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Sydney, Australia

Dahlen H.G.,University of Western Sydney | Caplice S.,Royal Hospital for Women
Women and Birth | Year: 2014

Background: There is evidence that a significant number of women are fearful about birth but less is known about the fears of maternity health providers and how their fear may impact on the women they care for. Aim: The aim of this study was to determine the top fears midwives in Australia and New Zealand hold when it comes to caring for childbearing women. Method: From 2009 to 2011, 17 workshops were held in Australia and New Zealand supporting over 700 midwives develop skills to keep birth normal. During the workshop midwives were asked to write their top fear on a piece of paper and return it to the presenters. Similar concepts were grouped together to form 8 major categories. Findings: In total 739 fears were reported and these were death of a baby (. n=. 177), missing something that causes harm (. n=. 176), obstetric emergencies (. n=. 114), maternal death (. n=. 83), being watched (. n=. 68), being the cause of a negative birth experience (. n=. 52), dealing with the unknown (. n=. 36) and losing passion and confidence around normal birth (. n=. 32). Student midwives were more concerned about knowing what to do, while homebirth midwives were mostly concerned with being blamed if something went wrong. Conclusion: There was consistency between the 17 groups of midwives regarding top fears held. Supporting midwives with workshops such as dealing with grief and loss and managing fear could help reduce their anxiety. Obstetric emergency skills workshops may help midwives feel more confident, especially those dealing with shoulder dystocia and PPH as they were most commonly recorded. © 2014 Australian College of Midwives.

Collier C.B.,Royal Hospital for Women
International Journal of Obstetric Anesthesia | Year: 2010

Background: Considerable uncertainty exists regarding accidental injection of local anaesthetic into the 'subdural space' during attempted epidural block. A whole range of clinical findings, from excessively high to failed blocks has been reported although many of these findings appear difficult to explain on the basis of our current knowledge of the anatomy. The existence of another, adjacent space, the intradural space, is postulated. Methods: Our study of atypical epidural blocks using contrast injection and radiographic screening has now obtained data on 130 patients, and results were reviewed retrospectively, searching for contrast flowing into the subdural region. Results: Radiographic studies have revealed 10 patients with an unusual dense localised collection of contrast in a space previously unrecognised by anaesthetists. Clinical presentation was of inadequate neuraxial block, which could eventually be corrected by top-up doses, but with the possible risk of developing a high block. Late radiographic pictures revealed contrast escaping from the mass into the epidural, subdural or subarachnoid spaces. Conclusions: A review of electron microscopy studies suggested that a 'secondary' subdural space could be opened up by trauma in the distal layers of the dura. Our findings suggest that injection into this 'intradural' space can occur, resulting in an initially inadequate neuraxial block with limited spread. Further volumes of local anaesthetic can be expected to produce satisfactory block, probably as a result of escape to the epidural space. However, late spread to the subdural or subarachnoid space may occur. © 2009 Elsevier Ltd. All rights reserved.

Meriki N.,King Saud University | Welsh A.W.,Royal Hospital for Women | Welsh A.W.,University of New South Wales
Fetal Diagnosis and Therapy | Year: 2012

