The first trimester abortion journey Aotearoa: health practitioners' perspectives.

Aim: To gain insight into health practitioners' understanding of how people experience the first trimester abortion journey.

Methods: Qualitative interviews informed by phenomenology with health practitioners from a range of practice settings across Aotearoa New Zealand. Participants were recruited via a separate but related study.

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.

What skills do New Zealand clinicians have to provide first trimester abortion in primary care and are they willing?

Objective: To determine the skills and intentions of health practitioners in New Zealand to provide first trimester abortion care.New Zealand achieved abortion law reform in 2020, changing how abortion could be delivered and experienced by pregnant people. However, little has changed in the way abortion care is provided.

Rates of Māori women receiving surgical treatment for urinary incontinence and pelvic organ prolapse in Southern District Health Board.

Aims: Pelvic organ prolapse (POP) and urinary incontinence (UI) are common gynaecological conditions that are amenable to surgical management. The prevalence of these conditions has not been well studied in the New Zealand population, but limited evidence suggests that Māori women are likely to have a higher prevalence of POP and UI than non-Māori women. The aim of this study was to formally document the rate of access to these surgical procedures for Māori and non-Māori women in the area served by Southern District Health Board (SDHB).

What does abortion law reform mean for primary care practitioners in New Zealand?

New Zealand achieved a major sexual reproductive health and rights milestone when abortion ceased to be a crime. Introduction of the Abortion Legislation Act 2020 has significantly changed the way abortion care can be provided in New Zealand, with the potential to improve access, reduce inequities and transform the abortion experience for those people who choose to end their pregnancy. The primary care sector stands to be a key player in the provision of first-trimester abortion care.

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 Before School Check (B4SC): reporting outcomes and referral rates for all New Zealand children.

Aims: Describe the data obtained through the Before School Check (B4SC) and report on the outcomes and referral rates of the B4SC measures.

Methods: Cross-sectional study of B4SC data collected between January 2012 and December 2016.

Results: After excluding duplicate entries, 287,572 children from the B4SC database were included for analysis.

Developmental outcomes at age four following maternal antiepileptic drug use.

We investigated whether prenatal antiepileptic drug (AED) exposure was associated with adverse outcomes in the Before School Check (B4SC) assessments, particularly the assessments measuring neurodevelopment. Children exposed to AEDs were identified by linking women dispensed AEDs in the Pharmaceutical Collection to births recorded on the National Minimum Dataset (NMDS). Multinomial logistic regression was used to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for outcomes of the parent-completed Parental Evaluation of Developmental Status (PEDS) questionnaire and Strengths and Difficulties Questionnaire (SDQ), after adjusting for gender, ethnicity, and socioeconomic deprivation.

Oral Riboflavin to Assess Ureteral Patency During Cystoscopy: A Randomized Clinical Trial.

Objective: To evaluate whether oral riboflavin is more effective than placebo as a marker of ureteric patency at cystoscopy.

Methods: Patients scheduled for gynecologic surgery where cystoscopy was a planned component of the procedure were randomized to receive riboflavin 400 mg or placebo orally the night before surgery. During cystoscopy, the operating surgeon visualized ureteric jets and video recorded the cystoscopy portion of the procedure.

Antiepileptic drug exposure in pregnancy and pregnancy outcome from national drug usage data.

Background: Antiepileptic drugs (AEDs) are used by pregnant women to manage conditions such as epilepsy and bipolar disorder even though they pose a risk to the developing foetus. This study aimed to determine the overall use of AEDs by women during their childbearing years and women who are pregnant and the association between AED use and rates of pregnancy termination and spontaneous abortion.

Methods: Retrospective population based cohort study using administrative databases in New Zealand between 2008 and 2014.

Are doses of lamotrigine or levetiracetam adjusted during pregnancy?

Subtherapeutic levels of lamotrigine and levetiracetam are more likely to occur during pregnancy owing to the effect of pregnancy on their pharmacokinetics. This can lead to suboptimal control of epilepsy, and guidelines recommend proactive dose adjustment in the second and third trimesters alongside therapeutic drug monitoring (TDM). This retrospective cohort study using administrative databases aimed to investigate whether prescribers adjust the dose of lamotrigine or levetiracetam during and after pregnancy and whether TDM is used to manage dose adjustment.

Patient-targeted Googling and social media: a cross-sectional study of senior medical students.

Background: Social media and Internet technologies present several emerging and ill-explored issues for a modern healthcare workforce. One issue is patient-targeted Googling (PTG), which involves a healthcare professional using a social networking site (SNS) or publicly available search engine to find patient information online. The study's aim was to address a deficit in data and knowledge regarding PTG, and to investigate medical student use of SNSs due to a close association with PTG.

Using Three-Dimensional Printing to Fabricate a Tubing Connector for Dilation and Evacuation.

