Journal Of Obstetrics And Gynaecology[JOURNAL]
Sun
200 papers
The influence of high maternal body mass index (≥35 kg/m) on haemodynamic parameters during pregnancy: a prospective observational study.
Hmeidan M, Leone FMT, Osman MW … +2 more , Webb D, Mousa HA
J Obstet Gynaecol · 2025 Dec · PMID 40910691 · Publisher ↗
BACKGROUND: Maternal obesity is a growing global health concern, yet its impact on maternal haemodynamic throughout pregnancy remains underexplored. We investigated haemodynamic adaptations across gestation in women with...
BACKGROUND: Maternal obesity is a growing global health concern, yet its impact on maternal haemodynamic throughout pregnancy remains underexplored. We investigated haemodynamic adaptations across gestation in women with high body mass index (BMI) (≥35 kg/m) and results were compared to low-risk controls (BMI 18.5-24.9 kg/m). METHODS: This prospective observational study used non-invasive cardiac output monitoring (NICOM; Baxter Healthcare, Deerfield, IL) to assess maternal haemodynamic parameters, including cardiac output (CO), stroke volume (SV), total peripheral resistance (TPR), systolic blood pressure (sBP) and mean arterial pressure (MAP) in pregnant women with high BMI. Assessments were carried out across five gestational windows (11-19 + 6, 20-27 + 6, 28-33 + 6, 34-37 + 6 and ≥38 weeks). Results were compared to low-risk healthy controls (BMI 18.5-24.9 kg/m). RESULTS: A total of 329 women were recruited, including 125 with high BMI and 189 controls. Across all gestational windows, women with high BMI consistently demonstrated significantly higher CO and SV. Compared to controls, median CO was high among women with high BMI, at 11-19 + 6 weeks [8.8 L/min (IQR 7.2-9.9) versus 6.7 L/min (5.8-7.6); < .001]; median SV was 104.2 mL (93.7-124.9) versus 81.9 mL (74.3-94.0) ( < .001). This trend persisted at later gestations. In contrast, median TPR was significantly lower in the high BMI group; at 28-33 + 6 weeks, 847 dyn·s·cm (unit of measurement of TPR: dynes·seconds per centimetre to the fifth power) (783-937) versus 1083 (924-1161) in the controls ( < .001). Despite reduced TPR, sBP and MAP were higher in women with high BMI throughout pregnancy. Heart rate (HR) and diastolic blood pressure (dBP) did not differ significantly between groups at any gestational window. CONCLUSIONS: Pregnant women with high BMI have a distinctive haemodynamic profile characterised by high CO with a compensatory reduction in TPR. Further research is required to assess the risk of placental mediated diseases in that group.
Systemic immune-inflammation index and risk of gestational diabetes and preeclampsia: a systematic review and meta-analysis.
Zhang T, He X
J Obstet Gynaecol · 2025 Dec · PMID 40910671 · Publisher ↗
BACKGROUND: The systemic immune-inflammation index (SII) has been a marker and prognostic indicator of several diseases. However, its utility in pregnancy is unknown. Herein, we reviewed the evidence on the ability of SI...
BACKGROUND: The systemic immune-inflammation index (SII) has been a marker and prognostic indicator of several diseases. However, its utility in pregnancy is unknown. Herein, we reviewed the evidence on the ability of SII to predict gestational diabetes mellitus (GDM) and preeclampsia (PE). METHODS: A systematic search of PubMed, Embase, Scopus and Web of Science was conducted for studies comparing SII between GDM/PE and non-GDM/non-PE groups. Studies reporting diagnostic accuracy data were also included. The last date of the search was 5 November 2024. Risk of bias was assessed using Newcastle Ottawa Scale. Random-effect meta-analysis was conducted comparing values of SII between GDM/PE and non-GDM/non-PE groups. RESULTS: Nine studies were eligible. Four studies reported data on GDM and five on PE. Most studies measured SII in the first trimester. The pooled analysis showed no statistically significant difference in the SII values between PE and non-PE groups (MD: 13.07, 95% confidence interval (CI): -117.21, 143.35, = 78%). Meta-analysis of four studies comparing data of GDM and non-GDM groups showed that SII was significantly higher in GDM females (MD: 210.32, 95% CI: 57.3, 363.34, = 94%). The sensitivity of SII to predict PE varied from 40 to 77.5% while specificity varied from 53.8 to 67.5%. For studies on GDM, the sensitivity and specificity values varied from 66 to 80.2% and 34.4 to 65%, respectively. CONCLUSIONS: SII values are significantly higher in GDM compared to non-GDM females. However, SII values did not correlate with PE. SII may have potential in predicting GDM which needs to be explored by further studies.
Associations between history of trauma and postnatal mental health problems - a cross-sectional study.
