{"title":"Main Program","authors":"H. Sherrell, V. Clifton, Sailesh Kumar","doi":"10.1111/ajo.13072","DOIUrl":"https://doi.org/10.1111/ajo.13072","url":null,"abstract":"","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":"81245337","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}
Then, in 2007, a poster was presented from the new Cochrane systematic review, which showed that in lowrisk pregnancies, induction of labour (IOL) before 40 weeks’ gestational age prevented caesarean section. The risk ratio was 0.68 (95% CI 0.34–0.99).1 I was astounded. The authors proposed an Australian randomised controlled trial among lowrisk women for improving perinatal outcomes. It was not undertaken, but the USA ARRIVE Trial was published in 2018. A total of 6106 lowrisk nulliparous women with singleton pregnancies were randomised to planned IOL at 39+0–39+4 weeks or expectant management.2 Severe perinatal complications occurred in 4.3% infants in the IOL group and 5.4% in the expectant group (P = 0.049). Caesarean section occurred in 18.6% of women in the IOL group and 22.2% in the expectant group (P < 0.001). Almost immediately, the American College of Obstetricians and Gynaecologists stated ‘it is reasonable for obstetricians and healthcare facilities to offer elective induction of labor to lowrisk nulliparous women at 39 weeks’ gestation’, a view endorsed by the Society for MaternalFetal Medicine.3 However, the trial also drew criticism based on the perceived lack of generalisability, discrepancies with observational data, availability of other methods to reduce caesarean section rates and unknown costeffectiveness.4–6 Should women be able to choose IOL at 39 weeks, thereby acknowledging a woman's right to autonomy? Or is IOL at 39 weeks so obviously wrong that it should not be discussed as an option, or even actively refused if requested? The aim of this opinion article is to argue the case for offering IOL 39 weeks’ gestational age to lowrisk women.
{"title":"Induction of labour at 39 weeks should be routinely offered to low‐risk women","authors":"B. D. de Vries, A. Gordon","doi":"10.1111/ajo.12980","DOIUrl":"https://doi.org/10.1111/ajo.12980","url":null,"abstract":"Then, in 2007, a poster was presented from the new Cochrane systematic review, which showed that in lowrisk pregnancies, induction of labour (IOL) before 40 weeks’ gestational age prevented caesarean section. The risk ratio was 0.68 (95% CI 0.34–0.99).1 I was astounded. The authors proposed an Australian randomised controlled trial among lowrisk women for improving perinatal outcomes. It was not undertaken, but the USA ARRIVE Trial was published in 2018. A total of 6106 lowrisk nulliparous women with singleton pregnancies were randomised to planned IOL at 39+0–39+4 weeks or expectant management.2 Severe perinatal complications occurred in 4.3% infants in the IOL group and 5.4% in the expectant group (P = 0.049). Caesarean section occurred in 18.6% of women in the IOL group and 22.2% in the expectant group (P < 0.001). Almost immediately, the American College of Obstetricians and Gynaecologists stated ‘it is reasonable for obstetricians and healthcare facilities to offer elective induction of labor to lowrisk nulliparous women at 39 weeks’ gestation’, a view endorsed by the Society for MaternalFetal Medicine.3 However, the trial also drew criticism based on the perceived lack of generalisability, discrepancies with observational data, availability of other methods to reduce caesarean section rates and unknown costeffectiveness.4–6 Should women be able to choose IOL at 39 weeks, thereby acknowledging a woman's right to autonomy? Or is IOL at 39 weeks so obviously wrong that it should not be discussed as an option, or even actively refused if requested? The aim of this opinion article is to argue the case for offering IOL 39 weeks’ gestational age to lowrisk women.","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":"82369516","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}
{"title":"Static Posters","authors":"","doi":"10.1111/ajo.13066","DOIUrl":"https://doi.org/10.1111/ajo.13066","url":null,"abstract":"","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":"81281649","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}
Dear Editor, We read with great interest a most engaging and pragmatic clinical guideline for decreased fetal movements (DFM).1 Between 30– 55% of women who experience a stillbirth retrospectively noted DFM in the preceding week.2 This presumed negative clinical incident has long been perceived as opportunity for intervention. The AFFIRM study, recently published (November, 2018), was to be the first randomised trial involving 409 175 pregnancies that used a similar intervention package as in Norway (subjective perception of DFM by a patient in a contemporaneous setting) and was expected to deliver a 30% reduction in the rate of stillbirths.2 The results of the AFFIRM study have been disappointing to the supporters of intervention for reduced fetal movements. There was no statistically significant reduction in the stillbirth rate but rather an increase in induction and caesarean section rates, and average neonatal length of stay in neonatal intensive care.2 Also, in the intervention group there was a higher rate of post neonatal deaths. In our exuberance to prevent stillbirths, have we violated the principle of nonmaleficence? Alternatively, as suggested by Walker and Thornton, it might be safer to retain our current approach but rather place limits on awareness campaigns to gestations greater than 37 weeks.3 Reflecting upon the negative or null findings of the AFFIRM study, should the local guideline have an immediate addendum to clarify that there is no robust scientific approach to reduced fetal movements while awaiting further evidence?
