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Ultrasound-guided Lipiodol® hysterosalpingography: A prospective study on pregnancy and complication rates 超声引导下 Lipiodol® 子宫输卵管造影术:关于妊娠和并发症发生率的前瞻性研究。
IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-02-01 DOI: 10.1111/ajo.13794
Glen Lo, Dana Hince, Neil Johnson, Paul L. Hofman, Jasmin Sekhon, Emmeline Lee

Background

Fluoroscopic hysterosalpingography (HSG) with Lipiodol® is safe and has a therapeutic effect on fertility: transient in endometriosis-related infertility and sustained in unexplained infertility. Ultrasound is replacing fluoroscopy as the preferred imaging modality for HSG due to comfort and radiation safety (no ionising radiation). The safety of ultrasound-guided Lipiodol® HSG is uncertain.

Aims

Prospectively observe pregnancy and complication rates after ultrasound-guided Lipiodol® HSG.

Materials and Methods

A single-centre prospective study of women with unexplained infertility undergoing ultrasound-guided Lipiodol® uterine bathing and tubal flushing after tubal patency confirmed with ExEm® Foam HyFoSy (hysterosalpingo-foam-sonography). Pregnancy outcomes at six months and serum and urinary thyroid function at one, three and eight weeks were recorded. Pain scores were recorded during and immediately after HSG. Descriptive statistics are reported.

Results

Fifty-two participants were enrolled between July 2019 and April 2021, median age 33 years (range 21–45). Only 45 (87%, 45/52) completed the Lipiodol® HSG; 5/7 experienced intravasation during initial HyFoSy. Of 30 women at follow-up, 57% had biochemical (17/30, 95% CI 37%–75%), 53% clinical (16/30 95% CI 34%–72%) and 35% ongoing pregnancies (11/30, 95% CI 20%–56%). The rate of subclinical hypothyroidism (SCH) at two months was 41% (7/17). One intravasation event occurred during Lipiodol® HSG (2%, 1/45). Median pain score was 5/10 (range 0–9, interquartile range 2.5–7). No anaphylaxis, infection or oil embolism was observed.

Conclusion

Outpatient ultrasound-guided Lipiodol® HSG was safe, with pregnancy rates comparable to previous studies of fluoroscopic guidance. Rates of intravasation and SCH were also similar, confirming the need to monitor thyroid function.

背景:使用 Lipiodol® 进行透视子宫输卵管造影(HSG)是安全的,对生育有治疗作用:对子宫内膜异位症相关不孕症有短暂疗效,对不明原因不孕症有持续疗效。由于舒适和辐射安全(无电离辐射),超声波正取代透视成为 HSG 的首选成像方式。目的:前瞻性观察超声引导下利必多®HSG术后的妊娠率和并发症发生率:单中心前瞻性研究:对不明原因不孕的妇女进行超声引导下 Lipiodol® 宫腔冲洗和输卵管冲洗,然后用 ExEm® 泡沫 HyFoSy(子宫输卵管造影)确认输卵管通畅。记录了六个月的妊娠结果以及一周、三周和八周的血清和尿甲状腺功能。记录了 HSG 期间和之后的疼痛评分。报告了描述性统计结果:52 名参与者于 2019 年 7 月至 2021 年 4 月间入组,中位年龄为 33 岁(21-45 岁不等)。只有 45 人(87%,45/52)完成了 Lipiodol® HSG;5/7 在最初的 HyFoSy 过程中出现了内侵。在随访的 30 名妇女中,57% 有生化指标(17/30,95% CI 37%-75%),53% 有临床指标(16/30 95% CI 34%-72%),35% 正在怀孕(11/30,95% CI 20%-56%)。两个月后出现亚临床甲状腺功能减退症(SCH)的比例为 41%(7/17)。在 Lipiodol® HSG 过程中发生了一起浸润事件(2%,1/45)。疼痛评分中位数为 5/10(范围 0-9,四分位间范围 2.5-7)。未观察到过敏性休克、感染或油栓塞:结论:门诊超声引导下的 Lipiodol® HSG 是安全的,妊娠率与之前的透视引导研究相当。浸润率和SCH的发生率也相似,这也证实了监测甲状腺功能的必要性。
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引用次数: 0
Mucinous ovarian carcinoma: A survey of practice in Australia and New Zealand 粘液性卵巢癌:澳大利亚和新西兰的实践调查。
IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-02-01 DOI: 10.1111/ajo.13792
Niveditha Rajadevan, Ariane Flinkier, Hugo Saunders, Yeh Chen Lee, Clare Scott, Pearly Khaw, Prue Allan, Claire Davies, John Andrews, Michelle Wilson, Janine M Lombard, Michelle Harrison, Heshani Nesfield, Anna DeFazio, Tarek Meniawy, Kylie L Gorringe

