Australian and New Zealand Journal of Obstetrics and Gynaecology

doi: 10.1111/j.1479-828X.2006.610_2.xpmid: N/A

HUMPHREY, Michael

doi: 10.1111/j.1479-828X.2006.610_1.xpmid: N/A

LYALL, Fiona

doi: 10.1111/j.1479-828X.2006.00589.xpmid: 16866784

The placental bed underlies the placenta and includes the decidua basalis and underlying myometrium containing the uterine spiral arteries. For successful human haemochorial placentation, the placental bed spiral arteries must undergo considerable alterations. These physiological modifications are thought to be brought about by the interaction of invasive cytotrophoblast with the spiral artery vessel wall. Failure of spiral artery transformation is thought to play an important role in the sequence of events that gives rise to pre‐eclampsia. The mechanisms that control human trophoblast invasion in normal, let alone abnormal pregnancy, are still poorly understood. Much of the information on the early physiological changes within the placental bed comes from studies on intact hysterectomy specimens. Details of such events in late pregnancy and in pregnancies complicated by pre‐eclampsia and fetal growth restriction are principally derived from the study of placental bed biopsies taken at Caesarean section. The methods of sampling the placental bed have been reviewed elsewhere. Many investigators have relied on in vitro models of trophoblast invasion. In vitro models can be extremely useful in dissecting out some of these processes but may be open to artefacts. The mechanisms underlying normal and failed trophoblast invasion appear to be complex. In this manuscript the mechanisms that control the invasion of trophoblast into the decidua and myometrium are reviewed. Along with this is a review of the purported mechanisms underlying failed spiral artery transformation. Particular emphasis has been placed on topics that have been best studied.

AKA, Nurettin; ATALAY, Sacide; SAYHARMAN, Sema; KILIÇ, Düzgün; KÖSE, Gültekin; KÜÇÜKÖZKAN, Tuncay

doi: 10.1111/j.1479-828X.2006.00590.xpmid: 16866785

Objective: To investigate the association between the leptin, leptin receptor and hormone levels and hyperemesis gravidarum, and to determine whether these two parameters may be early markers for hyperemesis gravidarum. Methods: The study group consisted of 18 pregnant women with hyperemesis gravidarum and the control group consisted of 18 healthy pregnant women. Demographic characteristics were recorded and body mass index (BMI) values were calculated for all the pregnant women. Serum leptin, leptin receptor, insulin, cortisol, thyroid hormone and human chorionic gonadotrophin (hCG) levels were measured. Results: When the two groups were compared with respect to leptin levels, the group with hyperemesis gravidarum was found to have significantly higher leptin levels (P = 0.037). No intergroup differences were observed in serum cortisol, insulin, hCG, thyroid hormone levels or BMI values. In the group with hyperemesis gravidarum, an inverse correlation was detected between cortisol and leptin (r = –0.762, P < 0.01), and hCG and thyroid‐stimulating hormone (r = –0.503, P < 0.05), whereas a significant correlation was detected between insulin and leptin (r = 0.538, P < 0.05), leptin and BMI (r = 0.711, P < 0.01), and between TT3 and hCG (r = 0.605, P < 0.01). Conclusion: It was concluded that leptin could play a role in, and be defined as, a marker of hyperemesis gravidarum.

