Effect of menstrual cycle and menopause on human gastric electrophysiology.

Chronic gastroduodenal symptoms disproportionately affect females of childbearing age; however, the effect of menstrual cycling on gastric electrophysiology is poorly defined. To establish the effect of the menstrual cycle on gastric electrophysiology, healthy subjects underwent noninvasive Body Surface Gastric Mapping (BSGM; 8x8 array) with the validated symptom logging App (Gastric Alimetry, New Zealand). Participants included were premenopausal females in follicular ( = 26) and luteal phases ( = 18) and postmenopausal females ( = 30) and males ( = 51) were controls.

Neonatal and maternal outcomes at early vs. full term following induction of labor; A secondary analysis of the OBLIGE randomized trial.

Introduction: Birth at early term (37-38 completed gestational weeks [GW] and additional days) is associated with adverse neonatal outcomes compared with waiting to ≥39 GW. Most studies report outcomes after elective cesarean section or a mix of all modes of births; it is unclear whether these adverse outcomes apply to early-term babies born after induction of labor (IOL). We aimed to determine, in women with a non-urgent induction indication (elective/planned >48 h in advance), if IOL at early and late term was associated with adverse neonatal and maternal outcomes compared with IOL at full term.

Sexual and reproductive health services in New Zealand primary care settings: A mixed-methods survey.

Background: New Zealand's recently released Women's Health Strategy aims to provide accessible, equitable care which prioritises prevention, early intervention and areas of unmet need. An example of such care is the management of common sexual and reproductive health (SRH) issues by appropriately trained primary care practitioners in the community.

Aims: The aim was to identify primary care SRH program initiatives currently operating in New Zealand, how they are accessed and funded, whether they have been co-designed using mātauranga (knowledge) Māori principles and whether any have undergone formal evaluation.

Barriers and enablers to implementing an induction of labour guideline: A clinician survey.

Background: Clinical guidelines improve outcomes, but poor compliance with recommendations is common. Insight into perceived barriers and enablers to the implementation of guidelines can engage maternity care providers and inform strategies for effective implementation.

Aim: To identify the perceived barriers and enablers to implementing the 2020 'Induction of Labour [IOL] in Aotearoa New Zealand; a Clinical Practice Guideline.

Outpatient balloon catheter vs inpatient prostaglandin for induction of labor: a randomized trial.

Background: Approximately 1 in 4 pregnant women undergo induction of labor. Meta-analyses have shown that mechanical methods of induction of labor are safe and effective, as is starting induction in an outpatient setting. However, few studies have evaluated outpatient balloon catheter induction in comparison with pharmacologic methods.

Screening of diabetes in pregnancy in New Zealand: translation of national guidelines into practice.

Aim: To evaluate the proportion of pregnant women who completed screening for pre-existing diabetes and GDM, following publication of the Guideline.

Methods: A stocktake was conducted of clinical audits by University of Auckland medical students in nine New Zealand public hospitals between 2015 and 2021. Audits were included if they investigated whether women who gave birth were screened for diabetes in pregnancy according to Guideline recommendations.

Audit of waiting time-to-treatment of atypical endometrial hyperplasia.

Background: Atypical endometrial hyperplasia (AEH) is the precursor lesion in endometrial carcinoma, the most common gynaecological malignancy in New Zealand, with inequities in disease burden and outcome for Māori and Pacific women.

Aims: In women diagnosed with AEH at two hospitals, to audit five standards of care for surgical management and time-to-treatment, and identify variation in care by ethnicity and other factors.

Materials And Methods: Demographic, referral, diagnostic and treatment characteristics were collected for women with a new AEH diagnosis between 1/1/2019 and 31/12/2020.

Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis.

Background: Heavy menstrual bleeding (HMB) is excessive menstrual blood loss that interferes with women's quality of life, regardless of the absolute amount of bleeding. It is a very common condition in women of reproductive age, affecting 2 to 5 of every 10 women. Diverse treatments, either medical (hormonal or non-hormonal) or surgical, are currently available for HMB, with different effectiveness, acceptability, costs and side effects.

Antiphospholipid antibodies do not cause retargeting of placental extracellular vesicles in the maternal body.

Antiphospholipid antibodies (aPL) are autoantibodies that cause pregnancy disorders by a poorly defined mechanism that involves the placenta. The human placenta is covered by a single multinucleated cell, the syncytiotrophoblast, which extrudes vast numbers of extracellular vesicles (EVs) into the maternal blood. Extracellular vesicles are tiny packages of cellular material used by cells for remote signalling.

Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery.

Background: Endometriosis is a condition characterised by the presence of ectopic deposits of endometrial-like tissue outside the uterus, usually in the pelvis. The impact of laparoscopic treatment on overall pain is uncertain and a significant proportion of women will require further surgery. Therefore, adjuvant medical therapies following surgery, such as the levonorgestrel-releasing intrauterine device (LNG-IUD), have been considered to reduce recurrence of symptoms.

Placental extracellular vesicles retain biological activity after short-term storage (14 days) at 4 °C or room temperature.

Introduction: To investigate the role of placental extracellular vesicles (EVs), especially in pathological pregnancy, the use of freshly isolated EVs is often limited due to the sporadic and unpredictable availability of placental samples. Therefore, it is important to understand and use optimised storage conditions for placental EVs. In this study, we investigated different conditions for the short-term storage of placental micro- and nano-EVs and examined their biological activity.

Perineal trauma management and follow-up: Are we meeting the standard of care?

Background: Birth-related third- and fourth-degree perineal trauma is common and associated with short- and long-term complications.

Aim: To conduct a review of clinical audits investigating management of women with perineal trauma.