Background

Mucinous ovarian carcinoma (MOC) is a rare ovarian cancer with limited evidence to support clinical care.

Aims

We undertook a clinician survey to better understand current practice in treating MOC in Australia and New Zealand, and to determine any features associated with variation in care. In addition, we aimed to understand future research priorities.

Methods

A RedCap survey was distributed to clinician members of the Australia New Zealand Gynaecological Oncology Group (ANZGOG). Questions included respondent demographics, three case studies and future research priorities. Clinicians were asked questions specific to their speciality.

Results

Respondents (n = 47) were commonly experienced gynae-oncology specialists, most often surgical (38%) or medical (30%) oncologists. There was good consensus for surgical approaches for stage I disease; however, variation in practice was noted for advanced or recurrent MOC. Variation was also observed for medical oncologists; in early-stage disease there was no clear consensus on whether to offer chemotherapy, or which regimen to recommend. For advanced and recurrent disease a wide range of chemotherapy options was considered, with a trend away from an ovarian-type toward gastrointestinal (GI)-type regimens in advanced MOC. This practice was reflected in future research priorities, with ‘Is a GI chemotherapy regimen better than an ovarian regimen?’ the most highly ranked option, followed by ‘Should stage 1C patients receive chemotherapy?’

Conclusions

Although the number of respondents limited the analyses, it was clear that chemotherapy selection was a key point of divergence for medical oncologists. Future research is needed to establish well-evidenced guidelines for clinical care of MOC.

背景:粘液性卵巢癌(MOC)是一种罕见的卵巢癌,支持临床治疗的证据有限。目的:我们开展了一项临床医生调查,以更好地了解澳大利亚和新西兰目前治疗粘液性卵巢癌的做法,并确定与治疗差异相关的任何特征。此外,我们还旨在了解未来的研究重点:我们向澳大利亚-新西兰妇科肿瘤组织(ANZGOG)的临床医生成员发放了一份RedCap调查问卷。问题包括受访者的人口统计学特征、三项病例研究和未来研究重点。临床医生被问及与其专业相关的问题:受访者(n = 47)通常都是经验丰富的妇科肿瘤专家,最常见的是外科肿瘤专家(38%)或内科肿瘤专家(30%)。对于 I 期疾病的手术方法已达成良好共识;但对于晚期或复发性 MOC,实践中存在差异。内科肿瘤学家的做法也不尽相同;对于早期疾病,是否提供化疗或推荐哪种化疗方案没有明确的共识。对于晚期和复发性疾病,则考虑了多种化疗方案,在晚期 MOC 中,化疗方案有从卵巢型向胃肠道(GI)型转变的趋势。这种做法反映在未来的研究重点中,"胃肠道化疗方案比卵巢化疗方案更好吗?"是排名最高的选项,其次是 "1C 期患者是否应该接受化疗?尽管受访者人数限制了分析结果,但化疗选择显然是肿瘤内科医生分歧的关键点。未来的研究需要为 MOC 的临床治疗制定有据可依的指南。
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引用次数: 0
Diverse presentations of Cushing's syndrome during pregnancy – A case series 妊娠期库欣综合征的多种表现形式--病例系列。
IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-01-29 DOI: 10.1111/ajo.13793
Natasha Stoinis, Katherine Creeper, Jessica Phillips, Dorothy Graham, Ee Mun Lim

Background

Cushing's syndrome (CS) encompasses various causes of hypercortisolism including adrenocorticotropic hormone (ACTH) secreting pituitary adenoma with or without bilateral adrenal hyperplasia, an adrenal adenoma or carcinoma, ectopic ACTH or corticotrophin-releasing hormone (CRH) secretion by a neoplasm or exogenous corticosteroid therapy. The diagnosis of CS in pregnancy presents a challenge due to overlapping clinical features of pregnancy (weight gain, striae, acne). If untreated, CS in pregnancy is associated with increased risk of maternal and fetal complications.

