BACKGROUND:Suicide in the peripartum is a leading cause of death in Australia. Appropriate screening and response to self-harm and suicidality during antenatal appointments is key to reducing the risk of suicide. AIM:The study explores the knowledge, confidence and behavioural changes resulting from an educational intervention for midwives in assessing and making appropriate referrals based on self-harm and suicide risks in antenatal women, as screened by question ten of the Edinburgh Postnatal Depression Scale (EPDS) eliciting thoughts of self-harm in the previous 7 days. MATERIALS AND METHODS:Educational workshops aimed at improving midwives' confidence and capabilities in conducting suicide risk assessments, developing safety plans and understanding referral pathways were completed. Changes to medical documentation in relation to risk assessment and follow-up actions were reviewed pre- and post- the education sessions. RESULTS:Midwives' (N = 115) self-reported knowledge and confidence increased from pre- to post-education. Pre-intervention, 86 (5.87%) antenatal women answered question ten positively on the EPDS. Medical documentation revealed that more midwives were able to screen for the frequency and persistence of suicidal thoughts following the training. CONCLUSION:While education enhanced knowledge and confidence as well as resulted in improvements to some risk assessment practices, further systemic and organisational support may be necessary to achieve consistent and comprehensive risk assessments and adherence to recommended follow-up actions in clinical practice. The study underscores the critical role of continuous training for midwives in self-harm/suicide assessment, particularly given the significant maternal mortality associated with suicide.
BACKGROUND:Anti-Müllerian hormone (AMH) tests are often promoted as a measure of fertility; however, AMH adds limited predictive value beyond age alone for estimating the likelihood of live birth in couples trying to conceive. AIMS:This study aimed to examine longitudinal trends in the rate of AMH testing for fertility in the Australian general practice setting. MATERIALS AND METHODS:Retrospective open cohort study of 1,393,931 females aged 20-44 years attending Australian general practices between 2011 and 2021 using the national general practice database, MedicineInsight. Free text 'test reason' fields were examined to identify AMH tests ordered by General Practitioners for fertility assessment. We calculated age-standardised annual prevalence rates for AMH tests overall, as well as stratified by age group and concession card status. To examine between-practice variation, the intraclass correlation coefficient (ICC) was estimated using a two-level logistic regression model. RESULTS:The annual age-standardised prevalence of AMH test requests increased from 0.32 per 1000 females in 2011 to 4.33 per 1000 females in 2021. AMH testing was more common among those residing in a major city and of higher socioeconomic status, but less common among concession card holders. Following adjustment for patient case-mix, 21% (95% CI 18%-24%) of observed variation in AMH testing was attributable to differences between practices, with 45/423 (10.6%) of general practices having no patients with an AMH test. CONCLUSIONS:The noted substantial increase in clinical and consumer demand for AMH testing does not appear to be evidence-based, with substantial patient- and practice-level variation in testing evident.
BACKGROUND:Robotic-assisted gynaecologic surgery has expanded globally, yet its adoption in Australasia remains variable. AIM:To evaluate the current attitudes, practice patterns, and perceived barriers surrounding robotic-assisted gynaecologic surgery among clinicians in Australia and New Zealand (Australasian). MATERIAL AND METHODS:A cross-sectional, anonymised electronic survey was distributed to all RANZCOG-certified obstetrician-gynaecologists practicing in Australasian. The survey assessed demographics, access to and use of robotic platforms, perceived advantages and limitations, and willingness to expand robotic practice. Associations between years of clinical experience and access, utilisation, and attitudes toward robotic surgery were analysed. RESULTS:A total of 276 clinicians responded. Most (62.2%) had more than 10 years of clinical experience. 37.5% reported access to robotic-assisted surgery, and among those, 34% currently performed robotic procedures mostly for < 25% of major operations. Willingness to expand usage remained low even if access improved (42.8%). Ergonomic benefit and surgeon longevity were the most cited advantages, while fewer than half believed robotics improved patient outcomes. Main barriers were high cost, longer operative time, limited evidence of benefit, and scarce training opportunities. Clinicians with ≤ 10 years of experience were more likely than senior colleagues to perceive advantages (68.3% vs. 38.8%) and to express willingness to adopt robotics if given access (56.9% vs. 33.7%). CONCLUSIONS:As of 2025, robotic surgery remains limited in Australasian gynaecology, with adoption shaped by practical concerns, limited evidence, cost, and access. Nevertheless, greater enthusiasm among early-career clinicians suggests future practice may evolve. Ongoing evaluation and evidence-based decision-making will be essential as the field advances.
