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Journal of obstetrics and gynaecology [journal]
- Does preconception care work? [JOURNAL ARTICLE]
- Aust N Z J Obstet Gynaecol 2014 Jul 30.
To date, there is a lack of evidence to suggest that a systematic and coordinated approach to prepregnancy care might make a difference.To evaluate whether women who receive preconception care through a structured approach will be more likely to be healthy around the time of conception compared with women who plan their pregnancy but have not been exposed to preconception care.A case control study was undertaken of women who attended the preconception care service and subsequently conceived, received maternity care and gave birth at Mater Health Services Brisbane between January 2010 and January 2013. Pregnancy information and birth outcomes for each woman who attended the service were matched with those of three women who reported that they had planned their pregnancy but did not attend the service. Records were matched for prepregnancy BMI, age, parity, prepregnancy smoking status and number of health conditions.Pregnant women who attended preconception care were more likely to have received adequate peri-conceptual folate, to report being vaccinated against influenza and hepatitis B, to have consulted with a specialist with the specific aim of optimising a pre-existing health condition and to report less weight gain up until booking. Preterm birth and hypertensive disorders of pregnancy were less common amongst women who had attended preconception care, and there were trends towards a decreased incidence of gestational diabetes, LGA and fetal anomalies.These preliminary data provide some optimism that a comprehensive preconception care service may positively influence maternal and neonatal outcomes.
- Rethinking unmet need: Determinants of contraceptive use in Santiago, the Dominican Republic. [JOURNAL ARTICLE]
- J Obstet Gynaecol 2014 Aug 14.:1-6.
Inadequate access to contraceptives is often considered the primary source of unmet need among women who desire to prevent pregnancy. This study evaluates two potential determinants of contraceptive use among Dominican women: (1) perceived access to family planning and (2) perceived personal reproductive control, a measure based in psychological theories of locus of control. Sexually active women aged 18-45 who did not desire fertility were surveyed to assess influences on contraceptive use. In-depth interviews were conducted among a subset of participants to contextualise survey results. Fewer than half (49%) of the 80 survey respondents had used contraception in the last 3 months. Higher personal reproductive control was significantly related to contraceptive use (aOR 1.18, 95% CI 1.04-1.34), however, higher perceived access to contraceptives was not (aOR 1.09, 95% CI 0.97-1.23). Male partner influence was identified as a barrier to contraceptive use. In this population, high personal reproductive control is a better predictor of contraceptive use than perceived access.
- Re: New directions in the prediction of pre-eclampsia. [Letter]
- Aust N Z J Obstet Gynaecol 2014 Aug; 54(4):395-6.
- Re: New directions in the prediction of pre-eclampsia. [Letter]
- Aust N Z J Obstet Gynaecol 2014 Aug; 54(4):395.
- Caution regarding first trimester screening for pre-eclampsia. [Letter]
- Aust N Z J Obstet Gynaecol 2014 Aug; 54(4):394-5.
- Offering HPV vaccination to women treated for high-grade cervical intra-epithelial neoplasia: What do you need to know? [Letter]
- Aust N Z J Obstet Gynaecol 2014 Aug; 54(4):393-4.
- Teetering near the edge; women's experiences of anal incontinence following obstetric anal sphincter injury: an interpretive phenomenological research study. [Journal Article]
- Aust N Z J Obstet Gynaecol 2014 Aug; 54(4):377-81.
Obstetric anal sphincter injury (OASIS) following vaginal delivery increases the risk of anal incontinence (AI). Subsequent vaginal delivery and ageing increase the risk of worsening symptoms. Very little literature describes any in-depth understanding of what it is like to live with AI following a history of known OASIS.To describe and interpret women's experience of AI following OASIS and its impact on quality of life.An interpretive phenomenological study was conducted in a level 2 tertiary hospital in South Australia. Women with a history of OASIS and AI were purposefully recruited. The St Marks Vaizey score was utilised to identify symptom severity. Semi-structured open-ended interviews were conducted, and data were analysed utilising Van Manen thematic analysis.Participants (n = 10) aged 26-56 years. All women were symptomatic of AI following OASIS, and 80% had received a primary OASIS at their first vaginal delivery. The St Marks Vaizey score mean was 9.1 (range within 4-22). Three essential themes grieving for loss, silence, striving for normality with eight subthemes identified a significant sense of loss and psychological impact of AI for this group of women.Health professionals require a greater understanding of the negative impact of OASIS and AI on women's quality of life. This may improve the management, education and clinical care of this condition which may result as a consequence of OASIS.
- Perineal outcome and the risk of pelvic floor dysfunction: A cohort study of primiparous women. [Journal Article]
- Aust N Z J Obstet Gynaecol 2014 Aug; 54(4):371-6.
Pelvic floor dysfunction (PFD) is the most common complication of childbirth. Assumptions have been made that perineal trauma increases the risk of PFD compared to an intact perineum, however the evidence for this is lacking. The aim of this study was to explore the relationship between perineal outcome and postpartum PFD.Prospective cohort study design, with a self-reported quality of life (QOL) questionnaire mailed to all primiparous women with a non-instrumental delivery at The Townsville Hospital between 2011 and 2012 (n = 766). ANOVA was used to compare how the symptoms of PFD affect QOL in women with an intact perineum, episiotomy or spontaneous tear.Seventy-nine percent of the population had perineal injury; 60% had a spontaneous tear and 19% had an episiotomy. Ninety-seven percent of women who completed the questionnaire (n = 196) complained of PFD symptoms. Women with episiotomy had the best QOL, reporting the lowest levels of urinary dysfunction (statistically significant). No differences between the groups were found for symptoms of bowel, prolapse or sexual dysfunction.This study shows a relationship between perineal outcome and PFD and suggests that an episiotomy is associated with the least morbidity due to symptoms of urinary incontinence. Additional large-scale prospective research is required to further investigate and delineate the impact of childbirth on PFD.
- Improving VBAC rates: the combined impact of two management strategies. [Journal Article]
- Aust N Z J Obstet Gynaecol 2014 Aug; 54(4):327-32.
Caesarean section rates in Australia have risen to >30%, with repeat caesarean delivery the most common indication. One method of reducing caesarean delivery rates is to increase rates of vaginal birth after caesarean section (VBAC).To determine the combined effect of two management strategies on the rates of successful VBAC in women experiencing their first pregnancy following primary caesarean section.Prospective cohort study from May 2009 to October 2010 at a metropolitan Australian teaching hospital. The strategies studied were (i) allocating responsibility for VBAC candidates attempting labour to the hospital's three high-risk obstetric consultants and (ii) implementing a next birth after caesarean (NBAC) antenatal clinic designed to counsel and support women deciding on mode of birth for their next pregnancy after a primary caesarean section. Data were collected from Obstetrix, a NBAC logbook and medical records of 396 eligible women who gave birth during the study period.Overall VBAC rates improved from 17.2% in 2006 prior to implementation of the combined strategies, to 27.0% over the studied period (P < 0.001). Of those women who desired and attempted a VBAC, the success rate was 64.4%. Regression analysis identified an increased likelihood of attempted vaginal birth where malpresentation was the indication for previous caesarean, while Eastern Asian ethnicity was associated with increased likelihood of choosing repeat caesarean.A dedicated NBAC clinic and more consistent approach to labour management can help improve VBAC rates. Further targeted counselling towards women with previous malpresentation and/or East Asian descent may further improve VBAC attempt rates.
- The CROWN Initiative: journal editors invite researchers to develop core outcomes in women's health. [Editorial]
- Aust N Z J Obstet Gynaecol 2014 Aug; 54(4):298-9.