ROBSON, Stephen; THOMPSON, Jane; ELLWOOD, David

doi: 10.1111/j.1479-828X.2006.00591.xpmid: 16866786

Background: Women who have an unexplained stillbirth are more likely to be delivered early, by induced labour or Caesarean section, in their next pregnancy. It is unclear whether these birth outcomes result from characteristics of the next pregnancy, or represent management strategies of obstetricians. Aim: To investigate obstetricians’ management strategies in the next pregnancy after an unexplained stillbirth. Methods: Anonymous postal survey of Australian obstetricians. Respondents were given a clinical scenario regarding a previous unexplained stillbirth and were asked about management. Results: The response rate was 69%. Tests of ‘fetal well‐being’ were undertaken by the majority of respondents. Additional third trimester ultrasound surveillance was recommended by 87% of respondents, regular cardiotograph monitoring by 72% and formal fetal movement charting by 39%. Elective induction of labour (in the absence of any other obstetric indication) was recommended by 93% of respondents, and elective Caesarean delivery by 35%. Conclusions: The tendency for subsequent pregnancies after an unexplained stillbirth to be delivered earlier, and more often by Caesarean section, may be due in part to altered management strategies, not solely as a result of complications of the pregnancy itself.

Gerda, TRUTNOVSKY; Josef, HAAS; Uwe, LANG; Edgar, PETRU

doi: 10.1111/j.1479-828X.2006.00592.xpmid: 16866787

Background: Pregnancy and birth mark a distinct period in the life of a woman. Hormonal alterations and bodily and social changes impact on women's physical well‐being, mood, relationship and sexuality. Most existing research on sexuality during pregnancy focuses on the quantitative analysis of sexual activities, but neglects subjective experiences of women. Aims: To examine women's sexual needs, sexual activities, subjective importance of sexuality and contentment with sex life, focusing on the changes over the course of pregnancy and post‐partum. Methods: Twenty‐six women completed a series of three extensive interviews in early and late pregnancy, as well as 6 months post‐partum. A semiqualitative approach, combining visual analogue scales and a semistructured interview with self‐developed questions, was used. Results: The statistical analysis revealed a significant decrease of perceived ‘importance of sexuality’, ‘importance of sexual intercourse’ and ‘contentment with present sex life’, from prepregnancy over early pregnancy to late pregnancy, which was followed by a slight increase in the post‐partum period. Samples from the structured interviews provide a detailed insight into female experiences, perceptions and opinions, and demonstrate the high interindividual variability. Conclusion: Doctors can provide invaluable advice to women regarding the psychosexual changes and help them to understand the normal fluctuations in sexual interest during pregnancy and the post‐partum.

DUNCOMBE, Dianne; SKOUTERIS, Helen; WERTHEIM, Eleanor H.; KELLY, Leanne; FRASER, Virginia; PAXTON, Susan J.

doi: 10.1111/j.1479-828X.2006.00594.xpmid: 16866788

Objective: This study examined the question of whether vigorous exercise undertaken by recreational exercisers across pregnancy, defined in two ways, were associated with reduced infant birthweight and gestational age at birth. Methods: A prospective approach was implemented. A total of 148 pregnant women participated. Average intensity duration and frequency of vigorous exercise reported were examined and compared with two existing definitions of vigorous exercise. Participants completed questionnaires (including retrospective reports on 3 months prepregnancy) and an exercise diary at 16–23 weeks pregnancy, 24–31 weeks pregnancy and 32–38 weeks pregnancy, and at 7 to 14 days post‐partum a birth outcomes questionnaire was completed. Results: There were no significant differences between exercise groups for birthweight and gestational age at birth. Conclusions: There was no evidence that the intensity duration and frequency of vigorous exercise were associated with significant reductions in mean birth outcomes for the infants of women who participated in the study. Replication in a large, more diverse sample is recommended.

BRENT, Kira; HADDEN, Wendy E.; WESTON‐WEBB, Marianne; JOHNSON, Neil P.