BACKGROUND:Australian endometriosis guidelines recommend transvaginal ultrasound (TVUS) as the first-line investigation for endometriosis. Where endometriosis has been surgically treated, there is a risk of recurrent disease and repeat surgery. It is unknown if the diagnostic accuracy of ultrasound for recurrent disease is equivalent to the surgery-naïve. AIMS:To compare the accuracy of TVUS to diagnose endometriosis in women undergoing a first versus any subsequent laparoscopy. MATERIALS AND METHODS:Retrospective analysis of the National Endometriosis Clinical and Scientific Trials registry included women aged 18-50 years who had undergone TVUS prior to gynaecological laparoscopy. Diagnostic accuracy of TVUS was compared between women with and without a history of surgical endometriosis treatment, with laparoscopy and histopathology as the reference standards. Subgroup analysis was undertaken by disease phenotype. RESULTS:There were 470 ultrasound-laparoscopy dyads included for analysis (first laparoscopy n = 245 vs. subsequent laparoscopy n = 225), with histopathology available for 443 cases (first laparoscopy n = 234 vs. subsequent laparoscopy n = 209). Diagnostic accuracy did not differ between the two groups when compared to either laparoscopy (first laparoscopy: AUC 0.58 [95% CI 0.31-0.85], sensitivity 40.7% [34.7%-47.0%], specificity 75.0% [29.0%-96.0%] vs. subsequent laparoscopy: AUC 0.60 [0.46-0.74], sensitivity 46.2% [39.6%-52.9%], specificity 73.3% [47.5%-89.3%]) or histopathology (first laparoscopy: AUC 0.54 [0.31-0.77], sensitivity 40.8% [34.6%-47.3%], specificity 66.7% [29.6%-90.4%] vs. subsequent laparoscopy: AUC 0.56 [0.45-0.67], sensitivity 47.5% [40.4%-54.8%], specificity 64.3% [45.7%-79.3%]). CONCLUSIONS:Diagnostic accuracy did not differ based on previous endometriosis surgery. Community-based TVUS performs considerably more poorly than research suggests, missing 55.5% of endometriosis overall and 63.2% of superficial disease, reinforcing that a negative ultrasound does not exclude endometriosis.
BACKGROUND:Adjunct therapies are defined by regulatory bodies as non-essential treatments of uncertain clinical value that may be offered alongside established fertility interventions. Despite ongoing debate regarding their cost, potential adverse effects and lack of proven benefit, many patients' undergoing in vitro fertilisation (IVF) remain interested in trying alternative or complementary options to improve their chances of success. AIMS:To explore the key factors influencing women's decisions to consider or use adjunct therapies during IVF treatment. MATERIALS AND METHODS:An anonymous online survey was distributed to women in Australia who had considered or used adjunct therapies as part of their IVF journey. Respondents provided information on the types of adjuncts used, their perceived benefits and risks, sources of information and factors influencing decision-making. RESULTS:A total of 99 participants completed the survey. Most participants (94%, n = 93) used or considered adjuncts such as acupuncture and nutritional supplements, valuing perceived benefits and a sense of control despite limited scientific evidence of efficacy or safety. While many acknowledged the lack of robust data, few were deterred by this, highlighting the emotional and psychological drivers of decision-making. However, participants still valued accessible, independent information sources and open, empathetic discussions with clinicians. CONCLUSIONS:Women undergoing IVF frequently consider and use adjunct therapies and report feeling well informed about their use, despite limited high-quality evidence supporting efficacy. Cost, risk and lack of proven benefit appear to have minimal influence on decision-making in the surveyed cohort. Given the ongoing and widespread interest in these treatments, clinicians should remain informed and open to discussing adjunct therapies to facilitate balanced, evidence-based and patient-centred decision-making.
