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Background: Chemotherapy is potentially harmful to a developing foetus, and there are limited data on the foetal impact of chemoimmunotherapy (CIT). Therefore, determining pregnancy status prior to initiation of CIT should be standard of care. Aims: To determine how many women of childbearing age are tested for pregnancy prior to immunochemotherapy administration. Methods: A retrospective chart review at a large Australian metropolitan cancer referral centre, including 304 women aged 18–51 years with a diagnosis of cancer receiving outpatient‐based CIT between 1 May 2015 and 12 June 2020. We assessed the uptake of pregnancy screening and contraception counselling prior to and during first‐line CIT. Results: Only 17.3% of CIT cycles (n = 416) screened patients for pregnancy no more than 90 days prior to administration, and the median time between pregnancy screening and treatment was approximately 3 weeks. One patient with early breast cancer had a spontaneous miscarriage estimated at 3–4 weeks' gestation, and neither the patient nor the treating oncologist was aware of this event. This was also the only patient who had a pregnancy test beyond the first cycle of CIT during their treatment. Conclusions: Our results highlight a concerningly low rate of pregnancy screening in women of childbearing age receiving CIT. The implication of missing a positive pregnancy test in this group of women could result in foetal complications, accidental miscarriage, potential bleeding risks and avoidable psychosocial stress. This highlights the urgent need for guidelines to mandate pregnancy testing in women of childbearing age receiving CIT and evidence‐based implementation tools. [ABSTRACT FROM AUTHOR]

Since early 2020, the world has been dealing with the COVID-19 pandemic. The rapid changing situation led to unforeseeable challenges and questions for many people, including pregnant women. Through a textual analysis of personal narratives told via pregnancy and/or laboring vlogs during COVID-19, this present study aims to understand how women from China who live in another country during pregnancy have utilized YouTube vlogs to share their experiences. Through this analysis, we identify various challenges that these women experienced during their pregnancy. The COVID-19 pandemic exaggerated the normal difficulties of these issues and also created additional problems for these women, including regular pregnancy tests, choice of birthing locations, and the support and caring that were normal during this time period. [ABSTRACT FROM AUTHOR]

An editorial is presented on induced abortion being presumably one of the most common gynaecological procedures in Australia. Topics include increasing use of medical abortion not reflecting an overall increase in the abortion rate which in fact appears to be declining in Australia; and restricting access to abortion serves increasing the number of unsafe abortions and the associated maternal morbidity.

Background: Fetuses affected by placental insufficiency do not receive adequate nutrients and oxygenation, become growth restricted and acidemic, and can demise. Preterm fetal growth restriction is a severe form of placental insufficiency with a high risk of stillbirth. We set out to identify maternal circulating mRNA transcripts that are differentially expressed in preterm pregnancies complicated by very severe placental insufficiency, in utero fetal acidemia, and are at very high risk of stillbirth.Methods: We performed a cohort study across six hospitals in Australia and New Zealand, prospectively collecting blood from 128 pregnancies complicated by preterm fetal growth restriction (delivery < 34 weeks' gestation) and 42 controls. RNA-sequencing was done on all samples to discover circulating mRNAs associated with preterm fetal growth restriction and fetal acidemia in utero. We used RT-PCR to validate the associations between five lead candidate biomarkers of placental insufficiency in an independent cohort from Europe (46 with preterm fetal growth restriction) and in a third cohort of pregnancies ending in stillbirth.Results: In the Australia and New Zealand cohort, we identified five mRNAs that were highly differentially expressed among pregnancies with preterm fetal growth restriction: NR4A2, EMP1, PGM5, SKIL, and UGT2B1. Combining three yielded an area under the receiver operative curve (AUC) of 0.95. Circulating NR4A2 and RCBTB2 in the maternal blood were dysregulated in the presence of fetal acidemia in utero. We validated the association between preterm fetal growth restriction and circulating EMP1, NR4A2, and PGM5 mRNA in a cohort from Europe. Combining EMP1 and PGM5 identified fetal growth restriction with an AUC of 0.92. Several of these genes were differentially expressed in the presence of ultrasound parameters that reflect placental insufficiency. Circulating NR4A2, EMP1, and RCBTB2 mRNA were differentially regulated in another cohort destined for stillbirth, compared to ongoing pregnancies. EMP1 mRNA appeared to have the most consistent association with placental insufficiency in all cohorts.Conclusions: Measuring circulating mRNA offers potential as a test to identify pregnancies with severe placental insufficiency and at very high risk of stillbirth. Circulating mRNA EMP1 may be promising as a biomarker of severe placental insufficiency. [ABSTRACT FROM AUTHOR]

