Bleeding after laparoscopic gynaecological surgery remains a potential complication. We assessed RADA16 (PuraStat®), a topical self-assembling peptide haemostatic agent, in a pilot study of 46 women undergoing laparoscopic gynaecological surgery. The primary outcome was intraoperative haemostatic efficacy for resection site bleeding. Haemostasis was achieved in all intraoperative bleeding situations (40/40 participants: 100%) with no clinically significant surgical bed bleeding or complications. Mean volume and time required to achieve haemostasis were 6 mL and 14 sec, respectively. This study suggests that PuraStat® is a safe, effective haemostatic agent in laparoscopic gynaecological surgery. Randomised controlled trials are warranted to confirm these findings.
{"title":"Efficacy and feasibility of the RADA16 self-assembling peptide, PuraStat® for haemostasis in laparoscopic gynaecological surgery: A pilot study","authors":"Philip Hall","doi":"10.1111/ajo.13798","DOIUrl":"10.1111/ajo.13798","url":null,"abstract":"<p>Bleeding after laparoscopic gynaecological surgery remains a potential complication. We assessed RADA16 (PuraStat®), a topical self-assembling peptide haemostatic agent, in a pilot study of 46 women undergoing laparoscopic gynaecological surgery. The primary outcome was intraoperative haemostatic efficacy for resection site bleeding. Haemostasis was achieved in all intraoperative bleeding situations (40/40 participants: 100%) with no clinically significant surgical bed bleeding or complications. Mean volume and time required to achieve haemostasis were 6 mL and 14 sec, respectively. This study suggests that PuraStat® is a safe, effective haemostatic agent in laparoscopic gynaecological surgery. Randomised controlled trials are warranted to confirm these findings.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"64 4","pages":"407-410"},"PeriodicalIF":1.4,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998379","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}
Valerio Pisaturo, Marco Reschini, Cristina Guarneri, Elena Sanzani, Alessio Paffoni, Edgardo Somigliana
Background
The use of intracytoplasmic sperm injection (ICSI) currently extends beyond male factor infertility, notably replacing conventional in vitro fertilisation (IVF) in scenarios like limited oocyte availability, where it is used as a precaution against complete fertilisation failure. While existing studies on the use of conventional IVF in such situations provide some reassurance, the available evidence is somewhat insufficient and ICSI is commonly used.
Aims
To evaluate whether conventional IVF can be a feasible option when only one oocyte is retrieved.
Materials and Methods
A retrospective study was performed to evaluate the fertilisation rate with conventional IVF in women retrieving only one oocyte and whose partner had normal semen. The study aimed at evaluating whether the fertilisation rate was aligned with the threshold indicated by recognized IVF laboratory performance indicators (Vienna Consensus). Clinical pregnancy and live birth rates were secondary outcomes.
Results
Out of 304 cycles with a single oocyte inseminated with conventional IVF, 209 achieved normal fertilisation and 82 did not. Thirteen had no mature oocytes. The fertilisation rate was 69% (95% CI: 63–74%) and increased to 72% (95% CI: 66–77%) when immature oocytes were excluded. The fertilisation rate surpassed the minimum competency threshold of the Vienna Consensus (60%), even if below the benchmark value (75%). Clinical pregnancy and live birth rates per oocyte retrieval were 10% and 8%, respectively. Univariate and multivariate analyses failed to identify any predictive factor of fertilisation.
Conclusion
Conventional IVF with one oocyte met Vienna Consensus standards even if it fell short of higher benchmarks.
