Lucy Lewis

Implanon as a contraceptive choice for teenage mothers: a comparison of contraceptive choices, acceptability and repeat pregnancy.

BACKGROUND This study was conducted to compare the incidence of repeat teenage pregnancy over a 24-month period postpartum among users of Implanon, the combined oral contraceptive pill (COCP) or depot medroxyprogesterone acetate (DMPA) and barrier methods or nothing (barrier/none). Contraceptive continuation rates 24 months postpartum for Implanon and COCP/DMPA were also compared. STUDY DESIGN A prospective cohort study was conducted. Comparison groups were postpartum teenagers (12-18 years old) who self-selected Implanon (n=73), COCP/DMPA (n=40) and barrier/none (n=24). Questionnaires were used to gather data at recruitment and postpartum at 6 weeks and then 3 monthly intervals for 2 years. RESULTS At 24 months postpartum, 48 (35%) teenagers had conceived. Implanon users became pregnant later than other contraceptive groups (p=.022), with mean time to first repeat pregnancy of 23.8 months [95% confidence interval (CI), 22.2-25.5], compared to 18.1 months (95% CI, 15.1-20.7) for COCP/DMPA and 17.6 months (95% CI, 14.0-21.3) for barrier/none. Implanon users were more likely to continue their use at 24 months than COCP/DMPA (p<.001) users. The mean duration for Implanon users was 18.7 months (95% CI, 17.0-20.3) compared to 11.9 months (95% CI, 9.5-14.3) for COCP/DMPA. CONCLUSION Teenagers who choose Implanon are significantly less likely to become pregnant and were found to continue with this method of contraception 24 months postpartum compared to those who choose COCP or DMPA and barrier methods or nothing.

Risk factors for severe perineal trauma during vaginal childbirth: A Western Australian retrospective cohort study

AIM To determine rates and risk factors for third and fourth degree perineal tears (severe perineal trauma) in a Western Australian context. DESIGN AND SETTING A retrospective hospital-based cohort study was performed using computerised data for 10,408 singleton vaginal deliveries from 28 weeks gestation. METHODS Women with severe perineal trauma were compared to those without. Logistic regression analysis, stratified by parity, was used to assess demographic and obstetric factors associated with perineal trauma. RESULTS Severe perineal trauma incidence was 3% (338/10408), 5.4% (239/4405) for primiparas and 1.7% (99/5990) for multiparas (p<0.001). Adjusted risk factors associated with trauma and common across parity included Asian or Indian ethnicity, shoulder dystocia and assisted delivery. Epidural analgesia (OR 0.72, 95% CI 0.54-0.96), preterm birth (OR 0.40, 95% CI 0.23-0.72) and episiotomy (OR 0.54, 95% CI 0.39-0.74) were protective in primiparas, while episiotomy was associated with increased risk in multiparas (OR 2.01, 95% CI 1.18-3.45). Additional factors among primiparas were occipito posterior (OP) delivery (OR 3.35, 95% CI 1.75-6.41) and prolonged second stage (OR 1.98, 95% CI 1.46-2.68), and among multiparas included gestational diabetes (OR 1.78, 95% CI 1.04-3.03) and birth weight >4000g (OR 1.86, 95% CI 1.10-3.15). CONCLUSION Parity differences in risk factors such as episiotomy, infant weight, OP delivery, gestational diabetes and prolonged second stage warrant investigation into clinical management. Although rates differ internationally, and replication evidence has confirmed consistency for certain demographic and obstetric factors, the development of internationally endorsed clinical guidelines and further research around interventions to protect the perineum are recommended.

Evaluating the Effects of Aluminum-Containing and Non-Aluminum Containing Deodorants on Axillary Skin Toxicity During Radiation Therapy for Breast Cancer: A 3-Armed Randomized Controlled Trial