Background: In 2015, the Tabbot Foundation launched a nationwide direct‐to‐patient telemedicine service to enable women to obtain medical abortion without visiting an abortion provider. Aims: We aimed to describe results from the first 18 months of this service. Materials and Methods: To have an abortion through the Foundation, a woman obtained screening tests locally and had a telephone consultation with a Foundation doctor. If she was eligible, mifepristone, misoprostol and other medications were sent to her by mail. After taking the drugs, the woman obtained follow‐up tests at local facilities and had a consultation with Foundation professionals. The Foundation charged $250 to patients with Medicare eligibility and $600 otherwise. We summarised clinical data collected by the service. Results: Between June 2015 and December 2016, 1010 women received medications, of whom 56% lived outside of major cities. Ninety‐five percent of packages were sent within 15 days after registration. Of the 965 women who took misoprostol, outcomes were definitively documented for 754 (78%), of whom 96% had a complete abortion without surgical intervention, and 95% had no face‐to‐face clinical encounter after treatment. Of women with Medicare cards, 72% paid no out‐of‐pocket charges other than to the Foundation. Nearly all women (781/802; 97%) were highly satisfied. Conclusions: The direct‐to‐patient telemedicine medical abortion service was effective, safe, inexpensive and satisfactory. It disproportionately served women in parts of Australia with limited access to abortion facilities. This experience may be instructive for others desiring to use telemedicine to enhance access to abortion. [ABSTRACT FROM AUTHOR]

The anti-Mullerian Hormone (AMH) test is a blood test indicating the number of eggs left in a woman's ovaries. Whilst the test is helpful in assisted reproduction, studies have found the test cannot reliably predict the likelihood of pregnancy or timing of menopause. It is unclear what people in Australia know about the AMH test or how widely it is being used, particularly for women without infertility. Data were collected via an online or telephone survey of a probability-based population panel in January 2022. All females aged 18-55 years were invited to participate. Questions about AMH testing included if and how participants had heard about AMH testing, whether they had ever had an AMH test, the main reason for AMH testing, and how they accessed the test. 1773 of the 2423 women who were invited responded. Of these, 229 participants (13%) had heard about AMH testing and 124 had had an AMH test 7%). Having had the test was associated with age and educational attainment. The highest rate of testing was for those aged 35-39 (14%), followed by 10% for those aged 40-44 years. 51% of women had the test during infertility investigations, 19% because they were considering pregnancy, 9% because they were curious, 11% to find out if a medical condition had affected their fertility, 5% as they were considering egg freezing, and 2% because they were considering delaying pregnancy. Whilst a substantial proportion of women underwent AMH testing for reasons supported by evidence, many did not. Potential implications of AMH testing in scenarios not related to infertility investigation include a false sense of security about delaying pregnancy, unwarranted anxiety about not being able to conceive, pressure to conceive earlier than desired or unnecessary procedures. [ABSTRACT FROM AUTHOR]

