ORCID Profile
0000-0001-7366-042X
Current Organisation
Sunshine Coast Hospital and Health Service
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Wiley
Date: 24-03-2017
DOI: 10.1111/AJO.12616
Abstract: Obesity in pregnancy is a growing health problem conferring higher risk to both the woman and her infant. Internationally, peak bodies offer little guidance regarding the method and timing of delivery in these patients. Our hypothesis is that induction of labour (IOL) at term will not increase the caesarean section (CS) rate when compared to expectant management. To compare perinatal outcomes between IOL and expectant management in obese women at term. A retrospective cohort study of all term, singleton, vertex deliveries at the Townsville Hospital and Health Service from January 2011 to June 2015 in women with a body mass index (BMI) ≥ 35. Women undergoing IOL at 37 weeks were compared with women expectantly managed at that gestational age. Similar comparisons were made at 38, 39 and 40 weeks. χ There was no difference in outcome of CS, or other maternal secondary outcomes. There was no difference in rates of neonatal nursery admission. Expectant management at 38 weeks was associated with lower odds of post-partum haemorrhage (odds ratio 0.371 95% confidence interval 0.163-0.845). In women with a BMI ≥ 35, IOL does not affect the CS rate, or the risk of neonatal adverse events, but may increase the rate of postpartum haemorrhage when compared with expectant management.
Publisher: Wiley
Date: 22-12-2021
DOI: 10.1111/AJO.13282
Abstract: Since the WOMAN trial, intravenous tranexamic acid (TXA) has been increasingly used in severe postpartum haemorrhage (PPH) but research evaluating use in high‐income settings is limited. To assess whether implementation of a new guideline involving early administration of 1 g intravenous TXA in active PPH with blood loss ≥ 1000 mL, was associated with a change in maternal morbidity. Retrospective study of all singleton, term, vaginal births from November 2016 to June 2019 with a PPH of ≥1000 mL, before and after hospital adoption of a guideline recommending early (within three hours of birth) administration of TXA for women with active PPH ≥ 1000 mL. Univariate analysis assessed the impact of this guideline implementation on a primary outcome of maternal morbidity, defined as one or more of haemoglobin 90 g/L, administration of blood products, hysterectomy or intensive care admission. Secondary outcomes were adverse events related to administration of TXA, use of an intrauterine balloon or postpartum iron infusion. There was no difference in morbidity (odds ratio (OR) 0.86, 95% CI 0.57–1.29, P = 0.46) or postpartum iron infusion (OR 1.44, 95% CI 0.92–2.27, P = 0.11), but there was a reduction in the use of intrauterine balloon t onade after the implementation of the TXA guideline (OR 0.33, 95% CI 0.16–0.67, P 0.01). This retrospective analysis showed a reduced use of intrauterine balloon but failed to show a benefit in maternal morbidity with early administration of TXA for severe postpartum haemorrhage in a high‐income setting.
Publisher: Wiley
Date: 31-07-2023
DOI: 10.1111/AJO.13593
Abstract: Lower urinary tract injury (LUTI) is a serious complication of major gynaecologic surgery. Although intra‐operative cystoscopy can facilitate timely diagnosis and treatment of LUTI, the optimal approach to cystoscopy at the time of benign hysterectomy remains debatable. To assess whether implementation of a policy of universal cystoscopy at the time of benign hysterectomy was associated with a difference in intra‐operative detection and rates of LUTI. Retrospective cohort study at a large regional teaching hospital where a policy of universal cystoscopy at the time of benign hysterectomy was implemented on 30 September 2019. Hysterectomies performed from 1 November 2016 to 31 March 2021 were included and categorised into the ‘pre‐policy’ and ‘post‐policy’ groups. Primary outcomes included the intra‐operative detection and overall rates of LUTI. Secondary outcome was the policy adherence rate. Multivariate analysis was used to examine the effect of this policy on the outcomes. There were 584 hysterectomies identified, including 325 in the pre‐policy group and 259 in the post‐policy group. Cystoscopy was performed in 55.1% in the pre‐policy group and 97.7% in the post‐policy group ( P 0.01). Adjusted for age, indication and route of hysterectomy, there were no significant differences in the intra‐operative cystoscopic detection of LUTI (42.9% vs 25.0%, P = 0.55) or the rate of LUTI (2.2% vs 1.5%, P = 0.25) after implementation of the policy. The practice of universal cystoscopy at the time of benign hysterectomy has not been associated with a significant change in the intra‐operative detection and rates of LUTI at our institution.
