Royal Women's Hospital Research Articles

Is penicillin and/or erythromycin resistance present in clinical isolates of group B streptococcus in our community?

Traditionally group B streptococcus (GBS) has not exhibited resistance to the antibiotics penicillin and erythromycin. Recently there are reports from North America whereby some GBS isolates have exhibited resistance to erythromycin. There have been no studies reported to date to determine whether this resistance trend is also occurring in the Australian population. Over a period of six months from January to June 1999, 250 GBS isolates were collected at the Royal Women's Hospital, Melbourne. Sensitivity to penicillin, erythromycin and vancomycin was determined by disk diffusion. Any isolates that had reduced zones to penicillin, vancomycin or erythromycin had minimum inhibitory concentrations (MIC) determined. No isolates had reduced susceptibility to penicillin or vancomycin. Of the 250 isolates, seven (2.8%, 95% CI = 1.1-5.6%) had resistant MICs to erythromycin of > 1.0 microg/mL. These preliminary data suggest that penicillin therapy is still an effective first-line antibiotic for intrapartum chemoprophylaxis and that erythromycin resistance is low in our population.

Labour ward 30, Royal Women's Hospital, Melbourne 1947-72.

Labour ward 30, Royal Women's Hospital, Melbourne 1947-72.

Book Review: Drugs and Pregnancy

Melbourne: Pharmacy Department, The Royal Women's Hospital, Women's and Children's Health; 2001

Sex and Suffering: Women's Health and a Women's Hospital: The Royal Women's Hospital, Melbourne 1856-1996

Sex and Suffering is a ground-breaking work. It tells the often shocking story of women's desperation to gain control over their lives and their health, and of medicine's struggle to comprehend and manage the mysteries of nature. It offers a graphic and revealing history of childbirth in Australia; of the medical care of women; of nursing and gender roles; and of the impact of immigration on Australian society. Remarkably, thousands of detailed case notes, from the 1850s to the 1930s, survived intact at the Royal Women's Hospital, Melbourne. For the first time in the English-speaking world a historian was allowed to work directly from these confidential patient records. Janet McCalman vividly recreates the lives of patients and the daily work of a hospital. She enables readers to follow the institution through times of growth and economic depression, through the grim history of criminal abortion, and through the inspiring story of medical science and surgery since the coming of anaesthesia. Sex and Suffering is a vivid and absorbing social history of women's health, seen through the work of Australia's oldest women's hospital.

Auditing complications of laparoscopy in a major tertiary hospital in Australia

To review complications in both diagnostic and operative laparoscopic procedures at a university‐affiliated major teaching hospital and to assess possible risk factors for complications.A retrospective review of all laparoscopic procedures at the Royal Women's Hospital Brisbane, Australia, from 1990 to 1997 inclusive. A non‐medical or nursing independent assessor reviewed charts. Data were collected on a standard form. Incomplete charts were excluded from analysis.There was a total of 1505 procedures. Analysis was based on 1435 complete data records. The overall complication rate was 2.86% with infection (1.3%) being the most common. The rate of gastrointestinal injury was 0.14%. Compared with women who had diagnostic laparoscopies, a higher rate of complication was found in women who had undergone operative laparoscopic procedures. However, this difference did not reach statistical significance. The complication rate was unrelated to seniority of the surgeon.Complications can occur in any laparoscopic procedure. Regular reviews, especially in teaching hospitals, will provide feedback to clinicians to improve quality of care.