Background: This is a proof-of-concept study to show that simple instrumentation problems encountered in surgery can be solved by fabricating devices using a three-dimensional printer. The device used in the study is a simple tubing connector fashioned to connect two segments of suction tubing used in a surgical procedure where no commercially available product for this use is available through our usual suppliers in New Zealand.

Materials And Methods: A cylindrical tubing connector was designed using three-dimensional printing design software.

Uterine Scar Dehiscence Associated with Misoprostol Cervical Priming for Surgical Abortion: A Case Report.

Background: Cervical priming prior to pregnancy termination is a common treatment. Both osmotic agents such as laminaria and Dilapan or pharmacologic agents such as misoprostol and mifepristone have been used for this purpose.

Case: A 30-year-old patient with a previous cesarean delivery was undergoing surgical termination of pregnancy at 13 weeks' gestation for a lethal fetal malformation.

Shoulder dystocia: management and documentation.

Shoulder dystocia is an obstetric emergency that occurs when the fetal shoulders become impacted at the pelvic inlet. Management is based on performing maneuvers to alleviate this impaction. A number of protocols and training mnemonics have been developed to assist in managing shoulder dystocia when it occurs.

Glove perforations with blunt versus sharp surgical needles in caesarean delivery: a randomized trial.

Aims: To compare the rate of glove perforations and surgeon satisfaction when utilizing blunt surgical needles compared to conventional sharp surgical needles.

Methods: Patients undergoing Caesarean delivery were randomly assigned to the use of blunt or sharp surgical suture needles. Surgical team members reported any known needlesticks or perforations of gloves and the primary surgeon completed a survey to gauge their satisfaction with the needles.

Plasma and tissue cefazolin concentrations in obese patients undergoing cesarean delivery and receiving differing pre-operative doses of drug.

Background: Patients undergoing cesarean delivery typically receive a 1-g to 2-g dose of cefazolin as pre-operative antibacterial prophylaxis. This traditional dosage may not provide an adequate tissue concentration of cefazolin in obese patients during the peri-operative period. This study compared the tissue concentrations of prophylactic cefazolin administered as a either a 2-g or a 4-g dose prior to cesarean delivery in obese patients.

Log-linear human chorionic gonadotropin elimination in cases of retained placenta percreta.

Purpose: To describe the human chorionic gonadotropin (hCG) elimination rate in patients with intentionally retained placenta percreta.

Methods: Medical records for cases of placenta percreta with intentional retention of the placenta were reviewed. The natural log of the hCG levels were plotted versus time and then the elimination rate equations were derived.

Laparoscopic removal of a large ovarian mass utilizing planned trocar puncture.

Background: Large cystic ovarian masses pose technical challenges to the laparoscopic surgeon. Removing large, potentially malignant specimens must be done with care to avoid the leakage of cyst fluid into the abdominal cavity.

Case: We present the case of a large ovarian cystic mass treated laparoscopically with intentional trocar puncture of the mass to drain and remove the mass.

Chronic postpartum uterine inversion treated by abdominal replacement and cerclage.

Background: Chronic uterine inversion is a potentially dangerous condition that often requires abdominal surgical reduction of the uterine inversion. Uterine inversion can recur after successful uterine replacement.

Case: A young primagravida presented with chronic recurrent uterine inversion 5 weeks after spontaneous vaginal delivery.

Vulvar abscess: a retrospective review.

Vulvar abscesses can progress to cause significant illness requiring disfiguring surgical debridement, broad spectrum antibiotics, and require hospitalization. A retrospective review of de-identified charts of 13 patients admitted for inpatient care for vulvar abscesses from 2004-2009 at West Virginia University Hospitals was conducted. Risk factors for vulvar abscess in these patients included obesity and diabetes.

Unruptured 32-week rudimentary horn pregnancy presenting as right upper quadrant pain.

Background: An unruptured third trimester rudimentary horn pregnancy is rare, life threatening, and can go undetected until the onset of symptoms. Given the high risk of uterine rupture, conservative management after viability is controversial.

Case: A 21 year-old with a 32-week rudimentary horn pregnancy, diagnosed via exploratory laparotomy five days earlier, presented with acute right upper quadrant pain.

Dilation of the vaginal cuff using the Bakri Postpartum Balloon to extract the large uterus at the time of robotic hysterectomy for endometrial carcinoma.

Removal of large uterine specimens during robotic or total laparoscopic hysterectomy poses surgical challenges, particularly in cases performed for gynecologic malignancy. A 23-year-old patient with endometrioid adenocarcinoma of the endometrium underwent robotic total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. The large uterine specimen was removed by dilating the colpotomy incision using the Bakri Postpartum Balloon™.

Assessment of a simulation training exercise to teach intrauterine tamponade for the treatment of postpartum hemorrhage.

Introduction: Postpartum hemorrhage is a common complication of vaginal birth. Few midwives have experience in the performance of procedures to manage hemorrhage that fails to respond to initial management with medications and bimanual compression.

Methods: A simulation model was constructed by using a half-pelvis birth simulator and a hollowed out cantaloupe.