Grundström H, Malmquist A, Thorsell M … +1 more , Nieminen K
J Obstet Gynaecol · 2025 Dec · PMID 40905175 · Publisher ↗
BACKGROUND: Pregnancy and childbirth are vulnerable periods for women's mental health, with common occurrences of postnatal depression (PPD), postpartum post-traumatic stress symptoms (PP-PTSS) and postnatal severe fear...
BACKGROUND: Pregnancy and childbirth are vulnerable periods for women's mental health, with common occurrences of postnatal depression (PPD), postpartum post-traumatic stress symptoms (PP-PTSS) and postnatal severe fear of childbirth (PP-FOC). While previous trauma is linked to higher rates of postpartum psychological difficulties, the mechanisms and variations by parity and sociodemographic factors remain poorly understood. The aim of this study was to compare the prevalence of PPD symptoms, postnatal post-traumatic stress disorder (PP-PTSD), PP-PTSS and PP-FOC between women with a history of trauma and those without. Additionally, the study aimed to analyse the prevalence of previous trauma and postnatal mental health problems in subgroups of primi- and multiparous women, and to investigate how trauma influenced mental health in relation to sociodemographic characteristics. METHODS: This was a cross-sectional study including 619 women who had given birth at five maternity clinics in Sweden. Data for the survey were collected online using validated instruments to measure PPD, PP-PTSD, PP-PTSS and PP-FOC. Data were analysed using Chi-squared tests, independent -tests and uni- and multivariable regression. RESULTS: Women with a trauma history ( = 298) showed significantly higher rates of PPD (26% vs. 13%) and PTSD (5% vs. 2%) than those without a trauma history ( = 321). Previous trauma, age and parity significantly influenced postnatal outcomes, with trauma having the most substantial impact. CONCLUSIONS: A history of trauma is correlated to higher risk of postpartum mental health problems, while previous births may offer some protection, especially against PP-PTSS and PP-FOC. Early identification and targeted support for women with trauma histories are recommended.
Preterm birth rates and risk factors among women with cervical incompetence undergoing prophylactic cerclage: a systematic review and meta-analysis.
Wang J, Rong HJ, Wang XM … +2 more , Shi GY, Song WH
J Obstet Gynaecol · 2025 Dec · PMID 40900437 · Publisher ↗
BACKGROUND: Preterm birth is the leading cause of neonatal mortality and long-term health complications. Cervical cerclage (CC) represents a critical intervention for extending pregnancy duration and enhancing neonatal s...
BACKGROUND: Preterm birth is the leading cause of neonatal mortality and long-term health complications. Cervical cerclage (CC) represents a critical intervention for extending pregnancy duration and enhancing neonatal survival in patients diagnosed with cervical insufficiency. The aim of this study was to identify risk factors for preterm birth through a meta-analysis comparing outcomes between preterm and full-term deliveries following non-emergency CC. METHODS: PubMed, EMBASE, Cochrane Library, Web of Science (WOS), and Scopus were searched to identify studies fulfilling predefined inclusion and exclusion criteria on 31 March 2025. The primary outcome measure was the preterm birth rate, which was calculated as the proportion of preterm birth cases in the total sample size. The impact of various risk factors on preterm birth was further analysed. RESULTS: A total of 45 studies were included, and the meta-analysis revealed that the aggregate preterm birth rate at 37 weeks was approximately 48.09% following CC. Compared with twin pregnancies, singleton pregnancies were associated with a lower risk of preterm birth (odds ratio [OR]: 0.71; 95% CI: 0.55-0.91; = 0.008). Among surgery-related factors, CC indicated by physical examination poses a greater risk. Short cervical length prior to CC and elevated inflammatory markers, such as C-reactive protein (CRP), were significantly associated with preterm birth (OR: 0.79; 95% CI: 0.66-0.95; = 0.011). CONCLUSIONS: This study identified critical risk factors for preterm birth following CC, including physical examination indications, a cervical length ≤ 1.5 cm, cervical dilatation, and CRP abnormalities. These findings are instrumental in identifying high-risk individuals and guiding effective medical resource allocation. However, due to study limitations, large-scale studies with multiple PTB cut-off timepoints and comprehensive analyses of risk factors are necessary to refine preventive and therapeutic approaches for preterm birth.
Associations between 1400 metabolites and subtypes of endometriosis: a two-sample Mendelian randomisation study.
Yan F, Chen Z, Wu L … +1 more , Huang Z
J Obstet Gynaecol · 2025 Dec · PMID 40874543 · Publisher ↗
BACKGROUND: Endometriosis is a chronic inflammatory disease with a prevalence of approximately 10% in women of childbearing age. Metabolic pathways have been demonstrated by previous studies to be potential avenues for t...