Outcome of 25 pregnancies complicated with CCAM

Congenital cystic adenomatoid malformation (CCAM) is a pulmonary developmental anomaly arising from an overgrowth of the terminal respiratory bronchioles, while the development of the alveoli is completely suppressed except at the periphery. The condition, in the vast majority of cases is confined to a single lung (85%) or lobe. Congenital cystic adenomatoid malformation has been classified into three subgroups according to the size of the cysts. The inheritance pattern of the lesion appears to be sporadic, with no known teratogenic associations. The condition is usually isolated and there is no association with chromosomal defects. The ultrasound diagnosis is based on the finding of a solid or cystic, non‐pulsatile intrathoracic tumor. Common associated findings are polyhydramnios (65%), which is likely to be due to decreased fetal swallowing, the consequence of esophageal compression by the mass or decreased absorption of lung fluid by the hypoplastic, malformed lungs, hydrops (common in microcystic form) and placentomegaly (in cases of hydrops). Unilateral lesions are often associated with deviation of the mediastinum in the contralateral side. In bilateral disease, the heart may be severely compressed, and this is usually associated with ascites from venocaval obstruction or cardiac compression. We wish to present the outcome of 25 pregnancies where a diagnosis of congenital cystic adenomatoid malformation was made on the basis of ultrasound findings during second and third trimester scans. The patients were subsequently managed through the Fetal Management Unit at the Royal Women's Hospital over the 6‐year period from 1995 to 2001. We will present data on the progression of the lesions through pregnancy, pregnancy outcome with short‐ and long‐term follow up data on the babies.

Birth weight

AIMSTo determine the respiratory health in adolescence of children of birth weight <1501 g, and to compare the results with normal birthweight controls.METHODSProspective cohort study of children born in the...

Improving antenatal recognition of women at risk for postnatal depression.

The purpose of this study was to assess the effectiveness of a practical antenatal screen used at the Royal Women's Hospital, Brisbane, to identify women at risk for postnatal depression. It was a prospective, hospital-based, cohort study of 901 women (600 with and 301 without prenatal risk factors for postnatal depression). Depression was measured 16 weeks after the birth using the Edinburgh Postnatal Depression Scale. More of the women with a prenatal risk factor for depression (25.9%) scored above 12 on the Edinburgh Postnatal Depression Scale than those without any risk (10.9%) (p < or = 0.001). Low social support (p < or = 0.001), a personal history of mood disorder (p < or = 0.001) and a past history of postnatal depression ( p = 0.002) were all strongly associated with postnatal depression in this sample. Results indicate that an objective, psychosocial assessment during pregnancy improves recognition of women at risk for postnatal depression.

Antenatal corticosteroids and outcome at 14 years of age in children with birth weight less than 1501 grams.

To determine whether exposure to antenatal corticosteroid therapy was associated with adverse effects on growth, sensorineural outcome, or lung function of children of birth weight <1501 g at 14 years of age. Cohort study. The Royal Women's Hospital, Melbourne, Australia. One hundred fifty-four consecutive survivors born from October 1, 1980 to March 31, 1982. The mothers of 78 survivors (51%) had been given corticosteroids antenatally to accelerate fetal lung maturation. Treatment with antenatal corticosteroids was nonrandom. No mother received >1 course of corticosteroids. The children were assessed at 14 years of age, corrected for prematurity. All assessors were unaware of the exposure of the child to antenatal corticosteroids. The assessments included measurements of growth and neurological, cognitive, and lung function. Growth measurements were converted into z scores (standard deviation) for the appropriate age and gender. Of the 154 survivors, 130 (84%) were assessed at 14 years of age. Overall, the children exposed to antenatal corticosteroids were significantly taller (height z score; mean difference:.39; 95% confidence interval:.001-. 79) and had better cognitive functioning (Wechsler Intelligence Scale for Children-Third Edition Full Scale; IQ mean difference: 6. 2; 95% confidence interval:.8-11.6) than those not exposed to corticosteroids. There were no other differences in sensorineural outcomes between the groups. Lung function was not significantly different between the groups. No conclusions were altered by adjustment for confounding variables. Exposure to 1 course of antenatal corticosteroid therapy was associated with some clinically and statistically improved outcomes at 14 years of age in children of birth weight <1501 g, with no obvious adverse effects on growth or on sensorineural, cognitive, or lung function. corticosteroids, growth, cognitive, IQ, lung function, adolescence.

