Preterm birth prevention-Time to PROGRESS beyond progesterone

In a Perspective, Jane Norman and Phillip Bennett argue that it is time to explore alternatives to progesterone for preventing preterm birth

Opportunities for primary and secondary prevention of excess gestational weight gain: General Practitioners' perspectives

BackgroundThe impact of excess gestational weight gain (GWG) on maternal and child health outcomes is well documented. Understanding how health care providers view and manage GWG may assist with influencing healthy gestational weight outcomes. This study aimed to assess General Practitioner\u27s (GPs) perspectives regarding the management and assessment of GWG and to understand how GPs can be best supported to provide healthy GWG advice to pregnant women.MethodsDescriptive qualitative research methods utilising semi - structured interview questions to assess GPs perspectives and management of GWG. GPs participating in shared antenatal care in Geelong, Victoria and Sydney, New South Wales were invited to participate in semi - structured, individual interviews via telephone or in person. Interviews were digitally recorded and transcribed verbatim. Data was analysed utilising thematic analysis for common emerging themes.ResultsTwenty eight GPs participated, 14 from each state. Common themes emerged relating to awareness of the implications of excess GWG, advice regarding weight gain, regularity of gestational weighing by GPs, options for GPs to seek support to provide healthy lifestyle behaviour advice and barriers to engaging pregnant women about their weight. GPs perspectives concerning excess GWG were varied. They frequently acknowledged maternal and child health complications resulting from excess GWG yet weighing practices and GWG advice appeared to be inconsistent. The preferred support option to promote healthy weight was referral to allied health practitioners yet GPs noted that cost and limited access were barriers to achieving this.ConclusionsGPs were aware of the importance of healthy GWG yet routine weighing was not standard practice for diverse reasons. Management of GWG and perspectives of the issue varied widely. Time efficient and cost effective interventions may assist GPs in ensuring women are supported in achieving healthy GWG to provide optimal maternal and infant health outcomes.<br /

Debunking 20th century myths and legends about the diagnosis of placenta accreta spectrum

Placenta accreta is a spectrum disorder, which was first defined in 1937 by Irving and Hertig1 clinically as having difficulties in delivery of the placenta and histologically by the absence of decidua with direct attachment of placental villi to the superficial myometrium1. Placenta accreta is a congenital disorder, which means that the process leading to the abnormal attachment of the placenta to the uterine wall develops during pregnancy2, 3. Although both the clinical and histological features of accreta placentation appear on a spectrum, meaning that patients are affected in different ways and to different degrees, the definition of Irving and Hertig has prevailed for over 80 years. In particular, histopathologic studies have used the absence of decidua with direct attachment of the villous tissue to the superficial myometrium as the gold standard for the diagnosis of placenta accreta spectrum (PAS), including when reporting on more severe PAS grades, i.e. placenta increta and placenta percreta4-7. The concept of an intact fibrin layer serving as a barrier to abnormal placental invasion extends even further back, to 1887, the year of Raissa Nitabuch's dissertation on the topic of normal placental circulation6. Most authors of clinical studies describe cases of PAS as ‘confirmed by histopathology’, without providing any detailed description of the methodology used. This has led to considerable heterogeneity in epidemiological data with wide variations in the prevalence of PAS and incidence of its different grades in general population studies8, 9