BACKGROUND: Endometriosis is a chronic inflammatory disease with a prevalence of approximately 10% in women of childbearing age. Metabolic pathways have been demonstrated by previous studies to be potential avenues for the development of new therapeutic strategies and may be used for early diagnosis of the disease. This study aimed to investigate the potential causal relationships between 1400 metabolites and various endometriosis subtypes using Mendelian randomisation (MR) analysis. METHODS: Data from a genome-wide association study were analysed. MR analysis was performed using the inverse-variance weighted, MR-Egger, and weighted-median methods, accompanied by heterogeneity testing, sensitivity analysis, and pleiotropy analysis. Metabolic-pathway enrichment analysis was conducted on the preliminarily screened differential metabolites, and colocalisation analysis was subsequently performed for exposure-outcome pairs that remained causally associated after multiple-testing correction. RESULTS: After multiple-testing correction, only the glycerol-to-palmitoylcarnitine (C16) ratio reduced the risk of stage 1-2 endometriosis ( = 0.045; odds ratio [OR], 0.737; 95% confidence interval [CI], 0.638-0.852) and pelvic peritoneal endometriosis ( = 0.039; OR, 0.721; 95% CI, 0.619-0.841). Colocalisation analysis revealed that they did not share causal variant loci at the genetic level. No reverse causal associations were found in the reverse Mendelian analysis. Metabolic pathway enrichment analysis identified major metabolic pathways, including caffeine metabolism, glutathione metabolism, arginine biosynthesis, sphingolipid metabolism, pantothenate and CoA biosynthesis, plasmalogen synthesis, and biosynthesis of unsaturated fatty acids. CONCLUSIONS: Our study suggests potential causal relationships between metabolites and various endometriosis subtypes from an MR perspective. However, the limited number of associations that survived multiple-testing correction indicates that these findings are preliminary and require validation in larger cohorts. This exploratory analysis may contribute to advancing future research on metabolomics-based diagnosis, treatment, and prevention of endometriosis.
Immune cell phenotype in endometrial cancer: from biological significance to clinical utility using Mendelian randomisation analysis.
Ye L, Chen B, Cen M … +1 more , Lin Q
J Obstet Gynaecol · 2025 Dec · PMID 40773140 · Publisher ↗
BACKGROUND: We investigated the relationship between immune cells and endometrial cancer by conducting a two-sample bidirectional Mendelian randomisation (MR) analysis. METHODS: MR uses genetic variation as an instrument...
BACKGROUND: We investigated the relationship between immune cells and endometrial cancer by conducting a two-sample bidirectional Mendelian randomisation (MR) analysis. METHODS: MR uses genetic variation as an instrumental variable to study the causal effects of exposure on observed data outcomes. We conducted a dual-sample MR analysis to investigate the causal relationship between 731 immune cell phenotypes and endometrial cancer (EC). The weighted-median method and inverse variance weighted method MR were mainly used, and the -value was corrected with the Benjamini-Hochberg procedure. RESULTS: The forward MR analysis revealed a causal relationship between EC and eight immune-cell phenotypes. The reverse MR analysis identified two immune-cell phenotypes with a potential causal effect on EC, with additional subtype-specific associations observed for endometrioid and non-endometrioid histology. CONCLUSION: Our study demonstrated a causal relationship between immune cells and EC, thereby providing guidance for the development of future immunoregulatory therapeutic strategies.
Lessons for the Next Global Health Crisis: A Qualitative Systematic Review of Women's Experiences of the Perinatal Period During the COVID-19 Pandemic in Australia.
Shipton A, Shang F, Wake M … +2 more , Goldfeld S, Mensah F
Aust N Z J Obstet Gynaecol · 2026 Feb · PMID 40770644 · Full text
BACKGROUND: During the coronavirus disease of 2019 (COVID-19) pandemic, pregnant women and new mothers in Australia experienced extreme pandemic societal responses but low SARS-CoV-2 incidence. This offers one of the few...
