The Australian & New Zealand journal of obstetrics & gynaecology
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Aust N Z J Obstet Gynaecol · Oct 2003
Randomized Controlled Trial Clinical TrialHysteroscopy under general anaesthesia, a near painless procedure.
Anecdotally, hysteroscopy and curettage under general anaesthesia causes crampy postoperative pain. A randomised, double-blind trial to investigate whether intrauterine lignocaine could decrease such pain was initiated by us. ⋯ Of the remainder, most rated pain as either 'mild', or less. For most women, hysteroscopy, dilatation and curettage causes either none or very little pain postoperatively.
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Aust N Z J Obstet Gynaecol · Aug 2003
The management of breech pregnancies in Australia and New Zealand.
To assess current obstetric practice in the management of singleton breech pregnancies in Australia and New Zealand. ⋯ While the majority of obstetricians recommend ECV and/or planned Caesarean section for breech presentation, barriers to the promotion of ECV and the use of tocolysis for ECV need to be identified if the rates of this effective manoeuvre are to be increased.
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Aust N Z J Obstet Gynaecol · Jun 2003
Vaginal birth after Caesarean section: a survey of practice in Australia and New Zealand.
Women with a single prior Caesarean section (CS) in a subsequent pregnancy will be offered either a planned elective repeat CS or vaginal birth after Caesarean (VBAC). Recent reports of VBAC have highlighted risks of increased morbidity, including uterine rupture, and adverse infant outcome. A survey of practice was sent to fellows and members of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists to determine current care for women in a subsequent pregnancy with a single prior CS, and to assess variations by length and type of obstetric practice. ⋯ Most obstetricians indicated VBAC to be the safest option for the woman, but were less certain about benefits and risks for the infant. The consensus of practice is to present VBAC as an option and induce labour if needed. Vaginal birth after Caesarean is preferred in a level two or three hospital, with an anaesthetist, neonatologist and operating theatre available within 30 min. The use of continuous electronic fetal heart rate monitoring and intravenous access are recommended. In planned CS, a neonatologist in theatre is preferred, and an in-dwelling urinary catheter an;! intraoperative antibiotics will be used.
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To assess current practices in the labour management of low risk primiparous women with epidural analgesia we surveyed delivery suites in New South Wales (NSW) that annually provide at least 100 epidurals to 'standard primipara'. Epidural rates among 'standard primipara' at these hospitals ranged from 14 to 85% (median 46%). ⋯ For 'standard primipara' with an epidural 62% of units usually augmented labour with oxytocin, 89% discontinued the epidural in second stage and 67% had policies of delayed pushing. There is wide variation in epidural availability and in labour management, perhaps reflecting the limited evidence for effective interventions to reduce any unintended effects of epidural analgesia.