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

英文中文

Uptake of Quitline Telephone Counselling by Women Who Smoke During Pregnancy 怀孕期间吸烟的妇女接受戒烟热线电话咨询。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-01-17 DOI: 10.1111/ajo.13933

Cheryl Bailey, David Ellwood, Philippa Middleton, Aleena M. Wojcieszek, Vicki Flenady, Christine Andrews

Background

While many pregnant women accept referrals for smoking cessation support, the uptake of telephone counselling appointments is unknown.

Aims

To determine the uptake rate of Quitline appointments among Australian pregnant women who smoke after being referred by a healthcare provider.

Materials and Methods

Data on attendance at telephone counselling appointments, number of appointments attended, gestational age at referral, referral source and smoking cessation upon completion of the program were requested from Quitline. Descriptive analysis of trends over time were undertaken using retrospective data from six Australian jurisdictions between 2016 and 2023 for pregnant women referred to Quitline by healthcare providers.

Results

A total of 7503 pregnant women who smoke were referred to Quitline in the study period. More than half (n = 4072, 54%) did not attend any telephone counselling appointments, 24% (n = 1812) attended one appointment, 10% (n = 725) two, 5% (n = 359) three and only 7% (n = 535) attended four or more appointments. Gestational age at referral was available for 1203 women in Queensland, with 52% (n = 624) attending their first phone appointment between 1 and 20 weeks of pregnancy and 48% (n = 579) attending between 21 and 40 weeks. The overall referred smoking cessation rate in this cohort was 4% and 52% for those completing the program.

Conclusions

The Quitline referral model for smoking cessation support for pregnant women is suboptimal. Comprehensive and consistent routinely collected data are urgently needed to monitor Quitline services for pregnant women who smoke across Australia. Further research is needed to understand the barriers to referral and uptake.

背景：虽然许多孕妇接受戒烟支持的转诊，但电话咨询预约的采用情况尚不清楚。目的：确定戒烟线上预约的澳大利亚孕妇谁吸烟后，由医疗保健提供者。材料和方法：从Quitline获取电话咨询预约的出席率、就诊次数、转诊时的胎龄、转诊来源和项目完成后的戒烟数据。使用2016年至2023年期间澳大利亚六个司法管辖区的回顾性数据，对医疗保健提供者转到戒烟热线的孕妇进行了一段时间的趋势描述性分析。结果：在研究期间，共有7503名吸烟的孕妇被转到戒烟线上。超过一半（n = 4072, 54%）没有参加任何电话咨询预约，24% （n = 1812）参加一次预约，10% （n = 725）参加两次预约，5% （n = 359）参加三次预约，只有7% （n = 535）参加四次或更多预约。昆士兰州1203名妇女转诊时的胎龄，其中52% （n = 624）在怀孕1至20周期间参加第一次电话预约，48% （n = 579）在怀孕21至40周期间参加第一次电话预约。在这个队列中，完成项目的人的总体转诊戒烟率为4%，而完成项目的人的转诊戒烟率为52%。结论：戒烟热线转诊模式对孕妇戒烟支持并不理想。迫切需要全面和一致的常规收集数据来监测澳大利亚各地吸烟孕妇的戒烟热线服务。需要进一步的研究来了解转诊和接受的障碍。

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引用次数: 0

Cystic Spaces in the Endometrium on Ultrasound and Correlations With Pathological Diagnosis: A Contemporary Retrospective Cohort Study in a Tertiary Centre 超声显示子宫内膜囊性间隙及其与病理诊断的相关性：一项在三级中心的当代回顾性队列研究。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-01-17 DOI: 10.1111/ajo.13914

Rosemary McBain, Karen Reidy, Ricardo Palma-Dias, Martin Healey

Objectives

To determine the correlation between the ultrasound finding of cystic spaces in the endometrium and endometrial hyperplasia or cancer.

Materials and Methods

We performed a retrospective cohort study at a tertiary teaching hospital in Victoria, Australia, between January 2014 and December 2016. Patients who had a tertiary ultrasound where the endometrium was assessed and underwent endometrial sampling in the subsequent year were included.