BACKGROUND: During the coronavirus disease of 2019 (COVID-19) pandemic, pregnant women and new mothers in Australia experienced extreme pandemic societal responses but low SARS-CoV-2 incidence. This offers one of the few opportunities internationally to learn from the pandemic's indirect effects on maternal health, informing future policy. AIMS: To explore women's qualitative experiences of pregnancy to the 12 postpartum months during the COVID-19 pandemic in Australia. MATERIALS AND METHODS: A systematic search followed PRISMA guidelines. MEDLINE, Embase, Web of Science and PubMed were searched from 1 January 2020, to 13 August 2023, using four categories of terms: 'COVID-19', 'perinatal', 'qualitative', 'Australia'. Studies were scored using the CASP checklist and common themes identified from thematic synthesis. The ENTREQ reporting statement was followed. RESULTS: From eight peer-reviewed studies, four themes were identified: (1) 'No one can give you any answers': Provision of information was inadequate in supporting women to make health-related decisions; (2) 'Very isolated' or 'It brought us closer': Social distancing restrictions caused major changes within women's informal support networks; (3) 'Have they seen enough of me?': Women felt unsupported during disruptions in maternal health services; (4) 'All you want to do is keep safe': Safeguarding family from SARS-CoV-2 added cognitive strain to women's daily decision-making and routine. All studies were of a good or high quality. CONCLUSIONS: Three lessons were highlighted. First, women need accurate, accessible health information to make informed decisions. Second, policies should support family bonding and social connections during government restrictions. Finally, health services must be strengthened to ensure continuous, high-quality, accessible care during global crises.
Normalising Choice: An Observational Study of Australian Clinicians' Perspectives on Written Informed Consent for Vaginal Birth.
Ananthram H, Vangaveti V, Wooley T … +2 more , Dawes A, Rane A
Aust N Z J Obstet Gynaecol · 2026 Feb · PMID 40747930 · Full text
BACKGROUND: The NSW Birth Trauma Report identified flawed consent processes and poor calibre antenatal information to have harmed birthing women. Written informed consent for vaginal birth may improve carer accountabilit...
BACKGROUND: The NSW Birth Trauma Report identified flawed consent processes and poor calibre antenatal information to have harmed birthing women. Written informed consent for vaginal birth may improve carer accountability and is currently applied in limited circumstances, for example, vaginal birth after caesarean section (VBAC). AIMS: This study explores how informed women are about birth, as perceived by clinicians, and perspectives on the implications of written informed consent for vaginal birth. MATERIALS AND METHODS: This study uses survey-based research for quantitative data and inductive content analysis for open-ended questions. Main outcome measures include carer perceptions on consent to the mode and/or location of birth and arguments against/in favour of written informed consent. RESULTS: One thousand two hundred and seventy-one responses were analysed for the final results, with 851 (67%) obstetric (Obs) and 420 (33%) midwifery (MW) respondents. Obs were eight times likelier to believe that women are never/rarely fully informed regarding vaginal birth (p < 0.001). The majority in both cohorts agreed women are frequently/always fully informed about VBAC. However, only 49 (6.6%) Obs and 20 (6%) MW were aware of written informed consent forms in use for vaginal birth. Themes developed include-'helpless clinicians' facing impediments to consent, flawed understanding of consent, rejection of consent requirements, juxtaposing consent with normality, disruption to collaboration and antenatal information undermining consent. CONCLUSIONS: Maternity carers in this Australian survey agree women are not fully informed regarding the risks and benefits of birth. Written informed consent alongside adjuncts like birth plans or technology-based platforms may offer a way ahead for the future.
Perinatal Outcomes According to Treatment Targets for Gestational Diabetes: A Multi-Centre Retrospective Cohort Study.
Montalto SL, Marzan M, Houlihan C … +7 more , Hui L, Rolnik DL, Price S, Said J, Soldatos G, Sheehan P, Shub A
Aust N Z J Obstet Gynaecol · 2026 Feb · PMID 40747903 · Publisher ↗
BACKGROUND: Gestational diabetes (GDM) is currently diagnosed in approximately 18% of pregnancies in Australia. GDM may lead to infants being born large for gestational age (LGA), and other complications. There is curren...
BACKGROUND: Gestational diabetes (GDM) is currently diagnosed in approximately 18% of pregnancies in Australia. GDM may lead to infants being born large for gestational age (LGA), and other complications. There is currently no consensus on optimal treatment targets. AIMS: This study aims to compare perinatal outcomes in patients with GDM when treated according to tighter or less tight fasting blood glucose level (BGL) targets. METHODS: Our retrospective cohort study included data from all 12 metropolitan public hospitals providing maternity care in Victoria between January 2020 and December 2022. Women who gave birth to a term singleton infant and who had a diagnosis of GDM were included. Women were grouped according to their delivery hospitals' fasting BGL targets: 'tighter' (< 5.0-5.2 mmol/L) or 'less tight' (< 5.5-5.6 mmol/L). The primary outcome was LGA and a range of secondary outcomes were compared. Inverse probability treatment weights were calculated based on sociodemographic and socioeconomic factors. We then performed multilevel Poisson regression with delivery hospitals as random intercept. RESULTS: There were 25 041 births included, 12 423 (49.6%) in the 'tighter' target group, and 12 618 (50.4%) in the 'less tight' group. After adjusting for hospital and maternal demographics, there was no difference in LGA births (10.4% in 'tighter' vs. 9.5% in 'less tight' (p = 0.85)). More women received insulin treatment in the 'tighter' group (53%) compared to 'less tight' (35%, p < 0.001). There were no significant differences in secondary outcomes. CONCLUSION: Tighter fasting BGL targets were not associated with improved perinatal outcomes but were associated with an increase in pharmacotherapy.
