Insights into the Genital Microbiota of Women Who Experienced Fetal Death in Utero.

The aim of this work was to achieve a better understanding of the bacterial pathogens associated with stillbirths that would serve to inform clinical interventions directed at reducing this adverse pregnancy outcome. A prospective observational study was conducted with the participation of 22 women from northern Peru, of whom 11 experienced fetal death in utero and 11 delivered preterm births. Swabs were taken from the vagina, placenta, amniotic fluid and axilla of the infant at birth by Caesarean section. The bacterial populations in the vagina and the amniotic space of each participant were determined by employing the amplicon sequencing of the V4 region of the 16S rRNA genes. The sequence data were analysed using bioinformatics tools. The work showed differences in the composition of the genital microbiomes of women who experienced preterm birth or fetal death in utero. There were no differences in the alpha diversity between the genital microbiotas of both groups of women, but there were more different taxa in the vagina and amniotic space of the preterm participants. Lactobacillus spp. was less abundant in the stillbirth cases. E. coli/Shigella, Staphylococcus, Gardnerella, Listeria and Bacteroides taxa were associated with the stillbirths. In each woman, there was a minimal concordance between the bacterial populations in the vagina and amniotic space.

Compliance with clinical guidelines increases the safety of vacuum-assisted delivery.

BACKGROUND: Vacuum-assisted delivery (VAD) is a common and safe obstetric procedure. However, occasionally serious complications may occur. Clinical guidelines and College Statements have been developed to reduce the risk of serious adverse events. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) College Statement C-Obs 16 has not been evaluated to see if advice improves outcomes. AIM: The aim was to evaluate whether compliance with RANZCOG College Statement C-Obs 16 advice reduced the risk of serious adverse outcomes, specifically clinically significant subgaleal haemorrhage and major birth trauma. MATERIALS AND METHODS: Retrospective audit of VADs in a level five hospital (NSW Maternity and Neonatal capability framework) from January 2020 to 2021. RESULTS: There were 1960 women who delivered in the study period, of whom 252 (12.8%) delivered by vacuum, and complete data were available from 241 cases. Statement compliance was observed in 81%. The main deviation from Statement compliance was pulls exceeding three. Statement compliance was associated with a significant reduction in the incidence of subgaleal haemorrhage (0% vs 11%, P = 0.0002), major birth trauma (3% vs 22%, P = 0.0001), requirement for neonatal resuscitation (14% vs 35%, P = 0.0026) and Apgar scores at one minute less than six (5% vs 22% P = 0.0006). Statement compliance was associated with a significant reduction in maternal blood loss at delivery (388 mL vs 438 mL, P = 0.01). Noncompliance with Statement advice was observed significantly more often in pregnancy complicated by gestational diabetes (3% vs 15%, P = 0.02) and birth requiring instrument change (4% vs 13% P = 0.031). CONCLUSION: Compliance with a College Statement is associated with lower rates of subgaleal haemorrhage and major neonatal trauma. The main deviation from compliance was pulls in excess of three. Keyword: birth trauma, clinical guidelines, quality and safety in healthcare, subgaleal haemorrhage, vacuum delivery.

Is there an association between the vaginal microbiome and first trimester miscarriage? A prospective observational study.

AIM: To examine whether there are differences in the vaginal microbiome of women who miscarry compared to those who have normal pregnancy outcomes. METHODS: Prospective observational study conducted at the Canberra Hospital, Australia, with 24 participant women in the first trimester of pregnancy. The vaginal microbiomes of the 24 women were characterized using sequencing analysis of the V4 region of the 16S rRNA gene employing an Illumina MiSeq instrument with QIAGEN reagents. Vaginal microbiome data were correlated with pregnancy clinical metadata. RESULTS: Ordination plots showed differences in the composition of microbiomes of women who miscarried and controls. In nulliparous women, Lactobacillus crispatus was the dominant bacterium in 50% of women. Lactobacillus iners was the dominant bacterium in 50% of women with a history of prior miscarriage and a miscarriage in the study compared to 15% (p = 0.011) in those with no history of miscarriage and no miscarriage in the study. There were significant differences in the number of operational taxonomic units and the richness of the microbiomes of women who miscarried compared to those who delivered at term. Eight taxa were found in different relative abundances in both groups of women. CONCLUSIONS: The study indicated that the composition of the vaginal microbiome varies with pregnancy history. Also, there was a significant difference in the vaginal microbiomes between women who suffered miscarriage and those who continued to term delivery both in the overall microbiome populations and in the abundances of individual taxa.

