Harrison Odgers, Shannon Philp, Trevor Tejada-Berges
Patients diagnosed with gestational trophoblastic diseases (GTD) can develop malignant gestational trophoblastic neoplasia (GTN). ß-hCG monitoring is important in the early detection of GTN. The primary outcome of this study was to describe ß-hCG monitoring completion rates and time from GTN diagnosis to chemotherapy commencement for patients cared for by a specialised GTD unit within a Gynecologic Oncology department. Secondary outcomes included imaging findings, quantitative ß-hCG levels and gestational age at the time of GTD diagnosis, WHO/FIGO scores and chemotherapy outcomes for those who developed GTN, and the time taken for ß-hCG normalisation for both groups. We collected data for 164 patients with molar pregnancies and 28 patients with GTN requiring chemotherapy. ß-hCG monitoring completion was 93.9%, and the median time to chemotherapy commencement was 7 days. Additional data found a low risk of GTN diagnosis following a negative ß-hCG and high complete response rates to chemotherapy for GTN.
{"title":"Management of Molar-Pregnancy and Associated Gestational Trophoblastic Neoplasia at a Specialised Unit: 10-Year Review","authors":"Harrison Odgers, Shannon Philp, Trevor Tejada-Berges","doi":"10.1111/ajo.70053","DOIUrl":"10.1111/ajo.70053","url":null,"abstract":"<p>Patients diagnosed with gestational trophoblastic diseases (GTD) can develop malignant gestational trophoblastic neoplasia (GTN). ß-hCG monitoring is important in the early detection of GTN. The primary outcome of this study was to describe ß-hCG monitoring completion rates and time from GTN diagnosis to chemotherapy commencement for patients cared for by a specialised GTD unit within a Gynecologic Oncology department. Secondary outcomes included imaging findings, quantitative ß-hCG levels and gestational age at the time of GTD diagnosis, WHO/FIGO scores and chemotherapy outcomes for those who developed GTN, and the time taken for ß-hCG normalisation for both groups. We collected data for 164 patients with molar pregnancies and 28 patients with GTN requiring chemotherapy. ß-hCG monitoring completion was 93.9%, and the median time to chemotherapy commencement was 7 days. Additional data found a low risk of GTN diagnosis following a negative ß-hCG and high complete response rates to chemotherapy for GTN.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"66 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12867547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tayla Miegel, Lisa Vincze, Taylor Guthrie, Helen Porteous, Shannon Huxtable, Susan De Jersey, Michelle Palmer
Background
Australian bariatric surgery (BSurg) rates more than doubled between 2005 and 2015, with around half being women of childbearing age. Few studies have reported gestational weight gain (GWG), and maternal and neonatal outcomes in pregnant women after sleeve gastrectomy.
Aims
This retrospective cohort study compared GWG, maternal and neonatal outcomes of women with and without a history of BSurg from one urban Australian hospital.
Materials and Methods
Eligible participants were pregnant women with and without a history of BSurg who gave birth between 2016 and 2020. A woman with BSurg was matched to one woman without BSurg based on age, pre-pregnancy body mass index (BMI) and estimated date of confinement. Demographic, pregnancy and GWG outcomes were sourced from hospital data and medical records. Chi-squared and t-tests were used to compare data between groups.
Results
There were 210 participants (105 in each group) with a median pre-pregnancy BMI of 30.5 kg/m2. The main BSurg type was sleeve gastrectomy (n = 87). Neonates of women post-BSurg had lower birthweights (BSurg: 3175 ± 484 g; non-BSurg: 3419 ± 562 g; p < 0.001). GWG (BSurg: 9 [4.9–13.9]kg; non-BSurg: 8.9 [3–15.3]kg, p = 0.987) and adherence to the Institute of Medicine's GWG recommendations (BSurg: 24%; non-BSurg: 22%, p = 0.897) were similar between groups. Women who conceived < 12 months after BSurg had on average 4.8 kg lower GWG (p < 0.001) and more had insufficient GWG (BSurg < 12 months:61%; BSurg ≥ 12 months: 25%, p = 0.002).