Before the Burn: Predicting Endometrial Ablation Failure.
Woolfield A, Phillips J, Hughes I … +4 more , Jones K, Harris R, Byford S, Walker G
Aust N Z J Obstet Gynaecol · 2026 Feb · PMID 40745994 · Full text
BACKGROUND: While endometrial ablation (EA) offers a minimally invasive alternative to a hysterectomy for women suffering from abnormal uterine bleeding (AUB), clinicians currently lack reliable predictive tools to ident...
BACKGROUND: While endometrial ablation (EA) offers a minimally invasive alternative to a hysterectomy for women suffering from abnormal uterine bleeding (AUB), clinicians currently lack reliable predictive tools to identify which patients will experience treatment failure, leaving both providers and patients to make treatment decisions with incomplete prognostic information. AIMS: The aim of this study is to identify factors that are associated with failure of EA, and use these to develop and internally validate a model predicting failure after EA. MATERIALS AND METHODS: Participants Women who have undergone an EA at a tertiary health service between the years of 2015 and 2021. DESIGN: Retrospective cohort study. RESULTS: Of the 646 patients who underwent an EA between 2015 and 2021, 21% required ongoing treatment. A model for predicting the failure of endometrial ablation was developed. The presence of fibroids and increasing BMI was associated with failure of EA. Increasing age and insertion of the Mirena at the time of EA made failure less likely. CONCLUSIONS: Despite many years of evidence supporting different factors that are associated with failure after an EA, this is the first study to develop a predictive model using Australian data and the first model incorporating the use of Mirena. Ongoing research is suggested to improve model performance and then validate the model externally prior to using it in a clinical context. The nomogram is a demonstration of a possible application of a predictive model.
Over-Transfusion and Unnecessary Transfusion Following Post-Partum Haemorrhage at Te Toka Tumai Auckland Hospital.
Grobler JS, Sadler LC, Thompson J … +4 more , Drake M, Treadwell B, McDougall J, Hill MG
Aust N Z J Obstet Gynaecol · 2026 Feb · PMID 40745991 · Full text
BACKGROUND: Blood transfusion is an important treatment for obstetric haemorrhage. Transfusion also engenders significant short and long-term risks. Ensuring blood products are only given when necessary is a priority in...
BACKGROUND: Blood transfusion is an important treatment for obstetric haemorrhage. Transfusion also engenders significant short and long-term risks. Ensuring blood products are only given when necessary is a priority in improving outcomes. AIMS: To describe the population transfused at a single unit in New Zealand and identify the proportion of patients over and unnecessarily transfused via adjustment of haemoglobin per unit of blood given. To assess whether the rate of inappropriate transfusion was modified by demographic and treatment characteristics. MATERIALS AND METHODS: A retrospective cohort study inclusive of all people who gave birth from 20 weeks between 2018 and 2021 at one hospital was assembled. People who were administered red blood cell-containing products were identified. The pre-discharge haemoglobin was adjusted per unit of blood given with patients being considered over or unnecessarily transfused at a pre-discharge haemoglobin of ≥ 90 mg/dL. RESULTS: The transfused population comprised 694/25 915 pregnancies (2.7% of the cohort). Appropriate transfusion (pre-discharge haemoglobin < 90) occurred in 332/694 (47.8%) people. There were 325 (46.8%) patients who were over- or unnecessarily transfused. There was no difference in appropriateness of transfusion for any ethnicity compared to Māori, our referent group. Over-transfusion rates did not differ and were high in both acute (53%) and non-acute (45%) settings. CONCLUSION: The rate of transfusion for obstetric haemorrhage was 2.7% in our study population. Approximately half of people receiving blood received either too many units or did not require a transfusion.
Second-Trimester Surgical Abortion Is Safe: Audit of Complication Rates at an Australian Tertiary Hospital.
Farrington E, Huguenin A, Moore P … +1 more , Neel A
Aust N Z J Obstet Gynaecol · 2026 Feb · PMID 40734334 · Publisher ↗
BACKGROUND: An estimated 73.3 million abortions occur annually worldwide. Second-trimester abortion is known to carry a higher risk of complications than first-trimester abortion, though the absolute risk is thought to b...
