Exploring access to vasectomy services: a case study of funding in Counties Manukau.

INTRODUCTION Although vasectomy rates in New Zealand have been reported as among the highest worldwide, there is limited information about who is receiving these services and how they are being accessed. This information is needed to develop equitable access to vasectomy services. AIM To describe the ethnicity and socioeconomic status of men accessing District Health Board-funded and self-funded vasectomies in Counties Manukau.

New screen on the block: non-invasive prenatal testing for fetal chromosomal abnormalities.

Non-invasive prenatal testing (NIPT) is a new screen for fetal chromosomal abnormalities. It is a screening test based on technology that involves the analysis of feto-placental DNA that is present in maternal blood. This DNA is then analysed for abnormalities of specific chromosomes (eg 13, 18, 21, X, Y).

Implementing non-invasive prenatal testing into publicly funded antenatal screening services for Down syndrome and other conditions in Aotearoa New Zealand.

Background: Non-invasive prenatal testing (NIPT) is a relatively new screen for congenital conditions - specifically, common fetal aneuploidies including Down Syndrome. The test is based on isolating freely circulating fragments of fetal-placental DNA that is present in the mother's blood. NIPT has a superior clinical performance compared to current screening, and has been available privately in Aotearoa New Zealand for the last 4 years.

Views of the obstetric profession on non-invasive prenatal testing in Aotearoa New Zealand: A national survey.

Background: Non-invasive prenatal testing (NIPT) has been available in Aotearoa New Zealand (NZ) for approximately four years. It is likely to be introduced into the publicly funded prenatal screening service.

Aim: To explore obstetrician use and views of NIPT, with consideration to its implementation into screening services for Down syndrome and other conditions.

Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; Findings from the New Zealand multicentre stillbirth case-control study.

Objective: Our objective was to test the primary hypothesis that maternal non-left, in particular supine going-to-sleep position, would be a risk factor for late stillbirth (≥28 weeks of gestation).

Methods: A multicentre case-control study was conducted in seven New Zealand health regions, between February 2012 and December 2015. Cases (n = 164) were women with singleton pregnancies and late stillbirth, without congenital abnormality.

The combination of bed sharing and maternal smoking leads to a greatly increased risk of sudden unexpected death in infancy: the New Zealand SUDI Nationwide Case Control Study.

Background: Despite a major reduction in overall infant mortality, sudden unexpected death in infancy (SUDI) continues to be of concern in New Zealand, as the rate is high by international standards, and is even higher in indigenous Māori.

Aim: To identify modifiable risk factors for SUDI.

Methods: A three-year (1 March 2012-28 February 2015) nationwide case-control study was conducted in New Zealand.

Gestational disruptions in metabolic rhythmicity of the liver, muscle, and placenta affect fetal size.

Maternal metabolic adaptations are essential for successful pregnancy outcomes. We investigated how metabolic gestational processes are coordinated, whether there is a functional link with internal clocks, and whether disruptions are related to metabolic abnormalities in pregnancy, by studying day/night metabolic pathways in murine models and samples from pregnant women with normally grown and large-for-gestational age infants. In early mouse pregnancy, expression of hepatic lipogenic genes was up-regulated and uncoupled from the hepatic clock.

Pounamu: E Hine: access to contraception for indigenous Mãori teenage mothers.

INTRODUCTION Timely and equitable access to contraception enables teenage mothers to make informed choices about their sexual and reproductive health. This study aimed to identify barriers and facilitators to contraception for Māori teenagers who become mothers. METHODS 'E Hine' is a longitudinal qualitative Kaupapa Māori (by Māori for Māori) study involving Māori women (aged 14-19 years), following them through pregnancy (n = 44) and the birth of their babies until their babies' first birthdays (n = 41).

Establishment of a national severe maternal morbidity preventability review in New Zealand.

Severe maternal morbidity (SMM) review is an accepted quality measure to evaluate maternity care standards. Assessment of the potential preventability of SMM enables identification of factors and themes to inform clinical training and policy to improve maternal outcomes. The present report outlines the introduction of a national/regional external case review system using multidisciplinary panels to assess potential preventability of SMM, to assist other health jurisdictions to establish similar processes.

Access to Secondary Mental Health Services in a Cohort of New Zealand Mothers.

To explore access to secondary mental health services for New Zealand women during pregnancy and for up to 1 year post-delivery. A retrospective cohort analysis of public hospital maternity data linked to mental health collections. 27 in 1000 pregnancies were associated with access to secondary mental health services (736/27,153).

PROMISE: first-trimester progesterone therapy in women with a history of unexplained recurrent miscarriages - a randomised, double-blind, placebo-controlled, international multicentre trial and economic evaluation.

Background And Objectives: Progesterone is essential to maintain a healthy pregnancy. Guidance from the Royal College of Obstetricians and Gynaecologists and a Cochrane review called for a definitive trial to test whether or not progesterone therapy in the first trimester could reduce the risk of miscarriage in women with a history of unexplained recurrent miscarriage (RM). The PROMISE trial was conducted to answer this question.

Exploring the maternal and infant continuum - ethnic disparities in infant hospital admissions for respiratory disease.

Objective: To investigate maternal and birth-related risk factors associated with infant respiratory hospitalisations in New Zealand.

Methods: A Kaupapa Māori-framed retrospective cohort analysis of public hospital maternal data linked to infant data (54,980 births 1995-2009). Primary outcome was rate of hospitalisation for respiratory disease in the first year of life.