Vitamin B3 levels in women who experience first-trimester miscarriage.

Miscarriage is the most common complication in early pregnancy. It was recently reported in mice that miscarriage can be prevented through the administration of niacin. We conducted a prospective, exploratory pilot study involving 24 women who were less than 14 weeks pregnant. Neither niacin intake (P = 0.24) nor urinary vitamin B3 measured as the 1-methyl-5-carboxylamide-2-pyridone/N-1-methylnicotinamide (2-pyr/MNA) ratio (P = 1.00) predicted miscarriage. However, the difference in mean 2-pyr/MNA ratios between women who miscarried and controls suggests there may be a threshold niacin level protective in miscarriage prevention warranting further investigation.

Improving vaccination of pregnant women against seasonal influenza through use of a mandatory field in the obstetric electronic medical record.

BACKGROUND: The aim of the present study was to determine whether using a mandatory data field in an electronic health record would increase compliance with the recommendation to vaccinate pregnant women against influenza. METHODS: Two cohorts of women who delivered at the Centenary Hospital for Women and Children between 1-31 July 2015 and 1-31 July 2017 were compared for compliance with the national public health recommendation to vaccinate all pregnant women against influenza. The single change between audit periods was programming the electronic health record to include a mandatory field preventing clinicians from closing patient files unless they selected an answer to the question asking whether influenza vaccination had been performed. Data were audited and compliance rates were compared. RESULTS: A total of 275 and 299 women delivered in the two audit periods. There were no significant differences in maternal or neonatal characteristics between the two cohorts except for maternal age, which was younger in the second period (33.3 versus 31.5 years; P = 0.001). Vaccination rates doubled between audit periods (35.0% versus 79.8%, P < 0.0001). CONCLUSION: Introducing a mandatory data field into an electronic health record system may increase compliance with public health interventions, such as influenza vaccination in pregnant women.

Comparison of the Genital Microbiomes of Pregnant Aboriginal and Non-aboriginal Women.

The genital microbiomes of women varies with racial background. Preterm birth and early-onset neonatal sepsis are two outcomes associated with genital infections during pregnancy. The rate of preterm birth in Aboriginal Australian mothers is high, as is the rate of early-onset sepsis in their infants. To date, no studies have been conducted to investigate genital microbiome taxa associated infection in this group of women. A prospective cohort study to characterize the vaginal and placental microbiomes of a group of these women from the Pilbara region was conducted at the Hedland Health Campus in Western Australia. Included in the study were gravidae Aboriginal (n = 23) and Non-aboriginal (n = 27) women in labor or for planned lower uterine segment Caesarean section. Employing sterile swabs, vaginal samples were obtained under sterile conditions immediately prior to vaginal delivery or planned Caesarean section; and placental samples were obtained under the same conditions during labor. Taxa present in the samples were identified by 16S rRNA amplicon sequencing (V4 region, 515F-806R). Taxon identity and abundance were established from Operational Taxonomic Unit (OTU) counts. Statistical analyses combining clinical metadata and sequencing results were employed to determine associations of taxa with racial background. The findings of this work served to enhance the current understanding of microbiota associated with health and disease in Aboriginal and Non-Aboriginal women. Differences were found between the vaginal and placental microbiomes of Aboriginal and Non-aboriginal women during pregnancy, as well as notable differences between the abundance of specific taxa in each racial group. The relative abundances of specific taxa were significantly different between participants with clinical signs of infection and those with healthy pregnancies. This work will contribute to understanding the causes of differences in rates of infection-driven preterm birth in various racial populations.

