Obstetrics and Gynaecology

There are minimal data involving predictors of success of external cephalic version (ECV) in an Australian healthcare setting. To determine the predictors of successful ECV as well as the success rate of ECV and the mode of, and presentation at, delivery for women undergoing ECV for breech presentation from 36-weeks gestation. A prospective review was carried out on all women who had undergone ECV from 36-weeks gestation at the Mater Mothers Hospital over an 8-year period from 2001 to 2008. Data were collected prospectively and were collated in conjunction with database review, chart review and telephonic patient interviews. A total of 355 women underwent ECV for breech presentation. The overall success rate was 66% (57% for nulliparous, 76% for multiparous). A woman who underwent ECV had a 46% chance of a vaginal birth. If the ECV was successful, she had a 70% chance of vaginal birth. From bivariate analysis, parity, amniotic fluid index (AFI) and estimated fetal weight (EFW) were determined to be possible predictors of success of ECV and were included in the logistic regression modelling. In the regression analysis, multiparity increased the odds of successful ECV by 2.18. For every one unit increase in AFI, the odds of successful ECV increased by 1.18. Multiparity and amniotic fluid volume as assessed by AFI were the significant predictors of immediate success of ECV. Conversely, lower AFI and nulliparity are factors that are likely to reduce the likelihood of successful ECV.

To report the outcomes of women admitted following preterm pre-labour rupture of membranes (pPROM) and to determine whether the location of care (hospital vs outpatient) influences maternal and perinatal outcomes. A retrospective cohort study was performed using routinely collected de-identified data of 144 women (between June 2007 and June 2011) who presented to the Mater Mother's Hospital, Brisbane, Australia, with pPROM (prior to 34 weeks 0 days gestation) and who remained undelivered after 72 h from the time of ruptured membranes. Outcomes were compared for women who were subsequently managed as an outpatient (n = 53) versus those who were managed in hospital (n = 91). The two primary outcome measures were composite outcomes of (i) maternal morbidity and (ii) perinatal morbidity/mortality. The composite outcome of maternal morbidity comprised one or more of antepartum haemorrhage, clinical chorioamnionitis and/or endometritis, cord prolapse, blood transfusion, wound infection/haematoma/dehiscence/seroma. The composite outcome of perinatal morbidity/mortality comprised one or more of stillbirth, neonatal death, respiratory distress syndrome, neonatal infection, chronic neonatal lung disease, intraventricular haemorrhage, periventricular leukomalacia and necrotising enterocolitis. When adjusted for confounders, there was no difference between hospital care and outpatient care in the composite outcome measure of perinatal morbidity/mortality (aOR 1.37; 95%CI 0.55-3.47) or the composite outcome measure of maternal morbidity (aOR 1.62; 95%CI 0.67-3.89). Women with pPROM who remain undelivered after 72 h and are managed out of hospital do not appear to have significant differences in major adverse maternal or perinatal outcomes compared with those managed as inpatients.

Cervical length measurement by transvaginal scanning (TVS) has been proposed by some as a universal screening test for preterm labour. The presence of prominent cervical mucous may affect assessment of the cervix; however, the exact technique to measure the cervix when there is prominent mucous or funnelling has not been described. We evaluated the level of agreement in cervical length measurements amongst Australian specialists and sonographers reporting on cervical assessment using an online survey. We conducted an online survey with 11 images of the cervix to assess how obstetric sonographers and sonologists report on the cervix when there is prominent mucous or funnelling. They were asked five questions about the image of the cervix. A kappa coefficient was calculated from the responses. We had 151 complete responses to the online survey. For the images which showed funnelling or prominent cervical mucous, there was little agreement regarding the cervix being open or closed and regards the location of the internal os. The Kappa coefficient was 0.22 indicating a low level of agreement for the location of the internal os. There is lack of agreement amongst Australian specialists and sonographers reporting on cervical assessment when there is prominent mucous or funnelling seen in the cervix. We propose a method to standardise reporting on the cervix incorporating the chorioamniotic membrane for the identification of the inner cervical os when there is prominent mucous or funnelling.