Publisher: Springer Science and Business Media LLC
Date: 24-03-2021
DOI: 10.1007/S00192-021-04714-0
Abstract: The role of the general obstetrician/gynaecologist completing routine urogynaecology procedures is controversial, and some research has suggested that these patients should be referred to high-volume subspecialists. In response to recent public and regulatory scrutiny of vaginal mesh procedures, credentialling guidelines have been released in Australia requiring surgeons to demonstrate a minimum caseload prior to performing tension-free vaginal tape (TVT) surgery for incontinence. Hence, a retrospective cohort study was conducted to evaluate the long-term quality of life outcomes of TVT procedures for high- and low-volume surgeons. One hundred seventy patients who had undergone TVT surgery between 1 May 2011 and 1 May 2016 in the Sunshine Coast health district were invited to complete the UDI-6 (Urinary Distress Inventory) and IIQ-7 (Incontinence Impact Questionnaire) surveys. Perioperative information was accessed from available health records. Mean UDI-6 and IIQ-7 scores were compared for high- and low-volume groups, and the groups were assessed for confounding factors. Of the 170 patients eligible, 83 completed the surveys (47.2%). No differences in UDI-6 or IIQ-7 scores were found between high- and low-volume surgeons (p > 0.05). High-volume surgeons completed more concomitant procedures amongst survey respondents (p < 0.05), though this was not reproduced when considering all 170 patients eligible for the study. There were no significant differences in age, ASA (American Society of Anaesthesiologists) score or complication rate amongst survey respondents. Amongst the patients surveyed, high- and low-volume surgeons had similar long-term quality of life outcomes for TVT surgery, without any significant difference in complication rate.
Publisher: Wiley
Date: 12-06-2021
DOI: 10.1111/JAN.14933
Abstract: Childbirth is a normal, physiological process, yet intervention is common. Arguably the most common intervention is the insertion of a peripheral intravenous catheter however, there are few studies guiding best practice. This study aimed to describe current intravenous catheter insertion practice, explore clinician decision‐making during insertion and perceptions of women. This prospective, observational cohort study recruited 101 women and clinicians from two Australian regional hospitals. Data collection incorporated non‐participant observation, brief interview and chart review. Variables measured included pain score, insertion attempts, catheter gauge and dwell time. Childbearing women were, on average, aged 31 with body mass index (BMI) above 28. Women reported a mean pain score of 3.3/10 at 24 h for catheter insertion and 12% reported bruising. An 18‐gauge catheter was considered more painful than a 16‐gauge, and multiple attempts did not increase perceived average pain score. Association between failed first attempts and higher BMI was not established. Participant clinicians were predominantly midwives, who selected and placed 18‐gauge catheters mostly in hand or wrist (66%). Decision‐making about site, catheter gauge, dressing and attempts varied. Thirty‐four per cent attempted two to three times, despite regular practise. Confidence to reliably insert determined catheter gauge and almost half clinician participants cited hospital policy and preferred non‐dominant arm as key reasons for the location of PIVC. Regular use of a large‐gauge catheter is counter intuitive when placed in the small veins of the hand with extension tubing. More research is needed to promote best practice around gauge selection, site and women's experience.
Publisher: Wiley
Date: 30-03-2021
DOI: 10.1111/AJO.13342
Abstract: There is no consensus to the implications of an increased sonographic fetal head circumference (HC) and its impact on delivery. To examine if there is any association between sonographic fetal HC, obstetric anal sphincter injury (OASIS) and mode of delivery. A retrospective cohort study of term, singleton births between April 2017 and March 2019 at a large regional hospital in Australia with a third trimester ultrasound. Logistic regressions were performed investigating sonographic fetal HC and additional risk factors for OASIS. Further multinomial logistic regressions assessed the relationship between the sonographic HC and mode of delivery. Odds ratios and their 95% CIs were reported. Of 667 eligible women, 487 (73%) had vaginal births, with 32 (6.6%) sustaining an OASIS and 180 (27%) had caesarean sections (CS). The sonographic fetal HC did not show an association with OASIS (odds ratio 1.005 CI 0.99–1.01, P = 0.447). A statistically significant association ( P 0.05) with OASIS was found with Asian ethnicity (4.38 1.5–11.32), prolonged second stage (≥2 h) (4.26 1.57–10.49) and occiput posterior position (4.01 1.08–11.92). For women with a sonographic fetal HC ≥ 90th percentile, the odds of having CS compared to a spontaneous vaginal birth are 2.77 (95% CI: 1.36, 5.62 P = 0.005) times higher than those who have a HC 90th percentile. This study does not support the use of sonographic fetal HC in assessing a woman’s risk of sustaining an OASIS. Sonographic fetal HC is associated with mode of delivery.
Publisher: Wiley
Date: 03-03-2023
DOI: 10.1111/AJO.13654
Abstract: Obstructive sleep apnoea (OSA) occurs in 15–20% of pregnant women living with obesity. As global obesity prevalence increases, OSA in pregnancy is concurrently increasing, yet remains under‐diagnosed. The effects of treating OSA in pregnancy are under‐investigated. A systematic review was conducted to determine whether treating pregnant women with OSA using continuous positive airway pressure (CPAP) will improve maternal or fetal outcomes, compared with no treatment or delayed treatment. Original studies in English published until May 2022 were included. Searches were conducted in Medline, PubMed, Scopus, the Cochrane Library and clinicaltrials.org . Maternal and neonatal outcome data were extracted, and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach (PROSPERO registration: CRD42019127754). Seven trials met inclusion criteria. Use of CPAP in pregnancy appears to be well tolerated with reasonable adherence. Use of CPAP in pregnancy may be associated with both a reduction in blood pressure and pre‐ecl sia. Birthweight may be increased by maternal CPAP treatment, and preterm birth may be reduced by treatment with CPAP in pregnancy. Treatment of OSA with CPAP in pregnancy may reduce hypertension and, preterm birth, and may increase neonatal birthweight. However, more rigorous definitive trial evidence is required to adequately assess the indication, efficacy, and applications of CPAP treatment in pregnancy.
