Louise Kornman

Managing back pain in pregnancy using a support garment: a randomised trial

Objective  Large population studies have shown that low back pain affects about 50% of pregnant women. The aim of this study was to determine whether the use of the BellyBra® in pregnant women with back pain is associated with changes in assessments of pain severity, physical activity and satisfaction with life after 3 weeks of intervention compared with tubigrip, a more generic form of support.

Cervical surveillance as an alternative to elective cervical cerclage for pregnancy management of suspected cervical incompetence

Objective:  The aim of the present study was to compare the outcome of pregnancies among patients with suspected cervical incompetence treated either by elective cervical cerclage or an alternative management program involving cervical surveillance.

Routine weighing to reduce excessive antenatal weight gain: A randomised controlled trial

To assess whether routinely weighing women at each antenatal visit leads to a difference in gestational weight gain and weight gain within the Institute of Medicine (IOM) recommendation.

Transferring responsibility and accountability in maternity care: clinicians defining their boundaries of practice in relation to clinical handover

Objective This exploratory study reports on maternity clinicians’ perceptions of transfer of their responsibility and accountability for patients in relation to clinical handover with particular focus transfers of care in birth suite. Design A qualitative study of semistructured interviews and focus groups of maternity clinicians was undertaken in 2007. De-indentified data were transcribed and coded using the constant comparative method. Multiple themes emerged but only those related to responsibility and accountability are reported in this paper. Setting One tertiary Australian maternity hospital. Participants Maternity care midwives, nurses (neonatal, mental health, bed managers) and doctors (obstetric, neontatology, anaesthetics, internal medicine, psychiatry). Primary outcome measures Primary outcome measures were the perceptions of clinicians of maternity clinical handover. Results The majority of participants did not automatically connect maternity handover with the transfer of responsibility and accountability. Once introduced to this concept, they agreed that it was one of the roles of clinical handover. They spoke of complete transfer, shared and ongoing responsibility and accountability. When clinicians had direct involvement or extensive clinical knowledge of the patient, blurring of transition of responsibility and accountability sometimes occurred. A lack of ‘ownership’ of a patient and their problems were seen to result in confusion about who was to address the clinical issues of the patient. Personal choice of ongoing responsibility and accountability past the handover communication were described. This enabled the off-going person to rectify an inadequate handover or assist in an emergency when duty clinicians were unavailable. Conclusions There is a clear lack of consensus about the transition of responsibility and accountability—this should be explicit at the handover. It is important that on each shift and new workplace environment clinicians agree upon primary role definitions, responsibilities and accountabilities for patients. To provide system resilience, secondary responsibilities may be allocated as required.

IVIG – Is it the answer? Maternal administration of immunoglobulin for severe fetal red blood cell alloimmunisation during pregnancy: A case series

Intrauterine transfusion (IUT) is the therapy of choice for fetal anaemia secondary to fetal red blood cell alloimmunisation. Although now standard practice for the anaemic fetus, IUT still confers significant fetal risk. Complication rates of up to 9% and fetal mortality rates of up to 5% have been reported. Particularly challenging is early-onset fetal anaemia with fetal morbidity secondary to IUT reportedly highest in those at mid-gestation. This relates to both increased technical challenges of IUT at early gestations as well as reduced capacity of the premature anaemic and ⁄ or hydropic fetus to adapt to acute correction of its anaemia. The tendency for alloimmunisation to occur ten weeks earlier and to worsen with each subsequent incompatible pregnancy, the technical difficulty at early gestations, and the potential morbidity associated with IUT have prompted the search for alternative treatment modalities. One such alternative is intravenous immunoglobulin (IVIG). Despite proven application in haematology and obstetric medicine, including its antenatal and postnatal use in platelet alloimmunisation, the role of IVIG, albeit promising in fetal red blood cell alloimmunisation, is yet to be fully determined. The objective of this case series was to report the maternal and perinatal outcomes in at risk pregnancies from a single tertiary level obstetric hospital during 2004–2007. In this setting, IVIG was used to eliminate or delay the need for IUT and to reduce overall IUT requirements in women who were at high risk for early-onset fetal red blood cell alloimmunisation.

Women's opinions on being weighed at routine antenatal visits

To assess the opinions of pregnant women regarding their weight gain and to assess the level of satisfaction and anxiety provoked by being weighed in clinic.

Contemporary clinical management of the cerebral complications of preeclampsia.

The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality arising from these conditions, for women and their infants alike. This paper outlines the evidence base for contemporary management principles pertaining to the neurological sequelae of preeclampsia, primarily from the maternal perspective, but with consideration of fetal and neonatal aspects as well. It concludes with a discussion regarding future directions in the management of this potentially lethal condition.

Autosomal recessive omodysplasia: Early prenatal diagnosis and a possible clue to the gene location

Autosomal recessive omodysplasia (ARO, OMIM#258315), a rare congenital skeletal dysplasia, is characterized by micromelia and craniofacial anomalies. Upper and lower limbs are affected in contrast to the dominant form in which the lower limbs are normal. Radiographic features include shortening and distal tapering of the humerus and femur, proximal radioulnar diastasis, and anterolateral radial head dislocation. We present a recurrence of ARO in a family, detected on prenatal ultrasound at 13 weeks of gestation. Chromosome analysis of the products of conception and the affected sibling showed a paternally‐inherited paracentric inversion of 15q13 to q21.3. Due to similarities in the clinical phenotype between diastrophic dysplasia and this condition, testing for DTDST mutation was performed with no mutation detected.

Outcomes following antenatal identification of hydrops fetalis: a single-centre experience from 2001 to 2012

Objective To describe the aetiologies and outcomes of pregnancies complicated by hydrops fetalis (HF). Study design Case series of all pregnancies complicated by HF managed at The Royal Women’s Hospital (RWH), Melbourne, Australia, between 2001 and 2012. Multiple pregnancies, and cases where antenatal care was not provided at RWH were excluded. Cases were identified from neonatal and obstetric databases. Data were extracted from maternal and neonatal case files, electronic pathology and radiology reports, and obstetric and neonatal databases. Results Over 12 years, 131 fetuses with HF with a median (IQR) gestational age (GA) at diagnosis of 24 (20–30) weeks were included in the analysis. There were 65 liveborn infants with a median (IQR) GA at birth of 33 (31–37) weeks and a median (IQR) birthweight Z-score of 1.4 (0.4–2.2). Overall survival from diagnosis was 27% (36/131) increasing to 55% (36/65) if born alive. Conclusions The perinatal mortality risk for fetuses and newborn infants with HF is high with important differences dependent on underlying diagnosis and the time at which counselling is provided. Clinicians need to be aware of the outcomes of both fetuses and neonates with this condition.

Chorionic villus sampling in the cell‐free DNA aneuploidy screening era: careful selection criteria can maximise the clinical utility of screening and invasive testing

To quantify the impact of cell‐free DNA (cfDNA) screening on chorionic villus sampling (CVS) test indications and outcomes in a tertiary maternity service.