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Background: Queensland introduced a colour‐coded cardiotocograph (CTG) classification system (green, blue, yellow and red) to complement the Royal Australian and New Zealand College of Obstetricians and Gynaecologists prose‐based classification system of 'low, unlikely, maybe or likely' fetal compromise. Aims: The aim of the study was to determine the clinical impact of the introduction of the colour‐coded CTG classification system compared to the prose‐based system. We hypothesised there would be no change in the rate of operative delivery for intrapartum fetal compromise (OD‐IFC). Materials and methods: This retrospective non‐inferiority study from November 2014 to May 2018 used routinely collected data from the Mater Mother's Hospital. Non‐insured women with a singleton, non‐anomalous, cephalic fetus at term, attempting a vaginal birth with continuous intrapartum CTG were included. The primary outcome was OD‐IFC. Secondary outcomes included various obstetric and perinatal outcomes. Non‐inferiority analysis was performed with a pre‐specified non‐inferiority margin of 2% risk difference. Results: Eleven thousand seven hundred and twenty‐seven participants were included. The OD‐IFC rate was similar across the study groups (prose‐based 15.1% vs colour‐coded 15.3%, adjusted odds ratio (aOR) 1.02, 95% CI 0.93–1.13) with the adjusted risk difference of 0.29% (95% CI −0.98 to 1.56), which did not exceed the inferiority margin. There were more spontaneous (aOR 1.11, 95% CI 1.04–1.19) and fewer instrumental (aOR 0.87, 95% CI 0.80–0.95) vaginal births in the colour‐coded cohort. There were no differences in neonatal outcomes. Conclusions: Reassuringly, the colour‐coded CTG classification system was non‐inferior to the prose‐based system, did not influence OD‐IFC but was associated with more spontaneous vaginal deliveries. [ABSTRACT FROM AUTHOR]

Background: Snoring, gasping or choking during sleep are common symptoms of sleep‐disordered breathing and are associated with multiple adverse maternal and obstetric outcomes. The mechanisms responsible remain unknown; however, placental dysfunction is suspected. Aims: The aim of this study was to investigate feto‐placental and fetal cardiac function in women with pregnancies complicated by obstructive sleep apnoea symptoms. Materials and methods: This was a prospective observational cohort study at a large tertiary obstetric hospital in Australia. Women were asked to complete a questionnaire relating to the presence and severity of obstructive sleep apnoea symptoms. They also underwent an ultrasound scan where Doppler indices of various feto‐placental vessels and fetal cardiac function were measured. Regional cerebral perfusion was also assessed. Results: A total of 255 women were included in the final analysis. Of these, 36.1% (92/255) of women reported no obstructive sleep apnoea symptoms; 63.9% (163/255) reported they experienced some form of obstructive sleep apnoea symptoms that included any frequency of snoring or choking/gasping, while 42.0% (107/255) complained of severe obstructive sleep apnoea symptoms (snoring ≥ 3 times a week or choking/gasping). There were no significant differences in feto‐placental Dopplers or fetal cardiac function parameters in women with obstructive sleep apnoea symptoms. There were also no differences in regional cerebral blood flow between groups, or any correlation with severity of symptoms. Conclusions: Our data challenge the current perspective that adverse perinatal outcomes in women with obstructive sleep apnoea symptoms are related primarily to placental dysfunction and fetal compromise. [ABSTRACT FROM AUTHOR]

Background: Central venous access devices (CVAD) are commonly employed in the management of cancer patients. While having several benefits they are associated with significant risks. Aim: To review the incidence and risk factors for catheter‐related thrombosis (CRT) in cancer patients with a CVAD. Methods: We performed a prospective observational cohort study of adult patients with cancer requiring a CVAD between 1 January 2004 and 29 June 2016. The rate of, and risk factors for the development of, symptomatic CRT were evaluated. Results: A total of 4920 central lines was inserted into 3130 patients. The incidence of CRT was 3.6%. CRT developed a median of 12 days following line insertion. Peripherally inserted central catheters (PICC) were associated with the highest rates of CRT (hazards ratio (HR) 22.2, 95% confidence interval (CI) 2.9–170.6). Older age groups developed CRT at lower rates (HR 0.57; 95% CI 0.39–0.84 for age 50–61 years, and HR 0.63; 95% CI 0.45–0.89 for age >61 years) compared to age <50 years. Increased CRT was seen in patients with prior CRT (HR 1.81; 95% CI 1.19–2.77). There was a trend to more CRT events with a Khorana tumour score of 1 compared to those with a score of 0 (HR 1.37, 95% CI 1.00–1.88). Hodgkin lymphoma, germ cell and oesophagus cancers had the highest CRT rates. Side of insertion was not associated with thrombosis risk (HR 0.77; 95% CI 0.57–1.05; P = 0.10). Conclusions: Age <50 years, PICC lines and prior CRT were associated with highest CRT rate. Cancer subtype and insertion side were not predictive of thrombosis. [ABSTRACT FROM AUTHOR]

Background: Placenta praevia (PP) is a rare obstetric condition associated with significant maternal and perinatal morbidity. Traditionally, the degree of PP has been classified into minor and major; however, there are very few robust studies that compare the maternal outcomes of these types of PP. Aims: To identify any significant differences in obstetric outcomes between major and minor PP, including antepartum, intraoperative and postpartum complications. Materials and Methods: A retrospective cohort study was conducted at the Royal Brisbane & Women's Hospital between 2009 and 2018; all women were diagnosed with PP. Results: Of the total of 368 women recruited, over half of the participants were diagnosed with major PP (57%), while the remaining had minor PP. Women with major PP, compared to women with minor PP, had an increased risk of antepartum haemorrhage (odds ratio (OR) 2.77, P < 0.001), delivery at an earlier gestational age (36.1 vs 37.4 weeks), general anaesthesia (OR 3.25, P < 0.001), greater proportion of emergency lower segment (51% vs 40%) and classical caesarean (7.7% vs 3.8%), increased number of uterotonics (incidence rate ratio (IRR) 1.17, P < 0.031), greater blood loss (IRR 1.32, P < 0.001) and higher frequency of blood transfusion (IRR 2.00, P < 0.027), and longer postpartum hospital stay (IRR 1.26, P < 0.001). Hysterectomy was performed for three women with major PP, compared to one with minor PP. Conclusions: The degree of PP significantly impacts obstetric outcomes, with major PP associated with worse maternal morbidity antenatally, intraoperatively and postpartum. Therefore, to optimise patient care, this study emphasises the importance of identifying and distinguishing between different types of PP. [ABSTRACT FROM AUTHOR]