Aims

With fewer than 250 cases currently published, we aim to review the clinical presentations, diagnostic methods, management, and outcomes of patients with CS in pregnancy to help optimise our clinical practice.

Materials and methods

This is a single-centre, retrospective review of woman with documented hypercortisolism receiving antenatal care at a tertiary maternity hospital in Perth between 2006 to 2022. Data were collated from electronic and chart reviews. OMNI calculator was used for birthweight calculations. Local ethics and patient consent were obtained.

Results

Five women and seven pregnancies were identified. Four women had a pituitary source of ACTH-dependent CS as confirmed by brain magnetic resonance imaging. One woman had an ectopic source of ACTH. Two women were diagnosed during pregnancy. All pregnancies occurring prior to treatment of the Cushing's disease were complicated by secondary hypertension and diabetes.

Conclusion

CS represents a rare and difficult to diagnose condition in pregnancy. When untreated, maternal and fetal outcomes are compromised. Close monitoring of the associated complications with involvement of a multidisciplinary team are recommended.

背景:库欣综合征(Cushing's Syndrome,CS)包括各种原因引起的皮质醇增多症,包括伴有或不伴有双侧肾上腺增生的促肾上腺皮质激素(ACTH)分泌型垂体腺瘤、肾上腺腺瘤或癌、由肿瘤或外源性皮质类固醇治疗引起的异位促肾上腺皮质激素(ACTH)或促肾上腺皮质激素释放激素(CRH)分泌。由于妊娠期的临床特征(体重增加、条纹、痤疮)与妊娠期 CS 相似,因此诊断妊娠期 CS 是一项挑战。目的:目前发表的病例不到 250 例,我们旨在回顾妊娠合并 CS 患者的临床表现、诊断方法、管理和结果,以帮助优化我们的临床实践:这是一项单中心回顾性研究,研究对象是2006年至2022年期间在珀斯一家三级妇产医院接受产前检查的皮质醇增多症孕妇。数据来自电子和病历审查。计算出生体重时使用了 OMNI 计算器。已获得当地伦理和患者同意:结果:共发现五名妇女和七名孕妇。经脑磁共振成像证实,四名妇女的垂体源性促肾上腺皮质激素依赖性 CS。一名妇女有异位的 ACTH 来源。两名妇女在怀孕期间被确诊。所有在库欣病治疗前发生的妊娠都并发了继发性高血压和糖尿病:CS是一种罕见且难以诊断的妊娠期疾病。如果不及时治疗,母体和胎儿的预后都会受到影响。建议在多学科团队的参与下密切监测相关并发症。
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引用次数: 0
A cross-sectional study exploring the characteristics of female survivors of sexual violence living with HIV/AIDS in the eastern region of Democratic Republic of Congo 一项横断面研究,探讨刚果民主共和国东部地区感染艾滋病毒/艾滋病的性暴力女性幸存者的特征。
IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-01-25 DOI: 10.1111/ajo.13789
Olivier Nyakio, Fabrice Kibukila, Denis Mukwege, Joyeux Bwani, Albert Tambwe, Priyadarshini Bhattacharjee, Soham Bandyopadhyay, Aymar Akilimali, Prosper Kakudji, Jean Baptiste Kakoma

Background

Sexual violence remains a persistent and devastating issue in eastern Democratic Republic of Congo (DRC).

Aim

To elucidate the sociodemographic, sexual, and obstetrical characteristics associated with the experiences of victims of sexual violence (VSV) among women in the region.

Materials and Methods

A cross-sectional study was conducted involving 625 women from eastern DRC. Participants provided self-reported data, collected through interviews conducted by trained female interviewers in secure environments. Associations between VSV and various sociodemographic and reproductive health factors were examined.