BACKGROUND:Endometriosis affects up to 10% of biological females of reproductive age. Current treatment options are limited and often unsuitable for prolonged use. Cannabis-based medicinal products (CBMPs) have emerged as an alternative for pain management. AIMS:To analyse changes in patient-reported outcome measures (PrOMs), prescribed opioid burden, and the prevalence of adverse events (AEs) in patients prescribed CBMPs for endometriosis-associated pain. MATERIALS AND METHODS:This was an observational analysis of prospectively collected data from the UK Medical Cannabis Registry. Biological females (≥ 18 years) with a primary diagnosis of endometriosis, enrolled ≥ 2 years prior to data extraction on 06/01/2025, were included. PrOMs and prescribed oral morphine equivalents (OME) were assessed between baseline and 1, 3, 6, 12, 18, and 24 months. Changes from baseline were assessed by repeated-measures ANOVA and Bonferroni-adjusted post hoc pairwise t-tests. p < 0.050 was considered statistically significant. RESULTS:One hundred and one patients were included. Improvements from baseline were observed in BPI Severity, BPI Interference, SF-MPQ-2 Total, Pain VAS, EQ-5D-5L Index, GAD-7, and SQS at all follow-ups (p < 0.001). Mean prescribed OME decreased from 19.9 ± 17.2 mg/day at baseline to 14.8 ± 15.9 mg/day at 24 months. Eighteen participants (17.8%) reported 165 AEs, of which 84 (50.9%) were mild. The most frequent were fatigue (n = 16; 15.8%), lethargy (n = 15; 14.9%), and headache (n = 13; 12.9%). CONCLUSION:CBMP treatment was associated with sustained improvements in pain, health-related quality of life, sleep, and anxiety at 24 months, with a favourable AE profile. Randomised controlled trials are required to establish efficacy and safety.
BACKGROUND:Diagnosis and management of cervical cancer require multiple investigations and specialist reviews, with delays leading to increased mortality and morbidity. Australia's Optimal Care Pathways (OCPs) recommends that patients with suspected diagnosis of cervical cancer should have their diagnostic processes completed within certain timeframes. Despite these guidelines, there is currently no benchmarking of cervical cancer timelines. AIMS:This study aims to benchmark cervical cancer care and identify factors associated with delay. MATERIALS AND METHODS:Patients who underwent radiotherapy for Stage I-III cervical cancer between 2015 and 2024 at a major tertiary hospital in New South Wales (NSW) were included in the study. This hospital provides centralised gynae-oncology care for all women in three NSW local health districts. Patients were stratified based on age, stage of disease, level of rurality and level of socioeconomic advantage/disadvantage. Each step of the diagnostic timeline was benchmarked against the OCPs. Univariate and multivariate logistic regression were performed to detect factors associated with delays. RESULTS:The study cohort comprised 155 patients. Under 60% of women were managed in-line with the OCPs recommended timelines. 86% (n = 19/22) of women from the least disadvantaged socio-economic tertile saw a gynae-oncology specialist within the recommended timeframe compared to 47% (36/76) from the most disadvantaged socio-economic tertile (OR: 6.24, CI: 1.60-24.27, p = 0.008). CONCLUSIONS:Recommended diagnostic timelines were not met in a significant proportion of women. Women from the greatest levels of socioeconomic disadvantage were more likely to face delays. Benchmarking processes need to be implemented in cancer care, to ensure equity in outcomes/processes for all patients.
