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.
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.
This retrospective cohort study compared GWG, maternal and neonatal outcomes of women with and without a history of BSurg from one urban Australian hospital.
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.
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).
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.
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.
Endometriosis may have a causal role in ectopic pregnancies.
To observe the prevalence and staging of endometriosis in women at the time of laparoscopic treatment of tubal ectopic pregnancy.
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.
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.
This study demonstrates endometriosis is significantly more common in women with surgically managed tubal EP compared to the general population.
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.
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.
A retrospective cohort study of women with GDM after metabolic surgery were audited between 2020 and 2024.
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.
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.
Previous caesarean section (CS) is increasingly common among women undergoing induced abortion.
To map and analyse existing literature on abortion safety, outcomes and management in those with previous CS.
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.
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).
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.
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.
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.
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%.
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.
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.
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.
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).
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.
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