Results

Of the respondents, 26.1% reported experiences of sexual violence. VSV were predominantly younger, with 56.44% aged between 15 and 24 years. Single women comprised 57.67% of VSV, and 37.42% identified as farmers. There were 33.13% of VSV who were illiterate, and 81.60% belonged to the low socio-economic stratum. Early physiological and reproductive milestones characterised VSV: 52.15% experienced menarche at or before 13 years, 34.97% initiated sexual intercourse before age 15, and 18.70% reported their first pregnancy before age 15. Higher nulliparity was observed in VSV (29.45%) compared to non-VSV (9.31%). A lower prevalence of HIV infection was found among VSV (11.04%) relative to non-VSV (25.76%).

Conclusion

Sexual violence in the eastern DRC exhibits multifactorial associations. Younger women, those in certain occupations, and those with specific reproductive histories appear more vulnerable. The findings underscore the urgency for targeted interventions, enhanced access to education, and improved reproductive health services. Addressing these pressing issues should remain a primary focus in both societal and public health spheres.

背景:在刚果民主共和国(刚果(金))东部,性暴力仍然是一个长期存在的破坏性问题:目的:阐明与该地区性暴力(VSV)受害者经历相关的社会人口、性和产科特征:这项横断面研究涉及刚果民主共和国东部的 625 名妇女。参与者提供了自我报告的数据,这些数据是由训练有素的女性访谈员在安全的环境中通过访谈收集的。研究考察了 VSV 与各种社会人口和生殖健康因素之间的关联:在受访者中,26.1% 的人报告了遭受性暴力的经历。性暴力受害者以年轻人为主,56.44%的人年龄在 15-24 岁之间。单身女性占 57.67%,37.42%自称是农民。33.13% 的 VSV 是文盲,81.60% 属于社会经济地位较低的阶层。早产儿的特点是生理和生殖发育较早:52.15%的早产儿在 13 岁或 13 岁之前月经初潮,34.97%的早产儿在 15 岁之前开始性生活,18.70%的早产儿在 15 岁之前报告首次怀孕。与非 VSV 群体(9.31%)相比,VSV 群体(29.45%)的非绝育率更高。VSV 感染率(11.04%)低于非 VSV 感染率(25.76%):结论:刚果(金)东部的性暴力与多种因素有关。年轻女性、从事特定职业的女性和有特殊生育史的女性似乎更容易受到伤害。研究结果突出表明,迫切需要采取有针对性的干预措施、增加受教育机会和改善生殖健康服务。解决这些紧迫问题仍应是社会和公共卫生领域的首要重点。
{"title":"A cross-sectional study exploring the characteristics of female survivors of sexual violence living with HIV/AIDS in the eastern region of Democratic Republic of Congo","authors":"Olivier Nyakio,&nbsp;Fabrice Kibukila,&nbsp;Denis Mukwege,&nbsp;Joyeux Bwani,&nbsp;Albert Tambwe,&nbsp;Priyadarshini Bhattacharjee,&nbsp;Soham Bandyopadhyay,&nbsp;Aymar Akilimali,&nbsp;Prosper Kakudji,&nbsp;Jean Baptiste Kakoma","doi":"10.1111/ajo.13789","DOIUrl":"10.1111/ajo.13789","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sexual violence remains a persistent and devastating issue in eastern Democratic Republic of Congo (DRC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To elucidate the sociodemographic, sexual, and obstetrical characteristics associated with the experiences of victims of sexual violence (VSV) among women in the region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A cross-sectional study was conducted involving 625 women from eastern DRC. Participants provided self-reported data, collected through interviews conducted by trained female interviewers in secure environments. Associations between VSV and various sociodemographic and reproductive health factors were examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the respondents, 26.1% reported experiences of sexual violence. VSV were predominantly younger, with 56.44% aged between 15 and 24 years. Single women comprised 57.67% of VSV, and 37.42% identified as farmers. There were 33.13% of VSV who were illiterate, and 81.60% belonged to the low socio-economic stratum. Early physiological and reproductive milestones characterised VSV: 52.15% experienced menarche at or before 13 years, 34.97% initiated sexual intercourse before age 15, and 18.70% reported their first pregnancy before age 15. Higher nulliparity was observed in VSV (29.45%) compared to non-VSV (9.31%). A lower prevalence of HIV infection was found among VSV (11.04%) relative to non-VSV (25.76%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Sexual violence in the eastern DRC exhibits multifactorial associations. Younger women, those in certain occupations, and those with specific reproductive histories appear more vulnerable. The findings underscore the urgency for targeted interventions, enhanced access to education, and improved reproductive health services. Addressing these pressing issues should remain a primary focus in both societal and public health spheres.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13789","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139564854","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}
引用次数: 0
An audit of the maternal medicine clinic: Cancer and pregnancy 孕产妇医学诊所审计:癌症与怀孕
IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-01-24 DOI: 10.1111/ajo.13796
Mia Harrison, Mark P. Umstad, Wanda Cui, Iniyaval Thevathasan, Sarah A.L. Price