Conclusion
Neonates of women who had BSurg prior to pregnancy had lower birthweights than neonates of women of similar age, pre-pregnancy BMI and confinement date. Delaying pregnancy for 12 months post-BSurg may be associated with adequate GWG.
{"title":"Comparison of Gestational Weight Gain and Maternal and Neonatal Outcomes Among Women With and Without a History of Bariatric Surgery: A Retrospective Cohort Study","authors":"Tayla Miegel, Lisa Vincze, Taylor Guthrie, Helen Porteous, Shannon Huxtable, Susan De Jersey, Michelle Palmer","doi":"10.1111/ajo.70052","DOIUrl":"10.1111/ajo.70052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Australian bariatric surgery (BSurg) rates more than doubled between 2005 and 2015, with around half being women of childbearing age. Few studies have reported gestational weight gain (GWG), and maternal and neonatal outcomes in pregnant women after sleeve gastrectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This retrospective cohort study compared GWG, maternal and neonatal outcomes of women with and without a history of BSurg from one urban Australian hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Eligible participants were pregnant women with and without a history of BSurg who gave birth between 2016 and 2020. A woman with BSurg was matched to one woman without BSurg based on age, pre-pregnancy body mass index (BMI) and estimated date of confinement. Demographic, pregnancy and GWG outcomes were sourced from hospital data and medical records. Chi-squared and <i>t</i>-tests were used to compare data between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 210 participants (105 in each group) with a median pre-pregnancy BMI of 30.5 kg/m<sup>2</sup>. The main BSurg type was sleeve gastrectomy (<i>n</i> = 87). Neonates of women post-BSurg had lower birthweights (BSurg: 3175 ± 484 g; non-BSurg: 3419 ± 562 g; <i>p</i> < 0.001). GWG (BSurg: 9 [4.9–13.9]kg; non-BSurg: 8.9 [3–15.3]kg, <i>p</i> = 0.987) and adherence to the Institute of Medicine's GWG recommendations (BSurg: 24%; non-BSurg: 22%, <i>p</i> = 0.897) were similar between groups. Women who conceived < 12 months after BSurg had on average 4.8 kg lower GWG (<i>p</i> < 0.001) and more had insufficient GWG (BSurg < 12 months:61%; BSurg ≥ 12 months: 25%, <i>p</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Neonates of women who had BSurg prior to pregnancy had lower birthweights than neonates of women of similar age, pre-pregnancy BMI and confinement date. Delaying pregnancy for 12 months post-BSurg may be associated with adequate GWG.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"66 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ben McLaughlin, Jonathan Panckhurst, Richard Carpenter
We conducted a day-case total laparoscopic hysterectomy service improvement project at Nelson Public Hospital, New Zealand, in August and September, 2024. A retrospective analysis was performed, and a voluntary patient questionnaire administered, at the 4-week postoperative review. Five participants were recruited and successfully discharged on the day of surgery without complication, and either agreed or strongly agreed with the statement, ‘I would recommend day-case total laparoscopic hysterectomy to friends and family’. Qualitative feedback was strongly positive. We conclude that with appropriate infrastructure and resourcing, offering day-case total laparoscopic hysterectomy in a regional centre is both viable and acceptable to patients.
{"title":"Day-Case Laparoscopic Hysterectomy: A Successful Pilot in Regional New Zealand","authors":"Ben McLaughlin, Jonathan Panckhurst, Richard Carpenter","doi":"10.1111/ajo.70049","DOIUrl":"10.1111/ajo.70049","url":null,"abstract":"<p>We conducted a day-case total laparoscopic hysterectomy service improvement project at Nelson Public Hospital, New Zealand, in August and September, 2024. A retrospective analysis was performed, and a voluntary patient questionnaire administered, at the 4-week postoperative review. Five participants were recruited and successfully discharged on the day of surgery without complication, and either agreed or strongly agreed with the statement, ‘I would recommend day-case total laparoscopic hysterectomy to friends and family’. Qualitative feedback was strongly positive. We conclude that with appropriate infrastructure and resourcing, offering day-case total laparoscopic hysterectomy in a regional centre is both viable and acceptable to patients.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"66 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12867546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jennifer Dean, Stephen Lee, Charlotte Reddington, Claudia Cheng, Michal Amir, Martin Healey
Background
Endometriosis may have a causal role in ectopic pregnancies.
