ABSTRACT Intrahepatic cholestasis of pregnancy (ICP) is associated with maternal morbidity and adverse perinatal outcomes and has historically been managed with planned early birth. This retrospective study examined temporal trends in gestational age at birth among 943 ICP pregnancies at an Australian tertiary hospital between 2014 and 2024, spanning three local policy updates. There was a progressive shift in gestational age distribution from 37 weeks towards later gestations over time. Although the majority of cases were mild or severe disease, 18.1% of births were preterm, of which 84.2% were iatrogenic, suggesting an ongoing opportunity to improve adherence to guideline‐recommended timing of birth.
ABSTRACT Background Mental health disorders are common during the perinatal period and women with gestational diabetes mellitus (GDM) may be at greater risk than the general pregnant population. Aim We assessed if factors associated with symptoms of anxiety, depression and poor mental health‐related quality of life (HRQoL) differed between women with and without GDM. Materials and Methods Prospective cohort study of participants from the GEMS Trial. Participants completed questionnaires screening for anxiety, depression or HRQoL at enrolment, 36 weeks' gestation and 6 months postpartum. Potential associations were assessed using multivariable logistic regression for each questionnaire at each timepoint. Results Of 4061 participants, 433 (10.7%) were diagnosed with GDM. At enrolment, non‐European ethnicity, obesity, maternal age and previous perinatal death were associated with symptoms of poor mental health (above threshold for any questionnaire) in the overall cohort. Among women with GDM, Other ethnicity (not European, Māori, Pacific or Asian) was associated with increased risk for poor mental health, while Pacific ethnicity was most often associated with poor mental health in women without GDM. Women with obesity (BMI ≥ 30 kg/m 2 ) had a greater risk for poor mental health at baseline in both groups, but only in women without GDM in late gestation. Older age (≥ 40 years) was associated with poor mental health among women with GDM, and younger age (< 30 years) among women without GDM. Conclusion Non‐European ethnicity, obesity and maternal age are associated with poor mental health, but at different time points and different magnitudes of risk in women with and without GDM.
ABSTRACT Classical caesarean section (CCS) remains an uncommon but important procedure in obstetrics. We performed a retrospective review of all CCSs at Wellington Regional Hospital between January 2019 and December 2023. 109 CCSs were performed, representing 1.8% of all caesarean sections ( n = 5913) and 0.7% of all births ( n = 16646). Most (58.7%) were performed before 28 weeks' gestation, with an unformed lower uterine segment being the most common reason for performing a classical incision. Maternal morbidity and foetal mortality were closely linked to underlying conditions prompting delivery. These findings provide contemporary data to support clinical decision‐making and patient counselling regarding CCS.
ABSTRACT Background Only one automated insulin delivery (AID) system is licensed in Australia for use in pregnancies complicated by Type 1 diabetes (T1D); however, some women using other AID systems have continued to use these ‘off‐label’ in pregnancy. Usage patterns from a single centre in Australia will be of interest to clinicians supporting women with T1D in pregnancy. Aims This is an observational study evaluating outcomes in women treated with different AID systems through a pregnancy cared for at a tertiary maternity centre. Materials and Methods All women using AID in one or more trimesters of pregnancy through a 3‐year study period are included in the reporting of glycaemic and insulin delivery measures in each trimester of pregnancy. All women using AID throughout the duration of a pregnancy within the study period are included in the reporting of birth outcomes. Results Four AID systems had been used during the study period, MiniMed with Smartguard, T:slim with Control IQ, YpsoMed with CamAPS and Omnipod with SmartAdjust. Small numbers of YpsoMed and Omnipod users precluded these from statistical analysis. Women using MiniMed and T:slim AID systems differed in terms of early HbA1c and smoking history with MiniMed users representing suboptimal pre‐pregnancy diabetes control. Use of continuous glucose monitoring (CGM) was additionally significantly lower for users of the MiniMed system. Median pregnancy‐specific time in range (pTIR) was above 62% for all systems by trimester 2 and above 64% for all systems by trimester 3 with no significant difference between MiniMed and T:slim systems. There was less pregnancy‐specific time below range (pTBR) and/or time well below range (pTWBR) for the MiniMed system in all trimesters compared with the T:slim system. Conclusions AID systems without the tight target considered necessary for pregnancy were still able to achieve good glycaemic outcomes.
ABSTRACT Aims This study sought to determine contemporary practice and opinions regarding the use of third parties when performing intimate examinations. Specifically: What constitutes an ‘intimate examination’, the role and preferred terminology of third parties involved in intimate examinations, the nature of the consent and regulatory processes. Methods Prospective, cross‐sectional, observational study with participants recruited using a convenience sampling approach. Following a scoping review, an anonymous, confidential online survey was developed and distributed to health professionals working within Western Australian outer metropolitan obstetrics and gynaecology units. Both qualitative and quantitative data were obtained. Results 141 health professionals participated; the majority were female (86%), with 56 respondents from a nursing/midwifery background, 53 from a medical background. Most respondents agreed on which components of physical examination could be viewed as ‘intimate’, expressed strong preferences for the third party to be called ‘chaperone’ and had similar opinions on what the role involved and the importance of using registered health professionals. Compared to doctors, nurse/midwife participants were significantly more likely to obtain written consent, report health professional norms, and chaperone availability influenced their use of chaperones, and were less likely to offer a chaperone for a breast examination. More than one third of respondents considered a medical student appropriate to act as chaperone. Discussion Although intimate examinations are an integral part of clinical practice, it remains under‐researched. This study indicates that despite RANZCOG and MBA guidance, womens' health professionals prefer the term ‘chaperone’. Respondents recognised the importance of consent and documentation, but it is concerning that a significant proportion of respondents consider it acceptable to use students in these roles.
