maternity care consent practices need to be improved. The results of this study indicate that material risks of vaginal birth, caesarean section and instrumental birth, are not routinely disclosed during antenatal courses. Urgent resources and structural change are required to uphold women's legal right to bodily autonomy.

Background: Delivery of safe maternity care requires not only individual competence but collective team work, influenced by knowledge, team culture and physical working spaces. The ideal layout for a birthing unit is not known, but deliberate changes to the built environment can influence patient care.

Aims: To explore the impact of creation of an open 'hub' on maternity team culture in a tertiary birthing unit and how physical changes to the environment shape values and practice.

Materials and methods: Semi-structured interviews of members of the interprofessional team in a tertiary birth suite were performed and analysed using thematic analysis.

Results: Seventeen healthcare workers participated in interviews. Themes included: (i) enhanced psychological safety; (ii) impacts on teamwork; (iii) unintended consequences; and (iv) future directions for team cohesion and collaboration.

Conclusions: Changes to the built environment can impact team work. This qualitative study identified benefits and unintended consequences to removing a wall, creating a maternity hub. Individuals, departmental leadership, and hospital executives should consider how changes to the built environment can be an effective and efficient way to shape teamwork and organisational culture.

Menstrual disorders are common, but their economic and social impact is still underreported. This study used a cross-sectional design to investigate menstrual symptom prevalence, impacts and economic burden in Australian women of reproductive age. One thousand two hundred thirty-eight responses were analysed (median age 33 years). Most respondents (77%) reported having bothersome menstrual symptoms, and almost half (44%) reported missed days of work or study because of their symptoms. Those aged 18-24 years were more likely to report bothersome menstrual symptoms, and time away from work and study, than those aged 35-44 years. The economic burden due to menstrual symptoms was approximately AUD $14.2 billion per year.

Objectives: To audit outcomes of patients registered in the Queensland Trophoblast Centre (QTC) database who develop resistance to primary chemotherapy. To determine any risk factors that may predict first-line chemotherapy resistance in patients diagnosed with gestational trophoblastic neoplasia (GTN).

Methods: Patients within the QTC who were diagnosed with GTN between January 2012 and December 2020 were reviewed.

Results: Of 138 patients with GTN registered in the QTC, 22 (15.9%) patients developed resistance to first-line chemotherapy. Three had high-risk GTN and 19 had low-risk GTN. Of the three high-risk patients, one patient died. This patient had an epithelioid trophoblastic tumour (ETT). The remaining two high-risk patients had complete hydatidiform moles (CHM) with GTN. Both achieved complete remission with salvage therapy. Of the 19 low-risk patients, one patient had a partial hydatidiform mole (PHM). This patient achieved remission following third-line treatment. The other 18 low-risk patients had CHM with GTN. All but two of these 18 patients were successfully treated with second-line chemotherapy, with the remaining two patients achieving remission with third-line chemotherapy. Five of the 18 patients received either actinomycin-D or methotrexate as salvage therapy. Thirteen patients were given multi-agent chemotherapy for second-line treatment. One patient in this group died but this was not due to her disease. Initial β human chorionic gonadotropin levels were not predictive of number of chemotherapy cycles or number of lines of chemotherapy required to achieve remission.

Conclusions: GTN is a curable condition. If resistance to first-line chemotherapy occurred, most patients achieved remission with salvage therapy.

Background: Cannabis use during pregnancy is becoming more prevalent. While numerous studies have explored the relationship of cannabis use during pregnancy and outcomes for mothers and infants, uncertainty remains regarding the impact of cannabis use on pregnancy complications and later-life outcomes for offspring.

Aims: To produce a summary of the short and long-term effects of prenatal cannabis exposure on fetal growth and development, neonatal conditions, later-life, and maternal outcomes.

Materials and methods: An overview of systematic reviews, an evidence and gap map, targeted updates of previous reviews, and de novo evidence synthesis was conducted. The databases searched include PubMed (National Center for Biotechnology Information); MEDLINE (Ovid); Embase (Ovid) and CINAHL with Full Text (EBSCO). Assessment of risk of bias was conducted in duplicate for all studies. Relevant studies were coded and are presented as an evidence and gap map. Where possible, meta-analyses were conducted with a narrative synthesis of the results. Primary studies and systematic reviews examining the relationship between cannabis consumption in pregnancy and the effect on fetal/child development, antenatal, and obstetric outcomes during pregnancy were eligible for inclusion.

Results: There were 89 studies/reviews eligible for inclusion in this review. There was a potentially harmful impact of prenatal cannabis exposure on all fetal growth and development outcomes, some neonatal outcomes, some later-life outcomes, and some maternal outcomes. The evidence regarding other neonatal conditions, later-life, and maternal outcomes was mixed.

Conclusions: The evidence suggests cannabis should be avoided during pregnancy.

Background: Menstrual cups offer a cost-effective and environmentally sustainable product for many young people. While clinical trials have shown their safety and effectiveness, no studies have investigated their performance in real-world use.

Aims: To describe the acceptability and functionality (continuation, discomforts, leakage, and adverse events) of menstrual cups and investigate the supportive role of product knowledge.

Materials and methods: A cross-sectional online survey of 530 people aged 15-24 living in Australia who had ever used a menstrual cup, recruited via a menstrual cycle tracking application.

Results: More than half of participants (55%) were still using their first menstrual cup at the time of the survey, 16% had switched to an alternative cup, and 29% had discontinued use. In their first cycle of use, 54% of participants reported leakage and 25% reported pain or discomfort with the cup in place. Many participants (45%) reported being unable to remove the cup on their first attempt, with subsequently 17% requiring help to remove it, and 2% reported displacement of an intra-uterine device during removal. These figures decreased for subsequent cycles. Half of the participants were aware prior to using a cup that different cup models may offer a better fit for different individuals. This knowledge was associated with decreased odds of needing help to remove the cup (adjusted odds ratio 0.57, 95% CI 0.35-0.94) or discontinuing use (adjusted relative risk ratio 0.66, 95% CI 0.44-1.00).

Conclusions: Difficulties using menstrual cups are common in real-world use and higher than reported in clinical trials. Improved education provision may support more positive user experiences.