{"title":"Conventional in vitro fertilisation rather than intracytoplasmic sperm injection when only one oocyte is retrieved: Time to overcome irrational fears","authors":"Valerio Pisaturo, Marco Reschini, Cristina Guarneri, Elena Sanzani, Alessio Paffoni, Edgardo Somigliana","doi":"10.1111/ajo.13806","DOIUrl":"10.1111/ajo.13806","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The use of intracytoplasmic sperm injection (ICSI) currently extends beyond male factor infertility, notably replacing conventional <i>in vitro</i> fertilisation (IVF) in scenarios like limited oocyte availability, where it is used as a precaution against complete fertilisation failure. While existing studies on the use of conventional IVF in such situations provide some reassurance, the available evidence is somewhat insufficient and ICSI is commonly used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate whether conventional IVF can be a feasible option when only one oocyte is retrieved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A retrospective study was performed to evaluate the fertilisation rate with conventional IVF in women retrieving only one oocyte and whose partner had normal semen. The study aimed at evaluating whether the fertilisation rate was aligned with the threshold indicated by recognized IVF laboratory performance indicators (Vienna Consensus). Clinical pregnancy and live birth rates were secondary outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 304 cycles with a single oocyte inseminated with conventional IVF, 209 achieved normal fertilisation and 82 did not. Thirteen had no mature oocytes. The fertilisation rate was 69% (95% CI: 63–74%) and increased to 72% (95% CI: 66–77%) when immature oocytes were excluded. The fertilisation rate surpassed the minimum competency threshold of the Vienna Consensus (60%), even if below the benchmark value (75%). Clinical pregnancy and live birth rates per oocyte retrieval were 10% and 8%, respectively. Univariate and multivariate analyses failed to identify any predictive factor of fertilisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Conventional IVF with one oocyte met Vienna Consensus standards even if it fell short of higher benchmarks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"64 4","pages":"361-367"},"PeriodicalIF":1.4,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984626","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}
Andrew Proudfoot, Sarah Duffy, Justin Sinclair, Jason Abbott, Mike Armour
People with endometriosis use cannabis to manage their symptoms. This study aimed to identify costs, modes of administration, product composition, and self-reported effectiveness for those accessing medicinal cannabis in Australia. There were 192 survey responses analysed. Most (63.5%) used a ‘cannabis clinic’ doctor, incurring an initial consultation cost of $100–$200+ (10.2% Medicare bulk-billed) and median cannabinoid medicine costs of $300AUD per month. Cost was a major barrier to access, necessitating reducing dosage (76.1%) and/or consuming illicit cannabis (42.9%), despite a prescription. Most (77%) medical consumers used two or more cannabis products, with delta-9-tetrahydrocannabinol predominant oil and flower products most frequently prescribed.
{"title":"A survey of cost, access and outcomes for cannabinoid-based medicinal product use by Australians with endometriosis","authors":"Andrew Proudfoot, Sarah Duffy, Justin Sinclair, Jason Abbott, Mike Armour","doi":"10.1111/ajo.13804","DOIUrl":"10.1111/ajo.13804","url":null,"abstract":"<p>People with endometriosis use cannabis to manage their symptoms. This study aimed to identify costs, modes of administration, product composition, and self-reported effectiveness for those accessing medicinal cannabis in Australia. There were 192 survey responses analysed. Most (63.5%) used a ‘cannabis clinic’ doctor, incurring an initial consultation cost of $100–$200+ (10.2% Medicare bulk-billed) and median cannabinoid medicine costs of $300AUD per month. Cost was a major barrier to access, necessitating reducing dosage (76.1%) and/or consuming illicit cannabis (42.9%), despite a prescription. Most (77%) medical consumers used two or more cannabis products, with delta-9-tetrahydrocannabinol predominant oil and flower products most frequently prescribed.</p>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"64 4","pages":"411-415"},"PeriodicalIF":1.4,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13804","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984625","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}
Christine A. Wade, Naomi Atkinson, Natasha E. Holmes, Lisa Hui
Objective
The aim of this study was to evaluate the indications for maternal TORCH (Toxoplasma gondii, rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV)) serology, with a focus on the yield in isolated fetal growth restriction (FGR).
Materials and Methods
A retrospective review of antenatal TORCH testing between January 2014 and December 2018 was carried out at two hospitals in Melbourne, Australia. TORCH testing ordered for pregnancy losses and stillbirth was excluded.