Fertility is crucial for pasture-based seasonal calving dairy herds, where cows are expected to calve in a single cohort at a time when peak milk production coincides with maximum pasture availability. However, dairy fertility has declined globally, and many Australian herds now use a split calving system, where non-pregnant cows are given additional opportunities to conceive by having two mating periods per year. Other factors prompting a move to split calving may include financial incentives for producing out-of-season milk, increasing levels of concentrate feeding, and pressure due to extreme seasonal conditions – all of which are particularly apparent in the northern Victorian irrigation region. The aim of our study was to describe the fertility and herd characteristics of the study population and to examine changes in reproductive performance and calving systems that have occurred over the same period. Our study population included 38 herds from the northern Victorian irrigation region in Australia. We collected individual cow records from each herd from the date on which they started herd recording (with a median start year of 2000 for mating event data) up until December 2016, comprising both fertility-related data such as insemination records, calving dates, and pregnancy test results, and systems-related data such as production, herd size and calving pattern. From a relatively small number of herds, we were able to obtain a dataset comprising 438,578 mating and pregnancy test records for 86,974 cows. From 2003 to 2016, 6-week in-calf rate and first service conception rate declined in the study population for both Holstein-Friesians and Jerseys, while 3-week submission rate remained unchanged. At the same time, the proportion of split calving herds in our cohort markedly increased, with a significant expansion in herd size compared to their seasonal counterparts. The proportion of first parity heifers in herds also increased, which may be a function of increasing herd size, or involuntary culling due to poor fertility. Split calving represents a significant system change for herd managers, with concomitant effects on labour management, input costs, and the lifestyle they experience. However, if this change has been implemented due to poor fertility without considering whether the increased income outweighs increased input costs, then a suboptimal decision may have been made. Finally, high quality data remains underutilised on individual farms, with significant benefits to the Australian dairy industry if we can overcome the numerous challenges to access it. [Display omitted] • Traditionally, the Australian dairy industry has been predominantly pasture-based and seasonal calving. • There has been a significant shift towards higher levels of concentrate feed and split calving patterns over two decades. • Northern Victorian dairy herds are more likely to change due to high grain availability, water reforms and climate change. • Fertility has decreased in our study cohort of northern herds, while the proportion of heifer replacements has increased. • If a system change to split calving has been forced due to poor fertility, then a suboptimal decision may have been made. [ABSTRACT FROM AUTHOR]

Preimplantation Genetic Testing (PGT) has been performed since 1989 and utilized in the diagnosis of all genetic conditions at preimplantation stage (1). In the previous years, only a disorder could be diagnosed with the use of multiplex nested PCR in PGT applications. Increased use of trophectoderm biopsy and vitrification together with Whole Genome Amplification (WGA) technology enabled the detection of single gene disorders together with 24 chromosome screening. This approach allowed us to select healthy and chromosomally euploid embryos. Even though single gene disorder carrier patients are mostly young and fertile, they still have high risk of spontaneous miscarriage. In the recent years, it has been reported that when the embryos are screened for aneuploidy (PGT-A) in addition to single gene disorder testing (PGT-M), pregnancy rates can be increased from 45% to 68% and spontaneous miscarriage rates decreased from 15% to 5%. 34 single gene disorder patients, whose embryos were found to be healthy in terms of single gene disorder, were included in this study and these embryos were further screened for aneuploidy using Next Generation Sequencing (NGS) technology (2). On the 5th and 6th days of embryonic development, WGA was performed using SurePlex DNA Amplification System (Illumina, USA) and DOPlify (PerkinElmer Health Sciences - Australia). Following multiplex nested PCR on WGA samples, fragment analysis for haplotyping and sequence analysis for mutation detection were performed. Embryos found to be suitable for transfer regarding the single gene disorder have further been screened for aneuploidy using NGS technology with VeriSeq PGS Kit (Illumina, USA). This study was conducted for single gene disoder and 24 chromosome screening in 44 patients with an average age of 34. 280 embryos derived from these patients were included in PGT-M. Among 153 embryos that were found to be suitable for transfer after PGT-M, PGT-A was performed on 121 embryos upon patients' requests and 49% of these embryos were euploid. Embryo transfer could not be performed in 12 patients due to the absence of euploid embryos. According to the data we acquired, 64% pregnancy was achieved in the rest of the patients. While pregnancy ratio can be improved with this approach, Allele drop out (ADO) and contamination errors are still major limitation which can lead to misdiagnosis of embryos. ADO ratio was demonstrated to be 25% in PGT for blastomere cells, whereas this ratio drops down to 5% when 5-7 cells obtained by trophectoderm biopsy are tested. Thus trophectoderm cells are more appropriate for PGT-M applications combined with PGT-A. Since stable and homogenous amplification of the entire genome is a crucial step, optimised WGA technologies will be a key factor in these applications. [ABSTRACT FROM AUTHOR]