BACKGROUND: An estimated 73.3 million abortions occur annually worldwide. Second-trimester abortion is known to carry a higher risk of complications than first-trimester abortion, though the absolute risk is thought to be low. There is limited Australian data about second-trimester surgical abortions and no studies have looked at surgical complications. AIMS: This study aimed to determine the complication rate of second-trimester surgical abortions at an Australian tertiary maternity hospital across a 5-year period. MATERIALS AND METHODS: A retrospective audit was conducted from 1 January 2019 to 31 December 2023. Inclusion criteria were women and pregnant people with a gestation of 14 + 0 to 23 + 6 weeks who underwent dilation and evacuation for termination of pregnancy. The primary outcome was the rate of complications. RESULTS: Two thousand, one hundred and sixty-four D&Es were performed for termination of pregnancy across the study period. Forty-seven of these women experienced complications, equating to a complication rate of 2.17%. The major complication rate was 0.55% (n = 12). The overall complication rate was significantly lower in women under 20 weeks' gestation compared to women over 20 weeks (1.71% vs. 4.19%, p = 0.007). This difference was significant when comparing minor complication rates only (RR 0.32, 95% CI 0.16-0.61); major complication rates demonstrated no significant difference between gestation groups (RR 1.12, 95% CI 0.25-5.15). CONCLUSIONS: This study demonstrates that surgical second-trimester abortions are safe. Increased complication risk with increased gestational age is evident, highlighting the importance of timely access to abortion care.
Does Antenatal Risk Stratification Match Initial and Eventual Model of Care Allocation? A 5-Year Multi-Centre Review of Risk Factors and Outcomes.
Brown J, Yu S, De Abreu Lourenco R … +1 more , Zen M
Aust N Z J Obstet Gynaecol · 2026 Feb · PMID 40734313 · Full text
BACKGROUND: Every woman who books into a public hospital for antenatal care in Australia is assessed for risk factors for adverse outcomes. However, no study has examined empirical patterns of risk stratification, subseq...
BACKGROUND: Every woman who books into a public hospital for antenatal care in Australia is assessed for risk factors for adverse outcomes. However, no study has examined empirical patterns of risk stratification, subsequent models of care and their relationship to perinatal outcomes. AIMS: This study aims to describe patterns of risk stratification and their intersection with allocated models of care and subsequent perinatal outcomes. MATERIALS AND METHODS: This is a multi-centre retrospective cohort study of all pregnancies booked in and delivered at the three maternity units in western Sydney between 1 January 2018 and 31 December 2022. Women were classified into one of three risk categories (A, B or C) as defined by the Australian College of Midwives' guideline. Variables measured include allocated models of care, maternal and fetal risk factors, birth outcome, and pregnancy morbidity and mortality. RESULTS: At time of both booking-in and birth admission, most women were classified as Category C ('high risk'). During antenatal care, the number of women classified as Category C grew by 70.7% from 21,847 at booking in to 37,290 at birth admission. Between booking-in and admission for birth, there was an over 25% increase in women allocated to medical models of care during the study period. There was higher perinatal morbidity in women classified as 'high risk'. CONCLUSIONS: Current antenatal risk stratification methods appear to detect women with a higher chance of adverse perinatal outcomes, but in doing so classify over three quarters of women as 'high-risk'. This has important ramifications for model of care, perceived patient risk, and resource allocation.
Endometrial cancer: emerging evidence for precision management.
Darwish A, Ewies AAA
J Obstet Gynaecol · 2025 Dec · PMID 40702762 · Publisher ↗
Abstract loading — click title to view on PubMed.
Abnormal expression of Hippo-YAP1 signalling pathway and progesterone resistance mechanism in endometrial polyps.
Yu X, Kong W, Shang K … +4 more , Xing H, Sun W, Li Q, Zhang H
J Obstet Gynaecol · 2025 Dec · PMID 40702758 · Publisher ↗
BACKGROUND: Endometrial polyps (EPs) are a localised hyperproliferative disorder of the endometrium, and its pathogenesis remains unclear. Progesterone resistance may influence the recurrence rate of progesterone-treated...
BACKGROUND: Endometrial polyps (EPs) are a localised hyperproliferative disorder of the endometrium, and its pathogenesis remains unclear. Progesterone resistance may influence the recurrence rate of progesterone-treated EPs. Expression of the Hippo-YAP1 signalling pathway has been studied in various diseases. However, few studies have explored their expression in EPs and association with progesterone resistance. Prolactin (PRL), a molecular marker of endometrial mesenchymal cell metaplasia, indirectly reflects progesterone action . This study aimed to explore the role of Hippo-YAP1 signalling pathway in EPs. METHODS: Endometrial tissue specimens obtained by surgical resection from 35 patients with a normal endometrium and 35 with EPs were collected between July 2023 and July 2024. Immunohistochemically, the expressions of mammalian STE20-like kinase 1 (MST1), Yes-associated protein 1 (YAP1), progesterone receptor (PR) and PRL in the normal endometrium and EPs tissues were detected. RESULTS: Compared to normal endometrial tissues, the expression of MST1 was relatively low in EPs ( < .05), while the total and nuclear expression of YAP1 was relatively high in EPs ( < .0001). The expression of PR in EPs tissues was significantly lower than that in normal endometrial tissues ( < .05), and the expression level of PRL was lower than that of normal endometrium in EPs tissues ( < .001). CONCLUSIONS: EPs have progesterone resistance, and the Hippo-YAP1 signalling pathway may be involved in the development and progression of EPs by acting on the progesterone resistance mechanism.
