Helen Paterson

Research priorities in urinary incontinence: results from citizens’ juries

Objective  The objective of this study was to elicit research ideas, priorities and outcome measures from women who suffer from urinary incontinence.

Antenatal catastrophic uterine rupture at 32 weeks of gestation after previous B-Lynch suture.

Please cite this paper as: Pechtor K, Richards B, Paterson H. Antenatal catastrophic uterine rupture at 32 weeks of gestation after previous B‐Lynch suture. BJOG 2010;117:889–891.

Exposure to the smoking cessation medicine varenicline during pregnancy: a prospective nationwide cohort study.

The purpose of this study was to investigate the extent of exposure to varenicline during pregnancy in ‘real‐life’ post‐marketing use and follow‐up all pregnancy exposures to identify maternal and fetal outcomes.

A survey of New Zealand RANZCOG Fellows on their use of the levonorgestrel intrauterine device in adolescents

Background: The levonorgestrel intrauterine device (LNG‐IUD) is an established treatment for adult women. Although it is being used in adolescents, there is little published research in this age group to date. Recent reviews and editorials have challenged the long‐held views that intrauterine devices should not be used in young women.

A review of intrauterine contraception in the Asia-Pacific region

BACKGROUND Across the Asia-Pacific region, approximately 38% of pregnancies are unintended. Long-acting reversible contraception, such as intrauterine contraception (IUC), is effective in reducing unintended pregnancy. OBJECTIVE This study aims to review access to, uptake of and influencing factors on IUC use in the Asia-Pacific region. METHODS We searched PubMed and MEDLINE for articles published between 1990 and 2015. We identified and reviewed primary studies that examined the following points and were relevant to the Asia-Pacific region: available types and utilization rates of IUC and factors that influence these. We also obtained the opinions of local experts to gain a better understanding of the situation in specific countries. RESULTS Types of IUC used and utilization rates vary widely across the region. Factors influencing rates of utilization relate to healthcare systems, such as government policy on and subsidization of IUC, types of healthcare providers authorized to place IUC and local guidelines on preinsertion screening. Healthcare provider factors include concerns around pelvic inflammatory disease and the suitability of IUC in certain groups of women, whereas end-user factors include lack of awareness of IUC, concerns about safety, cultural or religious attitudes, access to IUC and costs. CONCLUSIONS Across the Asia-Pacific region, clear data gaps and unmet needs exist in terms of access to and uptake of IUC. We believe that several recommendations are necessary to update future practice and policy for enhanced IUC utilization so that women across this region have better access to IUC.

Successful pregnancy following treatment of recurrent chronic histiocytic intervillositis

Chronic histiocytic intervillositis (CHI) is a rare placental lesion associated with adverse obstetric outcomes and high recurrence rate. We report a case of six consecutive pregnancies in one woman, where CHI was detected following an intrauterine death in the fifth pregnancy, after being missed in four earlier losses. The successful sixth pregnancy was treated with a combination of immunosuppressive and antithrombotic agents. While low-molecular-weight heparin (LMWH) and aspirin had been shown to improve pregnancy outcome in recurrent pregnancy loss, there was limited evidence of improved outcome in CHI. It has been suggested that CHI may result from a maternal immunological process and there have been a few reports of the use of corticosteroids because of this possibility, though without convincing evidence of efficacy. We too tried a corticosteroid, in combination with LMWH and aspirin. Comparative histopathological analysis of the placentae supported post-treatment effectiveness of our intervention strategy.

Teaching the Y generation obstetrics and gynaecology skills: A survey of medical students' thoughts on a new program

Delivering undergraduate obstetrics and gynaecology teaching to classes of increasing size in ways which will foster student interest in the discipline is becoming increasingly challenging. With major curriculum change implemented at Otago Medical School in 2008, we had the opportunity to rise to this challenge.

Teens and young adults should be started on long-acting reversible contraceptives before sexual activity commences: FOR: An opt-out programme would avoid teen pregnancy and associated costs.

Nature confers fertility on young people at an age when, developmentally and socially, at this time in history, a pregnancy is in neither the individual or society’s best interest (Lawlor D, et al. Int J Epidemiol 2011;40:5:1205– 14). Teen pregnancy places significant costs on the individual and society. These include costs to the state to support teen mother and child, opportunity costs for young women missing out on education and future earnings, and opportunity costs of the state benefitting from their contribution and taxation. Moreover, the children of teen pregnancies do poorly in statistics related to poverty, incarceration, and teen pregnancy [Office for National Statistics. Conceptions in England and Wales 2012, Statistical Bulletin (2014), The National Campaign to Prevent Teen and Unplanned Pregnancy (2013)]. Therefore proposals that long acting reversible contraceptives (LARCs) should be provided by the state free to all young people before they become sexually active are worthy of examination (Battin M. Soc Sci Med 1995;41:9:1203–5).

Registrar interest in academic obstetrics and gynaecology: A cross‐sectional survey

New Zealand has an urgent need to train and retain obstetrics and gynaecology academics, and postgraduate training pathways are being considered.

Validation of the Intuitive Eating Scale in pregnancy

The objective of this study was to examine the content validity and test–retest reliability of the Intuitive Eating Scale among pregnant women. A qualitative think-aloud study of the Intuitive Eating Scale analysed the content validity. Overall, the Intuitive Eating Scale made sense to pregnant women, but food safety affected the interpretation of some items. A version with instructions modified accounting for food safety, the Intuitive Eating Scale–Pregnancy, was subsequently shown to have stable scores over 5 weeks during the second trimester, mean change = −0.08 (95% limits of agreement: −0.61 to 0.45), r = 0.79, n = 240. The Intuitive Eating Scale–Pregnancy was acceptable for use in this New Zealand pregnant population.