Aims
To observe the prevalence and staging of endometriosis in women at the time of laparoscopic treatment of tubal ectopic pregnancy.
Methods
Prospective observational cohort study carried out in a tertiary obstetrics and gynaecology hospital. Seventy participants with ectopic pregnancy requiring laparoscopic treatment were recruited. A pre-operative questionnaire was completed by patients regarding symptoms of endometriosis and gynaecological history. A post operative questionnaire was completed by the surgical team regarding site of ectopic pregnancy, presence or absence of endometriosis and severity of endometriosis.
Results
After the exclusion of patients with non-tubal ectopic pregnancies, results were examined for 65 patients. Of the 65 histologically confirmed ectopic pregnancies, 36 had laparoscopically confirmed endometriosis, demonstrating a prevalence rate of 55% in our cohort. r-ARSM stage I or II (minimal or mild) disease made up 92% (33/36) of cases. There was little correlation between severity of patient symptoms and severity of endometriosis on laparoscopic evaluation.
Conclusion
This study demonstrates endometriosis is significantly more common in women with surgically managed tubal EP compared to the general population.
{"title":"Prevalence and Severity of Endometriosis at Laparoscopic Treatment of Tubal Ectopic Pregnancy","authors":"Jennifer Dean, Stephen Lee, Charlotte Reddington, Claudia Cheng, Michal Amir, Martin Healey","doi":"10.1111/ajo.70050","DOIUrl":"10.1111/ajo.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Endometriosis may have a causal role in ectopic pregnancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To observe the prevalence and staging of endometriosis in women at the time of laparoscopic treatment of tubal ectopic pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective observational cohort study carried out in a tertiary obstetrics and gynaecology hospital. Seventy participants with ectopic pregnancy requiring laparoscopic treatment were recruited. A pre-operative questionnaire was completed by patients regarding symptoms of endometriosis and gynaecological history. A post operative questionnaire was completed by the surgical team regarding site of ectopic pregnancy, presence or absence of endometriosis and severity of endometriosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After the exclusion of patients with non-tubal ectopic pregnancies, results were examined for 65 patients. Of the 65 histologically confirmed ectopic pregnancies, 36 had laparoscopically confirmed endometriosis, demonstrating a prevalence rate of 55% in our cohort. r-ARSM stage I or II (minimal or mild) disease made up 92% (33/36) of cases. There was little correlation between severity of patient symptoms and severity of endometriosis on laparoscopic evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates endometriosis is significantly more common in women with surgically managed tubal EP compared to the general population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"66 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
With the upsurge of obesity in Australia and worldwide, the incidence of metabolic surgery is increasing in women of reproductive age. Metabolic surgery reduces the rate of gestational diabetes mellitus, however, the risk remains about that for the general population.
Aim
To evaluate maternal and perinatal outcomes of consecutive women with GDM post-metabolic surgery presenting to an endocrine antenatal clinic in a single tertiary centre.
Methods
A retrospective cohort study of women with GDM after metabolic surgery were audited between 2020 and 2024.
Results
This cohort of 36 women were aged 32.9 (± 4.7) years and 3.3 (±2.0) years post-surgery with the majority undergoing sleeve gastrectomy (97.2%). Gestational diabetes was diagnosed at 25 (±6+0) weeks. Screening identified carbohydrate inadequacy or inconsistency (18/36, 50%) and micronutrient deficiency (34/36, 94.4%) were common, with 26/36 (72.2%) women deficient in more than one micronutrient. Insulin therapy was required in 16 women. Recurrent hypoglycaemia occurred in 10 (27.8%) women. Women birthed at 38 (±1+0) weeks, with unplanned Caesarean delivery in six (16.7%) women. Composite adverse neonatal outcomes occurred in 22/36 (61.1%) of births. Hypoglycaemia (< 2.6 mmol/L) occurred in 8/36 (22.2%) of neonates; 1/36 (2.8%) were small-for-gestational age, and 2/36 (5.6%) large-for-gestational age. A higher neonatal birthweight was observed in women with reported pre-pregnancy BMI ≥ 30 kg/m2 and women requiring insulin.