Aims

To explore the incidence and complexity of women presenting for maternity care who require concurrent cancer care, and to report the birth outcomes of these women.

Materials and Methods

A retrospective audit of women attending a ‘high risk’ maternal medicine clinic at an Australian tertiary maternity hospital between 1 October 2021 and 30 April 2023 was conducted. The inclusion criteria were a diagnosis of cancer and a concurrent pregnancy, or a diagnosis of cancer prior to the current pregnancy. Clinic lists and coding data were screened via the electronic medical record to identify potential subjects. Data were collected from the individual maternity and neonatal records.

Results

Forty of 705 (5.7%) women attending the maternal medicine clinic met the inclusion criteria, of which ten had a new diagnosis of cancer in pregnancy and 30 presented for maternity care after a previous diagnosis of cancer. Cancer therapy during pregnancy included surgery and chemotherapy. Most pregnancies (92.5%) resulted in term deliveries (≥37 weeks gestation). Four neonates were preterm, and one was small-for-gestational-age. Caesarean section delivery and post-partum haemorrhage were more common than expected, but the rate of other adverse pregnancy outcomes was consistent with the background population. Over half of neonates required neonatal intensive care unit / special care nursery admission but the indications for admission were common, self-limiting conditions, and the length of stay was short (mean <5.0 days).

Conclusions

Approximately 6% of women attending the maternal medicine clinic had a current or previous diagnosis of cancer. Most pregnancies resulted in term deliveries and neonatal outcomes were excellent.

目的:探讨需要同时接受癌症治疗的产妇的发病率和复杂性,并报告这些产妇的分娩结果:对 2021 年 10 月 1 日至 2023 年 4 月 30 日期间在澳大利亚一家三级妇产医院 "高风险 "孕产妇门诊就诊的妇女进行了回顾性审计。纳入标准为诊断出癌症并同时怀孕,或在本次怀孕前诊断出癌症。通过电子病历筛选门诊清单和编码数据,以确定潜在的受试者。数据收集自产妇和新生儿的个人记录:在 705 名孕产妇门诊中,有 40 名(5.7%)符合纳入标准,其中 10 名是在怀孕期间新诊断出癌症,30 名是在之前诊断出癌症后前来接受产科护理。孕期癌症治疗包括手术和化疗。大多数孕妇(92.5%)都是足月分娩(妊娠≥37周)。四名新生儿为早产儿,一名为小于胎龄儿。剖腹产和产后出血的发生率高于预期,但其他不良妊娠结局的发生率与背景人群一致。半数以上的新生儿需要入住新生儿重症监护室/特殊护理育婴室,但入院指征均为常见的自限性疾病,且住院时间较短(平均结论):约有 6% 的孕产妇目前或曾经被诊断患有癌症。大多数孕妇都能足月分娩,新生儿预后良好。
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引用次数: 0
Infertility in the Pacific: A crucial component of the sexual and reproductive health and rights agenda 太平洋地区的不孕症:性与生殖健康和权利议程的重要组成部分。
IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-01-23 DOI: 10.1111/ajo.13791
Elke Mitchell, Linda Rae Bennett

Across Pacific Island countries, women and men are disproportionately affected by several risk factors for infertility, including sexually transmissible infections, complications from unsafe abortions, postpartum sepsis, obesity, diabetes, tobacco smoking and excessive alcohol consumption. Despite this, little is known about community awareness of infertility, behavioural risk factors, the lived experiences of infertile couples or the contexts in which they access fertility care. In this opinion piece we discuss the current evidence and gaps in evidence regarding infertility in Pacific Island countries and the importance of locally tailored approaches to preventing infertility and the provision of fertility care.