Results

There were 1614 patients who were included, and 154 (9.5%) had endometrial cystic spaces on ultrasound. Sensitivity, specificity, positive predictive value and negative predictive value for a histological finding of polyps were 16.3%, 93.4%, 51.3% and 72.3%, respectively; for endometrial hyperplasia without atypia (EH no A) 40.7%, 91.0%, 7.1% and 98.9%, respectively; for hyperplasia with atypia (EH with A) 25.0%, 90.8%, 5.2%, 98.4%, respectively and for endometrial cancer were 19.5%, 90.7%, 5.2% and 97.7%, respectively. When adjusted for age, endometrial thickness and the presence of polyps on ultrasound, cystic spaces increased the odds of a histologic diagnosis of polyps (adjusted odds ratio (aOR) 2.13 (95% CI 1.41–3.21) P < 0.001) or EH no A (aOR 5.20 (95% CI 2.06–13.12) P < 0.001) and reduced the odds of endometrial cancer (aOR 0.26 (0.08–0.81) P = 0.02).

Conclusion

Cystic spaces on ultrasound are more likely to indicate the presence of EH no A or an endometrial polyp than endometrial cancer. As one in ten patients who had cystic spaces on tertiary ultrasound had a pathologic diagnosis of EH with A or carcinoma, there remains a need for sampling in this group until better data are available.

目的：探讨超声诊断子宫内膜囊性间隙与子宫内膜增生或癌的关系。材料和方法：我们于2014年1月至2016年12月在澳大利亚维多利亚州的一家三级教学医院进行了回顾性队列研究。接受第三次超声检查并在随后一年接受子宫内膜取样的患者也包括在内。结果：共纳入1614例患者，超声显示子宫内膜囊性间隙154例（9.5%）。息肉的敏感性、特异性、阳性预测值和阴性预测值分别为16.3%、93.4%、51.3%和72.3%；无异型性子宫内膜增生（EH no A）分别为40.7%、91.0%、7.1%和98.9%；异型增生（EH + A）分别为25.0%、90.8%、5.2%、98.4%，子宫内膜癌分别为19.5%、90.7%、5.2%、97.7%。经年龄、子宫内膜厚度和超声检查是否有息肉等因素调整后，囊性间隙增加了息肉的组织学诊断几率(调整优势比（aOR） 2.13 (95% CI 1.41-3.21) P结论：超声检查的囊性间隙更有可能提示EH - a或子宫内膜息肉的存在，而不是子宫内膜癌。由于三次超声显示囊性间隙的患者中有十分之一的患者病理诊断为EH伴a或癌，因此在获得更好的数据之前，仍需要对该组进行抽样。

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引用次数: 0

Beyond COVID-19: Reported clinical practices in maternity care in Victoria during the COVID-19 pandemic and implications for the future – A statewide review 超越COVID-19: COVID-19大流行期间维多利亚州产科护理的临床实践报告及其对未来的影响-全州审查。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-01-16 DOI: 10.1111/ajo.13904

Della A. Forster, Rebecca Hyde, Robyn Matthews, Charlie A. Benzie

Background

In Australia, during the COVID-19 pandemic many routine pregnancy visits were replaced by telehealth, along with changes to routine screening and visitor policies. Many providers plan to continue these changes.

Aims

Describe changes to maternity care provision across the state of Victoria during the COVID-19 pandemic.

Materials and Methods

A population-based cross-sectional design was used. Managers of maternity services (public and private) were invited to complete a questionnaire by telephone or online exploring changes to care delivery, telehealth practices, perceived impact of changes and future telehealth implementation.

Results

Fifty per cent of maternity service managers (34/68; 27 public, six private) responded (March–April 2021). Around 50% of all pregnancy visits became telehealth, with multiple combinations of face-to-face and telehealth visits; 92% conducted the first (booking) appointment via telehealth. No specific gestational visit was conducted face-to-face by all services. Visits most likely to be face-to-face were at 39 and 40 weeks gestation (65%). For telehealth appointments, there was an ad hoc approach to routine screening, eg, measuring blood pressure (11% did not advise at all), fetal growth (26%—no specific strategy) and fetal heart rate (15%—no specific strategy). Over half (52%) would consider maintaining telehealth post-pandemic.

Conclusions

Even in a single state, there was great variation in what constitutes telehealth, when pregnant women should have face-to-face visits, and what routine screening in pregnancy should be maintained. This is concerning given over half the services are planning to continue telehealth post-pandemic, despite the lack of evidence of safety, efficacy and input from women and clinicians.