Conclusion
Nutritional deficiencies occur commonly in women with gestational diabetes after metabolic surgery. There was a high rate of composite adverse neonatal outcome suggesting that these pregnancies may be higher risk. Further research is required to evaluate the optimal methods of screening and recommended glycaemic targets.
{"title":"Impact of Metabolic Surgery on Gestational Diabetes Mellitus: A Cohort Analysis","authors":"Jasmine Wintour, Sarjana Afrin, Nicole Buxton, Mercy Madzivanyika, Katie Wynne","doi":"10.1111/ajo.70051","DOIUrl":"10.1111/ajo.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>With the upsurge of obesity in Australia and worldwide, the incidence of metabolic surgery is increasing in women of reproductive age. Metabolic surgery reduces the rate of gestational diabetes mellitus, however, the risk remains about that for the general population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate maternal and perinatal outcomes of consecutive women with GDM post-metabolic surgery presenting to an endocrine antenatal clinic in a single tertiary centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study of women with GDM after metabolic surgery were audited between 2020 and 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This cohort of 36 women were aged 32.9 (± 4.7) years and 3.3 (±2.0) years post-surgery with the majority undergoing sleeve gastrectomy (97.2%). Gestational diabetes was diagnosed at 25 (±6<sup>+0</sup>) weeks. Screening identified carbohydrate inadequacy or inconsistency (18/36, 50%) and micronutrient deficiency (34/36, 94.4%) were common, with 26/36 (72.2%) women deficient in more than one micronutrient. Insulin therapy was required in 16 women. Recurrent hypoglycaemia occurred in 10 (27.8%) women. Women birthed at 38 (±1<sup>+0</sup>) weeks, with unplanned Caesarean delivery in six (16.7%) women. Composite adverse neonatal outcomes occurred in 22/36 (61.1%) of births. Hypoglycaemia (< 2.6 mmol/L) occurred in 8/36 (22.2%) of neonates; 1/36 (2.8%) were small-for-gestational age, and 2/36 (5.6%) large-for-gestational age. A higher neonatal birthweight was observed in women with reported pre-pregnancy BMI ≥ 30 kg/m<sup>2</sup> and women requiring insulin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Nutritional deficiencies occur commonly in women with gestational diabetes after metabolic surgery. There was a high rate of composite adverse neonatal outcome suggesting that these pregnancies may be higher risk. Further research is required to evaluate the optimal methods of screening and recommended glycaemic targets.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"66 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12867551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Welcome to this issue of <i>ANZJOG</i>. This issue contains a diverse array of articles covering many aspects of our specialty.</p><p>One of my aims for <i>ANZJOG</i> is to publish articles which are of direct use to clinicians in their practice. The Australian Sickle Cell Disease Working Group position statement on the management of pregnancy in sickle cell disease (SCD) by Yue et al. is a fine example of such an article [<span>1</span>]. This guideline provides clear and practical guidance for maternity care providers for the management of this relatively rare condition in Australia and New Zealand. SCD has significant implications for preconception, prenatal, intrapartum, and postnatal care for the mother and inheritance potential for the fetus and neonate which warrant specific consideration in order to minimise the risk of potentially serious complications. As migration patterns change the demographic of the pregnant population, we are likely to see an increase in pregnancies in women with SCD and this statement will be of benefit particularly to clinicians unfamiliar with its management before, during, and after pregnancy.</p><p>Jenkinson et al. present their evaluation of the implementation of a suite of resources for ‘partnering with the woman who declines recommended maternity care’ [<span>2</span>]. This paper describes the rigorous development and refinement of clinical guidance for managing this difficult clinical situation. The situation where a woman declines recommended care presents her carers with a conflict between providing what they consider as optimal care for the clinical scenario and maintain respect for the woman's autonomy. The difficulty of these situations varies enormously, influenced by a variety of factors such as the chance of an adverse outcome, the severity of such an outcome, whether the risk is primarily to the mother, the fetus, or both, the existing relationship, or lack thereof, between the woman and the carer, the urgency of the clinical situation, and the numerous psychosociocultural factors that impact clinical communication. A defined and systematic approach such as that presented allows clinicians to navigate this space more effectively, aiming to maintain a therapeutic relationship such that a woman's rights are respected and that clinical outcomes can be optimised. Clinical Excellence Queensland have made this suite of resources freely publicly available, including for adaptation for other maternity services to fit their local needs.</p><p>Aboud et al. present a single-centre review of haemorrhagic and thromboembolic complications of pregnancies to women with mechanical heart valves [<span>3</span>]. As long as Australia continues to struggle to reduce rheumatic heart disease in marginalised populations such as remote First Nations communities, and for decades following, we will continue to be faced with the challenge of peripartum anticoagulation management in this high-thromboembolic-risk situatio