{"title":"Sleep in multiple pregnancy: Obstructive sleep apnoea and beyond","authors":"Y. Bin, J. Ford, P. Cistulli","doi":"10.1111/ajo.12985","DOIUrl":"https://doi.org/10.1111/ajo.12985","url":null,"abstract":"Dear Editor, We read with great interest a most engaging and pragmatic clinical guideline for decreased fetal movements (DFM).1 Between 30– 55% of women who experience a stillbirth retrospectively noted DFM in the preceding week.2 This presumed negative clinical incident has long been perceived as opportunity for intervention. The AFFIRM study, recently published (November, 2018), was to be the first randomised trial involving 409 175 pregnancies that used a similar intervention package as in Norway (subjective perception of DFM by a patient in a contemporaneous setting) and was expected to deliver a 30% reduction in the rate of stillbirths.2 The results of the AFFIRM study have been disappointing to the supporters of intervention for reduced fetal movements. There was no statistically significant reduction in the stillbirth rate but rather an increase in induction and caesarean section rates, and average neonatal length of stay in neonatal intensive care.2 Also, in the intervention group there was a higher rate of post neonatal deaths. In our exuberance to prevent stillbirths, have we violated the principle of nonmaleficence? Alternatively, as suggested by Walker and Thornton, it might be safer to retain our current approach but rather place limits on awareness campaigns to gestations greater than 37 weeks.3 Reflecting upon the negative or null findings of the AFFIRM study, should the local guideline have an immediate addendum to clarify that there is no robust scientific approach to reduced fetal movements while awaiting further evidence?","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":"86006746","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}
Dear Editor, We read with great interest a most engaging and pragmatic clinical guideline for decreased fetal movements (DFM).1 Between 30– 55% of women who experience a stillbirth retrospectively noted DFM in the preceding week.2 This presumed negative clinical incident has long been perceived as opportunity for intervention. The AFFIRM study, recently published (November, 2018), was to be the first randomised trial involving 409 175 pregnancies that used a similar intervention package as in Norway (subjective perception of DFM by a patient in a contemporaneous setting) and was expected to deliver a 30% reduction in the rate of stillbirths.2 The results of the AFFIRM study have been disappointing to the supporters of intervention for reduced fetal movements. There was no statistically significant reduction in the stillbirth rate but rather an increase in induction and caesarean section rates, and average neonatal length of stay in neonatal intensive care.2 Also, in the intervention group there was a higher rate of post neonatal deaths. In our exuberance to prevent stillbirths, have we violated the principle of nonmaleficence? Alternatively, as suggested by Walker and Thornton, it might be safer to retain our current approach but rather place limits on awareness campaigns to gestations greater than 37 weeks.3 Reflecting upon the negative or null findings of the AFFIRM study, should the local guideline have an immediate addendum to clarify that there is no robust scientific approach to reduced fetal movements while awaiting further evidence?
