Recurrent pregnancy loss (RPL) is when a woman experiences two or more pregnancy losses. Investigating for causes of RPL can provide an explanation and possible treatment options. This is a summary of Parts 1 and 2 of Australasian Recurrent Pregnancy Loss Clinical Management Guidelines in an easy-to-read patient friendly format. These original publications can be found with a digital object identifier (DOI) 10.1111/ajo.13821 and DOI 10.1111/ajo.13820.
Systematic, multi-disciplinary review of Severe Acute Maternal Morbidity (SAMM) can improve maternal outcomes. Routinely collected data, collated into the Queensland SAMM Dashboard, may facilitate local case review. We wanted to understand how SAMMs are reviewed locally and how centrally collated data supports review processes.
The purpose of this survey was to assess local SAMM recording and review practices in Queensland.
A cross-sectional online survey, using multiple choice and free-text response formats, sampled multi-disciplinary health care workers (HCW) involved in SAMM review in Queensland public maternity units. Responses were analysed for content, with thematic analysis performed on free-text comments.
Twenty HCW responded from a mix of tertiary, regional and rural maternity facilities. HCW responses identified a lack of clarity around the terms ‘maternal morbidity’, ‘SAMM’ and ‘Near-Miss’. HCW reported various approaches for recording and reviewing SAMM. The commonest structures were Root Cause Analysis and Human Error and Patient Safety incident analysis. Reviews commonly involved: patient safety teams (50%); staff involved in the case (45%); independent/external reviewers (40%) and hospital management (40%). Few responses (10%) indicated consumers were involved. 30%–80% reviewed the ACSQHC defined SAMM, 70% Near-Miss cases and up to 70% reviewed other severe maternal morbidity indicators. 20% of HCW stated lessons learned during reviews were shared with other hospitals.
In Queensland, we have found variability in: HCW understanding of SAMM definitions, how cases are recorded, reviewed and improvements facilitated. A standardised approach to SAMM review and collaboration to share lessons learned may benefit maternity care.
The widespread and rapid adoption of private payments for non-invasive prenatal testing (NIPT) in Australia has introduced complexities to the decision-making process for the public regarding prenatal screening. NIPT has the potential to be a useful screening tool, but concerns have been raised about its cost, the psychological consequences of testing and the information available to support informed decision-making.
To explore the attitudes, values and beliefs around prenatal screening in Australia, and how perspectives may differ between people living in metropolitan locations versus rural/regional locations.
Three focus groups were conducted in New South Wales (NSW), Australia. Participants (N = 25) were recruited by a market research group. Focus groups took place face-to-face in metropolitan and rural/regional areas, and online via videoconference. Discussions were transcribed and analysed thematically.
Participants generally expressed interest in undertaking prenatal screening but held misconceptions about the purpose of NIPT (i.e. screening, not diagnosis) and the conditions assessed. There were varied opinions among participants on expanding the scope of screening: some felt additional information provided reassurance, whilst others thought it would increase stress due to the decreased accuracy. People living in rural/regional areas had greater concerns over access to screening (cost, wait times and distance) than people living in metropolitan areas.
Our findings demonstrate different approaches are needed to improve understanding of NIPT (to ensure informed consent), and to improve access to NIPT for people living in rural/regional areas. The pre-test information needs to account for the range of perspectives observed across geographic locations.
In Aotearoa New Zealand, there are limited data on ethnicity-specific prevalence and management of endometriosis and persistent pelvic pain. In the international literature, there appears to be a wide variation in both diagnosis and treatment access for these common conditions.
To explore ethnicity-specific referral data for people with symptoms of endometriosis and pelvic pain referred to two tertiary hospitals in Aotearoa New Zealand.
Referrals to two gynaecology departments, in the North and South Islands of New Zealand, for women aged 16–52 during 2021 were screened and included if the primary referral reason was pelvic pain > 3 months, abdominal pain, dysmenorrhea, endometriosis or dyspareunia. Denominator data were obtained from Statistics NZ.
There was a significantly lower referral rate at the North Island unit for Māori, Pacific and Asian people compared to European/MELAA; and a significantly lower referral rate in the South Island unit for Pacific and Asian people compared to European/MELAA and Māori, per 1000 women aged 16–52 years per year. Similar patterns occurred in the rates of waitlisting for surgery.
