Background Blended teaching combines traditional in-person components (simulation-based training and clinical-based placement) with online resources. Due to the COVID-19 pandemic, we modified our Women's Health Interprofessional Learning through Simulation (WHIPLS) program - to develop core obstetric and gynaecological skills - into a blended teaching program. There is limited literature reporting the observations of blended teaching on learning. Aims To qualitatively evaluate the blended teaching program and explore how it contributes to learning. Materials and Methods This study was performed at Monash University in Melbourne, Australia. A total of 98 medical students and 39 midwifery students participated. Data were collected by written survey and analysed by authors using a thematic analysis framework. Results Students reported that in-person teaching remains a vital aspect of their curriculum, contributing an averaged 63.2% toward an individual's learning, compared with online. Five substantial themes demonstrate how students learnt and maximised education opportunities using a blended teaching program: 'low-pressure simulation environments', 'peer-assisted learning', 'haptic learning', 'scaffolded learning' and 'the impact of online discourse'. Discussion In-person teaching remains a cornerstone of obstetric and gynaecological clinical skills education, of which interprofessional simulation and clinical-based placement are key components. Teaching via online discourse alone, is not sufficient to completely replace and provide comparable learning outcomes, but certainly plays an important role to prime students' learning and to maximise in-person opportunities and resources. Our study reveals key pedagogies of a blended (online and in-person) learning program, providing further evidence to support its ongoing utility as a feasible and warranted approach to learning.

Screening for chromosomal abnormalities based on cell-free fetal DNA (cfDNA) has been clinically available since 2011. While highly accurate for detection of trisomy 21, the accuracy of the test depends on the proportion of the total cfDNA that contains fetal genetic material (ie, the fetal fraction [FF]), with accuracy being higher when the FF is high and lower when the FF is low. Because cell-free " fetal" DNA originates from the developing placenta, studies have suggested that the release of cfDNA might be related to the size of the placenta and the rate of trophoblastic apoptosis. Although various studies show an increase in both fetal and total cfDNA in the maternal circulation in women diagnosed with preeclampsia (PE), little is known regarding FF in these cases and whether its measurement could be used as a marker of placental dysfunction in asymptomatic women. These researchers performed a retrospective cohort study including all women with a singleton pregnancy who had risk calculation for PE and fetal growth restriction (FGR) between 11 + 0 and 13 + 6 weeks' gestation and who also had cfDNA as a primary or secondary screening test for chromosomal abnormalities at any gestational age at 2 fetal medicine clinics in Sydney and Melbourne, Australia, between March 2013 and May 2017. Logarithmically transformed FF results were adjusted for gestational age and maternal characteristics. Associations with mean arterial pressure, mean uterine artery pulsatility index, pregnancy-associated plasma protein A (PAPP-A), placental growth factor, and risks of PE at less than 34 weeks, PE at less than 37 weeks, and FGR at less than 37 weeks were analyzed using correlation analysis and univariable and multivariable linear regressions. In total, 4317 singleton pregnancies that underwent cfDNA testing with FF reported were included. Significant prediction of FF was provided by gestational age, conception by in vitro fertilization, maternal age, body mass index, chronic hypertension, diabetes mellitus, South Asian ethnicity, and being parous without a history of PE or FGR. Fetal fraction was associated inversely with mean arterial pressure and mean uterine artery pulsatility index and associated positively with PAPP-A and placental growth factor. The lower the FF, the higher were the risks of PE at less than 34 weeks, PE at less than 37 weeks, and FGR at less than 37 weeks (P < 0.001 for all). The researchers concluded that there is a significant association between FF and first-trimester markers for adverse pregnancy outcome. Low FF is associated with an increased risk of pregnancy complications, but its capacity to act an as independent first-trimester marker in an algorithm for screening for PE and FGR requires further research.

Objectives To evaluate the association between fetal fraction on cell-free DNA (cfDNA) testing and first-trimester markers for pre-eclampsia, and to investigate the possible association of low fetal fraction with increased risks for pre-eclampsia (PE) and fetal growth restriction (FGR). Methods This was a retrospective cohort study including all women with a singleton pregnancy who had risk calculation for PE and FGR between 11 + 0 and 13 + 6 weeks' gestation and who also had cfDNA as a primary or secondary screening test for chromosomal abnormalities at any gestational age at two fetal medicine clinics in Sydney and Melbourne, Australia, between March 2013 and May 2017. Logarithmically transformed fetal fraction results were adjusted for gestational age and maternal characteristics. Associations with mean arterial pressure (MAP), mean uterine artery pulsatility index (UtA-PI), pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PlGF), and risks for PE < 34 weeks, PE < 37 weeks and FGR < 37 weeks were analyzed using correlation analysis and univariable and multivariable linear regressions. Results In total, 4317 singleton pregnancies that underwent cfDNA testing with fetal fraction reported were included. Significant prediction of fetal fraction was provided by gestational age, conception by in-vitro fertilization, maternal age, body mass index, chronic hypertension, diabetes mellitus, South Asian ethnicity and being parous without history of PE or FGR. Fetal fraction was associated inversely with MAP and UtA-PI and associated positively with PAPP-A and PlGF. The lower the fetal fraction, the higher were the risks for PE < 34 weeks, PE < 37 weeks and FGR < 37 weeks (P < 0.001 for all). Conclusions There is a significant association between fetal fraction result and first-trimester markers for adverse pregnancy outcome. Low fetal fraction is associated with an increased risk for pregnancy complication, but its capacity to act an as independent first-trimester marker in an algorithm for screening for PE and FGR requires further research. Copyright (C) 2017 ISUOG. Published by John Wiley & Sons Ltd.