Results
Medical records of 718 pregnancies were reviewed, representing 760 fetuses. Isolated FGR was the indication for TORCH screening in 71.2% of pregnancies. Screens ordered for isolated FGR were positive in 7.4% (95% CI 5.5–10.0%). There were 49 positive maternal immunoglobulin M (CMV = 34, Toxoplasma = 15). Two acute maternal infections during pregnancy were diagnosed (CMV = 1, Toxoplasma = 1), with both screens ordered to assess symptomatic maternal illness. There was one neonatal CMV infection, born to a woman with symptomatic primary CMV. No maternal or neonatal rubella or HSV infections were identified. We found a diagnostic yield of TORCH screening for isolated FGR of 0.0% (95% CI 0.00–0.8%). An estimated AUD$64 269.75 was expended on maternal TORCH screens in this study.
Conclusion
Maternal TORCH testing for isolated FGR is of no diagnostic yield and should be abandoned.
{"title":"Clinical utility of maternal TORCH screening in fetal growth restriction: A retrospective two-centre study","authors":"Christine A. Wade, Naomi Atkinson, Natasha E. Holmes, Lisa Hui","doi":"10.1111/ajo.13802","DOIUrl":"10.1111/ajo.13802","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of this study was to evaluate the indications for maternal TORCH (<i>Toxoplasma gondii</i>, rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV)) serology, with a focus on the yield in isolated fetal growth restriction (FGR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A retrospective review of antenatal TORCH testing between January 2014 and December 2018 was carried out at two hospitals in Melbourne, Australia. TORCH testing ordered for pregnancy losses and stillbirth was excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Medical records of 718 pregnancies were reviewed, representing 760 fetuses. Isolated FGR was the indication for TORCH screening in 71.2% of pregnancies. Screens ordered for isolated FGR were positive in 7.4% (95% CI 5.5–10.0%). There were 49 positive maternal immunoglobulin M (CMV = 34, <i>Toxoplasma</i> = 15). Two acute maternal infections during pregnancy were diagnosed (CMV = 1, <i>Toxoplasma</i> = 1), with both screens ordered to assess symptomatic maternal illness. There was one neonatal CMV infection, born to a woman with symptomatic primary CMV. No maternal or neonatal rubella or HSV infections were identified. We found a diagnostic yield of TORCH screening for isolated FGR of 0.0% (95% CI 0.00–0.8%). An estimated AUD$64 269.75 was expended on maternal TORCH screens in this study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Maternal TORCH testing for isolated FGR is of no diagnostic yield and should be abandoned.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"64 4","pages":"354-360"},"PeriodicalIF":1.4,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13802","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139914104","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}
Hossam Elzeiny, Franca Agresta, John Stevens, David K. Gardner
Background
Non-obstructive azoospermia (NOA) diagnosis poses challenges for couples seeking parenthood. Microdissection testicular sperm extraction (MD-TESE) excels in retrieving testicular sperm cells for NOA cases. However, limited live birth data in Australian NOA patients hinders accurate counselling.
Aims
This study aimed to determine the likelihood of infertile couples with a male partner diagnosed with NOA conceiving biological children using MD-TESE / intracytoplasmic sperm injection (ICSI).
Materials and methods
A retrospective cohort study included 108 NOA men treated at a public fertility unit and a private fertility centre (May 2009–May 2022). Primary outcome: live birth rate (LBR); secondary outcomes: sperm retrieval rate, pregnancy rate, and neonatal outcomes.
Results
Among 108 patients undergoing MD-TESE, the positive sperm retrieval rate (PSRR) was 64.8% (70/108). Histology best predicted sperm retrieval success, with hypo-spermatogenesis yielding a 94.1% PSRR. Age, testicular volume, and hormonal parameters had no significant impact. Mean male age: 35.4 years; mean partner age: 32.7 years. Fertilisation rate: 50.7%. LBR per initiated cycle: 58.7% (37/63); per embryo transfer: 63.8% (37/58); per initially diagnosed NOA man: 34.3% (37/108). Cumulative LBR: 74.1% (43/58); twin rate: 10.8% (4/37). No neonatal deaths or defects were observed among 47 live offspring.