European women are privileged in Aotearoa compared to Māori, Pacific and Asian people in secondary referral and population waitlisting for surgery. This privilege was not evident in waitlisting for surgery from the gynaecology clinic. We suggest that a nationally consistent approach to the management of endometriosis and persistent pelvic pain is required.
Low birth weight (LBW) is associated with adverse short-term and long-term health outcomes for neonates. The impact of maternal geographical location on rates of LBW in Australia is conflicted in existing literature.
The aim was to identify if a difference in rates of LBW exist between neonates born to rural versus metropolitan maternal residence. Secondary aim was to identify any associated factors influencing LBW.
A secondary data analysis of retrospective health surveillance data from all births from 2018 to 2022 in the Hunter New England Local Health District (New South Wales, Australia) was performed. Logistic regression was used to determine odds ratio and adjusted odds ratio of LBW for rural versus metropolitan residence.
A total of 39,579 neonates were included in this analysis, with 50.9% of the maternal cohort residing rurally. Median maternal was age 29.2 years. Rates of LBW were higher in rural maternal residence (5.7%) compared to metropolitan residence (5.2%). Odds of neonatal LBW did not differ between rural and maternal metropolitan residence after adjusting for confounders (adjusted Odds Ratio (aOR) = 0.90, 95% CI 0.79–1.01, p = 0.07). Socioeconomic disadvantage was significantly identified as an issue associated with LBW.
LBW neonates were more likely to be born to rural maternal residence and LBW risk factors disproportionately affected those living in rural locations. To reduce LBW in neonates, it is imperative that access to safe and affordable healthcare is available, and resources addressing LBW risk factors are specific to geographical locations.
Maternal obesity-risk behaviours during pregnancy have a direct impact on the weight trajectory of their children. Targeting these behaviours may help improve birth outcomes and child health. This study aimed to identify sociodemographic factors associated with unhealthy dietary behaviours and insufficient physical activity in pregnant women.
We undertook a cross-sectional secondary analysis using data from the Communicating Healthy Beginnings Advice by Telephone (CHAT) trial conducted in NSW, Australia in 2017–2019. Multiple logistic regression models were built to determine associations.
A total of 1155 pregnant mothers attended antenatal clinics from 28 to 34 weeks gestation. Younger age (< 30 years, adjusted odds ratio [AOR] 2.01, 95% confidence interval [CI] 1.53–2.64) and paternal unemployment (AOR1.86, 95% CI1.44–2.39) were associated with a cluster of unhealthy dietary behaviours. Excessive intake of discretionary foods (processed meat, fast food, potato crisps) was associated with: younger age (AOR1.62, 95% CI 1.24–2.11), being Australian-born (AOR1.55, 95% CI 1.20–2.01), paternal unemployment (AOR1.57, 95% CI 1.01–2.43) and lower paternal education level (AOR1.77, 95% 1.37–2.28). Insufficient physical activity behaviours were associated with maternal employment (AOR1.55, 95% CI 1.21–1.98) and those with tertiary-level education (AOR1.39, 95% CI 1.08–1.79).
Mothers aged under 30 years and those born in Australia were more likely to have a cluster of obesity-risk behaviours. Maternal and paternal employment status, and education level were also associated with such clusters.
EXPRESSION OF CONCERN: S. A. M. Shazly, L. H. O. Embaby, and S. S. Ali. “The Labour Scale—Assessment of the Validity of a Novel Labour Chart: A Pilot Study†.” Australian and New Zealand Journal of Obstetrics and Gynaecology 54, no. 4 (2014): 322–326. https://doi.org/10.1111/ajo.12209.
This Expression of Concern for the above article published online on 17 May 2014 in Wiley Online Library (wileyonlinelibrary.com) has been published by agreement between the journal Editor-in-Chief, Scott White; The Royal Australian and New Zealand College of Obstetricians and Gynaecologists; and John Wiley & Sons Australia Ltd. The Expression of Concern has been agreed due to concerns raised about the accuracy of the mean age of nullipara and multipara presented in Table 1. Furthermore, the feasibility of the 1-min APGAR scores listed in Table 1 was also questioned. The authors provided an explanation and an incomplete data set excluding some of the results flagged as implausible. This was not considered satisfactory, thus the journal has decided to issue an Expression of Concern to alert the readers.