Publisher: Wiley
Date: 07-07-2023
DOI: 10.1111/AJO.13555
Abstract: Maternal preference for warm water immersion (WWI) and waterbirth is increasing, but adoption into obstetric guidelines and clinical practice remains limited. Concerns regarding safety and a paucity of evidence have been cited as reasons for the limited adoption and uptake. The aim was to investigate maternal and neonatal outcomes after WWI and/or waterbirth compared with land birth. A prospective cohort study was conducted in an Australian public maternity hospital between 2019 and 2020. Maternal and neonatal outcomes for 1665 women who had a vaginal birth were studied. Primary outcome was admission to the neonatal unit (NNU). Secondary outcomes included neonatal antibiotic administration, maternal intrapartum fever, epidural use and perineal injury. Multivariate logistical regression analyses compared the outcomes between three groups: waterbirth, WWI only and land birth. NNU admissions for a suspected infectious condition were significantly higher in the land birth group ( P = 0.035). After accounting for labour duration, epidural use and previous birth mode, no significant difference was detected between groups in the odds of NNU admission ( P = 0.167). No babies were admitted to NNU with water inhalation or drowning. Women birthing on land were more likely to be febrile (2 vs 0% P = 0.007) obstetric anal sphincter injury and postpartum haemorrhage were similar between groups. Regional analgesia use was significantly lower in the WWI group compared to the land birth group (21.02 vs 38.58% P = .001). There was one cord avulsion in the waterbirth group (0.41%). Maternal and neonatal outcomes were similar between groups, with no increased risk evident in the waterbirth and WWI groups.
Publisher: Wiley
Date: 21-04-2022
DOI: 10.1111/AJO.13535
Abstract: Immediate postpartum long‐acting reversible contraception (LARC) has been shown to reduce unintended pregnancy but uptake of this type of contraception in Australia is low compared to European counterparts. To assess self‐reported continuation rates, complications and satisfaction in patients having immediate postpartum hormonal intrauterine device (IUD) inserted at caesarean section (CS) or after vaginal birth (VB). Retrospective cohort study of all patients with immediate postpartum hormonal IUD insertion over three years at a tertiary maternity service. Primary outcomes were patient satisfaction, continuation and expulsion rates. Secondary outcomes were reason for discontinuation, patient‐reported complications, attendance for postpartum check with a general practitioner (GP) and rate of unplanned pregnancy. Simple descriptive statistics were used to analyse the data. One hundred and ninety‐three women had a hormonal IUD inserted and 143 consented to involvement (CS n = 79 VB n = 64). Six and 12 months continuation rates for CS were 60.8% and 54.4%, and VB were 46.9% and 39.1%. The most common reasons for removal were: pain (34.5%), heavy or irregular bleeding (25.9%) and partial expulsion (24.1%). Expulsion was more likely after VB (34.1%) than CS (10.1%), (odds ratio 2.72 95% CI 1.07–6.90 P = 0.036). There were 60.8% of women post‐CS and 56.3% of women post‐VB who were satisfied with their decision to have immediate postpartum insertion and most women attended routine postpartum follow‐up with their GP (89.5%). Immediate postpartum hormonal IUD insertion in this cohort is associated with higher rates of expulsion and lower satisfaction rates compared to those documented in the literature for delayed postpartum insertion cohorts.
Publisher: Wiley
Date: 23-05-2019
DOI: 10.1111/AJO.12830
Abstract: Maternal obesity is a growing health concern that has previously been associated with increased need for induction of labour (IOL) and caesarean section (CS) rates. Currently, limited evidence explores the influence of maternal body mass index (BMI) on Bishop Score (BS) and outcome of IOL. This study hypothesises that maternal obesity will lead to a lower BS at presentation, higher rates of failed IOL, and increased CS rates. To explore the influence of maternal obesity on BS and likelihood of failed IOL. A retrospective cohort analysis was conducted of all live, term, singleton, cephalic deliveries initiated with IOL across normal BMI (18.00-24.99), overweight BMI (25.00-29.99), and obese BMI (>30.00) at the Townsville Hospital and Health Service (THHS) between July 2011 to June 2016. Student's t-test, χ A total of 1543 women were included, 678 with normal BMI, 370 with overweight BMI, and 495 with obese BMI. Obese women are more likely to have a low BS (<5) at presentation (unadjusted odds ratio (OR) 1.5 (1.1-2.0), P < 0.05), an increased rate of failed IOL (adjusted OR (aOR) 1.6 (1.0-2.5), P < 0.05) and increased CS rate (aOR 1.1 (1.0-1.9), P < 0.05), compared to normal weight women. Maternal obesity is associated with a lower BS, more difficult IOL process, and increased risk of failed IOL and CS.
No related grants have been discovered for Rachael Nugent.