Conclusion
This study provides valuable data for counselling NOA couples on the probability of conceiving biological offspring. MD-TESE and ICSI yielded favourable PSRR (64.8%) and LBR (63.8%). However, couples should be aware that once NOA is confirmed, the chance of taking home a baby is 34%.
{"title":"A step closer to parenthood with non-obstructive azoospermia: Unveiling the impact of microdissection testicular sperm extraction in Australia's largest single-centre study","authors":"Hossam Elzeiny, Franca Agresta, John Stevens, David K. Gardner","doi":"10.1111/ajo.13800","DOIUrl":"10.1111/ajo.13800","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Non-obstructive azoospermia (NOA) diagnosis poses challenges for couples seeking parenthood. Microdissection testicular sperm extraction (MD-TESE) excels in retrieving testicular sperm cells for NOA cases. However, limited live birth data in Australian NOA patients hinders accurate counselling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to determine the likelihood of infertile couples with a male partner diagnosed with NOA conceiving biological children using MD-TESE / intracytoplasmic sperm injection (ICSI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>A retrospective cohort study included 108 NOA men treated at a public fertility unit and a private fertility centre (May 2009–May 2022). Primary outcome: live birth rate (LBR); secondary outcomes: sperm retrieval rate, pregnancy rate, and neonatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 108 patients undergoing MD-TESE, the positive sperm retrieval rate (PSRR) was 64.8% (70/108). Histology best predicted sperm retrieval success, with hypo-spermatogenesis yielding a 94.1% PSRR. Age, testicular volume, and hormonal parameters had no significant impact. Mean male age: 35.4 years; mean partner age: 32.7 years. Fertilisation rate: 50.7%. LBR per initiated cycle: 58.7% (37/63); per embryo transfer: 63.8% (37/58); per initially diagnosed NOA man: 34.3% (37/108). Cumulative LBR: 74.1% (43/58); twin rate: 10.8% (4/37). No neonatal deaths or defects were observed among 47 live offspring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study provides valuable data for counselling NOA couples on the probability of conceiving biological offspring. MD-TESE and ICSI yielded favourable PSRR (64.8%) and LBR (63.8%). However, couples should be aware that once NOA is confirmed, the chance of taking home a baby is 34%.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"64 4","pages":"347-353"},"PeriodicalIF":1.4,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139747858","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}
Rebecca Deans, Daniel Moses, Toos Anthony Sach, Thierry Vancaillie, Bill Ledger, Jason A. Abbott
Background
Microvascular scarring compromises the functionality of the endometrium, and vascular flow at the junctional zone (JZ) may be the key to understanding poor reproductive outcomes in women with Asherman syndrome (AS).
Aims
To investigate whether vascular perfusion of the uterus, measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is impaired in women with intrauterine adhesions (IUA) and AS.
Materials and Methods
A prospective observational cohort pilot study of 23 women with IUA treated with hysteroscopic synecholysis and a control group of two patients with cervix cancer were subject to DCE-MRI with gadolinium to assess uterine vascularity. Twelve regions of interest (ROIs) were allocated on the DCE-MRI image incorporating the JZ, with control ROI placed at the psoas muscle. Individual ROIs were compared to the mean total perfusion (TP) in the same uterus. Pre- and post-operative perfusion analyses were performed on five women. Receiver operator curves (ROC) were used to analyse MRI as a predictor of IUA.
Results
There was no significant difference in perfusion; a trend toward reduced perfusion was observed in women with IUA compared to the controls. The ROC was predictive of higher-grade and inoperable IUA.
Conclusions
Reduced perfusion on DCE-MRI as assessed by ROC predicted higher-stage AS. The results of this study support further investigation of DCE-MRI as a prognostic tool for AS prior to surgical intervention to assist in providing prognostic guidance for women suffering from AS.