doi: 10.1111/j.1479-828X.2006.00595.xpmid: 16866789

Objectives: To assess the demographics, efficacy and safety of lipiodol flushing fertility treatment. Design: Prospective observational study. Setting: Secondary level care infertility clinic and radiology centre based in Auckland, New Zealand. Population: The first cohort of 100 New Zealand women with infertility to undergo lipiodol flushing as an innovative fertility treatment. Methods: Women received lipiodol flushing performed by a hysterosalpingogram technique and were followed up at 6 months. Main outcome measures: Clinical pregnancy at 6 months post‐treatment; and live birth or ongoing pregnancy. Results: The overall pregnancy rate was 30% and the live birth or ongoing pregnancy rate 27%. For women under 40 years old, a 32% pregnancy rate and a 25% live birth or ongoing pregnancy rate were seen in women with unexplained infertility, and a 50% pregnancy rate and a 47% live birth or ongoing pregnancy rate were seen in women with endometriosis. Of women aged 40 years and older, the pregnancy rate was 13% and the live birth or ongoing pregnancy rate was 13%. The pregnancy rates included those occurring after additional interventions, such as intrauterine insemination and in vitro fertilisation, accounting for 12 of the 30 pregnancies. There were no treatment complications. Conclusion: This study provides further evidence of the efficacy and safety of lipiodol flushing fertility treatment.

JOHNSON, Neil P.; FISHER, Rosalie A.; BRAUNHOLTZ, David A.; GILLETT, Wayne R.; LILFORD, Richard J.

doi: 10.1111/j.1479-828X.2006.00596.xpmid: 16866790

Objective: To evaluate clinicians’ beliefs concerning the effectiveness of lipiodol flushing as a treatment for unexplained infertility, and to integrate these prior beliefs with evidence from randomised trials. Design: Survey. Setting: Specialists in Australasian in vitro fertilisation (IVF) clinics in 2001. Methods: One of two types of structured survey was used to gather information from fertility specialists in Australasian IVF clinics. Prior beliefs were captured graphically and textually from responses. Results: Nineteen specialists returned questionnaires. Eighteen of the 19 specialists believed that lipiodol flushing was more likely to be beneficial than harmful. The most widely held prior belief, reflected in both textual and numerical responses, was that lipiodol was likely to produce a small beneficial response. The credible limits of this belief were compatible with a reasonable fertility benefit, as more than 50% believed that a 1.5‐fold increase in pregnancy rate was plausible. The two surveys found that a 1.2‐fold or 1.4‐fold increase in pregnancy rate was the median expected level of benefit at which clinicians would have been inclined to recommend lipiodol flushing to their patients (combined range 1.1‐ to 2.3‐fold) – new evidence suggests that for women with endometriosis but otherwise unexplained infertility, these levels of benefit are exceeded. Conclusions: Among Australasian fertility specialists there is variation in prior beliefs concerning the effectiveness of lipiodol flushing as a treatment for unexplained infertility and in the expected level of benefit at which clinicians are inclined to recommend this treatment. Generalisability of these beliefs remains uncertain owing to a low study response rate.

ROBSON, Stephen; CAMERON, Carolyn A.; ROBERTS, Christine L.

doi: 10.1111/j.1479-828X.2006.00597.xpmid: 16866791

Background: Pregnancy and childbirth in teenage women are associated with obstetric and social risks, and there is evidence that the birth rate among teenagers in rural and remote areas of Australia is not in decline. The combination of non‐urban residence and young age at delivery might define a subgroup of women at special risk of adverse birth outcomes. Aims: To compare birth outcomes of New South Wales (NSW) teenagers residing in rural and remote areas with those living in larger centres with greater access to services. Methods: Outcomes for all singleton deliveries to teenage women living in NSW during the period 1998–2003 were reviewed. The women's place of residence was assigned an ARIA (Accessibility/Remoteness Index of Australia) classification according to remoteness and access to services. Analysis included obstetric factors (such as parity), and smoking status. Logistic regression analysis was undertaken to examine the impact of maternal factors on obstetric outcomes. Results: During the study period, 21 880 teenage women had singleton deliveries. Babies of teenage mothers in very remote areas had higher rates of preterm birth, small‐for‐gestational age and stillbirth. Rates of smoking were higher in more remote areas, and smoking correlated with preterm birth and stillbirth. Conclusions: Teenagers living in remote areas of NSW face a higher risk of adverse pregnancy outcomes than their urban cousins.