Objectives: To construct gestational age-adjusted reference ranges of the left fetal modified myocardial performance index (Mod-MPI) in the Australian population and assess the influence of valve click caliper position on constituent time intervals and the Mod-MPI. Methods: This is a prospective longitudinal study of 117 normal singleton fetuses undergoing 318 ultrasound scans at 4-6 weekly intervals between 18 and 38 weeks of gestation. The isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and ejection time (ET) were measured at 3 different caliper positions in each fetus: beginning of the original valve clicks ('original'), beginning of the reflected valve clicks ('reflected'), and peak of valve clicks ('peak'). The Mod-MPI was calculated as (ICT + IRT)/ET. Results: The Mod-MPI increased throughout gestation with means ± SD of 0.42 ± 0.05 'reflected' and 'peak' versus 0.49 ± 0.03 'original' at 19 weeks, and means of 0.46 ± 0.05 'reflected and peak' versus 0.51 ± 0.08 'original' at 36 weeks. Throughout gestation, ICT remained fairly constant and IRT increased, while ET decreased with 'original' click and remained constant for 'reflected' and 'peak' clicks. A modest increase in Mod-MPI was seen with increasing fetal heart rate. Analysis of repeatability for the 3 methods showed the following ICCs: 'original', 0.797 (95% CI 0.762-0.829); 'reflected', 0.809 (95% CI 0.775-0.839), and 'peak', 0.799 (95% CI 0.764-0.831). Conclusions: Detailed exploration of the morphology of mitral and aortic valve closure and opening clicks shows how selection of different phases of these clicks may significantly influence the Mod-MPI. We recommend that the peak of the valve clicks be standardized between research groups. Copyright © 2012 S. Karger AG, Basel.

Costello M.F.,Royal University for Women | Lindsay K.,Royal University for Women | McNally G.,Royal Hospital for Women
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2011

Objective: To investigate the effect of uterine adenomyosis diagnosed by transvaginal ultrasound on IVF/ICSI treatment outcome. Study design: A retrospective cohort study of all women aged ≤ 42 years with infertility who underwent IVF/ICSI treatment at IVFAustralia-East between January 2000 and June 2006. Patients were divided into two groups according to findings on a baseline pre-treatment transvaginal pelvic ultrasound: group A consisted of women with adenomyosis and group NA consisted of women without adenomyosis. The primary outcome measure was live birth rate per patient (cycle). Results: A total of 201 patients (37 patients in Group A, 164 patients in group NA) undergoing a single stimulated cycle of IVF/ICSI were included in the data analysis. There was no difference in live birth rate per patient (cycle) between the two groups with both raw and logistic regression adjusted data (29.7% V 26.1%; p = 0.395; OR 1.45 with 95% CI 0.61-3.43). There were no other differences in ovarian response, embryological parameters or clinical outcomes between the two groups. Conclusions: The presence of transvaginal ultrasound diagnosed adenomyosis did not adversely affect outcome in women undergoing IVF/ICSI treatment at our unit. However, the results are not conclusive and further large, well-designed prospective cohort studies are required in order to confirm our findings. © 2011 Elsevier Ireland Ltd.

Awan N.,University of New South Wales | Bennett M.J.,University of New South Wales | Walters W.A.W.,Royal Hospital for Women
Australian and New Zealand Journal of Obstetrics and Gynaecology | Year: 2011

Background: There appears to be a rise in the rate of emergency peripartum hysterectomy (EPH) in the developed world. Aims: To determine the incidence, indications, risk factors, complications and management of EPH in our tertiary level teaching hospital, the Royal Hospital for Women (RHW) in Sydney, over the last decade. Methods: A retrospective analysis was conducted of all cases of EPH performed at the RHW between the years 1999-2008 inclusive. EPH was defined as one performed after 20 weeks gestation for uncontrollable uterine bleeding not responsive to conservative measures occurring at any time after delivery but within the first 6 weeks post-partum. Cases were ascertained via our hospital obstetric database. Results: There were 33 EPH among 38 998 births, a rate of 0.85 per 1000 births. Indications for EPH were morbid adherence of the placenta (54.8%), placenta praevia (19.4%), uterine atony (12.9%) and uterine rupture or cervical laceration (9.7%). A significant association between previous caesarean section (CS) and abnormal placentation was confirmed (P = 0.011), especially for morbid adherence of the placenta (P = 0.004). There was one maternal death. Maternal morbidity was significant, with disseminated intravascular coagulation and urinary tract injury among the most common complications. All women required blood transfusions, and over a quarter were admitted to the intensive care unit. Conclusions: In our series, abnormal placentation causing severe haemorrhage was the commonest indication for EPH. Previous CS is a risk factor for abnormal placentation and particularly for morbid adherence of the placenta. The morbidity associated with EPH is considerable. © 2011 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

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