Current Breastfeeding Attitudes, Knowledge and Confidence of Obstetricians and Gynaecologists in Australia and New Zealand.
Cher G, Bond DM, Nassar N … +4 more , Hunt K, Svensson J, Aleshin O, Shand A
Aust N Z J Obstet Gynaecol · 2026 Apr · PMID 40693748 · Full text
BACKGROUND: There are limited data on what obstetricians and gynaecologists (O&G) know and think about supporting breastfeeding women. AIMS: To investigate breastfeeding attitudes, knowledge and confidence of Australian...
BACKGROUND: There are limited data on what obstetricians and gynaecologists (O&G) know and think about supporting breastfeeding women. AIMS: To investigate breastfeeding attitudes, knowledge and confidence of Australian and New Zealand O&G specialists and trainees in educating, assessing and managing breastfeeding women. MATERIALS AND METHODS: An online REDCap survey was distributed via email in February 2023 to fellows and trainees of the Royal Australian New Zealand College of Obstetricians and Gynaecologists (RANZCOG). The survey included questions on demographic characteristics, knowledge, attitudes and confidence about breastfeeding. RESULTS: Of 312 (11%) respondents, 63% were > 40 years old, 78% female and two-thirds had personally breastfed. Half had no formal breastfeeding education. Mean score related to attitude was 4.8/7 (71.1%) with higher scores associated with extra training (β = 0.44 (95% CI 0.04, 0.84)) and personal breastfeeding (β = 0.37 (95% CI 0.15, 0.60)). Mean correctly answered knowledge score was 9/12 (75%). After adjusting for covariates, the main factors associated with higher knowledge were personal breastfeeding (β = 0.45 (95% CI 0.21, 0.69)) and being female (β = 0.58 (95% CI 0.10, 1.07)). Overall mean confidence score was 4.8/7 (68.6%); however, only 37% felt confident in managing breastfeeding challenges, and 60% would value more breastfeeding education. Factors associated with increased confidence included personal breastfeeding (β = 0.52 (95% CI 0.31, 0.73)), increased age (β = 0.39 (95% CI 0.64, 0.71)), and extra training (β = 0.84 (95% CI 0.46, 1.21)). CONCLUSIONS: Confidence about breastfeeding in RANZCOG specialists and trainees was low. The majority of respondents wanted more formal and improved breastfeeding education and training. Breastfeeding educational resources and ongoing training should be developed for O&G trainees and specialists.
Editor-In-Chief's Introduction to ANZJOG 65(3).
White SW
Aust N Z J Obstet Gynaecol · 2025 Jun · PMID 40693598 · Publisher ↗
Abstract loading — click title to view on PubMed.
GDM links to increased neonatal myocardial hypertrophy via ANGPTL7: prospective cohort study.
Jian W, Shi S, Yang X … +10 more , Huang Y, Du C, He M, Li X, Huang M, Yuan R, Wei L, Yang S, Cai S, Yang J
J Obstet Gynaecol · 2025 Dec · PMID 40679909 · Publisher ↗
BACKGROUND: Gestational diabetes mellitus (GDM) can negatively impact newborn cardiac health, particularly causing myocardial hypertrophy. This study examined the relationship between umbilical cord blood levels of angio...
BACKGROUND: Gestational diabetes mellitus (GDM) can negatively impact newborn cardiac health, particularly causing myocardial hypertrophy. This study examined the relationship between umbilical cord blood levels of angiopoietin-like protein 7 (ANGPTL7) in term neonates born to mothers with GDM and myocardial development, assessing its potential as an early predictive marker. METHODS: The study involved 46 newborns exposed to GDM and 46 healthy controls. Measure the interventricular septum (IVS) thickness through cardiac ultrasound and evaluate the level of ANGPTL7 in umbilical cord blood using the ELISA method. RESULTS: The incidence of myocardial hypertrophy in the GDM group was 19.6%, significantly higher than 0% in the control group, and increased to 27.3% in neonates of mothers with GDM and poor glycaemic control. ANGPTL7 levels in the GDM group were significantly elevated compared to the control group (1.87 vs. 1.11 ng/mL). Furthermore, these levels were positively correlated with IVS thickness. In the poorly-controlled GDM subgroup (GDM-A), neonates had significantly higher ANGPTL7 levels and IVS/LVPW ratio (1.19 vs. 1.03), indicating more severe myocardial abnormalities. CONCLUSION: ANGPTL7 may contribute to myocardial hypertrophy in GDM neonates by promoting insulin resistance. Monitoring ANGPTL7 levels in umbilical cord blood could help identify high-risk neonates and guide optimal glycaemic management during pregnancy. Although the sample size was small, the study offers new evidence of ANGPTL7's clinical utility. Future research should expand the sample size and investigate the molecular mechanisms of ANGPTL7 to develop personalised interventions. TRIAL REGISTRATION: This study was not registered prospectively.
