ANZJOG as an international journal

Abstract

One of the interesting aspects of the editor's role is to receive and read manuscripts from all over the world. It is remarkable how diverse are the sources from which articles are submitted. While the journal is still predominantly exhibiting an Australian and New Zealand flavour with about half the published articles originating from these two countries, no less than 20 different countries from all of the continents of the world have made up the balance since I started as Editor. It is also interesting to see that the same clinical problems are being faced and studied across the globe. In this issue I have included an article on rising caesarean section rates in northern Greece, which shows a similar pattern and concerns as have been expressed by many in this country. I was recently asked to comment on the new American College of Obstetricians and Gynecologists statement on maternal request for caesarean section. This is an excellent document that clearly summarises the current evidence about the benefits and harm of caesarean section. It is well-balanced and makes some important conclusions. While neither endorsing nor arguing against maternal choice as a valid reason, the point is made that this should not be done in women who are planning to have ‘several’ children because of the increasing risks of bleeding and hysterectomy after multiple caesarean sections. Over the next few months there will be a number of articles dealing with various aspects of this issue, including maternal satisfaction with their choices. I trust these articles will stimulate debate and look forward to many Letters to the Editor. I have chosen as the lead article the opinion piece (written by three midwives) about the importance of maternal death review. Maternal mortality reports in Australia have gone through a number of evolutions over the 40 years or so since they started. At present, the national report is entirely reliant on the information provided to the National Perinatal Statistics Unit by individual jurisdictions. While the process is robust in some states, there is concern about the veracity and completeness of the information provided in some cases and whether there is complete ascertainment. Without this, it is impossible to know how well or badly we perform in relation to international comparisons. It seems hard to believe that there are no national regulations or even guidelines that stipulate such things as the need for coronial referral and/or autopsy in the case of direct maternal deaths. Even in many indirect cases, the exact cause of death may be unclear and therefore an understanding of avoidable factors may be incomplete. The four case reports chosen for this issue are all about important clinical lessons. While the messages in two are quite simple they may lead to avoidance of significant morbidity. There is also an interesting exchange of letters about the question of mesh erosion after infracocygeal sacrocolpopexy. I would encourage any further comments on this important question. Finally, we are publishing a short series of cases of laparoscopic cervico-isthmic cerclage. Personally, I do not doubt that this type of procedure is superior to the traditional cerclage performed vaginally at the end of the first trimester for those who have true cervical incompetence. The important questions are when and how to do it. Is it time for the exponents of the two operations to combine to do a randomised trial?