The Australian & New Zealand journal of obstetrics & gynaecology
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Aust N Z J Obstet Gynaecol · Aug 2012
Vitamin D levels in pregnant women booking for antenatal care in Far North Queensland.
Serum concentrations of vitamin D were measured in pregnant women booking for antenatal care in Cairns Base Hospital, Queensland. Of 116 women, none was found to be vitamin D deficient. With a threshold of 50 nmol/L, no woman demonstrated vitamin D insufficiency; with a threshold of 75 nmol/L, 6.9% would have mild insufficiency. Further investigation into vitamin D concentrations of women living in northern Australia is required before recommendations are made for universal vitamin D screening of all pregnant women in Australia.
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Aust N Z J Obstet Gynaecol · Apr 2012
Ethical issues: the multi-centre low-risk ethics/governance review process and AMOSS.
The Australasian Maternity Outcomes Surveillance System (AMOSS) conducts surveillance and research of rare and serious conditions in pregnancy. This multi-centre population health study is considered low risk with minimal ethical impact. ⋯ The AMOSS research system provides an important resource to enhance knowledge of conditions that cause rare and serious maternal morbidity. Yet the highly variable ethical approval processes required to implement this study have been excessively repetitive and burdensome. This process jeopardises timely, efficient research project implementation, without corresponding benefits to research participants. The resource burden to establish research governance for AMOSS confirms the urgent need for the Harmonisation of Multi-centre Ethical Review (HoMER) to further streamline ethics/governance review processes for multi-centre research.
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Aust N Z J Obstet Gynaecol · Apr 2012
The accuracy of spot urinary protein-to-creatinine ratio in confirming proteinuria in pre-eclampsia.
The gold standard for diagnosis of proteinuria in pre-eclampsia is traditionally a 24-h urine collection. Current Australian guidelines advocate use of the spot urine protein-to-creatinine ratio (PCR); however, there is controversy in the international literature about its accuracy and little recent Australian data exists. ⋯ The urine PCR is highly accurate in predicting significant proteinuria in women with pre-eclampsia using the recommended cut-off of 30 mg/mmol. Our findings support current guidelines suggesting the use of a 24-h urine collection is now rarely required.
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Aust N Z J Obstet Gynaecol · Feb 2012
Practice GuidelineRecommendations for the diagnosis and treatment of deep venous thrombosis and pulmonary embolism in pregnancy and the postpartum period.
Venous thromboembolism (VTE) in pregnancy and the postpartum is an important cause of maternal morbidity and mortality; yet, there are few robust data from clinical trials to inform an approach to diagnosis and management. Failure to investigate symptoms suggestive of pulmonary embolism (PE) is a consistent finding in maternal death enquiries, and clinical symptoms should not be relied on to exclude or diagnose VTE. In this consensus statement, we present our recommendations for the diagnosis and management of acute deep venous thrombosis (DVT) and PE. ⋯ In observational cohort studies, using once-daily regimens appears adequate, in particular with the LMWH tinzaparin; however, pharmacokinetic data support twice-daily therapy with other LMWH and is recommended, at least initially, for PE or iliofemoral DVT in pregnancy. Treatment should continue for a minimum duration of six months, and until at least six weeks postpartum. Induction of labour or planned caesarean section maybe required to allow an appropriate transition to unfractionated heparin to avoid delivery in women in therapeutic doses of anticoagulation.