Unlabelled: Ionizing radiation used in diagnostic nuclear medicine procedures has the potential to have biologic effects on a fetus. Nuclear medicine technologists (NMTs) therefore have a responsibility to ensure that they question all patients of childbearing age about their pregnancy status before starting any procedure, to avoid unnecessary fetal irradiation. In Australia, there are no clearly defined practice guidelines to assist NMTs in determining whom to question or how to question their patients., Methods: Semistructured interviews were conducted with chief NMTs and staff NMTs in 8 nuclear medicine departments in Australia. Questions were based around 5 areas: regulations and policy, fetal radiation exposure, questioning of the patient, difficulties in determining pregnancy status, and the impact of the use of hybrid imaging. Audio files of the interviews were transcribed and coded., Results: Topics were coded into 5 themes: policy and awareness of guidelines, questioning the patient, radiation knowledge, decisions and assumptions made by NMTs, and the use of pregnancy testing. There was a wide variation in practice between and within departments. NMTs demonstrated a lack of knowledge and awareness of the possible biologic effects of radiation., Conclusion: This study identified a need in Australia for nuclear medicine to arrive at a consensus approach to verifying a patient's pregnancy status so that NMTs can successfully question patients about their pregnancy status. Continuing education programs are also required to keep NMTs up to date in their knowledge.

Background: The objective of this analysis was to assess the second-trimester surgical abortion practices of National Abortion Federation (NAF) members in North America and Australia., Study Design: In 2002, questionnaires were mailed to 364 active member clinics of NAF for completion by their clinic administrators and individual providers., Results: Two hundred eighty-nine (79%) clinics responded. Most NAF clinics (72%) offer second-trimester abortion services. The majority of second-trimester providers are obstetrician/gynecologists (63%), male (62%) and at least 50 years old (63%). We describe second-trimester surgical abortion practices in terms of patient eligibility, cervical ripening, ultrasound use, anesthesia and postoperative care., Conclusions: Surgical techniques and postoperative practices for second-trimester abortions are similar among these respondents, suggesting that NAF's efforts to promulgate best practices using evidence-based guidelines are succeeding. The aging of skilled practitioners raises concerns about the future availability of second-trimester abortion.

A total of 7495 postpuberal beef cows from herds in north Queensland and the Northern Territory were examined at abattoirs to define the extent of wastage due to the slaughter of pregnant cows. On the basis of examination of teeth most cows (57%) were considered mature (approximately 3.5 to 7 years) at slaughter; 14% were young (9 months to 3.5 years) and 29% were old (over 7 years). In herds where pregnancy diagnosis by rectal examination had not been used at time of culling, 71.6% of slaughtered cows were pregnant and 42% of these cows were in the second trimester. This high pregnancy rate was considered an important source of herd wastage. Pregnancy rate varied little with season, but the highest percentages of cows pregnant in the first and third trimesters were recorded in autumn and spring, respectively. Most cows found non-pregnant had active ovaries at time of slaughter. Anoestrus was observed to be most common in winter and in old cows. Lactational status was not recorded. Mean cold carcase weight of 4229 cows was 161 +/- 40 kg. Maximum carcase weight was observed in cows slaughtered at 4 to 6 years of age; old cows had the lowest carcase weight (147 +/- 31 kg) of the age groups considered. Highest (170 +/- 43 kg) and lowest (135 +/- 41 kg) carcase weights in relation to pregnancy or ovarian status were observed in non-pregnant/ovary-active and non-pregnant/anoestrus cows respectively. Carcase weight of cows in the third trimester (165 +/- 35 kg) was greater than in the second (161 +/- 35 kg) or first (157 +/- 36 kg) trimesters; difference between the first and third trimesters was significant (P less than 0.01).

A total of 487 Standardbred and Thoroughbred mares at two studs were manually tested for pregnancy at 20 to 24, 30 to 34, and greater than 42 days after service and the abortion rate compared to that obtained in previous years when only the greater than 42-day test was performed. The results indicated that early manual pregnancy testing does not increase the abortion rate if undertaken carefully and enables non-pregnant mares to be re-mated earlier in the same season.