BACKGROUND:Clinical chorioamnionitis is a major contributor to preterm birth and neonatal morbidity. Diagnosis in women with intact membranes is challenging, particularly in the subclinical phase where maternal signs are subtle and conventional serum markers are limited in predictive value. AIMS:To evaluate the diagnostic performance of selected novel amniotic fluid biomarkers (interleukin-6, interleukin-10, tumour necrosis factor-ɑ, matrix metalloproteinase-8), and conventional amniotic and serum biomarkers in predicting delivery for clinical chorioamnionitis within 14 days of amniocentesis in women with suspected subclinical infection and intact membranes. MATERIALS AND METHODS:A prospective cohort study was conducted at a single Australian tertiary hospital. Thirty-two women with singleton pregnancies and suspected subclinical chorioamnionitis underwent amniocentesis. Amniotic fluid and serum were analysed for selected biomarkers. The primary outcome was delivery for clinical chorioamnionitis within 14 days of amniocentesis. ROC curves were constructed to assess biomarker performance. RESULTS:Delivery for clinical chorioamnionitis occurred in 11 of 31 evaluable cases (35%). Matrix metalloproteinase-8, lactate dehydrogenase, and glucose were the strongest predictors (area under the curve (AUC) of 0.93 (95% CI 0.85-1.0), 0.93 (95% CI 0.85-1.0), and 0.92 (95% CI 0.8-1.0) respectively). Amniotic fluid biomarkers outperformed serum markers (C-reactive protein AUC 0.70 (95% CI 0.49-0.91) and white cell count AUC 0.67 (95% CI 0.46-0.86)). Novel amniotic fluid biomarkers did not demonstrate superior diagnostic performance over conventional amniotic fluid biomarkers including lactate dehydrogenase and glucose. CONCLUSIONS:Amniotic fluid biomarkers show promise in identifying women with subclinical chorioamnionitis. These findings support further validation of scalable biomarker-based testing to guide early intervention and improve perinatal outcomes.
Hysteroscopic assessment of the endometrial cavity is essential in the investigation and management of abnormal uterine bleeding (AUB) and intra-uterine pathology. Out-patient hysteroscopy is both resource efficient and acceptable to patients. This study aims to compare protocols in 13 outpatient hysteroscopy centres across Australia and New Zealand. The findings of this study suggest an overall alignment with the Royal College of Obstetricians and Gynaecologists (RCOG) Green-top Guideline recommendations. Heterogeneity between protocols suggests that standardisation of the process could be further improved to enhance the patient experience.
BACKGROUND:Online information in Australia about abortion has not been assessed, despite its capacity to impact the trajectory of care without face-to-face medical expertise. AIM:To evaluate the online information that women in Australia can access for an unintended pregnancy. STUDY DESIGN:Mixed methods were employed in four phases. A search identified abortion portals (defined as a webpage under a single domain, providing access to other abortion websites). DISCERN scores evaluated portals quality standard. A Student's t-test was employed to assess the difference in quality by type of organisation (portals ending in .gov.au vs. .org.au). A one-way ANOVA compared portals according to the population size they targeted: ≤ 3 million, > 3 million to 8.2 million and > 8.2 million. Summative content analysis explored the framework of written words within portals associated with decision-making. RESULTS:Two hundred and thirty-seven results were identified, with 24 selected. Portals were generally high quality (61.25 out of a possible 80). Quality standard did not significantly differ by type of organisation (.gov.au: 64.9, .org.au: 59.1; p = 0.28), nor by population size targeted (≤ 3 million: 64.2, > 3 million to 8.2 million: 58.3, > 8.2 million: 61.25; p = 0.59). Summative content analysis identified five categories associated with decision-making: I am pregnant now what?, emotional support, facts that impact choices, practicalities and procedural knowledge. CONCLUSION:The rigorous methods employed to review the online abortion sites provided women with the information required to better prepare for and navigate abortion services and make decisions expeditiously. We now need to assess if women are using these resources to make decisions about their care.