Small interface changes have dramatic impacts: how mandatory fields in electronic medical records increased pertussis vaccination rates in Australian obstetric patients.

INTRODUCTION: Electronic health records have been widely introduced into clinical practice. The aim of this study was to determine whether a small interface change could improve compliance with a key quality indicator, namely antenatal pertussis vaccination. METHODS: Audits were performed between 1-31 July 2015 and 1-31 July 2017 of all deliveries at the Centenary Hospital for Women and Children to determine compliance with antenatal pertussis vaccination. The single difference between time points was changing the interface so the antenatal pertussis vaccination field became compulsory. RESULTS: 275 and 299 women delivered in the audit periods. Vaccination rates almost doubled (52.7% vs 91.4%, p<0.0001). CONCLUSION: Small interface changes increase compliance. Interface change could be considered for key quality outcomes in patient care.

Can a clinical senate enhance state-wide clinician engagement? A survey study.

Objective Clinician engagement correlates with quality, safety and efficacy outcomes. The aim of the present study was to explore whether a clinical senate model achieves clinical input into system manager and operational health service boards. Methods A mixed-methods survey was undertaken. Participants were current or immediate past members of the Clinical Senate of Western Australia (CS). For the 124 surveys sent out, the response rate was 60%. Results Respondents stated the CS played a role in clinician engagement (95%), contributed to healthcare reform (82%), knowledge of contemporary health issues (92%), feedback to decision makers (82%), clinician networking (94%), debate on important issues (93%), enabled clinicians to work on recommendations to improve health at a state level (87%), contributed to clinician thinking on health reform (88%) and enabled clinicians to share their knowledge (91%). Four major themes emerged in the qualitative analysis: (1) the need for a strong independent clinician forum and voice at a state level; (2) the need to strengthen clinician interactions with operational healthcare boards; (3) a strong belief that clinician engagement strengthened quality and safety outcomes at a state level; and (4) that membership was important and needed to be diverse, multidisciplinary and independent, but structurally representative of clinicians in the state. Conclusion A clinical senate model can facilitate state-wide clinician engagement. What is known about the topic? High levels of clinical engagement foster a culture within healthcare organisations that is associated with the delivery of sustained high-quality, safe and efficient services. This has led to a focus on strategies to optimise clinical engagement in healthcare planning and reform. However, there is limited data exploring how to achieve clinical engagement at a state, rather than local, level within the healthcare system. What does this paper add? This survey study evaluates the effectiveness of the Western Australian clinical senate model in achieving clinical engagement at a state level with regard to the outcomes of quality and safety, planning and reform. The survey findings suggest the clinical senate model is an effective strategy for state-based clinical engagement. What are the implications for practitioners? Clinical engagement is important. It is necessary to have in place strategies that address not only local engagement within a health service, but also system-wide engagement in order to promote quality and safety, planning and reform agendas at a state level.

Australian Fathers' Study: What Influences Paternal Engagement With Antenatal Care?

This mixed-methods study explores factors associated with and levels of engagement of fathers in antenatal care. One hundred expectant fathers were recruited from antenatal clinics and community settings in Western Australia. They completed validated questionnaires. Eighty-three percent of expectant fathers reported a lack of engagement with antenatal care. Factors significantly associated with lack of engagement in multivariate analysis were working more than 40 hours a week and lack of adequate consultation by antenatal care staff. In qualitative analysis, 6 themes emerged in association with a lack of engagement. They were role in decision making, time pressures, the observer effect, lack of knowledge, barriers to attendance, and feeling unprepared or anxious. Care providers should involve fathers in consultations to improve paternal engagement.