背景：在澳大利亚，在2019冠状病毒病大流行期间，许多常规妊娠就诊被远程医疗取代，常规筛查和访客政策也发生了变化。许多供应商计划继续这些变化。目的：描述在2019冠状病毒病大流行期间维多利亚州产妇保健服务的变化。材料和方法：采用基于人群的横断面设计。邀请产科服务（公共和私营）的管理人员通过电话或在线填写一份调查问卷，探讨护理服务的变化、远程保健做法、变化的感知影响和未来远程保健的实施情况。结果：50%的产妇服务管理人员(34/68；27个公共部门，6个私人部门)回应了（2021年3月至4月）。约50%的妊娠就诊是远程保健，包括面对面和远程保健就诊的多种组合；92%的人通过远程医疗进行了第一次预约。所有服务机构都没有进行面对面的具体妊娠访问。在怀孕39周和40周时（65%），面谈的可能性最大。对于远程保健预约，有一种特殊的常规筛查方法，例如测量血压（11%的人根本没有建议），胎儿生长（26%的人没有具体策略）和胎儿心率（15%的人没有具体策略）。超过一半（52%）的人会考虑在大流行后维持远程医疗。结论：即使在一个州，在什么构成远程保健、孕妇何时应进行面对面访问以及应保持哪些孕期常规筛查方面存在很大差异。这令人担忧，因为半数以上的服务机构计划在大流行后继续开展远程保健，尽管缺乏安全性、有效性的证据，也缺乏妇女和临床医生的投入。

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引用次数: 0

Increasing Use of Antenatal Magnesium Sulphate Prior to Preterm Birth for Preventing Cerebral Palsy in Australia and New Zealand, 2012–2020: A Binational Registry Study 2012-2020年，澳大利亚和新西兰在早产前增加产前硫酸镁的使用以预防脑瘫：一项两国注册研究。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-01-16 DOI: 10.1111/ajo.13937

Emily Shepherd, Sarah McIntyre, Alice Rumbold, Tasneem Karim, Shona Goldsmith, Amy Keir, Amanda Poprzeczny, Rod W. Hunt, Nadia Badawi, Christopher J. D. Mckinlay, Caroline A. Crowther, Lisa Yelland, the Australian and New Zealand Neonatal Network (ANZNN)

We assessed the use of magnesium sulphate prior to preterm birth for preventing cerebral palsy in an Australian and New Zealand registry study. Use increased markedly from 32.3% (2012) to 78.8% (2020) (p < 0.001). Binational approaches to sustain and explore the feasibility of further increasing use, informed by evolving evidence and guidelines, are needed.

我们在澳大利亚和新西兰的一项登记研究中评估了早产前使用硫酸镁预防脑瘫的情况。使用率从32.3%（2012年）显著增加到78.8%（2020年）

引用次数: 0

E-Poster Abstracts 2024年10月14-16日。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-01-13 DOI: 10.1111/ajo.3_13921

C CHAN, T VANCAILLIE and E HOWARD

Introduction: In 2017, a senate inquiry was undertaken after hundreds of Australian women reported serious pain and side effects from the use of transvaginal mesh implants, including incontinence, dyspareunia, persistent pain. In response to the high numbers of severely affected women, we customised our clinical approach with dual consult (pain physician and pain education osteopath) to maximise patient outcomes.

Aims: The aim of this pilot study is to substantiate that neuroscience-based pain education, as an integral component of management, can benefit patient's understanding, emotions, and coping skills related to their pain experience.

Methods: Thirty-three patients who presented (and consented for research) in the past six months with pelvic pain were randomly identified within the database of the Women's Health and Research Institute of Australia and asked a series of pre-selected questions.

Results: Twenty-one patients participated. Nineteen patients responded that it was their first experience of a dual consult. Twenty patients found the experience valuable with a score of 4 or 5 on a 5-point Likert scale with the greatest value of the dual consult being the opportunity to ask more questions.

Similarly, twenty and sixteen patients responded with a score of 4 or 5 for recommending to family and for finding what they paid for worth it respectively.

Discussion: This small-cohort retrospective audit supports that single-session neuroscience-based education (listening to and explaining individualised management) is valuable in conjunction with spending time to clinically examine patients. This pilot qualitative study calls for further research into the impact of dual consultation on outcome measures.