PURPOSE Deodorant use during radiation therapy for breast cancer has been controversial as there are concerns deodorant use may exacerbate axillary skin toxicity. The present study prospectively determined the use of both aluminum-containing and non aluminum containing deodorants on axillary skin toxicity during conventionally fractionated postoperative radiation therapy for breast cancer. METHODS AND MATERIALS This 3-arm randomized controlled study was conducted at a single center, tertiary cancer hospital between March 2011 and April 2013. Participants were randomized to 1 of 2 experimental groups (aluminum-containing deodorant and soap or non-aluminum containing deodorant and soap) or a control group (soap). A total of 333 participants were randomized. Generalized estimating equations were used to estimate and compare the odds of experiencing high levels of sweating and skin toxicity in each of the deodorant groups to the odds in the control group. The study evaluated a range of endpoints including objective measurements of axilla sweating, skin toxicity, pain, itch and burning. Quality of life was assessed with a validated questionnaire. RESULTS Radiation characteristics were similar across all groups. Patients in the deodorant groups did not report significantly different ratings for axillary pain, itch, or burning compared with the control group. Patients in the aluminum-containing deodorant group experienced significantly less sweating than the control; the odds of their sweating being barely tolerable and frequently or always interfering with their daily activities was decreased by 85% (odds ratio, 0.15; 95% confidence interval, 0.03-0.91). CONCLUSIONS We found no evidence that the use of either aluminum-containing or non-aluminum containing deodorant adversely effects axillary skin reaction during conventionally fractionated radiation therapy for breast cancer. Our analysis also suggests patients in the aluminum-containing deodorant arm had significantly less sweating without increased symptoms of axillary radiation skin toxicity. These results add to the evidence that the prescription of deodorants during radiation therapy for breast cancer is now questionable.

Psychosocial characteristics and smoking behaviour in young Western Australian pregnant women at their first hospital appointment for pregnancy care

• This study builds on the evidence around young Australian women who continue to smoke in pregnancy.

Maternal and neonatal outcomes of Hepatitis C positive women attending a midwifery led drug and alcohol service: A West Australian perspective

BACKGROUND the Women and Newborn Drug and Alcohol Service (WANDAS) is a specialist, midwifery-led service providing pregnancy care to women dealing with alcohol and other drug (AOD) use, at the sole tertiary maternity hospital in Western Australia. AIM to assess the antenatal, intrapartum and neonatal outcomes of women with Hepatitis C (HCV) who attended the WANDAS service between 2009 and 2012. DESIGN this retrospective cohort study used data obtained from computerised midwifery records. Univariate comparisons between those who were HCV positive and those who were not, were performed. Multivariable logistic regression was utilised to investigate the simultaneous factors associated with being HCV positive and an opiate user. FINDINGS the incidence of HCV in this cohort was 37% (213 of 570). Compared to those who were HCV negative those who were positive were more likely to: be older (P<0.001); use opioids in pregnancy (P<0.001); be an intravenous drug user (P<0.001); engage in polysubstance use (P<0.001); and receive an induction of labour (P=0.036). There were no intrapartum characteristics found to be significant at a multivariate level associated with being HCV positive and an opiate user, but there were a couple of neonatal complications. These were having a baby admitted to Special Care Nursery (OR 1.95, 95% CI 1.33-2.88, P<0.001) and a baby at increased risk of being diagnosed with neonatal abstinence syndrome (OR 3.40, 95% CI 2.24-5.15, P<0.001). CONCLUSION our findings highlight the complexity of caring for pregnant women who are HCV positive, they also highlight that all pregnant women who are AOD users are an at risk population. IMPLICATIONS FOR PRACTICE these results improve our understanding of the obstetric and midwifery issues associated with caring for pregnant women who are HCV positive and the value of provision of specialist care from a multidisciplinary team, led by a consultant midwife.

Adolescent Pregnancy in Australia

Adolescent pregnancy is a major health, social, and economic issue for Australia. Although there has been a downward trend in the number of Australian adolescents giving birth since the 1980s, the rate of Indigenous adolescent pregnancy is declining at a slower rate and is high when compared with the average rate of Australian adolescent pregnancy. In Australia, adolescent mothers are more likely to be: single, smoke, have high levels of illicit and licit substance use, live in an area of socioeconomic disadvantage, have pregnancies with uncertain dates, have partners at increased risk of exposure to domestic violence and family dysfunction as children, and partners who are often involved with illegal activities especially illicit drugs. Over the last few decades, the median age of first pregnancy has increased significantly but not for non Indigenous girls. When Indigenous adolescents are compared with non Indigenous adolescents, Indigenous girls are more likely to smoke, have anemia, and experience pregnancy-induced hypertension. Providing Indigenous adolescents with culturally appropriate and accessible contraceptive services should be an integral part of this process. This is important in terms of reducing Indigenous adolescent mothers exposure to the increased social inequality associated with adolescent pregnancy. There are a number of maternal risk factors (e.g., smoking and being an Indigenous adolescent) which may precipitate medical and obstetric conditions resulting in adverse birth outcomes such as preterm delivery, low birth weight, and stillbirth. These maternal risk factors may be individual, psychological, or behavioral and identifying the individual pathways of the association between these maternal risk factors and adverse birth outcomes is difficult as they are likely to be multifaceted. Greater understanding of the issues that surround adolescent pregnancy should be a high priority for Australia, especially in terms of evidence to assist with the development of effective intervention programs.