背景：微血管瘢痕损害了子宫内膜的功能，而交界区（JZ）的血管流动可能是了解阿什曼综合征（AS）妇女不良生殖结局的关键。目的：研究动态对比增强磁共振成像（DCE-MRI）测量的子宫血管灌注在宫腔内粘连（IUA）和AS妇女中是否受损：一项前瞻性观察性队列试验研究对23名接受宫腔镜溶栓术治疗的IUA妇女和两名宫颈癌患者组成的对照组进行了钆剂DCE-MRI检查，以评估子宫血管情况。在结合 JZ 的 DCE-MRI 图像上分配了 12 个感兴趣区（ROI），对照组的 ROI 位于腰大肌。将单个 ROI 与同一子宫的平均总灌注（TP）进行比较。对五名妇女进行了术前和术后灌注分析。使用接收器操作曲线（ROC）分析核磁共振成像对 IUA 的预测作用：结果：灌注量无明显差异；与对照组相比，IUA妇女的灌注量呈下降趋势。ROC可预测更高等级和无法手术的IUA：结论：根据 ROC 评估，DCE-MRI 上的灌注减少可预测较高分期的 AS。本研究的结果支持在手术干预前将DCE-MRI作为强直性脊柱炎的预后工具进行进一步研究，以帮助为患有强直性脊柱炎的妇女提供预后指导。
{"title":"Perfusion magnetic resonance imaging in Asherman syndrome","authors":"Rebecca Deans, Daniel Moses, Toos Anthony Sach, Thierry Vancaillie, Bill Ledger, Jason A. Abbott","doi":"10.1111/ajo.13799","DOIUrl":"10.1111/ajo.13799","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Microvascular scarring compromises the functionality of the endometrium, and vascular flow at the junctional zone (JZ) may be the key to understanding poor reproductive outcomes in women with Asherman syndrome (AS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To investigate whether vascular perfusion of the uterus, measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is impaired in women with intrauterine adhesions (IUA) and AS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A prospective observational cohort pilot study of 23 women with IUA treated with hysteroscopic synecholysis and a control group of two patients with cervix cancer were subject to DCE-MRI with gadolinium to assess uterine vascularity. Twelve regions of interest (ROIs) were allocated on the DCE-MRI image incorporating the JZ, with control ROI placed at the psoas muscle. Individual ROIs were compared to the mean total perfusion (TP) in the same uterus. Pre- and post-operative perfusion analyses were performed on five women. Receiver operator curves (ROC) were used to analyse MRI as a predictor of IUA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was no significant difference in perfusion; a trend toward reduced perfusion was observed in women with IUA compared to the controls. The ROC was predictive of higher-grade and inoperable IUA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Reduced perfusion on DCE-MRI as assessed by ROC predicted higher-stage AS. The results of this study support further investigation of DCE-MRI as a prognostic tool for AS prior to surgical intervention to assist in providing prognostic guidance for women suffering from AS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"64 4","pages":"341-346"},"PeriodicalIF":1.4,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13799","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742793","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}
Janna Lawson, Lahiru Amaratunge, Melody Goh, Roshan J. Selvaratnam
Background
Regional analgesia is a common and effective form of in-labour analgesia. However, there are concerns whether it is associated with adverse maternal and neonatal outcomes.
Aims
To examine the association between regional analgesia and maternal and neonatal outcomes.
Materials and Methods
A retrospective population-based cohort study of singleton term births in Victoria, Australia, between 2014 and 2020. Women who received regional analgesia were compared with women who did not. Multivariable logistic and linear regressions were used.
Results
There were 107 013 women who received regional analgesia and 214 416 women who did not. Compared to women who did not receive regional analgesia, regional analgesia was associated with an increased risk of instrumental birth (adjusted odds ratio (aOR) = 3.59, 95% CI: 3.52–3.67), caesarean section (aOR = 2.30, 95% CI: 2.24–2.35), longer duration of the second stage of labour (β coefficient = 26.6 min, 95% CI: 26.3–27.0), Apgar score below seven at five minutes (aOR = 1.30, 95% CI: 1.21–1.39), need for neonatal resuscitation (aOR = 1.44, 95% CI: 1.40–1.48), need for formula in hospital (aOR = 1.68, 95% CI: 1.65–1.72), and the last feed before discharge not exclusively from the breast (aOR = 1.59, 95% CI: 1.56–1.62).