在整个太平洋岛国,妇女和男子受不孕不育的几个风险因素的影响尤为严重,这些因素包括性传播感染、不安全堕胎并发症、产后败血症、肥胖、糖尿病、吸烟和过度饮酒。尽管如此,人们对不孕不育的社区意识、行为风险因素、不孕不育夫妇的生活经历或他们获得生育护理的背景却知之甚少。在这篇观点文章中,我们讨论了有关太平洋岛国不孕不育症的现有证据和证据差距,以及因地制宜地预防不孕不育症和提供生育保健的重要性。
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引用次数: 0
Severe acute maternal morbidity reporting in Australia: Why is it so hard? 澳大利亚严重急性孕产妇发病率报告:为什么这么难?
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-01-12 DOI: 10.1111/ajo.13787
Joanne Frost, Edward Weaver, Leonie Callaway

Adverse outcomes associated with pregnancy, including severe acute maternal morbidity (SAMM) and mortality, are internationally regarded as important indicators of quality of maternity services. Varied definitions and processes are barriers for SAMM recording, reporting and review. Identifying and documenting these cases of SAMM is a critical first step. Case reviews allow exploration of factors contributing to SAMM. Translation of the lessons learnt into practice improvement strategies and dissemination of this knowledge is essential for continual quality improvement. This review will outline the current status of SAMM review internationally and in Australia.

与妊娠有关的不良后果,包括严重急性孕产妇发病率(SAMM)和死亡率,在国际上被视为衡量产科服务质量的重要指标。不同的定义和流程阻碍了严重急性孕产妇发病率的记录、报告和审查。识别和记录这些 SAMM 病例是至关重要的第一步。通过病例审查,可以探索导致 SAMM 的因素。将吸取的经验教训转化为实践改进策略并传播这些知识对于持续改进质量至关重要。本综述将概述国际和澳大利亚的 SAMM 审查现状。
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引用次数: 0
Sexual and reproductive health services in New Zealand primary care settings: A mixed-methods survey 新西兰初级保健机构的性健康和生殖健康服务:混合方法调查。
IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-01-11 DOI: 10.1111/ajo.13788
Orna McGinn, Michelle Wise

Background

New Zealand's recently released Women's Health Strategy aims to provide accessible, equitable care which prioritises prevention, early intervention and areas of unmet need. An example of such care is the management of common sexual and reproductive health (SRH) issues by appropriately trained primary care practitioners in the community.

Aims

The aim was to identify primary care SRH program initiatives currently operating in New Zealand, how they are accessed and funded, whether they have been co-designed using mātauranga (knowledge) Māori principles and whether any have undergone formal evaluation.

Methods

A mixed-methods electronic anonymous survey of primary care practitioners and secondary care obstetrics and gynaecology clinical directors was distributed in April 2023. Qualitative analysis of free text answers was undertaken.

Results

Few funded SRH services are available in community settings in New Zealand. Access and eligibility criteria to those which exist varies by region. A lack of co-design and governance was reported, along with difficulties in access to skills training and specialist advice.

Conclusions

The current SRH landscape in New Zealand appears fragmented and lacks an overarching strategic focus. To achieve the aims of the Women's Health Strategy, a suite of core community-based SRH programs should be developed and formally evaluated, focusing on equitable access, integration and specific outcomes. These should be co-designed using mātaurangi Māori principles.

