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Background: Cervical insufficiency is a significant cause of morbidity and mortality. Cervical cerclage is one option in the management of cervical insufficiency. Aim: To evaluate obstetric outcomes following insertion of a pre‐pregnancy laparoscopic transabdominal cerclage in women at high risk for pre‐term labour and/or mid‐trimester pregnancy loss. Methods: A prospective observational study of consecutive women who underwent laparoscopic transabdominal cerclage from 2007 to 2017. Eligible women had a diagnosis of cervical insufficiency based on previous obstetric history and/or a short or absent cervix and were considered not suitable for a transvaginal cerclage. The primary outcome was neonatal survival and the secondary outcome was delivery of an infant at ≥34 weeks gestation. Surgical morbidity and complications were also evaluated. Results: During the study period, 225 women underwent laparoscopic transabdominal cerclage. We present the outcomes of 121 pregnancies resulting in 125 babies. The perinatal survival rate of viable pregnancies was 98.5% with a mean gestational age at delivery of 35.2 weeks; 79.7% of babies were delivered at ≥34.0 weeks gestation. Conclusion: Laparoscopic transabdominal cerclage is a safe and effective procedure resulting in favourable obstetric outcomes in women with a poor obstetric history. For optimal success the procedure requires the correct surgical expertise, equipment and appropriate patient selection. [ABSTRACT FROM AUTHOR]

The article offers information on the 50 years of the Rhesus (Rh) D immunoglobulin (Ig) or anti-D program in Australia, which prevents the negative effects of the incompatibility between an RhD-positive baby and an RhD-negative mother, which can result in haemolytic disease of the fetus and infant.

Background: Excessive gestational weight gain can result in poor maternal and child health outcomes. Estimates from single studies indicate the prevalence of excessive gestational weight gain in Australia could lie between 38 and 67 %. The risk of excessive weight gain can be reduced through healthy eating and exercise. We describe the rationale and methods of the Get Healthy in Pregnancy Service, a trial service which aims to support women in achieving appropriate gestational weight gain through an existing telephone-based health coaching service.Methods/design: This study aims to compare the effectiveness of a telephone-based health coaching program versus provision of information only in supporting pregnant women to achieve appropriate gestational weight gain. A pragmatic stratified clustered randomised controlled trial will be conducted with 710 women who present to 5 hospitals for their first antenatal appointment during the recruitment period (6-8 months), have a pre-pregnancy body mass index (BMI) ≥ 18.50 (healthy weight or above), are 18 years and over, singleton gestation, English speaking, have no pre-existing medical conditions that may limit their ability to exercise or require a restricted diet and are 18 weeks or less gestation. Hospitals will be randomised into one of two intervention models: a) information only; or b) information plus 10 telephone-based health coaching sessions with a university qualified coach. Both interventions will set a weight-range target with pregnant women. The women attending antenatal clinics at participating hospitals will be screened at their initial hospital appointment to assess their eligibility. Women recruited to the trial will have a number of measures recorded including anthropometrics (self-reported height and weight) and dietary and physical activity scores during and following pregnancy. These measurements will be collected at baseline (prior to 18 weeks gestation), 36 weeks gestation and 12 months post-birth.Discussion: This study responds to a need for an effective intervention that targets excessive gestational weight gain at a population level. This study investigates the potential for an innovative intervention combining two existing services; a free state-wide telephone-based health coaching service and hospital-based antenatal care to support pregnant women to achieve healthy weight gain during pregnancy. The use of existing services provides the potential for immediate post-study implementation. While the impacts of telephone-based lifestyle programmes have been tested in a number of settings, there are few studies which evaluate the effectiveness and acceptability of telephone support in achieving healthy gestational weight gain in association with routine antenatal care.Trial Registration: ACTRN12615000397516 (Registration date: 26 June 2014, retrospectively registered). [ABSTRACT FROM AUTHOR]