Severe mental illness and induction of labour: outcomes for women at a specialist antenatal clinic in Western Australia

Limited evidence is available around induction of labour (IOL) and obstetric outcomes for pregnant women with severe mental illness (SMI).

Obstetric and neonatal outcomes for women intending to use immersion in water for labour and birth in Western Australia (2015–2016): A retrospective audit of clinical outcomes

Research supports water immersion for labour if women are healthy, with no obstetric or medical risk factors.

An Exploration of Young Australian Women's Smoking Cessation Goals across the Trajectory of Pregnancy and Post Birth

Objective: Young pregnant women are more likely than other pregnant women to smoke tobacco during pregnancy and post birth. This study explored young women’s perceptions of the factors which impact their smoking cessation goals throughout pregnancy and post birth. Methods: This qualitative descriptive study was performed at two metropolitan obstetric hospitals in Western Australia. Forty three women aged 16 to 24 years old who reported smoking tobacco at their first antenatal visit were interviewed at each scheduled antenatal visit and every two weeks upto six weeks post birth. Interviews were subjected to thematic analysis. Results: A total of 244 interviews were performed; a mean of six interviews per woman (four in pregnancy and two post birth). Four overarching themes across three time periods were identified: the baby; the social bond of smoking; the chaotic nature of life; and access to social support. Pregnant women had a foetus-centric approach to cessation. Post birth those who sustained cessation held this belief for their newborn, whilst those who relapsed did not. The social bond of smoking highlighted smoking as the norm. Initially, women sought out non-smokers to support them. A partner’s smoking status post birth appeared pivotal to remaining tobacco free. The chaotic nature of life, reflected through multiple stressful, negative events, challenged women in achieving their smoking cessation goals. Women who sought social support appeared to stay smoke free post birth. Conclusion: The longitudinal nature of this study provides new insight into complex issues faced by this marginalised group of young, pregnant, tobacco smokers throughout the journey of pregnancy and post birth. Findings enhance our understanding of the complex real life issues some young pregnant Australian smokers face and may be considered when women focused smoking cessation interventions are developed.

A Multiple Component Intervention to Assist Young Pregnant Smokers to Cease Smoking: A Randomised Controlled Pilot Study

Objective: Australian rates of cigarette smoking are the lowest in the world. Young pregnant smokers are a sub population where smoking remains high. This pilot study assessed the feasibility of a multi-component intervention (Carbon Monoxide testing, motivational interviewing and a non-smoking buddy) to assist young pregnant women to cease smoking. Methods: Between October 2013 and June 2015, this multi-centred West Australian study recruited pregnant smokers aged 16 to 24, attending their first antenatal visit. Women (n=80) were randomised to the intervention and standard smoking cessation advice (n=43) or standard smoking cessation advice alone (n=37). At 36 weeks gestation and six weeks post birth, cessation rates were compared between groups using repeated measures survival analysis and reduction in smoking was examined using repeated measures linear regression on the number of cigarettes smoked. Results: The majority (89%) of women were unemployed or not in education, used illicit drugs (43%) and had experienced sexual abuse (23%). Involvement with child protection services was common (38%). Cigarette initiation occurred at a mean age of 13 years, median number of cigarettes smoked at baseline was 10 in both groups. Smoking cessation in intervention and controls were 17% vs. 14% at 36 weeks and 23% vs. 7% 6 weeks post birth. No significant differences in cessation or smoking reduction between groups were found individually or in the repeated events analysis. Conclusion: Given the low number of participants our findings cannot conclusively rule out this multi-component intervention. We believe it remains possible this intervention may prove effective in a larger group of participants and in another setting. Monitoring trends in this vulnerable, difficult to engage group of pregnant young women is important if we are to continue to devise effective interventions.