The drug epidemic: effects on newborn infants and health resource consumption at a tertiary perinatal centre.

Illicit drug taking in Australia, with its attendant social and medical consequences, is increasing and the effects extend to maternity hospitals where infants born to addicted mothers have more health problems in the neonatal period. The aims of this study were to evaluate (1) the patterns of illness of such infants and (2) the burden imposed on the neonatal department of a large tertiary maternity centre. An audit was conducted of all Chemical Dependency Unit (CDU) mothers and babies delivered at the Royal Women's Hospital, Melbourne, Australia during 1997. Data were compared with those from a concurrent control group of mothers and babies randomly generated from the hospital's obstetric database. Ninety-six infants born to CDU mothers were compared with a control group of 200 infant/mother pairs. The majority of women in the CDU clinic were treated for narcotic addiction with methadone (90%) but most continued to use heroin during pregnancy (68%). Infants born to CDU mothers were significantly less mature and lighter than control infants. Fifty-three (55%) CDU infants required admission to the Special Care Nursery either because of neonatal abstinence syndrome (n = 29) or other medical reasons (n = 24). The median length of hospital stay was significantly longer in CDU compared with control infants (8 vs 3 days, P < 0.01). Infants born to drug dependent mothers have more neonatal problems requiring specialized medical and nursing expertise, compared with control infants. These infants are large consumers of scarce health resources.

Measuring social support in pregnancy: can it be simple and meaningful?

It is important to determine the level of a woman's social support at the booking-in interview for prenatal care, but measurement tends to be ad hoc and nonquantifiable. The purpose of this study was to describe the Maternity Social Support Scale and the relationship between support scale ratings and the Edinburgh Postnatal Depression Scale and other health and service use outcomes. Women (n = 901) who attended the antenatal clinic at the Royal Women's Hospital in Brisbane, Australia, were asked to complete a support scale as part of their booking-in interview. Participants were contacted at 16 weeks postpartum and invited to complete a follow-up questionnaire. Relationships between the scale and study outcomes were explored using analysis of variance and chi-square tests. Women with low social support in pregnancy were more likely than well-supported women to report poorer health during pregnancy (p = 0.006) and postnatally (p < 0.001), to book later for prenatal care (p = 0.000), to seek medical help more frequently (p = 0.004), and to be more depressed postnatally (p = 0.0001). Social support during pregnancy can be measured in a meaningful and simple way through the use of a short questionnaire administered at the prenatal booking-in visit.

Estimation of fetal weight by ultrasound prior to 33 weeks gestation.

The aim of this study was to develop an accurate formula for the ultrasonic prediction of fetal weight for infants < 33 weeks gestational age and < or = 1500 g birthweight. The subjects comprised live births free of lethal malformations or chromosomal anomalies, < 33 weeks gestational age and with birthweights +/- 1500 g born in the Royal Women's Hospital between January 1990 and March 1996. All subjects had accurate gestational age confirmed by ultrasound prior to 20 weeks gestation and ultrasound measurements within 72 hours of birth of biparietal diameter (BPD), femur length (FL) and abdominal circumference (AC). A formula with the highest explained variance was computed by linear regression analysis using the three fetal variables in various combinations from 54 infants born between January 1990 and December 1993. The optimal formula was: Log(10)birthweight = 0.714627 + 0.077362.AC + 0.058758.BPD + 0.287037.FL - 0.011274.AC.FL. The new formula was more accurate compared with existing formulae when tested in a separate cohort of 39 infants born between January 1994 and March 1996.

A preliminary study of the application of the transductal velocity ratio for assessing persistent ductus arteriosus

OBJECTIVETo compare the transductal velocity ratio (TVR) of the persistent ductus arteriosus (PDA) with other echocardiographic criteria for haemodynamic significance of a PDA.METHODSThis was a prospective study (from January 1997...