Background: The Australian Guide to Healthy Eating (AGHE) for pregnancy provides a number of food- and nutrition-related recommendations to assist pregnant women in optimizing their dietary behavior. However, there are limited data demonstrating pregnant women's knowledge of the AGHE recommendations. This study investigated Australian pregnant women's knowledge of the AGHE and related dietary recommendations for maintaining a healthy pregnancy. The variations in nutrition knowledge were compared with demographic characteristics. Methods: A cross-sectional study assessed eight different nutrition knowledge domains and the demographic characteristics of pregnant women. Four hundred women across Australia completed a multidimensional online survey based on validated and existing measures. Results: More than half of the pregnant women surveyed (65%) were not familiar with the AGHE recommendations. The basic recommendations to eat more fruit, vegetables, bread, and cereals but less meat were poorly understood. An in-depth investigation of knowledge of nutrition information revealed misconceptions in a range of areas, including standard serving size, nutrients content of certain foods, energy density of fat, and the importance of key nutrients in pregnancy. Univariate analysis revealed significant demographic variation in nutrition knowledge scores. Multiple regression analysis confirmed the significant independent effects on respondents' nutrition knowledge score (P<0.000) of the education level, income, age, stage of pregnancy, language, and having a health/nutrition qualification. The model indicated that independent variables explained 33% (adjusted R2) of the variance found between respondents' knowledge scores. Conclusion: Australian pregnant women's knowledge regarding AGHE for pregnancy and other key dietary recommendations is poor and varies significantly with their demographic profile. The setting of dietary guidelines is not sufficient to ensure improvement in their nutrition knowledge. It is essential that women receive support to achieve optimal and healthy diets during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To examine pre-conception dietary patterns in pregnant asthmatic women and to identify associations between maternal diet and asthma control during pregnancy.Design: Cross-sectional study. Pre-conception food frequency data were collected retrospectively. Asthma control was assessed using the Global Initiative for Asthma guidelines. Dietary patterns were derived using factor analysis. Binary logistic regression analyses were used to test the association between uncontrolled asthma and each dietary pattern (Z-score), with values presented as odds ratio and 95 % confidence interval.Setting: Antenatal clinic in a tertiary hospital, Adelaide, Australia, May 2009-July 2013.Subjects: One hundred and fifty-eight asthmatic pregnant women.Results: Three dietary patterns were identified: (i) 'high protein/fruit' (strong food group loadings for fish, meat, chicken, fruit); (ii) 'high fat/sugar/takeaway' (takeaway foods, crisps, refined grains); and (iii) 'vegetarian-type' (vegetables, fruit, soya milk, whole grains). A 1 sd increase in score on the high fat/sugar/takeaway pattern was associated with increased likelihood of uncontrolled asthma (adjusted OR=1·54; 95 % CI 1·07, 2·23; P=0·022). Women with uncontrolled asthma (n 115) had higher energy-adjusted intakes of saturated fat, monounsaturated fat, carbohydrate, sugar and fibre compared with women with controlled asthma (n 43, all P≤0·05).Conclusions: Pre-pregnancy dietary patterns may influence maternal asthma control. Our work highlights the importance of achieving a healthy diet before pregnancy that is low in saturated fat, sugar and takeaway foods, and therefore higher in lean meats, poultry and fish, as well as fruits, vegetables and whole grains. A healthy dietary pattern should be encouraged in all asthmatic women who are of childbearing age, and should additionally be promoted before pregnancy and beyond. [ABSTRACT FROM AUTHOR]

Objective: To assess whether routinely weighing women at each antenatal visit leads to a difference in gestational weight gain and weight gain within the Institute of Medicine (IOM) recommendation.Design: A randomised controlled trial.Setting: Antenatal clinics in a tertiary obstetric hospital in Melbourne, Australia.Population: Healthy women were enrolled during their antenatal booking visit if they were between 18 and 45 years of age, were <21 weeks' gestation with a singleton pregnancy.Methods: The intervention was weighing at each antenatal clinic appointment followed by counselling by their treating clinician according to IOM gestational weight gain guidelines. The control group had standard antenatal care comprising recording weight at booking and then at 36 weeks. Primary analysis was by intention-to-treat.Outcome: The primary outcome was difference in mean weight gain between groups. An important secondary outcome was gestational weight gain within IOM recommendations. Secondary outcomes also included maternal or neonatal morbidity.Results: Seven hundred and eighty two women consented to take part and 386 were randomised to the intervention group and 396 to the control group. There was no significant difference in weight gain between the intervention group (0.54 kg/week) compared with the control group (0.53 kg/week) (P = 0.63). A similar proportion of women gained more weight than the IOM recommended range: 75% in the intervention group and 71% in the control group (P = 0.21). There were no significant differences in secondary outcomes between the two groups.Conclusion: We found no evidence that regular weighing in antenatal clinics changed weight gain or was effective at reducing excessive gestational weight gain. [ABSTRACT FROM AUTHOR]

