C. Henry, S. Filoche, M. Thunders, D. Kenwright, A. Ekeroma
Incidence of endometrial cancer is increasing rapidly in the developed world and is the most common gynaecological cancer in Australia and New Zealand. In line with obesity rates, the landscape and average age of women diagnosed with endometrial cancer are changing. There is still unmet need in early diagnosis, directed treatment, management of comorbidities and prevention strategies. This opinion piece aims to reflect on the current status of endometrial cancer in New Zealand in parallel to Australia, drawing out areas for future research and discussion.
{"title":"Reflection on the current status of endometrial cancer in New Zealand","authors":"C. Henry, S. Filoche, M. Thunders, D. Kenwright, A. Ekeroma","doi":"10.1111/ajo.13057","DOIUrl":"https://doi.org/10.1111/ajo.13057","url":null,"abstract":"Incidence of endometrial cancer is increasing rapidly in the developed world and is the most common gynaecological cancer in Australia and New Zealand. In line with obesity rates, the landscape and average age of women diagnosed with endometrial cancer are changing. There is still unmet need in early diagnosis, directed treatment, management of comorbidities and prevention strategies. This opinion piece aims to reflect on the current status of endometrial cancer in New Zealand in parallel to Australia, drawing out areas for future research and discussion.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88212367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chris Ongzalima, M. Greenland, G. Vaughan, A. Ng, J. Fitz-Gerald, F. Sanfilippo, J. Dickinson, J. Hung, J. Katzenellenbogen
This retrospective study assessed maternal and perinatal outcomes for women with rheumatic heart disease (RHD) admitted to the largest tertiary obstetric hospital in Western Australia from 2009 to 2016. Of 54 women identified, 75.9% were Indigenous, 59.3% lived in rural areas and 40.7% had severe RHD. Heart failure developed in 10% who gave birth. Indigenous women were younger, had higher gravidity (P = 0.0305), were more likely to receive secondary prophylaxis (P = 0.0041) and have sub‐optimal antenatal clinic attendance (P = 0.0078). There were no maternal deaths and two perinatal deaths (4.0%), reflecting vigilance in the obstetric management of women with RHD in Western Australia.
{"title":"Rheumatic heart disease in pregnancy: Profile of women admitted to a Western Australian tertiary obstetric hospital","authors":"Chris Ongzalima, M. Greenland, G. Vaughan, A. Ng, J. Fitz-Gerald, F. Sanfilippo, J. Dickinson, J. Hung, J. Katzenellenbogen","doi":"10.1111/ajo.13102","DOIUrl":"https://doi.org/10.1111/ajo.13102","url":null,"abstract":"This retrospective study assessed maternal and perinatal outcomes for women with rheumatic heart disease (RHD) admitted to the largest tertiary obstetric hospital in Western Australia from 2009 to 2016. Of 54 women identified, 75.9% were Indigenous, 59.3% lived in rural areas and 40.7% had severe RHD. Heart failure developed in 10% who gave birth. Indigenous women were younger, had higher gravidity (P = 0.0305), were more likely to receive secondary prophylaxis (P = 0.0041) and have sub‐optimal antenatal clinic attendance (P = 0.0078). There were no maternal deaths and two perinatal deaths (4.0%), reflecting vigilance in the obstetric management of women with RHD in Western Australia.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74263249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In recent years, significant improvements in survival and survival‐free of major morbidity in babies born at 23+0 to 24+6 weeks of gestation have led to a more pro‐active approach to resuscitation at these peri‐viable gestations. Antenatal counselling and interventions, intrapartum care and postnatal advice should be part of the package of care provided to optimise outcomes for these babies and their families. This observational study assesses the perinatal care provided to mothers and their babies who were born at 23 and 24 weeks of gestations over a two‐year period at a tertiary maternity hospital in New Zealand.