{"title":"Editor-In-Chief's Introduction to ANZJOG 65(2)","authors":"Scott W. White","doi":"10.1111/ajo.70043","DOIUrl":"10.1111/ajo.70043","url":null,"abstract":"<p>Welcome to this issue of <i>ANZJOG</i>. This issue contains a diverse array of articles covering many aspects of our specialty.</p><p>One of my aims for <i>ANZJOG</i> is to publish articles which are of direct use to clinicians in their practice. The Australian Sickle Cell Disease Working Group position statement on the management of pregnancy in sickle cell disease (SCD) by Yue et al. is a fine example of such an article [<span>1</span>]. This guideline provides clear and practical guidance for maternity care providers for the management of this relatively rare condition in Australia and New Zealand. SCD has significant implications for preconception, prenatal, intrapartum, and postnatal care for the mother and inheritance potential for the fetus and neonate which warrant specific consideration in order to minimise the risk of potentially serious complications. As migration patterns change the demographic of the pregnant population, we are likely to see an increase in pregnancies in women with SCD and this statement will be of benefit particularly to clinicians unfamiliar with its management before, during, and after pregnancy.</p><p>Jenkinson et al. present their evaluation of the implementation of a suite of resources for ‘partnering with the woman who declines recommended maternity care’ [<span>2</span>]. This paper describes the rigorous development and refinement of clinical guidance for managing this difficult clinical situation. The situation where a woman declines recommended care presents her carers with a conflict between providing what they consider as optimal care for the clinical scenario and maintain respect for the woman's autonomy. The difficulty of these situations varies enormously, influenced by a variety of factors such as the chance of an adverse outcome, the severity of such an outcome, whether the risk is primarily to the mother, the fetus, or both, the existing relationship, or lack thereof, between the woman and the carer, the urgency of the clinical situation, and the numerous psychosociocultural factors that impact clinical communication. A defined and systematic approach such as that presented allows clinicians to navigate this space more effectively, aiming to maintain a therapeutic relationship such that a woman's rights are respected and that clinical outcomes can be optimised. Clinical Excellence Queensland have made this suite of resources freely publicly available, including for adaptation for other maternity services to fit their local needs.</p><p>Aboud et al. present a single-centre review of haemorrhagic and thromboembolic complications of pregnancies to women with mechanical heart valves [<span>3</span>]. As long as Australia continues to struggle to reduce rheumatic heart disease in marginalised populations such as remote First Nations communities, and for decades following, we will continue to be faced with the challenge of peripartum anticoagulation management in this high-thromboembolic-risk situatio","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"65 2","pages":"181-182"},"PeriodicalIF":1.7,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natalie Drever, Vinay Gangathimmaiah, Brittany van Der Lugt, Cecelia O'Brien, Catriona Melville, Kirsten Black, Caroline de Costa
Background
Previous caesarean section (CS) is increasingly common among women undergoing induced abortion.
Aims
To map and analyse existing literature on abortion safety, outcomes and management in those with previous CS.
Materials and Methods
Four databases were systematically searched from inception to July 2024. Primary human studies in English reporting on outcomes, safety or management of first- or second-trimester medical (MToP) or surgical (SToP) abortion in women with previous CS were included. Uterine rupture incidence was analysed cumulatively in the first and secondtrimesters by the number of CS and the type of prostaglandin used. Data on the efficacy and safety of MToP and SToP, including studies reporting on the management of abortion in the setting of abnormal placentation, were collected and analysed by theme.