Background: Concern that mild iodine deficiency in pregnancy may adversely affect neurodevelopment of offspring has led to recommendations for iodine supplementation in the absence of evidence from randomised controlled trials. The primary objective of the study was to investigate the effect of iodine supplementation during pregnancy on childhood neurodevelopment. Secondary outcomes included pregnancy outcomes, maternal thyroid function and general health.Methods: Women with a singleton pregnancy of fewer than 20 weeks were randomly assigned to iodine (150 μg/d) or placebo from trial entry to birth. Childhood neurodevelopment was assessed at 18 months by using Bayley Scales of Infant and Toddler Development (Bayley-III). Iodine status and thyroid function were assessed at baseline and at 36 weeks' gestation. Pregnancy outcomes were collected from medical records.Results: The trial was stopped after 59 women were randomly assigned following withdrawal of support by the funding body. There were no differences in childhood neurodevelopmental scores between the iodine treated and placebo groups. The mean cognitive, language and motor scores on the Bayley-III (iodine versus placebo, respectively) were 99.4 ± 12.2 versus 101.7 ± 8.2 (mean difference (MD) -2.3, 95 % confidence interval (CI) -7.8, 3.2; P = 0.42), 97.2 ± 12.2 versus 97.9 ± 11.5 (MD -0.7, 95 % CI -7.0, 5.6; P = 0.83) and 93.9 ± 10.8 versus 92.4 ± 9.7 (MD 1.4, 95 % CI -4.0, 6.9; P = 0.61), respectively. No differences were identified between groups in any secondary outcomes.Conclusions: Iodine supplementation in pregnancy did not result in better childhood neurodevelopment in this small trial. Adequately powered randomised controlled trials are needed to provide conclusive evidence regarding the effect of iodine supplementation in pregnancy.Trials Registration: The trial was registered with the Australian New Zealand Clinical Trials Registry at http://www.anzctr.org.au . The registration number of this trial is ACTRN12610000411044 . The trial was registered on 21 May 2010. [ABSTRACT FROM AUTHOR]

Background: High levels of childbirth fear impact birth preparation, obstetric outcomes and emotional wellbeing for around one in five women living in developed countries. Higher rates of obstetric intervention and caesarean section (CS) are experienced in fearful women. The efficacy of interventions to reduce childbirth fear is unclear, with no previous randomised controlled trials reporting birth outcomes or postnatal psychological wellbeing following a midwife led intervention.Method: Between May 2012 and June 2013 women in their second trimester of pregnancy were recruited. Women with a fear score ≥ 66 on the Wijma Delivery Expectancy / Experience Questionnaire (W-DEQ) were randomised to receive telephone psycho-education by a midwife, or usual maternity care. A two armed non-blinded parallel (1:1) multi-site randomised controlled trial with participants allocated in blocks of ten and stratified by hospital site and parity using an electronic centralised computer service. The outcomes of the RCT on obstetric outcomes, maternal psychological well-being, parenting confidence, birth satisfaction, and future birth preference were analysed by intention to treat and reported here.Results: 1410 women were screened for high childbirth fear (W-DEQ ≥66). Three hundred and thirty-nine (n = 339) women were randomised (intervention n = 170; controls n = 169). One hundred and eighty-four women (54 %) returned data for final analysis at 6 weeks postpartum (intervention n = 91; controls n = 93). Compared to controls the intervention group had a clinically meaningful but not statistically significant reduction in overall caesarean section (34 % vs 42 %, p = 0.27) and emergency CS rates (18 % vs 25 %, p = 0.23). Fewer women in the intervention group preferred caesarean section for a future pregnancy (18 % vs 30 %, p = 0.04). All other obstetric variables remained similar. There were no differences in postnatal depression symptoms scores, parenting confidence, or satisfaction with maternity care between groups, but a lower incidence of flashbacks about their birth in the intervention group compared to controls (14 % vs 26 %, p = 0.05). Postnatally women who received psycho-education reported that the 'decision aid' helped reduce their fear (53 % vs 37 %, p = 0.02).Conclusion: Following a brief antenatal midwife-led psycho-education intervention for childbirth fear women were less likely to experience distressing flashbacks of birth and preferred a normal birth in a future pregnancy. A reduction in overall CS rates was also found. Psycho-education for fearful women has clinical benefits for the current birth and expectations of future pregnancies.Trial Registration: Australian New Zealand Controlled Trials Registry ACTRN12612000526875 , 17th May 2012. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to examine the extent to which antenatal emotional wellbeing (EW) assessments are undertaken in primary health care (PHC) centres and factors associated with completion of EW screening. Methods: Medical records of 797 pregnant women from 36 PHC centres in five states (NSW, QLD, SA, WA and NT) were audited. Results: Overall, 85% of the women were Aboriginal. The proportion of women with documented screening for EW varied from 5 to 38% between states (mean 17%). Aboriginal women were four times more likely (adjusted Odds Ratio (OR = 4.13, 95% CI = 2.46-6.92) to not be screened for antenatal EW than non-Aboriginal women. Aboriginality, <4 antenatal visits, absence of an antenatal and birth care plan, and lack of counselling on financial support were independently linked with no screening of EW. Conclusion: Provision of training for health service providers and further research on appropriate screening tools for Aboriginal women are needed to help redress this gap. [ABSTRACT FROM AUTHOR]