Clinical Experience and Major Learning Points Following the Implementation of the sFlt-1/PlGF Ratio in the Management of Suspected Preeclampsia in a South Australian Tertiary Hospital.
Lane A, Amy LU, Parange A … +1 more , Dekker G
Aust N Z J Obstet Gynaecol · 2025 Dec · PMID 40679219 · Publisher ↗
INTRODUCTION: The ability to measure pro-angiogenic (PlGF) and anti-angiogenic (sFlt-1) factors, specifically the sFlt-1/PlGF ratio, allows obstetricians to assess syncytiotrophoblast stress, a key mechanism in preeclamp...
INTRODUCTION: The ability to measure pro-angiogenic (PlGF) and anti-angiogenic (sFlt-1) factors, specifically the sFlt-1/PlGF ratio, allows obstetricians to assess syncytiotrophoblast stress, a key mechanism in preeclampsia. In Australia, the introduction of this ratio to clinical practice, particularly its high negative predictive value, was led by Professor Brennecke (Melbourne). At our tertiary centre, adapted Victorian guidelines were introduced in October 2021. Despite multiple educational sessions, the transition from assessing 'end organ damage' to the 'placental syndrome' presented challenges for clinicians. MATERIALS AND METHODS: This retrospective audit examined 431 women over 20 months to assess the implementation of the sFlt-1/PlGF ratio. The primary objective was to identify key educational points to improve clinical decision-making and the accurate use of the ratio in a tertiary centre. RESULTS: Of 750 tests, 79% (n = 596) were ordered according to guidelines. Among 154 tests ordered outside the guidelines, 57% (n = 88) were performed within a reassuring time frame from the previous test, 41% (n = 63) outside validated gestational windows, 1% (n = 2) with an unknown indication and 1% (n = 1) following a 'severe risk' result. DISCUSSION: Common errors included repeating tests too frequently (despite the high negative predictive value over 3-4 weeks), testing prior to 20 weeks or after 37 weeks, and underestimating the prognostic value of very high sFlt-1/PlGF ratios.
LINC01094 targets miR-1266-5p to halt neoplasm progression of cervical cancer.
Zhang W, Shang W, Cao J … +1 more , Zhao H
J Obstet Gynaecol · 2025 Dec · PMID 40667605 · Publisher ↗
BACKGROUND: To investigate the mechanism and prognostic value of LINC01094 in cervical cancer (CC). METHODS: This study included 113 patients with CC. Their cervical tumour tissues and tumour-free cervical tissues were c...
BACKGROUND: To investigate the mechanism and prognostic value of LINC01094 in cervical cancer (CC). METHODS: This study included 113 patients with CC. Their cervical tumour tissues and tumour-free cervical tissues were collected, with patient follow-up for a five-year prognostic period. Reverse transcription-quantitative PCR (RT-qPCR) was used to identify LINC01094 and measure miR-1266-5p expression, Kaplan-Meier curves were used to predict patient survival, and multivariate Cox regression analysis revealed the factors affecting CC prognosis. A dual luciferase reporter (DLR) assay was performed to verify the targeting relationship of reciprocal genes. The Cell Counting Kit-8 (CCK8) assay was used to measure cell proliferation, and the Transwell recorded cell migration and invasion. RESULTS: Lower LINC01094 expression and higher level of miR-1266-5p expression were detected in-tumour tissues than in the tumour-free cervical tissues, with a negative correlation. Low LINC01094 expression, International Federation of Gynaecology and Obstetrics (FIGO) stage, and lymph node metastasis were identified as risk factors for CC prognosis, LINC01094 downregulation predicted higher patient mortality. The DLR assay identified miR-1266-5p as a possible target gene of LINC01094. Additional experiments revealed miR-1266-5p downregulation and decreased cell proliferation, migration and invasion of CC cells transfected with oe-LINC01094. These effects were restored after co-transfection with miR-mimic. CONCLUSIONS: Low LINC01094 expression in patient with CC is a risk factor for prognosis. Overexpression of LINC01094 targeting miR-1266-5p prevents the progression of CC neoplasm.
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