Conclusion
Regional analgesia use in labour was associated with adverse maternal and neonatal outcomes. These findings may add to the risk–benefit discussion regarding regional analgesia for pain relief and highlight the importance of shared decision-making. Further large prospective studies and randomised controlled trials will be useful.
{"title":"Perinatal outcomes after regional analgesia during labour","authors":"Janna Lawson, Lahiru Amaratunge, Melody Goh, Roshan J. Selvaratnam","doi":"10.1111/ajo.13797","DOIUrl":"10.1111/ajo.13797","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Regional analgesia is a common and effective form of in-labour analgesia. However, there are concerns whether it is associated with adverse maternal and neonatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To examine the association between regional analgesia and maternal and neonatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A retrospective population-based cohort study of singleton term births in Victoria, Australia, between 2014 and 2020. Women who received regional analgesia were compared with women who did not. Multivariable logistic and linear regressions were used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 107 013 women who received regional analgesia and 214 416 women who did not. Compared to women who did not receive regional analgesia, regional analgesia was associated with an increased risk of instrumental birth (adjusted odds ratio (aOR) = 3.59, 95% CI: 3.52–3.67), caesarean section (aOR = 2.30, 95% CI: 2.24–2.35), longer duration of the second stage of labour (β coefficient = 26.6 min, 95% CI: 26.3–27.0), Apgar score below seven at five minutes (aOR = 1.30, 95% CI: 1.21–1.39), need for neonatal resuscitation (aOR = 1.44, 95% CI: 1.40–1.48), need for formula in hospital (aOR = 1.68, 95% CI: 1.65–1.72), and the last feed before discharge not exclusively from the breast (aOR = 1.59, 95% CI: 1.56–1.62).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Regional analgesia use in labour was associated with adverse maternal and neonatal outcomes. These findings may add to the risk–benefit discussion regarding regional analgesia for pain relief and highlight the importance of shared decision-making. Further large prospective studies and randomised controlled trials will be useful.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"64 4","pages":"334-340"},"PeriodicalIF":1.4,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725040","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}
<p>Welcome to the 64th volume of the <i>Australian and New Zealand Journal of Obstetrics and Gynaecology</i>. We are now well into a new year which brings much work to progress for our <i>Journal</i> in 2024. It is my hope that during this year we will continue to grow <i>ANZJOG</i> as a leading source of clinically relevant scientific literature, providing guidance to those in clinical roles and driving the work of those undertaking research in obstetrics and gynaecology and related disciplines. I wish to diversify the ways in which our community interacts with our publication by providing content which is more accessible in an increasingly media-saturated world and to provide clinical context to the published research, allowing it to drive evidence-based practice at the bedside.</p><p>This issue features several invited editorials to draw attention to current topics of relevance to our field. In the first, a group of world-leading journal editors, led by Vincenzo Berghella, discuss the problem of trustworthiness in women's health and how to address it.<span><sup>1</sup></span> Poor experimental design, flawed statistical analysis, and deliberate research fraud, among other factors, contribute to erroneous conclusions being drawn from published research. This is not just of academic significance, with flawed studies contributing to inappropriate clinical practice, either in response to the individual studies themselves, to the systematic reviews and meta-analyses in which they are included, or to the clinical guidelines developed based on this evidence. Deliberate research misconduct is difficult to detect even with the most robust peer-review processes, but poor research design and statistical methodology errors can be reduced with appropriate research training and support, a task for those of us in senior academic positions to take on and implement.</p><p>Endometriosis remains a topical and potentially contentious issue, and Jason Abbott reflects on the Australian National Action Plan in his editorial discussing recent achievements and the remaining challenges in this area.<span><sup>2</sup></span> Endometriosis is a common and potentially debilitating condition which has traditionally been (and may continue to be) underdiagnosed or delayed in diagnosis due to societal expectations of what is normal, steeped in what was a misogynistic view of women's health. The National Action Plan aims to address the ongoing challenges in endometriosis care, and RANZCOG has key roles in the Plan, particularly in terms of evidence review, guideline development, and clinical implementation, all of which are currently in progress.</p><p>Kothari <i>et al</i><span><sup>3</sup></span> discuss the importance of considering fathers in maternity care, highlighting the important contributions paternal factors make to fertility, obstetric, perinatal, and longer-term offspring outcomes. This editorial also acknowledges the benefits from paternal involvement in maternity