背景:新西兰最近发布的《妇女健康战略》旨在提供方便、公平的保健服务,优先考虑预防、早期干预和未满足需求的领域。这种保健的一个例子就是由经过适当培训的社区初级保健从业人员对常见的性健康和生殖健康(SRH)问题进行管理。目的:本研究旨在确定目前在新西兰实施的初级保健SRH计划举措,这些举措是如何获得和资助的,是否利用毛利知识(mātauranga)原则共同设计了这些举措,以及是否对任何举措进行了正式评估:方法:2023 年 4 月,对初级保健从业人员和二级保健妇产科临床主任进行了一次混合方法电子匿名调查。对自由文本答案进行了定性分析:结果:在新西兰的社区环境中,很少有受资助的性健康和生殖健康服务。获得现有服务的途径和资格标准因地区而异。据报告,缺乏共同设计和管理,同时也很难获得技能培训和专家建议:结论:新西兰目前的性健康和生殖健康状况似乎支离破碎,缺乏总体战略重点。为实现妇女健康战略的目标,应制定一套以社区为基础的性健康和生殖健康核心方案,并对其进行正式评估,重点关注公平获取、整合和具体成果。这些方案应采用毛利人原则共同设计。
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引用次数: 0
Pregnancy outcomes post-kidney transplantation across 23 years 肾移植术后23年的妊娠结局。
IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-01-08 DOI: 10.1111/ajo.13786
Jessica Han, Ciara Anne McCormick, Anna Krelle, Paul Champion de Crespigny, Julia Unterscheider

Background

Pregnancy in kidney transplant recipients has become increasingly common. However, pregnancy carries higher risks to these patients compared to the general population.

Aims

To describe pregnancy outcomes in kidney transplant recipients.

Materials and Methods

We conducted a single-centre retrospective cohort study of kidney transplant recipients who delivered after 20 weeks gestation at a quaternary hospital in Victoria, Australia, between 2000 and 2022 inclusive.

Results

The study included 37 pregnancies from 27 patients, accounting for 38 infants. Over half of recorded pregnancies occurred in the past five years (56.8%, n = 21). There were high rates of pre-existing hypertension (75.7%, n = 28). Pregnancy-induced hypertension and pre-eclampsia were common antenatal complications (21.6%, n = 8 and 48.6%, n = 18 respectively). Soluble fms-like tyrosine kinase-1 / placental growth factor ratios were elevated in all patients who developed severe pre-eclampsia (16.2%, n = 6). The median gestational age at birth was 36.4 weeks (range 20–40.4, Q1 32.9, Q3 37.6) and 59.5% (n = 22) of births were preterm. Unplanned caesarean without labour was the most common mode of birth (35.1%, n = 13). The overall caesarean rate was 62.1% (n = 23). Post-partum haemorrhage complicated over half of pregnancies (56.8%, n = 21). Fifty percent (n = 19) of infants were admitted for neonatal care, in particular neonatal intensive care, and had low birthweights under 2500 g. While there was a transient deterioration in kidney function, there was no graft rejection within one year of birth.

Conclusions

Clinicians should consider the high rates of pre-existing hypertension, preterm birth, and caesarean birth when counselling and managing pregnant kidney transplant recipients.

背景:肾移植受者怀孕已变得越来越普遍。目的:描述肾移植受者的妊娠结局:我们对 2000 年至 2022 年(含 2022 年)期间在澳大利亚维多利亚州一家四级医院妊娠 20 周后分娩的肾移植受者进行了一项单中心回顾性队列研究:研究包括 27 名患者的 37 次妊娠,共产下 38 名婴儿。超过一半的记录妊娠发生在过去五年中(56.8%,n = 21)。妊娠前患有高血压的比例很高(75.7%,n = 28)。妊娠高血压和先兆子痫是常见的产前并发症(分别为 21.6%,8 人和 48.6%,18 人)。在所有出现严重子痫前期的患者中,可溶性酪氨酸激酶-1/胎盘生长因子比率均升高(16.2%,n = 6)。出生时的中位胎龄为36.4周(范围为20-40.4周,Q1为32.9周,Q3为37.6周),59.5%(n = 22)的新生儿为早产儿。最常见的分娩方式是未经分娩的意外剖腹产(35.1%,n = 13)。总体剖腹产率为 62.1%(n = 23)。半数以上的孕妇(56.8%,n = 21)因产后出血而并发症。50%的婴儿(n = 19)需要新生儿护理,尤其是新生儿重症监护,且出生体重不足 2500 克。虽然肾功能出现了短暂的恶化,但出生后一年内未出现移植排斥反应:结论:临床医生在咨询和管理肾移植受体孕妇时,应考虑到其原有高血压、早产和剖腹产的高发率。
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引用次数: 0
Continuity obstetric care demonstrates greater vaginal birth after caesarean success 产科护理的连续性表明,剖腹产后经阴道分娩的成功率更高。
IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-01-05 DOI: 10.1111/ajo.13790
Georgina Facchetti, Zhen Teo, Meenu Sharma, Aaron Budden