Results
In total, 164 articles met inclusion criteria. Incidence of uterine rupture in first-trimester MToP was 0 of 2194 cases, in second-trimester misoprostol MToP in those with 1 previous CS was 0.5% (10/1910) and 2.2% (18/835) in women with ≥ 2 CS (p < 0.001). Mifepristone priming did not increase the rupture rate in second-trimester MToP (p = 0.77). Previous CS was a modest risk factor for retained products after MToP across both trimesters (OR 1.48, CI 1.29–1.70).
Conclusion
Medical and surgical abortion in the first and second trimester appears safe in women with prior CS; however, risks include uterine rupture, need for surgical intervention and haemorrhage from undiagnosed placenta accreta. Further research and guidance are needed on managing abortion after previous classical CS, ≥ 3 previous CS and those with abnormally invasive placenta.
{"title":"Induced Abortion After Previous Caesarean Section: A Scoping Review","authors":"Natalie Drever, Vinay Gangathimmaiah, Brittany van Der Lugt, Cecelia O'Brien, Catriona Melville, Kirsten Black, Caroline de Costa","doi":"10.1111/ajo.70013","DOIUrl":"10.1111/ajo.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Previous caesarean section (CS) is increasingly common among women undergoing induced abortion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To map and analyse existing literature on abortion safety, outcomes and management in those with previous CS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Four databases were systematically searched from inception to July 2024. Primary human studies in English reporting on outcomes, safety or management of first- or second-trimester medical (MToP) or surgical (SToP) abortion in women with previous CS were included. Uterine rupture incidence was analysed cumulatively in the first and secondtrimesters by the number of CS and the type of prostaglandin used. Data on the efficacy and safety of MToP and SToP, including studies reporting on the management of abortion in the setting of abnormal placentation, were collected and analysed by theme.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 164 articles met inclusion criteria. Incidence of uterine rupture in first-trimester MToP was 0 of 2194 cases, in second-trimester misoprostol MToP in those with 1 previous CS was 0.5% (10/1910) and 2.2% (18/835) in women with ≥ 2 CS (<i>p</i> < 0.001). Mifepristone priming did not increase the rupture rate in second-trimester MToP (<i>p</i> = 0.77). Previous CS was a modest risk factor for retained products after MToP across both trimesters (OR 1.48, CI 1.29–1.70).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Medical and surgical abortion in the first and second trimester appears safe in women with prior CS; however, risks include uterine rupture, need for surgical intervention and haemorrhage from undiagnosed placenta accreta. Further research and guidance are needed on managing abortion after previous classical CS, ≥ 3 previous CS and those with abnormally invasive placenta.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"65 5","pages":"564-585"},"PeriodicalIF":1.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12723096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Azriel Gan Lin Lo, Lauren J. Breen, Zoe Bradfield, Scott White, Sonya Criddle, Georgia Griffin, Bligh Berry, Jane Warland
Background
In many countries, a baby's cause of death (COD) following stillbirth is informed only by case notes and pathology investigations. However, parents' understanding of their baby's COD may inform or even change the COD diagnosis. We aimed to produce a standardised co-designed interview schedule to enable parents to contribute information to improve overall understanding of the causes of stillbirth.
Materials and Methods
Consensus for the interview schedule was sought via a two-round modified Delphi study. We recruited internationally for panel membership comprising bereaved parents, clinicians, and researchers. In Round 1, each panellist provided up to five questions to ask bereaved parents. After collation into categories, Round 2 asked panellists to rate the importance of each question category on a four-point scale.
Results
Panellists (n = 126 Round 1, n = 75 Round 2) were mainly bereaved parents. In Round 1, 553 potential interview questions were generated. These were grouped into categories which were pregnancy experience, antenatal care, fetal wellbeing, maternal wellbeing, days Prior to stillbirth and perceived COD. These proposed questions and question categories were then put to panel members in Round 2. All categories achieved consensus for inclusion in the final interview schedule with positive consensus percentage scores ranging from 83% to 98%.
Conclusions
Panel membership comprising mainly bereaved parents provided a clear mandate for questions parents want to be asked. The interview schedule will soon be trialled with recently bereaved parents at a tertiary-referral maternity health service. Findings from the study will inform future research on how to include parents' voices in COD determination.