Materials And Methods: We identified all audits undertaken in eight New Zealand public hospitals between 2005 and 2014 that investigated whether women with birth-related third- and fourth-degree perineal trauma were receiving care according to clinical guidelines.

Levonorgestrel-releasing intrauterine system for endometrial hyperplasia.

Background: In the absence of treatment, endometrial hyperplasia (EH) can progress to endometrial cancer, particularly in the presence of histologic nuclear atypia. The development of EH results from exposure of the endometrium to oestrogen unopposed by progesterone. Oral progestogens have been used as treatment for EH without atypia, and in some cases of EH with atypia in women who wish to preserve fertility or who cannot tolerate surgery.

Outpatient balloon catheter vs inpatient prostaglandin for induction of labour (OBLIGE): a randomised controlled trial.

Background: Approximately one in four pregnant women undergo an induction of labour. The purpose of this study is to investigate the clinical effectiveness, safety, and cost-effectiveness for mothers and babies of two methods of cervical ripening - inpatient care for women starting induction with vaginal prostaglandin E2 hormones, or allowing women to go home for 18 to 24 h after starting induction with a single-balloon catheter.

Methods/design: This is a multi-centre randomised controlled trial in New Zealand.

The State of Quality Improvement Teaching in Medical Schools: A Systematic Review.

Introduction: While teaching patient safety and quality improvement (QI) skills to medical students is endorsed as being important, best practice for achieving learner outcomes in QI is particularly unclear. We systematically reviewed QI curricula for medical students to identify approaches to QI training that are associated with positive learner outcomes.

Methods: We searched databases (Medline, EMBASE, and Scopus) and article bibliographies for studies published from 2009 to 2018.

Birth choices for women in a 'Positive Birth after Caesarean' clinic: Randomised trial of alternative shared decision support strategies.

Background: Systematic approaches to information giving and decision support for women with previous caesarean sections are needed.

Aim: To evaluate decision support within a 'real-world' shared decision-making model.

Methods: A pragmatic comparative effectiveness randomised trial in the Positive Birth After Caesarean Clinic.

Combined hormonal contraceptives for heavy menstrual bleeding.

Background: Menorrhagia or heavy menstrual bleeding (HMB) is an excessive blood loss that impairs a woman's quality of life, either physical, emotional, social or material. It is benign and not associated with pregnancy or any other gynaecological or systemic disease. Medical treatments used to reduce excessive menstrual blood loss (MBL) include prostaglandin synthetase inhibitors, antifibrinolytics, oral contraceptive pills, and other hormones.

Neighborhood Income and Cesarean Section Rates at a Tertiary Care Center in Canada.

With rising rates of cesarean sections (CSs) in Canada and worldwide, nonclinical factors for CS warrant consideration. To determine the association between a primigravid woman's neighborhood income and rates of CSs. A retrospective cohort study was conducted at an Ontario tertiary care center from January 2003 to December 2013.

Body Mass Index is Negatively Associated with Endometrial Cancer Stage, Regardless of Subtype and Menopausal Status.

: Obesity is one of the common risk factors for developing of endometrial cancer and is negatively associated with its survival, although this result is controversial. Endometrial cancer stages range from stage I, which has better clinical outcomes to stage IV, which has poorer clinical outcomes. Endometrial cancer traditionally divides into type 1 and type 2 dependent on histology which has different clinical outcomes.

Estimation of the burden of human placental micro- and nano-vesicles extruded into the maternal blood from 8 to 12 weeks of gestation.

Background: The human placenta extrudes a variety of extracellular vesicles (EVs) into the maternal blood daily. These vesicles may be crucial to the adaptation of the maternal cardiovascular and immune systems to pregnancy. Quantifying the EVs that are released in early gestation is important to our understanding of how placental EVs may contribute to the regulation of maternal physiology.

Risk of perinatal mortality in the first year of midwifery practice in New Zealand: analysis of a retrospective national cohort.

Objectives: To determine whether there was an increased risk of perinatal mortality among mothers booked for care with community lead maternity carer (LMC) midwives in their first compared with later years of practice.

Design: Retrospective cohort study using linked national maternity, mortality and workforce data; adjusted analysis using logistic regression.

Setting: New Zealand.

Late stillbirth post mortem examination in New Zealand: Maternal decision-making.

Background: For parents who experience stillbirth, knowing the cause of their baby's death is important. A post mortem examination is the gold standard investigation, but little is known about what may influence parents' decisions to accept or decline.

Aim: We aimed to identify factors influencing maternal decision-making about post mortem examination after late stillbirth.

An evaluation of the objective quality and perceived usefulness of maternity clinical practice guidelines at a tertiary maternity unit.

Background: Compliance with maternity clinical practice guidelines developed by National Women's Health has been found to be low at audit.

Objective: To explore the reasons for poor compliance with maternity guidelines by evaluating the quality of a sample of National Women's Health guidelines using a validated instrument and assessing local guideline users' perceptions of and attitudes toward guidelines.

Design: Five independent reviewers evaluated the quality of 10 purposively selected guidelines for adherence to the Appraisal of Guidelines Research & Evaluation (AGREE) II instrument standards.

Teaching quality improvement to medical students: over a decade of experience.

Aim: To describe how we incorporate experiential quality improvement (QI) learning at the University of Auckland by integrating a clinical audit project into the Year 6 obstetrics and gynaecology clinical attachment.

Methods: Students gain insight into the relevance of QI while engaged in day-to-day clinical work. Students work with a clinical supervisor to identify an area for potential improvement, set a standard of care, measure current practice, investigate reasons for deviation from the standard and make real-world suggestions to close the gap between best evidence and observed practice.