{"title":"Perinatal care provided for babies born at 23 and 24 weeks of gestation","authors":"L. Dawes, M. Buksh, L. Sadler, J. Waugh, K. Groom","doi":"10.1111/ajo.13094","DOIUrl":"https://doi.org/10.1111/ajo.13094","url":null,"abstract":"In recent years, significant improvements in survival and survival‐free of major morbidity in babies born at 23+0 to 24+6 weeks of gestation have led to a more pro‐active approach to resuscitation at these peri‐viable gestations. Antenatal counselling and interventions, intrapartum care and postnatal advice should be part of the package of care provided to optimise outcomes for these babies and their families. This observational study assesses the perinatal care provided to mothers and their babies who were born at 23 and 24 weeks of gestations over a two‐year period at a tertiary maternity hospital in New Zealand.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79443041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Agresta, Romano A. Fois, C. Garrett, G. Rozen, A. Polyakov
Translation of findings from randomised controlled trials (RCT), the foundation of evidence‐based medicine, into clinical practice requires an understanding of relationships between patient characteristics, treatment practices and outcomes. We propose a novel technique, External Validity Analysis (EVA), to evaluate applicability of findings from a large RCT, comparing baseline characteristics, interventions and outcomes between the RCT and a large clinical database.
{"title":"Is it possible to apply trial outcomes to a real‐world population? A novel approach to External Validity Analysis","authors":"F. Agresta, Romano A. Fois, C. Garrett, G. Rozen, A. Polyakov","doi":"10.1111/ajo.13090","DOIUrl":"https://doi.org/10.1111/ajo.13090","url":null,"abstract":"Translation of findings from randomised controlled trials (RCT), the foundation of evidence‐based medicine, into clinical practice requires an understanding of relationships between patient characteristics, treatment practices and outcomes. We propose a novel technique, External Validity Analysis (EVA), to evaluate applicability of findings from a large RCT, comparing baseline characteristics, interventions and outcomes between the RCT and a large clinical database.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72998256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
With the recent introduction of the renewed National Cervical Screening Program (NCSP) in Australia, utilising primary human papillomavirus (HPV) nucleic acid testing (NAT) for known oncogenic HPV types rather than cervical cytology, we reflect on three asymptomatic women with negative oncogenic HPV test results and high‐grade cervical abnormalities including cervical intraepithelial neoplasia (CIN) III and cervical squamous cell carcinoma (SCC). The two cases with CIN III had a ‘probable’ oncogenic subtype (HPV 53) identified on further testing, while the case of SCC had no HPV virus identified. These cases serve as a reminder of the need for ongoing diligence despite low‐risk screening under the new program.
{"title":"CIN III and cervical SCC with negative oncogenic HPV PCR: A case series","authors":"Sam Sturrock, A. Griffiths, T. Jobling","doi":"10.1111/ajo.13092","DOIUrl":"https://doi.org/10.1111/ajo.13092","url":null,"abstract":"With the recent introduction of the renewed National Cervical Screening Program (NCSP) in Australia, utilising primary human papillomavirus (HPV) nucleic acid testing (NAT) for known oncogenic HPV types rather than cervical cytology, we reflect on three asymptomatic women with negative oncogenic HPV test results and high‐grade cervical abnormalities including cervical intraepithelial neoplasia (CIN) III and cervical squamous cell carcinoma (SCC). The two cases with CIN III had a ‘probable’ oncogenic subtype (HPV 53) identified on further testing, while the case of SCC had no HPV virus identified. These cases serve as a reminder of the need for ongoing diligence despite low‐risk screening under the new program.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89911860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity is prevalent in the Australian antenatal population, but there are scarce data on the prevalence and associated outcomes of body mass index (BMI) ≥50 kg/m2.
{"title":"Maternal and perinatal outcomes for women with body mass index ≥50 kg/m2 in a non‐tertiary hospital setting","authors":"Anita Pratt, P. Howat, L. Hui","doi":"10.1111/ajo.13064","DOIUrl":"https://doi.org/10.1111/ajo.13064","url":null,"abstract":"Obesity is prevalent in the Australian antenatal population, but there are scarce data on the prevalence and associated outcomes of body mass index (BMI) ≥50 kg/m2.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75044949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeffrey H.J. Tan, Michael J. Malloy, R. Thangamani, D. Gertig, Kelly T. Drennan, C. Wrede, M. Saville, M. Quinn
Adenocarcinoma in situ of cervix is increasingly managed by local excision rather than hysterectomy and this study will ascertain if conservative management by excision alone is adequate.