{"title":"Verbal Information From Parents About Stillbirth: The VIPS Study (Phase One)","authors":"Azriel Gan Lin Lo, Lauren J. Breen, Zoe Bradfield, Scott White, Sonya Criddle, Georgia Griffin, Bligh Berry, Jane Warland","doi":"10.1111/ajo.70018","DOIUrl":"10.1111/ajo.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In many countries, a baby's cause of death (COD) following stillbirth is informed only by case notes and pathology investigations. However, parents' understanding of their baby's COD may inform or even change the COD diagnosis. We aimed to produce a standardised co-designed interview schedule to enable parents to contribute information to improve overall understanding of the causes of stillbirth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Consensus for the interview schedule was sought via a two-round modified Delphi study. We recruited internationally for panel membership comprising bereaved parents, clinicians, and researchers. In Round 1, each panellist provided up to five questions to ask bereaved parents. After collation into categories, Round 2 asked panellists to rate the importance of each question category on a four-point scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Panellists (<i>n</i> = 126 Round 1, <i>n</i> = 75 Round 2) were mainly bereaved parents. In Round 1, 553 potential interview questions were generated. These were grouped into categories which were pregnancy experience, antenatal care, fetal wellbeing, maternal wellbeing, days Prior to stillbirth and perceived COD. These proposed questions and question categories were then put to panel members in Round 2. All categories achieved consensus for inclusion in the final interview schedule with positive consensus percentage scores ranging from 83% to 98%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Panel membership comprising mainly bereaved parents provided a clear mandate for questions parents want to be asked. The interview schedule will soon be trialled with recently bereaved parents at a tertiary-referral maternity health service. Findings from the study will inform future research on how to include parents' voices in COD determination.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"65 5","pages":"671-680"},"PeriodicalIF":1.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12723081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Farnoosh Asghar Vahedi, Leila Gholizadeh, Marjan Khajehei
Background
Cardiovascular disease (CVD) is the leading cause of death worldwide, and women who experience complications during pregnancy, such as pregnancy loss (miscarriage and stillbirth), hypertensive disorders of pregnancy and gestational diabetes, have a significantly higher risk of future CVD. Increasing awareness of CVD risk among these women is crucial for effective engagement in risk reduction programs.
Methods
A descriptive cross-sectional survey using a non-probability sampling method was adopted to explore the CVD knowledge and awareness of women with a history of complications of pregnancy. Distribution occurred from February to December 2021 via two tertiary hospitals in Australia and various groups in social media.
Results
Of 364 survey responses received, a sample of 299 completed responses were considered for final analysis. The participants' mean knowledge score regarding CVD risk factors was 14.5 (SD ± 4.6; range 0–25). Among them, 50.2% had poor knowledge, 25.1% had moderate knowledge, and only 24.7% had good knowledge of CVD and its risk factors in women. Statistically significant differences in knowledge scores were observed based on ethnicity (p = 0.009) and education level (p = 0.007).
Conclusion
This study revealed a significant gap in CVD knowledge among women with pregnancy complications, highlighting the need for targeted educational programs. Improving health literacy, particularly among high-risk and lower socioeconomic groups, is crucial for reducing CVD incidence.
