Antenatal depression screening and psychosocial assessment in an Australian private hospital: An evaluation.

BACKGROUND: Universal mental health screening and psychosocial assessment during pregnancy have been recommended as best practice, but uptake of universal programs in the private hospital system has been slow. AIM: The aim of this study was to evaluate the Pre-admission Midwife Appointment Program (PMAP), an antenatal mental health screening program at the Mater Hospital, Sydney. MATERIALS AND METHODS: In this mixed-methods design study, PMAP interview data were collected for a consecutive series of 485 women who attended the PMAP during a 10-month period. Women also completed two postnatal telephone interviews (10 weeks and 9 months postpartum). The interviews involved depression screening and questions about the program. RESULTS: Of the 485 participants, 4.1% screened positive for depression on the Edinburgh Postnatal Depression Scale. In total, 19% were identified as currently suffering from, or at risk of developing, perinatal mental health issues; referrals to support services were provided for the 13% who were not already linked in with appropriate supports. All women displayed a decrease in depressive symptom severity from pregnancy to 10 weeks and 9 months postpartum. The PMAP was viewed positively by consumers, with >93% viewing the program as helpful and >98% saying that they would recommend the program to others. Additional program benefits identified included opportunities to gain practical information and prepare for motherhood and to think/reflect on their emotional well-being. CONCLUSIONS: Given the observed rates of psychosocial risk among this sample, related referral opportunities and positive consumer feedback, we recommend other Australian private hospitals consider implementing PMAP or similar programs.

The National COVID-19 Clinical Evidence Taskforce: pregnancy and perinatal guidelines.

INTRODUCTION: Pregnant women are at higher risk of severe illness from coronavirus disease 2019 (COVID-19) than non-pregnant women of a similar age. Early in the COVID-19 pandemic, it was clear that evidenced-based guidance was needed, and that it would need to be updated rapidly. The National COVID-19 Clinical Evidence Taskforce provided a resource to guide care for people with COVID-19, including during pregnancy. Care for pregnant and breastfeeding women and their babies was included as a priority when the Taskforce was set up, with a Pregnancy and Perinatal Care Panel convened to guide clinical practice. MAIN RECOMMENDATIONS: As of May 2022, the Taskforce has made seven specific recommendations on care for pregnant women and those who have recently given birth. This includes supporting usual practices for the mode of birth, umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, and using antenatal corticosteroids and magnesium sulfate as clinically indicated. There are 11 recommendations for COVID-19-specific treatments, including conditional recommendations for using remdesivir, tocilizumab and sotrovimab. Finally, there are recommendations not to use several disease-modifying treatments for the treatment of COVID-19, including hydroxychloroquine and ivermectin. The recommendations are continually updated to reflect new evidence, and the most up-to-date guidance is available online (https://covid19evidence.net.au). CHANGES IN MANAGEMENT RESULTING FROM THE GUIDELINES: The National COVID-19 Clinical Evidence Taskforce has been a critical component of the infrastructure to support Australian maternity care providers during the COVID-19 pandemic. The Taskforce has shown that a rapid living guidelines approach is feasible and acceptable.

Alignment of national COVID-19 vaccine recommendations for pregnant and lactating women.

The rapid development and roll-out of coronavirus disease 2019 (COVID-19) vaccines is providing hope for a way to control the pandemic. As pregnant and lactating women are generally excluded from clinical trials, the vaccination programme was launched without adequate safety and efficacy data for pregnant women. Yet many professional organizations have recognized the need for administration of COVID-19 vaccines in pregnancy and have issued their own set of recommendations. The lack of evidence, however, has often led to confused messaging, inconsistent language and differing recommendations across organizations, potentially contributing to delay or refusal to accept vaccination by pregnant women. We summarize those differences and recommend that leaders collaborate at a country level to produce joint recommendations. We use the example of Australia, where two professional authorities along with the government and partners in New Zealand worked towards one message, consistent language and a unified recommendation. The aim was to help health professionals and women who are planning pregnancy or who are currently pregnant or breastfeeding to make an informed decision about COVID-19 vaccination. National advisory groups for immunization, professional obstetric organizations and government bodies should be encouraged to coordinate their statements on COVID-19 vaccination for pregnant and lactating women and to use similar language and phrasing for greater clarity.