{"title":"Reduced fetal movements – First do no harm","authors":"A. Saunders, C. Griffin","doi":"10.1111/ajo.12976","DOIUrl":"https://doi.org/10.1111/ajo.12976","url":null,"abstract":"Dear Editor, We read with great interest a most engaging and pragmatic clinical guideline for decreased fetal movements (DFM).1 Between 30– 55% of women who experience a stillbirth retrospectively noted DFM in the preceding week.2 This presumed negative clinical incident has long been perceived as opportunity for intervention. The AFFIRM study, recently published (November, 2018), was to be the first randomised trial involving 409 175 pregnancies that used a similar intervention package as in Norway (subjective perception of DFM by a patient in a contemporaneous setting) and was expected to deliver a 30% reduction in the rate of stillbirths.2 The results of the AFFIRM study have been disappointing to the supporters of intervention for reduced fetal movements. There was no statistically significant reduction in the stillbirth rate but rather an increase in induction and caesarean section rates, and average neonatal length of stay in neonatal intensive care.2 Also, in the intervention group there was a higher rate of post neonatal deaths. In our exuberance to prevent stillbirths, have we violated the principle of nonmaleficence? Alternatively, as suggested by Walker and Thornton, it might be safer to retain our current approach but rather place limits on awareness campaigns to gestations greater than 37 weeks.3 Reflecting upon the negative or null findings of the AFFIRM study, should the local guideline have an immediate addendum to clarify that there is no robust scientific approach to reduced fetal movements while awaiting further evidence?","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":"85294294","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}
{"title":"Journal Editorial Board","authors":"","doi":"10.1111/ajo.12860","DOIUrl":"https://doi.org/10.1111/ajo.12860","url":null,"abstract":"","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":"74342138","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}
We thank the authors for their recent letter and agree with the observation of a striking disparity between recognition of OSA in pregnancy by hospital coding data (0.08%) in contrast with a rate of 8.3% in prospectively screened nulliparous singleton pregnancy at 21-33 weeks of gestation [1] This emphasises that OSA is likely to be greatly underestimated in usual clinical practice in Australia. We anticipate that rates are also likely to be significantly higher in women with twin or multiple pregnancy than identified by hospital coding data. The relationship between OSA and adverse pregnancy outcomes makes this a problem worthy of further study.
{"title":"A Reply to: Sleep in multiple pregnancy: Obstructive sleep apnoea and beyond","authors":"M. Rees","doi":"10.1111/ajo.13007","DOIUrl":"https://doi.org/10.1111/ajo.13007","url":null,"abstract":"We thank the authors for their recent letter and agree with the observation of a striking disparity between recognition of OSA in pregnancy by hospital coding data (0.08%) in contrast with a rate of 8.3% in prospectively screened nulliparous singleton pregnancy at 21-33 weeks of gestation [1] This emphasises that OSA is likely to be greatly underestimated in usual clinical practice in Australia. We anticipate that rates are also likely to be significantly higher in women with twin or multiple pregnancy than identified by hospital coding data. The relationship between OSA and adverse pregnancy outcomes makes this a problem worthy of further study.","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":"80651396","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}
Raelia Lew, J. Foo, Ben Kroon, C. Boothroyd, M. Chapman
One in six Australian women and couples suffer infertility. A rising proportion relates to advanced maternal age, associated with poorer oocyte quality and in vitro fertilisation (IVF) outcomes. Internationally, oocyte cryopreservation technology applied to oocytes vitrified before 35 years provides similar live‐birth statistics compared to IVF treatment using fresh oocytes. Oocyte cryopreservation is accessible in Australasian settings and elective uptake is increasing. For women accessing treatment, oocyte cryopreservation may expand future family building options.
{"title":"ANZSREI consensus statement on elective oocyte cryopreservation","authors":"Raelia Lew, J. Foo, Ben Kroon, C. Boothroyd, M. Chapman","doi":"10.1111/ajo.13028","DOIUrl":"https://doi.org/10.1111/ajo.13028","url":null,"abstract":"One in six Australian women and couples suffer infertility. A rising proportion relates to advanced maternal age, associated with poorer oocyte quality and in vitro fertilisation (IVF) outcomes. Internationally, oocyte cryopreservation technology applied to oocytes vitrified before 35 years provides similar live‐birth statistics compared to IVF treatment using fresh oocytes. Oocyte cryopreservation is accessible in Australasian settings and elective uptake is increasing. For women accessing treatment, oocyte cryopreservation may expand future family building options.","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":"82374389","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}
Perinatal loss is often considered an emotionally and physically traumatic event for expectant parents. While there is strong evidence of its impact on women, limited research has independently explored men's lived experiences.
{"title":"Men's lived experiences of perinatal loss: A review of the literature","authors":"Van Nguyen, M. Temple-Smith, J. Bilardi","doi":"10.1111/ajo.13041","DOIUrl":"https://doi.org/10.1111/ajo.13041","url":null,"abstract":"Perinatal loss is often considered an emotionally and physically traumatic event for expectant parents. While there is strong evidence of its impact on women, limited research has independently explored men's lived experiences.","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91428802","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}
{"title":"Journal Editorial Board","authors":"","doi":"10.1111/ajo.12858","DOIUrl":"https://doi.org/10.1111/ajo.12858","url":null,"abstract":"","PeriodicalId":8599,"journal":{"name":"Australian and New Zealand Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79076580","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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