BACKGROUND:Transabdominal cervical cerclage (TACC) may be used for those at very high risk of spontaneous preterm birth, where transvaginal cerclage has been ineffective previously or is not possible. High-quality randomised evidence supports the use of this relatively uncommon procedure, but there is no published experience of its use in Aotearoa New Zealand. AIMS:To review all cases of TACC performed in a tertiary hospital that receives referrals from across Aotearoa New Zealand. MATERIALS AND METHODS:This is a single-centre retrospective observational study. All TACC performed at National Women's Health, Auckland City Hospital, Auckland between 1st January 2007 and 31st August 2023 were included. Cases were identified from hospital theatre records. Data were obtained from medical records and perinatal databases. Outcomes for the index and all subsequent births up to 31st October 2024 were included. RESULTS:Forty people received a TACC. The most common indication was obstetric history (27, 62.5%), followed by extensive cervical surgery (13, 32.5%). There were 47 pregnancies in 33 people, including five early miscarriages and one pregnancy termination for foetal anomalies. In the remaining 41 pregnancies, 37 (90.2%) resulted in a live birth ≥ 24 weeks, with a mean gestation at birth of 36 + 1 weeks. All 37 neonates were alive at hospital discharge with low rates of complications. CONCLUSIONS:This study demonstrates favourable perinatal outcomes following TACC in those at high risk of spontaneous preterm birth in Aotearoa New Zealand.
BACKGROUND:Progesterone elevation (PE) is perceived as the product of cumulative secretion of low levels of progesterone from multiple developing follicles and is commonly present in high responders. Therefore, PE occurring with an unexpectedly low number of follicles potentially represents a different pathophysiological entity such as follicular dysregulation, which may reflect poorer follicular and oocyte quality, which is not yet well studied. AIM:To determine if progesterone elevation is associated with oocyte or embryo quality in patients with 1-4 follicles ≥ 10 mm on the day of triggering final oocyte maturation. METHODS:This is a multi-centre retrospective cohort study of 1393 IVF/ICSI cycles with a low response (1-4 follicles ≥ 10 mm) to ovarian stimulation performed from January 2018 to April 2022. Unexpected PE was defined as serum progesterone levels > 4.77 nmol/L on the day of triggering final oocyte maturation. The primary outcome was the number of usable Day 5 blastocysts. Generalised estimating equations were used to account for the clustered nature of data and to adjust for the effect of multiple confounders. RESULTS:A negative association of PE with the primary outcome measure of this study was shown in the multivariable regression analysis where the number of usable blastocysts was significantly (p < 0.0001) lower in the PE group (adjusted mean 0.18, 95% CI 0.07-0.28) compared to the non-PE group (adjusted mean 0.27, 95% CI 0.24-0.31) after adjusting for confounders. CONCLUSION:PE on day of triggering final oocyte maturation is negatively associated with fertilisation rates and the number of usable blastocysts in patients with 1-4 follicles ≥ 10 mm.
BACKGROUND:In Australia, ultrasonography to confirm gestational age (GA) and pregnancy location is a routine component of early medical abortion (EMA) care. Internationally, protocols have been developed using a history-based screening tool to identify women not requiring ultrasound. This approach, now supported by Australian guidelines, aims to reduce unnecessary barriers to abortion care. AIMS:To assess the validity and accuracy of an eligibility assessment tool for no-ultrasound EMA care. Self-reported estimation of GA and risk factors for ectopic pregnancy were compared to ultrasound findings. MATERIALS AND METHODS:This was a multicentre prospective observational study. Patients aged 14 years and over attending for EMA completed a questionnaire, including estimation of GA using last menstrual period (LMP) or date of conception (DOC), if known, and identification of risk factors for ectopic pregnancy. All patients subsequently underwent routine abortion care, including ultrasound assessment, and outcomes were determined. RESULTS:Of 705 patients who completed the questionnaire between 4 January 2022 and 30 August 2023, 469 were certain of their LMP or DOC (66.5%). When the screening tool was applied, 214 (30.4%) patients remained eligible for no-ultrasound care, and all these were found to have an intrauterine pregnancy. One patient had a GA over 63 days by ultrasound. CONCLUSIONS:A history-based screening tool determined 30% of patients eligible for no-ultrasound EMA care. No eligible patients had an ectopic pregnancy and only one had an ultrasound confirmed GA above 63 days. Models of EMA care not requiring routine ultrasound may improve abortion access, especially for those in rural and remote areas where ultrasound availability can be challenging.