La rapidité de développement et de déploiement des vaccins contre la maladie à coronavirus 2019 (COVID-19) entretient l'espoir d'un jour pouvoir contrôler la pandémie. Étant donné que les femmes enceintes et allaitantes sont généralement exclues des essais cliniques, le programme de vaccination a été lancé en l'absence de données adéquates sur l'efficacité et l'innocuité du vaccin au sein de cette catégorie. Pourtant, de nombreuses associations professionnelles ont reconnu la nécessité de vacciner contre la COVID-19 durant la grossesse, et ont émis leurs propres recommandations. L'absence de preuves a toutefois souvent donné lieu à une communication incohérente, à un discours contradictoire et à des recommandations divergentes d'une organisation à l'autre, ce qui pourrait avoir conduit certaines femmes enceintes à retarder ou refuser la vaccination. Dans le présent document, nous exposons ces différences et exhortons les dirigeants à collaborer au niveau national pour formuler des recommandations communes. Nous utilisons l'exemple de l'Australie, où deux autorités professionnelles ont travaillé avec le gouvernement et des partenaires en Nouvelle-Zélande afin de transmettre un message unique, d'adopter un langage cohérent et de fournir des directives homogènes. L'objectif était d'aider les soignants et les femmes enceintes, allaitantes ou planifiant une grossesse à prendre une décision éclairée en matière de vaccination contre la COVID-19. Les organes consultatifs nationaux sur la vaccination, les associations professionnelles d'obstétrique et les pouvoirs publics devraient être encouragés à aligner leurs déclarations concernant la vaccination contre la COVID-19 chez les femmes enceintes et allaitantes, ainsi qu'à employer des termes et énoncés similaires pour davantage de clarté.

El rápido desarrollo y puesta en marcha de las vacunas contra el coronavirus de la enfermedad por coronavirus (COVID-19) está dando esperanzas sobre una forma de controlar la pandemia. Como las mujeres embarazadas y lactantes suelen estar excluidas de los ensayos clínicos, el programa de vacunación se puso en marcha sin datos adecuados de seguridad y eficacia para las mujeres embarazadas. Sin embargo, muchas organizaciones profesionales han reconocido la necesidad de administrar las vacunas contra la COVID-19 durante el embarazo y han emitido su propio conjunto de recomendaciones. Sin embargo, la falta de pruebas a menudo ha ocasionado mensajes confusos, un lenguaje incoherente y recomendaciones diferentes en las distintas organizaciones, lo que puede contribuir a retrasar o rechazar la vacunación de las mujeres embarazadas. Resumimos esas diferencias y recomendamos que los líderes colaboren a nivel de país para elaborar recomendaciones conjuntas. Utilizamos el ejemplo de Australia, donde dos autoridades profesionales, junto con el gobierno y los socios de Nueva Zelanda, trabajaron para lograr transmitir un único mensaje con un lenguaje coherente y una recomendación unificada. El objetivo era ayudar a los profesionales sanitarios y a las mujeres que planean un embarazo o embarazadas o en periodo de lactancia a tomar una decisión informada sobre la vacunación contra la COVID-19. Hay que animar a los grupos consultivos nacionales de inmunización, a las organizaciones profesionales de obstetricia y a los organismos gubernamentales a que coordinen sus declaraciones sobre la vacunación contra la COVID-19 para las mujeres embarazadas y lactantes y a que utilicen un lenguaje y una redacción similares para mayor claridad.

Health professional perspectives on an antenatal mental health screening program in a private hospital.

BACKGROUND: Perinatal mental ill-health is a global health priority. Mental health screening during pregnancy is a routine part of clinical practice in many public hospital obstetric services across Australia, but implementation in the private hospital system has lagged. AIMS: This study explored health professionals' perspectives on the Pre-admission Midwife Appointment Program (PMAP), an antenatal mental health screening program at the Mater Hospital, Sydney. MATERIALS AND METHODS: Nine midwives and three medical specialists participated in focus groups or individual interviews; key themes were determined using thematic qualitative analysis. RESULTS: Five major themes and three sub-themes were identified: immediate benefits to women (identifying women at risk; referrals to support services; supporting and educating women); enhanced overall quality of care at the hospital; the dilemma of partners attending; factors that make the program successful; and recommendations for improvement. CONCLUSIONS: Results will inform the implementation of antenatal mental health screening programs at other private hospitals across Australia.

Clinical care of pregnant and postpartum women with COVID-19: Living recommendations from the National COVID-19 Clinical Evidence Taskforce.

To date, 18 living recommendations for the clinical care of pregnant and postpartum women with COVID-19 have been issued by the National COVID-19 Clinical Evidence Taskforce. This includes recommendations on mode of birth, delayed umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, antenatal corticosteroids, angiotensin-converting enzyme inhibitors, disease-modifying treatments (including dexamethasone, remdesivir and hydroxychloroquine), venous thromboembolism prophylaxis and advanced respiratory support interventions (prone positioning and extracorporeal membrane oxygenation). Through continuous evidence surveillance, these living recommendations are updated in near real-time to ensure clinicians in Australia have reliable, evidence-based guidelines for clinical decision-making. Please visit https://covid19evidence.net.au/ for the latest recommendation updates.

Vulvoplasty in New South Wales, 2001-2013: a population-based record linkage study.