A retrospective cohort study of the association between midwifery experience and perinatal mortality.

Objective: To determine whether experience of midwife-only and nurse-midwife lead maternity carers (LMCs) is related to perinatal mortality.

Methods: In a retrospective analysis, routinely collected data were obtained for all pregnancies resulting in live births (or stillbirth at ≥20weeks or weighing >400g) in New Zealand in 2005-2009. An anonymized dataset of date of midwife registration was used.

Contraception post severe maternal morbidity: a retrospective audit.

Introduction: Rapid repeat pregnancy is associated with maternal and neonatal morbidity. Effective postpartum contraception should be offered to all women, including those who experience severe acute maternal morbidity (SAMM), but little is known about contraceptive initiation in this group. Severe preexisting comorbidities with high pregnancy-related mortality risks are an important subset.

Rifampicin in the treatment of severe intrahepatic cholestasis of pregnancy.

Objective: To describe the use of combined ursodeoxycholic acid (UDCA) and rifampicin treatment in intrahepatic cholestasis of pregnancy (ICP).

Study Design: A questionnaire survey of 27 women with 28 affected pregnancies identified via the UK and International Obstetric Medicine forum. The clinical case notes of women with ICP treated with combined UDCA and rifampicin therapy were reviewed, and data regarding maternal and perinatal outcomes extracted.

Immediate postabortion initiation of levonorgestrel implants reduces the incidence of births and abortions at 2 years and beyond.

Objectives: The aims of this study were to compare immediate postabortion uptake of recently subsidized (no-cost) levonorgestrel-releasing implants with already available intrauterine and shorter-acting methods and to compare the incidence of subsequent pregnancies (ending in birth or abortion) within 2 years.

Study Design: Retrospective chart review of 4698 women attending a New Zealand public hospital abortion clinic over 2 years (2010-2012) to describe postabortion contraceptive choice, with follow-up via clinic and national births records to assess subsequent pregnancies at 12, 24, 36, and 48 months.

Results: Twenty percent of the cohort (934/4698) received an implant, 26% an intrauterine method (927 copper intrauterine device, 301 levonorgestrel-releasing intrauterine system [LNG-IUS]), and 54% chose other shorter-acting methods (2536/4698).

Time to second abortion or continued pregnancy following a first abortion: a retrospective cohort study.

Study Question: What proportions of women have a second abortion or continued pregnancy within 12-46 months of a first abortion?

Summary Answer: Estimated return rates for a second abortion were 5, 10.9 and 19.8% at 12, 24 and 46-months, respectively, and rates of continued pregnancy were 5.

Uterine cancer: exploring access to services in the public health system.

Background: Māori are the indigenous peoples of New Zealand and experience higher rates of uterine cancer and poorer survival rates. Postmenopausal bleeding (PMB) is the most common presenting symptom for uterine cancer. Prompt investigation is essential with 28 days being viewed as an appropriate time from first medical contact (FMC) to first specialist appointment (FSA).

Initiation of maternity care for young Maori women under 20 years of age.

Aim: To explore the lived realities of pregnant Maori women <20 years through pregnancy and motherhood, to identify barriers to, and facilitators of, access to maternity care.

Method: Using a Kaupapa Maori research paradigm, 44 pregnant or recently pregnant Maori woman <20 years of age were recruited in two case study sites. Participants completed a series of interviews during different stages of pregnancy and motherhood.

Associations between individual lower urinary tract symptoms and bacteriuria in random urine samples in women.

Aims: Previous studies have noted an association between a diagnosis of overactive bladder and bacteriuria, but little is understood about the relationship of bacteriuria to specific LUTS. We hypothesized that bacteriuria in women would be associated with increased self-reported symptom scores for a wide range of LUTS.

Methods: Women were recruited from general gynecology and urogynecology outpatient clinics in a secondary care setting.

The effect of midwifery care on rates of cesarean delivery.

Objective: To examine whether changing to a midwifery-led maternity service model was associated with a lower national rate of cesarean delivery.

Methods: We analyzed trends in the rate of cesarean delivery per 1000 live births between 1996 and 2010 in New Zealand. Estimates of relative increases in rate were calculated via Poisson regression for several maternal age groups over the study period.

Wāhine hauora: linking local hospital and national health information datasets to explore maternal risk factors and obstetric outcomes of New Zealand Māori and non-Māori women in relation to infant respiratory admissions and timely immunisations.

Background: Significant health inequities exist around maternal and infant health for Māori, the indigenous people of New Zealand. The infants of Māori are more likely to die in their first year of life and also have higher rates of hospital admission for respiratory illnesses, with the greatest burden of morbidity being due to bronchiolitis in those under one year of age. Timely immunisations can prevent some respiratory related hospitalisations, although for Māori, the proportion of infants with age appropriate immunisations are lower than for non-Māori.

The menopausal transition does not appear to accelerate age-related increases in arterial stiffness.

Objective: Arterial stiffness is an independent marker of cardiovascular risk that increases with age, hypertension, diabetes and hyperlipidemia, both for men and women (although more pronounced in women). This study was designed to establish whether menopause augments the age-dependent change.

Methods: The study evaluated pulse wave analysis and pulse wave velocity using applanation tonometry in 468 women (aged 40-80 years) sampled from the general population.