{"title":"ANZJOG in 2024","authors":"Scott W. White","doi":"10.1111/ajo.13801","DOIUrl":"10.1111/ajo.13801","url":null,"abstract":"<p>Welcome to the 64th volume of the <i>Australian and New Zealand Journal of Obstetrics and Gynaecology</i>. We are now well into a new year which brings much work to progress for our <i>Journal</i> in 2024. It is my hope that during this year we will continue to grow <i>ANZJOG</i> as a leading source of clinically relevant scientific literature, providing guidance to those in clinical roles and driving the work of those undertaking research in obstetrics and gynaecology and related disciplines. I wish to diversify the ways in which our community interacts with our publication by providing content which is more accessible in an increasingly media-saturated world and to provide clinical context to the published research, allowing it to drive evidence-based practice at the bedside.</p><p>This issue features several invited editorials to draw attention to current topics of relevance to our field. In the first, a group of world-leading journal editors, led by Vincenzo Berghella, discuss the problem of trustworthiness in women's health and how to address it.<span><sup>1</sup></span> Poor experimental design, flawed statistical analysis, and deliberate research fraud, among other factors, contribute to erroneous conclusions being drawn from published research. This is not just of academic significance, with flawed studies contributing to inappropriate clinical practice, either in response to the individual studies themselves, to the systematic reviews and meta-analyses in which they are included, or to the clinical guidelines developed based on this evidence. Deliberate research misconduct is difficult to detect even with the most robust peer-review processes, but poor research design and statistical methodology errors can be reduced with appropriate research training and support, a task for those of us in senior academic positions to take on and implement.</p><p>Endometriosis remains a topical and potentially contentious issue, and Jason Abbott reflects on the Australian National Action Plan in his editorial discussing recent achievements and the remaining challenges in this area.<span><sup>2</sup></span> Endometriosis is a common and potentially debilitating condition which has traditionally been (and may continue to be) underdiagnosed or delayed in diagnosis due to societal expectations of what is normal, steeped in what was a misogynistic view of women's health. The National Action Plan aims to address the ongoing challenges in endometriosis care, and RANZCOG has key roles in the Plan, particularly in terms of evidence review, guideline development, and clinical implementation, all of which are currently in progress.</p><p>Kothari <i>et al</i><span><sup>3</sup></span> discuss the importance of considering fathers in maternity care, highlighting the important contributions paternal factors make to fertility, obstetric, perinatal, and longer-term offspring outcomes. This editorial also acknowledges the benefits from paternal involvement in maternity","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"64 1","pages":"3-4"},"PeriodicalIF":1.7,"publicationDate":"2024-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13801","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681978","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}
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.
{"title":"Ultrasound-guided Lipiodol® hysterosalpingography: A prospective study on pregnancy and complication rates","authors":"Glen Lo, Dana Hince, Neil Johnson, Paul L. Hofman, Jasmin Sekhon, Emmeline Lee","doi":"10.1111/ajo.13794","DOIUrl":"10.1111/ajo.13794","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Prospectively observe pregnancy and complication rates after ultrasound-guided Lipiodol® HSG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"64 4","pages":"326-333"},"PeriodicalIF":1.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13794","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139652248","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}
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。
{"title":"Mucinous ovarian carcinoma: A survey of practice in Australia and New Zealand","authors":"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","doi":"10.1111/ajo.13792","DOIUrl":"10.1111/ajo.13792","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mucinous ovarian carcinoma (MOC) is a rare ovarian cancer with limited evidence to support clinical care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Respondents (<i>n</i> = 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?’</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":"64 4","pages":"319-325"},"PeriodicalIF":1.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13792","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139652247","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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