2017年，数百名澳大利亚女性报告了使用经阴道网状植入物带来的严重疼痛和副作用，包括大小便失禁、性交困难、持续疼痛，随后参议院展开了一项调查。为了应对大量严重影响的女性，我们定制了双重咨询（疼痛医生和疼痛教育整骨师）的临床方法，以最大限度地提高患者的治疗效果。目的：本初步研究的目的是证实基于神经科学的疼痛教育，作为管理的一个组成部分，可以使患者的理解，情绪和应对技能与他们的疼痛经历有关。方法：从澳大利亚妇女健康与研究所的数据库中随机抽取33名在过去6个月内出现（并同意研究）骨盆疼痛的患者，并询问一系列预先选择的问题。结果：21例患者参与。19名患者表示这是他们第一次接受双重咨询。20名患者认为这种体验很有价值，在5分李克特量表中得分为4或5分，双重咨询的最大价值是有机会提出更多问题。同样，有16名患者在向家人推荐和发现他们所花的钱物有所值方面分别获得了4分或5分。讨论：这项小队列回顾性审计支持单次神经科学教育（倾听和解释个体化管理）与花时间临床检查患者是有价值的。这项试验性质的研究要求进一步研究双重协商对结果措施的影响。

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引用次数: 0

Main Program Abstracts 2024年10月14-16日。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-01-13 DOI: 10.1111/ajo.13921

引用次数: 0

Static Poster Abstracts 2024年10月14-16日。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-01-13 DOI: 10.1111/ajo.2_13921

引用次数: 0

Three Minute Thesis Abstracts 2024年10月14-16日。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-01-13 DOI: 10.1111/ajo.1_13921

引用次数: 0

‘Screening should not be based on ability to pay’: Australian healthcare providers' and consumers' perspectives on public funding for non-invasive prenatal testing “筛查不应基于支付能力”：澳大利亚医疗保健提供者和消费者对非侵入性产前检测公共资金的看法。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-01-13 DOI: 10.1111/ajo.13915

Cecilia Pynaker, Molly Johnston, Catherine Mills, Katie Vasey, Michelle Taylor-Sands, Hilary Bowman-Smart, Lisa Hui

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.

背景：无创产前检查（NIPT）不接受任何医疗保险回扣。本研究调查了澳大利亚医疗保健提供者和消费者对NIPT公共资金的看法。材料和方法：从2022年9月到2023年1月进行了两次匿名的在线横断面调查。调查的对象是产妇保健专业人员（“提供者”）和最近怀孕的个人（“消费者”）。定量资料采用χ2检验。采用归纳内容分析法对自由文本回复进行分析。结果：对381家供应商和630名消费者的反馈进行了分析。绝大多数供应商（96.8%）认为财务成本是消费者使用NIPT的障碍。对NIPT的公共资助得到了86.4%的提供者和90.4%的消费者的支持，自由文本回应引用了公平、临床、健康经济、生殖自主和道德理由。在145名最近怀孕期间没有使用NIPT的消费者中，63.1%的人认为成本是放弃NIPT的“重要/非常重要”因素。与使用NIPT的消费者相比，不使用NIPT的人更年轻，家庭收入和教育程度较低，更有可能生活在农村或偏远地区。结论：从临床、公平、卫生经济和伦理角度考虑，产妇保健提供者和消费者高度支持为NIPT提供公共资金作为一线筛查试验。我们的研究结果证实了NIPT使用者和非使用者之间存在显著的社会经济差异，成本是阻碍公平获得产前筛查最佳实践的最重要因素。需要进一步的研究和宣传，以实现公平获得产前保健最佳做法。

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引用次数: 0

Association Between COVID-19 Pandemic Phases and the Risk of Maternal Intensive Care Unit Admission: A Retrospective Analysis of 215,363 Victorian Hospital Admissions COVID-19大流行阶段与孕产妇重症监护病房入院风险之间的关系：对维多利亚州215,363例入院患者的回顾性分析

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2025-01-02 DOI: 10.1111/ajo.13931

Michele Barrese, Melvin B. Marzan, Lisa Hui

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.

背景：在广泛接种疫苗前后，澳大利亚没有公布的基于人群的covid -19相关严重孕产妇发病率数据。目的：比较全国孕产妇COVID-19疫苗接种率达到70%前后住院孕妇的COVID-19感染率、重症监护病房（ICU）入院率和住院时间。材料和方法：基于人群的回顾性队列研究，涉及2020年3月1日至2022年3月31日在维多利亚州所有住院的15岁以上COVID-19孕妇。第一阶段定义为2020年3月至2021年10月，孕产妇疫苗接种覆盖率。结果：我们分析了215,363例住院患者，其中2128例（0.99%）患有COVID-19。结论：2期妊娠COVID-19患者入院风险和住院时间均明显低于1期（3.27% vs. 0.41%），这可能与孕产妇COVID-19疫苗接种率高和SARS-CoV-2变异的变化共同作用。

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