{"title":"Knowledge and Awareness of Cardiovascular Risk Factors Among Women With a History of Pregnancy Complications in Australia: A World Heart Federation Cross-Sectional Study","authors":"Farnoosh Asghar Vahedi, Leila Gholizadeh, Marjan Khajehei","doi":"10.1111/ajo.70026","DOIUrl":"10.1111/ajo.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiovascular disease (CVD) is the leading cause of death worldwide, and women who experience complications during pregnancy, such as pregnancy loss (miscarriage and stillbirth), hypertensive disorders of pregnancy and gestational diabetes, have a significantly higher risk of future CVD. Increasing awareness of CVD risk among these women is crucial for effective engagement in risk reduction programs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A descriptive cross-sectional survey using a non-probability sampling method was adopted to explore the CVD knowledge and awareness of women with a history of complications of pregnancy. Distribution occurred from February to December 2021 via two tertiary hospitals in Australia and various groups in social media.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 364 survey responses received, a sample of 299 completed responses were considered for final analysis. The participants' mean knowledge score regarding CVD risk factors was 14.5 (SD ± 4.6; range 0–25). Among them, 50.2% had poor knowledge, 25.1% had moderate knowledge, and only 24.7% had good knowledge of CVD and its risk factors in women. Statistically significant differences in knowledge scores were observed based on ethnicity (<i>p</i> = 0.009) and education level (<i>p</i> = 0.007).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study revealed a significant gap in CVD knowledge among women with pregnancy complications, highlighting the need for targeted educational programs. Improving health literacy, particularly among high-risk and lower socioeconomic groups, is crucial for reducing CVD incidence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"65 5","pages":"688-695"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12723095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Due to the shortage of oocyte donors in Australia, Australian women increasingly travel overseas for oocyte donation. South Africa is a recognised ‘repro-hub’ due to the accessibility of relatively affordable, high-quality assisted reproductive technology services and the availability of donors. In contrast to Australia, where only known and identity release altruistic gamete donation is permitted, in South Africa, oocyte donors are anonymous and receive fixed compensation.
Aims
To explore the consequences for Australian recipients of cross-border oocyte donation (CBOD) in South Africa.
Materials and Methods
Semi-structured interviews were conducted with 12 Australian recipients who had at least one live birth after oocyte donation in South Africa between 2012 and 2020. Interviews were transcribed and transcripts analysed thematically.
Results
Most participants had failed assisted reproductive treatment in Australia before travelling to South Africa. Inability to secure an Australian donor led to CBOD. Ten recipients had at least one double embryo transfer (DET). Of the 15 pregnancies, participants reported one third were twin pregnancies. Some had more than one double embryo transfer cycle. Donors were anonymous, creating disparity around access to genetic information between children conceived with an Australian donor and those conceived with a South African donor. Some Australian recipients used sleuthing methods to locate donor siblings whose recipient parents had used the same donor.
Conclusions
Double embryo transfers increase the possibility of multiple pregnancy and its associated risks of poorer obstetric outcomes, and donor anonymity prevents donor conceived children's ability to officially access information about the donor through donor registers. Strategies to address the shortage of Australian oocyte donors could alleviate the need for CBOD. Education about the consequences of DET and donor anonymity is needed.
{"title":"Consequences for Australian Recipients of Cross Border Oocyte Donation in South Africa: Double Embryo Transfer and Donor Anonymity","authors":"Cal Volks, Karin Hammarberg, Andrea Whittaker","doi":"10.1111/ajo.70027","DOIUrl":"10.1111/ajo.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Due to the shortage of oocyte donors in Australia, Australian women increasingly travel overseas for oocyte donation. South Africa is a recognised ‘repro-hub’ due to the accessibility of relatively affordable, high-quality assisted reproductive technology services and the availability of donors. In contrast to Australia, where only known and identity release altruistic gamete donation is permitted, in South Africa, oocyte donors are anonymous and receive fixed compensation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To explore the consequences for Australian recipients of cross-border oocyte donation (CBOD) in South Africa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Semi-structured interviews were conducted with 12 Australian recipients who had at least one live birth after oocyte donation in South Africa between 2012 and 2020. Interviews were transcribed and transcripts analysed thematically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most participants had failed assisted reproductive treatment in Australia before travelling to South Africa. Inability to secure an Australian donor led to CBOD. Ten recipients had at least one double embryo transfer (DET). Of the 15 pregnancies, participants reported one third were twin pregnancies. Some had more than one double embryo transfer cycle. Donors were anonymous, creating disparity around access to genetic information between children conceived with an Australian donor and those conceived with a South African donor. Some Australian recipients used sleuthing methods to locate donor siblings whose recipient parents had used the same donor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Double embryo transfers increase the possibility of multiple pregnancy and its associated risks of poorer obstetric outcomes, and donor anonymity prevents donor conceived children's ability to officially access information about the donor through donor registers. Strategies to address the shortage of Australian oocyte donors could alleviate the need for CBOD. Education about the consequences of DET and donor anonymity is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"65 5","pages":"696-702"},"PeriodicalIF":1.7,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12723088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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