In May 2026, the Legislation (Definitions of Woman and Man) Amendment Bill was introduced into the New Zealand Parliament; seeking to legally define 'woman' in law as 'an adult human biological female', and 'man' as 'an adult human biological male'. It would affect how trans, non-binary, takatāpui, and intersex people are viewed in the eyes of the law, weakening anti-discrimination protections and restricting rights and access to healthcare. RANZCOG's commitment to cultural safety is an important asset to guide health professionals as we grapple with how to respond to the Bill. Equitable health outcomes for everyone depend on it.
INTRODUCTION:Intrapartum antibiotics are often used to reduce neonatal risk of early-onset Group B Streptococcus (GBS) disease. Protocols aim to achieve a fetal serum and amniotic fluid concentration above the minimum inhibitory concentration (MIC) of GBS at the time of birth. AIMS:We aimed to summarise the evidence for currently recommended doses of benzylpenicillin by comparing intrapartum fetal serum and amniotic fluid concentrations of benzylpenicillin with the associated MIC of GBS at the time of birth. METHODS:We systematically reviewed PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, and Embase databases. We sought studies in which umbilical cord blood and/or amniotic fluid were examined for Benzylpenicillin concentrations after intrapartum intravenous administration. RESULTS:Seven studies were included, using a variety of doses, applying different assay techniques, and reporting a wide range of concentrations reported in the umbilical cord serum and amniotic fluid. Concentrations were often significantly higher than the target MIC of 0.125 mcg/mL. Significant methodological limitations included reporting of total concentrations of antibiotic only and substantial protocol violations. DISCUSSION:There is a lack of high-quality evidence to support the current dosing of intrapartum antibiotics, with regards to whether appropriate MICs are achieved in the fetus. Studies applying rigorous methodology and accounting for drug protein binding are required to determine the dosing regimens required to achieve these concentrations in the umbilical cord serum and amniotic fluid.
BACKGROUND:Foetal growth restriction (FGR) increases risks of neonatal morbidity and mortality. Identifying and preventing FGR is key to improving neonatal outcomes. FGR risk assessment tools are designed to recognise women at high risk of FGR. AIMS:This study aims to compare the theoretical effectiveness of four different FGR risk factor assessment pathways in identifying women at risk for FGR: New South Wales (NSW) Foetal Safety Risk Assessment, Safer Baby Bundle FGR pathway, NHS Saving Babies' Lives risk assessment tool and RCOG Screening for Small Gestational Age foetus pathway. These pathways recommend management plans for women identified to be at risk for FGR. MATERIALS AND METHODS:This retrospective study at Westmead Hospital compared singleton births between 2018 and 2021 that were ≥ 40 weeks' gestation with birthweight < 3rd percentile, against the four FGR pathways. Prior to 2022, NSW had no recommended algorithm to identify patients at risk for FGR. RESULTS:116 women and 116 growth-restricted babies were included for analysis. The NSW Foetal Safety Risk Assessment would have identified 32 (27.6%) women to be at risk for FGR, the Safer Baby Bundle 39 (33.6%), the NHS tool 44 (37.9%) and the RCOG pathway 36 (30%). 32 (23%) babies required neonatal intensive care or special care nursery admission with no neonatal deaths or stillbirths. CONCLUSION:Foetal risk assessment tools increase identification of women at risk of FGR, although none are perfect. Ongoing improvements to risk assessment algorithms will help identify larger cohorts of patients at risk of FGR and reduce poor neonatal outcomes.
Background Antiemetic use during pregnancy is rising in high-income countries. Increasing use of antiemetics has also been documented in Aotearoa New Zealand (NZ); however, the specific antiemetics dispensed have not been reported.Aim To describe patterns of antiemetic dispensing during pregnancy in NZ, 2005-2020.Materials and Methods Community-based antiemetic dispensings were linked with 1.37 million pregnancies in the New Zealand Pregnancy Cohort. The proportions of pregnancies in which there was at least one dispensing of any and of specific antiemetics were calculated for each trimester and calendar year. Maternal characteristics and the sequence in which unique antiemetic regimens were introduced were described for pregnancies with first trimester exposure.Results First trimester antiemetic exposure increased from 4.1% to 19.7% of pregnancies between 2005 and 2019. Although metoclopramide was the most commonly dispensed antiemetic during Trimester 1 in all years (increasing from 3.1% to 12.4%), there was a substantial increase in ondansetron dispensing (0.1% to 9.1%). Ondansetron users were more likely than metoclopramide users to be European/Other and have a hospital admission for hyperemesis gravidarum. Metoclopramide and ondansetron monotherapy were first-line regimens in 70.0% and 1.9% of pregnancies with Trimester 1 exposure between 2005 and 2010 versus 46.5% and 26.5% between 2016 and 2020.Conclusions Ondansetron dispensing increased substantially over time. Further exploration of the context of ondansetron prescribing in NZ is warranted, as is further research into potential adverse outcomes.