Background There is an impression of poor management of pregnancy sickness in Australia, specifically an apparent total reliance on metoclopramide, as a first-line choice. Aims To determine what management options are commonly used in by distributing a survey to Fellows and Diplomates of RANZCOG. Methods A web-based survey questionnaire distributed using an email list obtained from RANZCOG. Results A total of 495 responses were received (23%). For morning sickness, 89% of those replying give dietary advice frequently or always, and 70% prescribe metoclopramide frequently or always, whereas 59% advise pyridoxine and 10% prescribe doxylamine. For hyperemesis gravidarum, 86% prescribe metoclopramide and 75% ondansetron. Conclusions Despite guidelines suggesting the use of antihistamines and dopamine agonists (phenothiazines), very few practitioners in this region make use of these in any numbers. [ABSTRACT FROM AUTHOR]

Background: There is uncertainty regarding the efficacy of increasing n--3 long-chain PUFA (LCPUFA) intake during pregnancy in reducing the risk of gestational diabetes mellitus (GDM) and preeclampsia. Objectives: The objective was to determine whether n--3 LCPUFA supplementation in pregnancy reduces the incidence of GDM or preeclampsia. A secondary objective was to assess the effect of n--3 LCPUFA supplementation on perinatal complications. Design: This was a double-blind, multicenter randomized control trial-the DHA to Optimize Mother Infant Outcome (DOMInO) trial. Pregnant women (n = 2399) of <21 wk gestation were randomly assigned to receive DHA-enriched fish oil (800 mg/d) or vegetable oil capsules without DHA from trial entry to birth. The presence of GDM or preeclampsia was assessed through a blinded audit of medical records. Birth outcomes and prenatal complications were also assessed. Results: The overall incidences of GDM and preeclampsia were 8% and 5%, respectively, based on clinical diagnosis. The RR of GDM was 0.97 (95% CI: 0.74, 1.27) and of preeclampsia was 0.87 (95% CI: 0.60, 1.25), and they did not differ significantly between the groups. Birth weight, length, and head circumference z scores also did not differ between the groups. There were 12 perinatal deaths and 5 neonatal convulsions in the control group compared with 3 perinatal deaths and no neonatal convulsions in the DHA group (P = 0.03 in both cases). Conclusion: DHA supplementation of 800 mg/d in the second hah0 of pregnancy does not reduce the risk of GDM or preeclampsia. Whether supplementation reduces the risk of perinatal death and neonatal convulsions requires further investigation. The DOMInO trial was registered with the Australian New Zealand Clinical Trials Registry as TRN12605000569606. [ABSTRACT FROM AUTHOR]

The authors discuss new study findings on the adverse effects of maternal obesity on mothers and babies. The authors agree that clinicians, researchers and nutritionists understand the benefits of managing obesity before pregnancy. Also discussed are the Limiting weight gain (LIMIT) trial in Australia that showed reduction of macrosomia, maternal gestational weight gain and large for gestational age (LGA) babies and the pre-conception care of the U.S. Centers for Disease Control (CDC).

With the increasing prevalence of diabetes and obesity in Australia, more women with type 2 diabetes are becoming pregnant. Our study confirms that pregnancies with type 2 diabetes have poorer outcomes and there is a strong need for further research into modification of risk factors associated with adverse pregnancy outcomes, particularly in type 2 diabetes. We believe it is time to rethink the strategies to improve their outcomes. [ABSTRACT FROM AUTHOR]