OBJECTIVES: To compare the characteristics of women who have undergone vulvoplasty with those of other women of reproductive age; to quantify short term adverse events and complications; to determine any association between vulvoplasty and subsequent outcomes for women giving birth. DESIGN, SETTING AND PARTICIPANTS: A population-based record linkage study, analysing New South Wales Admitted Patient Data Collection and NSW Perinatal Data Collection data. The characteristics of all women who had vulvoplasties in NSW hospitals during 2001-2013 were compared with those of all women of reproductive age. MAIN OUTCOME MEASURES: Admissions for vulvoplasty and repeat vulvoplasties; serious complications or adverse events after vulvoplasty; birth mode and perineal outcomes for primiparous women with and without vulvoplasty. RESULTS: 4592 vulvoplasty procedures were performed on 4381 women in NSW hospitals and day-stay centres; the annual rate increased by 64.5% between 2001 and 2013. Compared with the reference population, women who had vulvoplasty were more likely to have been born in Australia (74.6% v 67.6%), to have other cosmetic surgery (10.1% v 1.7%), and to have never been married (43.0% v 33.1%). The serious short term adverse event rate was 7.2%. Of 257 women who had a first birth after their vulvoplasty procedure, 40.0% had caesarean deliveries, compared with 30.3% of other women (P < 0.001). There were no significant differences in the rates of perineal outcomes for women who had vaginal births. CONCLUSIONS: The number of vulvoplasties performed in NSW has increased dramatically since 2001. The procedure is not without serious complications that can necessitate re-admission to hospital. We provide objective information about outcomes for counselling women who are contemplating vulvoplasty.

Antenatal psychosocial assessment and depression screening in a private hospital.

BACKGROUND: It has been recommended that psychosocial assessment (including depression screening) be integrated into routine antenatal care across Australia, but implementation in the private sector has lagged. AIMS: This study aimed to report preliminary outcomes associated with an antenatal psychosocial assessment and depression screening program implemented at an Australian private obstetric hospital setting and to report characteristics and correlates of elevated depression symptoms in this sample. MATERIALS AND METHODS: A total of 993 pregnant women (mean ± SD gestational age 27.9 ± 6.7 weeks) participated in a structured psychosocial assessment interview and completed the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Six per cent of participants scored ≥13 on the EPDS. Psychosocial correlates of antenatal depressive symptoms included low income, history of pregnancy termination, poor practical support, lack of confidence and history of depression. Almost 1 in 10 of the total sample was referred for further assessment and clinical support. CONCLUSIONS: The prevalence of clinically significant antenatal depressive symptoms in this sample highlights the importance of antenatal depression screening for all women, including those who choose to access private obstetric care.

Paternal pregnancy-related anxiety: Systematic review of men's concerns and experiences during their partners' pregnancies.

BACKGROUND: Up to 25 % of expectant parents experience anxiety symptoms. Pregnancy-related anxiety is characterised by concerns and worries specific to pregnancy, childbirth, and the transition to parenthood. While pregnancy-related anxiety is well-researched in women, the exact nature of this construct in men is unclear. The purpose of the current review was to examine men's concerns, worries, and fears during pregnancy and gain an understanding of their experiences during pregnancy. METHODS: An integrative review design was adopted, using thematic content analysis to synthesise findings from quantitative and qualitative studies. Quality appraisal of the quantitative studies used the AXIS appraisal tool. The Critical Appraisal Skills Program (CASP) checklist was used for the qualitative studies. RESULTS: A comprehensive search of nine databases led to inclusion of 14 quantitative and 41 qualitative studies. Ten dimensions of paternal pregnancy-related anxiety were identified: childbirth concerns, attitudes towards childbirth, baby concerns, acceptance of pregnancy, partner concerns, relationship concerns, worry about self, transition to parenthood, attitudes towards health care professionals, and practical and financial concerns. The pregnancy transition was characterised by mixed emotions and conflicted experiences for fathers. LIMITATIONS: Generalizability of review findings was limited by poor reporting of demographic information by many included studies, exclusion of studies not published in English, and focus on heterosexual relationships. CONCLUSIONS: Expectant fathers may experience anxiety symptoms characterised by excessive worry across multiple domains of pregnancy-related concerns. Clinicians play an important role in identifying and supporting fathers with pregnancy-related anxiety and addressing the sense of exclusion often experienced by them.

Setting Preconception Care Priorities in Australia Using a Delphi Technique.

Preconception health affects fertility, pregnancy, and future health outcomes but public awareness of this is low. Our aims were to rank priorities for preconception care (PCC), develop strategies to address these priorities, and establish values to guide future work in preconception healthcare in Australia. A Delphi technique involved two rounds of online voting and mid-round workshops. Inputs were a scoping review of PCC guidelines, a priority setting framework and existing networks that focus on health. During July and August, 2021, 23 multidisciplinary experts in PCC or social care, including a consumer advocate, completed the Delphi technique. Ten priority areas were identified, with health behaviors, medical history, weight, and reproductive health ranked most highly. Six strategies were identified. Underpinning values encompassed engagement with stakeholders, a life course view of preconception health, an integrated multi-sectorial approach and a need for large scale collaboration to implement interventions that deliver impact across health care, social care, policy and population health. Priority populations were considered within the social determinants of health. Health behaviors, medical history, weight, and reproductive health were ranked highly as PCC priorities. Key strategies to address priorities should be implemented with consideration of values that improve the preconception health of all Australians.