AIM:This review sought to ascertain which features of antenatal models promote better outcomes among Indigenous pregnant women living in rural areas. METHODS:Four databases were searched, and then peer-reviewed research comparing models of antenatal care were critically appraised and themes identified. RESULTS:Twenty-nine articles met inclusion criteria and were of acceptable methodological quality for data extraction and analysis. Three main themes around service structure, accessibility and environment emerged, which were broken down into 17 subthemes. Most studies emphasised the importance of involving Indigenous elders and family, as well as Indigenous and female staff, to build community-based and controlled antenatal care, resulting in more holistic and culturally safe practices. A focus on communication, relationship-building and development of trust improved levels of preventative healthcare, risk screening, past negative experiences addressed and health education. In addition to conventional clinical care, home visiting, outreach programmes and quality-improvement approaches (CQI) proved vital for accessibility, engagement and overall model success. CONCLUSION:Successful models of antenatal care for Indigenous women living rurally are those created, managed and run by the community, and should have a focus on culturally safe communication, relationship-building, preventative healthcare and education. PRACTICE IMPLICATIONS:These findings can inform the development of evidence-based, culturally safe antenatal models of healthcare at clinical and policy level, in partnership with and for rural Indigenous women; as well as guide funding and work personnel allocation.
BACKGROUND:Fear of procedural pain is a significant barrier to intrauterine device (IUD) uptake. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in IUD insertion for their analgesic and anti-inflammatory properties; however, evidence for their effectiveness remains inconsistent. AIMS:This systematic review and meta-analysis aimed to synthesise current evidence regarding the effectiveness of NSAIDs for pain relief during outpatient IUD insertion. MATERIALS AND METHODS:A search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL and Scopus was performed from inception to March 3, 2025. The search strategy was developed using the Population, Intervention, Comparator, Outcome (PICO) framework. Two reviewers independently selected studies, extracted data and assessed included studies for bias using the Risk of Bias 2 (RoB 2) tool. Trials comparing pain scores between NSAID and placebo were pooled in a meta-analysis. RESULTS:Twenty-two studies, published between 2006 and 2024, met inclusion criteria. Ibuprofen (n = 6) was most used, followed by diclofenac (n = 4) and naproxen (n = 4). NSAIDs were administered orally (n = 17), intramuscularly (n = 2) and rectally (n = 2), with route not specified in one study. A meta-analysis of fourteen studies comparing NSAID with placebo, with a total sample size of 3358, found a statistically significant reduction in pain scores (mean reduction 0.77, 95% CI -1.29, -0.25). Side effects and adverse events did not differ significantly between groups. CONCLUSIONS:Our review demonstrates an analgesic role for NSAIDs during IUD insertion, with a significant reduction in pain scores when compared to placebo. This evidence, limited by clinical and statistical heterogeneity, is of low certainty.
Endometriosis is a challenging condition to diagnose, frequently typified by long diagnostic delays. In an online survey study of 657 endometriosis patients from Aotearoa New Zealand, awareness of endometriosis at symptom onset was low, contributing a two-year increase to diagnostic delay. While respondents most frequently learnt of endometriosis from friends and family (33.8%), they predominantly accessed resources regarding endometriosis online (77.9%). Patients highlighted that resources explaining the full range of endometriosis symptoms were needed for the general public, students, and endometriosis patients to improve surveillance for the condition and allow earlier recognition and diagnosis.