Background

Australia's caesarean rate is higher than Organisation for Economic Co-operation and Development (OECD) average, and is rising. Vaginal birth after caesarean (VBAC) is safe for selected women. Midwifery continuity of care (CoC) is associated with higher rates of vaginal birth compared to other models; however, impacts on VBAC attempts and success are unknown.

Aims

The primary aim was to determine if there is a difference in achieving VBAC between CoC and non-CoC (NCoC) models. The secondary aim was to determine if there is a difference in the proportion of women attempting VBAC between these models.

Materials and Methods

Retrospective review of antenatal records and birthing data of all women who birthed in 2021 with one or more previous caesareans. Women were included if they had two or fewer caesareans. Women were excluded if contraindications to VBAC existed.

Results

There were 142/1109 (12.8%) women who had previous caesareans and were eligible to attempt VBAC. There were 47/109 (43.1%) women who attempted vaginal birth after one caesarean with 78.7% success. After one caesarean, women in CoC were more likely to achieve VBAC than NCoC (45.2% vs 26.1%; relative risk (RR) 1.76, 95% CI 1.04–3.00), although when stratified by private and midwifery CoC models, women in midwifery CoC models were more likely to be successful (private RR 0.69, 95% CI 0.23–2.07 vs midwifery RR 2.48, 95% CI 1.50–4.11). Women in CoC were more likely to attempt VBAC (54.7% vs 34.8%; RR 1.57, 95% CI 1.02–2.41), and receive counselling about VBAC (92.5% vs 62%; RR 1.48, 95% CI 1.41–3.11).

Conclusion

CoC improves the rate of attempted and successful VBAC through several factors, including increased counselling and greater provision of birth choices.

背景:澳大利亚的剖腹产率高于经济合作与发展组织(OECD)的平均水平,而且还在不断上升。剖腹产后经阴道分娩(VBAC)对特定产妇是安全的。与其他模式相比,助产士持续护理(CoC)与更高的阴道分娩率相关;然而,对 VBAC 尝试和成功的影响尚不清楚。目的:首要目的是确定在实现 VBAC 方面,CoC 和非 CoC(NCoC)模式之间是否存在差异。次要目的是确定在这些模式中尝试 VBAC 的产妇比例是否存在差异:回顾性审查所有在 2021 年分娩并曾有一次或多次剖腹产经历的产妇的产前记录和分娩数据。剖腹产次数为两次或两次以下的产妇被纳入其中。如果存在VBAC禁忌症,则排除在外:142/1109(12.8%)名曾进行过剖腹产的妇女符合尝试 VBAC 的条件。47/109(43.1%)名产妇在一次剖腹产后尝试了阴道分娩,成功率为 78.7%。在一次剖腹产后,CoC 的产妇比 NCoC 的产妇更有可能实现 VBAC(45.2% vs 26.1%;相对风险 (RR) 1.76,95% CI 1.04-3.00),尽管按私立和助产 CoC 模式进行分层时,助产 CoC 模式的产妇更有可能成功(私立 RR 0.69,95% CI 0.23-2.07 vs 助产 RR 2.48,95% CI 1.50-4.11)。CoC中的妇女更有可能尝试VBAC(54.7% vs 34.8%;RR 1.57,95% CI 1.02-2.41),并接受VBAC咨询(92.5% vs 62%;RR 1.48,95% CI 1.41-3.11):CoC通过几个因素提高了尝试VBAC和成功VBAC的比率,包括增加咨询和提供更多的分娩选择。
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引用次数: 0
期刊
Australian & New Zealand Journal of Obstetrics & Gynaecology
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