Research has linked postcode-level sociodemographic, food and built environment factors to maternal and perinatal outcomes like overweight (BMI > 25 kg/m2), gestational diabetes mellitus (GDM) and large for gestational age (LGA) birthweight. However, little is known about how these factors were influenced by the COVID-19 pandemic. We examine how postcode-level indicators and lockdown conditions are associated with the prevalence of maternal overweight, GDM and LGA.
We analysed birth records from 12 public maternity hospitals in Melbourne, integrating postcode-level environmental indicators. Spatial regression models assessed associations between these indicators and maternal health outcomes, distinguishing between (a) the COVID-19 lockdown and (b) post-lockdown periods.
We included 31 083 singleton birth records from 2020 to 2023 across 235 postcodes in Greater Melbourne. The prevalence of maternal overweight, GDM and LGA were 496, 178 and 103 per 1000 births, respectively. Maternal overweight was less prevalent in postcodes with higher median ages and socioeconomic scores, with disparities intensifying during lockdowns. GDM was more common in areas with younger, overseas-born populations, while LGA correlated with higher median age and fewer overseas-born residents. Notably, maternal overweight mediated the effect of socioeconomic status on GDM and LGA.
The prevalence of maternal overweight, GDM and LGA varies significantly across Melbourne, shaped by postcode-level factors. The pandemic lockdown amplified existing health disparities. The food and built-environment factors independently influence maternal and perinatal outcomes.
Modern assisted reproductive technology (ART), including pre-implantation genetic testing for aneuploidy (PGT-A), has opened new avenues in understanding early embryonic events and has simultaneously raised questions about the impact of ART itself on sex ratios.
The primary aim was to investigate whether patient demographic characteristics, ovarian stimulation protocols or laboratory characteristics in ART influence sex ratios. The secondary aim was to relate the blastocyst sex ratio (BSR) to the corresponding secondary sex ratio (SSR) in our patient cohort.
We conducted a retrospective single-centre cohort study on consecutive PGT-A cycles from January 2019 to February 2022. We analysed demographic data, stimulation protocols, laboratory characteristics and pregnancy outcomes.
The euploidy rate was 45.1% (2608/5777), BSR 1.07 and euploid BSR 1.03. There was no statistical difference in the ploidy status of XX and XY blastocysts and on multivariate logistic regression analysis, there was no association between euploidy and BSR or any other variables examined, including female age and stimulation protocol. The SSR was 1.02 (1294 embryo transfers) with no statistical difference in biochemical pregnancy (p = 0.41), clinical pregnancy (p = 0.56), miscarriage (p = 0.65) or live birth rates (p = 0.40) based on embryo sex.
Our study indicates that the euploid BSR is not skewed by sex, and there is no relationship between BSR and euploidy, patient characteristics or stimulation protocols. Pregnancy outcomes did not vary by sex, and the SSR was consistent with the SSR of the general Australian population at birth.
This study aims to investigate the psychological characteristics, motivations and experiences of potential living donors assessed for the first uterus transplant (UTx) clinical trial in Australia.
Mixed methods study.
Tertiary hospital.
Seven female potential UTx donors.
A mixed-methods design was used to evaluate seven self-referred potential uterus donors for the UTx program. Potential donors underwent rigorous clinical and psychological screening, including self-reported psychological assessments. Additionally, five potential donors participated in semi-structured interviews conducted by the study social worker.
Scores from measures of quality of life, depression, anxiety and stress, along with thematic analysis from semi-structured interviews.
Thematic analysis identified six key themes: feelings about donating a uterus, health history, informed consent, impact of donation, relationships, and access to educational resources. Several sub-themes were also identified, including awareness of surgical complications and dynamics of relationships and sexuality. Quantitative results indicated clinical levels of depression, anxiety, and stress in some donors. Overall, the quality-of-life scores of the donors were comparable to those of the general Australian female population.
The study provides a deeper understanding of the psychological profiles and motivations of potential UTx donors in Australia. It reveals the complexity of donor motivations, which include altruistic desires to help others experience pregnancy, and practical considerations. The findings emphasise the need for rigorous psychological screening and continuous support to address potential mental health challenges. These insights are valuable for developing future UTx protocols and support systems to ensure donor wellbeing.
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