{"title":"Management and long‐term outcomes of women with adenocarcinoma in situ of the cervix: A retrospective study","authors":"Jeffrey H.J. Tan, Michael J. Malloy, R. Thangamani, D. Gertig, Kelly T. Drennan, C. Wrede, M. Saville, M. Quinn","doi":"10.1111/ajo.13047","DOIUrl":"https://doi.org/10.1111/ajo.13047","url":null,"abstract":"Adenocarcinoma in situ of cervix is increasingly managed by local excision rather than hysterectomy and this study will ascertain if conservative management by excision alone is adequate.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88489235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the article published in this issue's edition of ANZJOG a case has been made for the procedure known as ‘axillary traction’.1 It is a procedure which has probably been used inadvertently by many clinicians when they have been unable to reach the extended posterior arm2 but also described using a plastic sling.3 The authors in the current article justifiably suggest it as an alternative procedure to internal rotation or delivery of the posterior arm. Whether or not it is proven to be better and should be advised as the primary procedure is still open to debate. The article does highlight though the issues that need to be addressed if there is to be further improvement in the management of shoulder dystocia (SD). In particular, the article emphasises the lack of consistency in the definition and diagnosis of SD and the bigger problem of lack of quality information. The authors go as far as stating that ‘even when a proforma was introduced in 2010 to capture the order of the manoeuvres used and the length of time each manoeuvre was attempted it was often not completed and the methods of management were extracted from the written clinical notes.’ This statement could have been written from any labour and delivery ward (LDW) in the world. SD occurs in approximately 1% of vaginal deliveries. It may result in significant injuries for babies and mothers4 and a traumatic experience for the woman, her partner and the staff involved. The lack of a universally accepted definition of SD has hampered knowing the true incidence of SD and made appropriate management options difficult to assess. SD is difficult to predict and therefore difficult to prevent unless all women are delivered by caesarean section. Antenatal and intrapartum risk factors all have a low positive predictive value, and although SD is related to fetal birthweight, this is of limited value because fetal size is difficult to determine accurately antenatally. Most babies over 4.5 kg deliver without SD and some cases of SD occur in babies < 4 kg. If we cannot predict and prevent SD then we need to be better prepared to manage it when it occurs. Much effort has been made to improve training for all staff to be able to react appropriately as a labour ward team when SD occurs. Great progress has been made in establishing appropriate training programs and communicating how important they are in order to prepare clinicians for the emergency. It is essential that these are present in each LDW in order to improve the physical outcome for mother and baby, but also to recognise and improve the psychological impact it may have on the woman, her partner and the staff involved.5 Simulation training is helpful, but it is not always the manipulative techniques that are crucial in SD. It is the calmness and logical decision‐making process, individually and as a team, required during the time following delivery of the fetal head, that are crucial. Those skills are difficult to teach and develop, and often on
{"title":"Shoulder dystocia: Is it time to think differently?","authors":"M. Robson","doi":"10.1111/ajo.13060","DOIUrl":"https://doi.org/10.1111/ajo.13060","url":null,"abstract":"In the article published in this issue's edition of ANZJOG a case has been made for the procedure known as ‘axillary traction’.1 It is a procedure which has probably been used inadvertently by many clinicians when they have been unable to reach the extended posterior arm2 but also described using a plastic sling.3 The authors in the current article justifiably suggest it as an alternative procedure to internal rotation or delivery of the posterior arm. Whether or not it is proven to be better and should be advised as the primary procedure is still open to debate. The article does highlight though the issues that need to be addressed if there is to be further improvement in the management of shoulder dystocia (SD). In particular, the article emphasises the lack of consistency in the definition and diagnosis of SD and the bigger problem of lack of quality information. The authors go as far as stating that ‘even when a proforma was introduced in 2010 to capture the order of the manoeuvres used and the length of time each manoeuvre was attempted it was often not completed and the methods of management were extracted from the written clinical notes.’ This statement could have been written from any labour and delivery ward (LDW) in the world. SD occurs in approximately 1% of vaginal deliveries. It may result in significant injuries for babies and mothers4 and a traumatic experience for the woman, her partner and the staff involved. The lack of a universally accepted definition of SD has hampered knowing the true incidence of SD and made appropriate management options difficult to assess. SD is difficult to predict and therefore difficult to prevent unless all women are delivered by caesarean section. Antenatal and intrapartum risk factors all have a low positive predictive value, and although SD is related to fetal birthweight, this is of limited value because fetal size is difficult to determine accurately antenatally. Most babies over 4.5 kg deliver without SD and some cases of SD occur in babies < 4 kg. If we cannot predict and prevent SD then we need to be better prepared to manage it when it occurs. Much effort has been made to improve training for all staff to be able to react appropriately as a labour ward team when SD occurs. Great progress has been made in establishing appropriate training programs and communicating how important they are in order to prepare clinicians for the emergency. It is essential that these are present in each LDW in order to improve the physical outcome for mother and baby, but also to recognise and improve the psychological impact it may have on the woman, her partner and the staff involved.5 Simulation training is helpful, but it is not always the manipulative techniques that are crucial in SD. It is the calmness and logical decision‐making process, individually and as a team, required during the time following delivery of the fetal head, that are crucial. Those skills are difficult to teach and develop, and often on","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75816904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
1Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Sydney, New South Wales, Australia 2Women and Babies Research, Kolling Institute, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia 3Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Sydney, New South Wales, Australia Correspondence: Dr Tanya A.C. Nippita, Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065, Sydney, Australia. Email: tanya.nippita@sydney.edu.au
1澳大利亚新南威尔士州悉尼悉尼大学北部临床学院医学与健康学院2澳大利亚新南威尔士州悉尼悉尼大学皇家北岸医院科林研究所妇女和婴儿研究3澳大利亚新南威尔士州悉尼悉尼大学北部临床学院医学与健康学院产科、妇科和新生儿学学科Tanya A.C. Nippita博士，悉尼大学北部临床学院医学与健康学院，皇家北岸医院道格拉斯大楼5楼，St Leonards, NSW 2065，悉尼，澳大利亚。电子邮件:tanya.nippita@sydney.edu.au
{"title":"Offering routine induction of labour at 39 weeks in low‐risk nulliparous women: No need for hasty change","authors":"T. Nippita, D. Randall, S. Seeho","doi":"10.1111/ajo.13049","DOIUrl":"https://doi.org/10.1111/ajo.13049","url":null,"abstract":"1Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Sydney, New South Wales, Australia 2Women and Babies Research, Kolling Institute, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia 3Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Sydney, New South Wales, Australia Correspondence: Dr Tanya A.C. Nippita, Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Level 5, Douglas Building, Royal North Shore Hospital, St Leonards, NSW 2065, Sydney, Australia. Email: tanya.nippita@sydney.edu.au","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86768225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gynaecologists have been at the receiving end of much regulatory intervention in recent years, some of it inappropriate and heavy‐handed such as the recent ban on midurethral slings in the National Health Service, others appropriate and, if anything, occurring too late. Regulatory agencies have failed, and so have individual doctors and their organisations. An example of individual and systemic failure involves the Tissue Fixation System. It is an Australian story that is not yet widely known, which is why the author has decided to acquaint the readers of ANZJOG with the situation in this country, where the Tissue Fixation System was invented, manufactured and used on thousands of patients over a period of eight years before its manufacture, sale and export from Australia ended in 2014.
{"title":"The Tissue Fixation System: How obsolete and potentially dangerous technology continues to be ‘sold’","authors":"H. Dietz","doi":"10.1111/ajo.13036","DOIUrl":"https://doi.org/10.1111/ajo.13036","url":null,"abstract":"Gynaecologists have been at the receiving end of much regulatory intervention in recent years, some of it inappropriate and heavy‐handed such as the recent ban on midurethral slings in the National Health Service, others appropriate and, if anything, occurring too late. Regulatory agencies have failed, and so have individual doctors and their organisations. An example of individual and systemic failure involves the Tissue Fixation System. It is an Australian story that is not yet widely known, which is why the author has decided to acquaint the readers of ANZJOG with the situation in this country, where the Tissue Fixation System was invented, manufactured and used on thousands of patients over a period of eight years before its manufacture, sale and export from Australia ended in 2014.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90312796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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