Dizygotic to monozygotic twinning ratio at The Royal Women's Hospital, Melbourne 1947-1997, compared with Australian national twinning incidence.

The incidence of dizygotic (Dz) twinning can be used as an index of natural human fertility. A retrospective study was done at The Royal Women's Hospital, Australia, to see whether the dizygotic to monozygotic (Mz) twinning ratio from one hospital can accurately reflect the national incidence of Dz twinning. The yearly twinning incidence from 1947-1997 was expressed as a Dz:Mz ratio, standardised for maternal age and plotted against previously published national statistics. The proportion of mothers born in Asia (of both singleton and multiples) between 1983-1997 was analysed to see whether different racial mixes might influence twinning trends. There were 5275 twins born of known sex and maternal age between 1947-1997. The age-standardised Dz:Mz ratio increased non-significantly from 1.39 in 1947 to 2.29 in 1953 (P = 0.08), underwent a significant decline to 0.73 in 1977, then remained stable until 1997 (P>0.05). The same trends were also apparent when the data was pooled into 2-year groups with the increase from 1947/48-1953/54 becoming highly significant (P<0.009). These trends observed in the hospital-based data were in close agreement with those found in the national statistics, with the exception of a rise in 1977-1982 only reflected in the Australia-wide data. In 1993, 2.6% of mothers were born in Asian countries; by 1997, this had risen to 10.6%. We found that the Dz:Mz ratio from one hospital closely reflects national twinning trends. Prospective studies must account for race, and would need around 200-300 twin pairs per year to minimise fluctuations of the ratio.

Dizygotic to monozygotic twinning ratio at The Royal Women's Hospital, Melbourn 1947–1997, compared with Australian national twinning incidence

AbstractThe incidence of dizygotic (Dz) twinning can be used as an index of natural human fertility. A retrospective study was done at The Royal Women's Hospital, Australia, to see whether the dizygotic to monozygotic (Mz) twinning ratio from one hospital can accurately reflect the national incidence of Dz twinning. The yearly twinning incidence from 1947–1997 was expressed as a Dz:Mz ratio, standardised for maternal age and plotted against previously published national statistics. The proportion of mothers born in Asia (of both singleton and multiples) between 1983–1997 was analysed to see whether different racial mixes might influence twinning trends. There were 5275 twins born of known sex and maternal age between 1947–1997. The agestandardised Dz:Mz ratio increased non-significantly from 1.39 in 1947 to 2.29 in 1953 (P = 0.08), underwent a significant decline to 0.73 in 1977, then remained stable until 1997 (P &gt; 0.05). The same trends were also apparent when the data was pooled into 2-year groups with the increase from 1947/48–1953/54 becoming highly significant (P &lt; 0.009). These trends observed in the hospital-based data were in close agreement with those found in the national statistics, with the exception of a rise in 1977–1982 only reflected in the Australia-wide data. In 1993, 2.6% of mothers were born in Asian countries; by 1997, this had risen to 10.6%. We found that the Dz:Mz ratio from one hospital closely reflects national twinning trends. Prospective studies must account for race, and would need around 200–300 twin pairs per year to minimise fluctuations of the ratio. Twin Research (2000) 3, 12–16.

Survival, cranial ultrasound and cerebral palsy in very low birthweight infants: 1980s versus 1990s.

To determine the changes in the rates of survival, cranial ultrasound abnormalities and cerebral palsy in very low birthweight (VLBW) (birthweight 500-1499 g) infants between the early 1980s and the early 1990s. A cohort study of consecutive VLBW live births in one tertiary perinatal hospital during two distinct eras was performed at The Royal Women's Hospital, Melbourne, a level-III perinatal centre. Consecutive VLBW infants born over the 18-month period from 1 October 1980 (n = 222), and over the 12-month period from 1 January 1992 (n = 202) were identified. The main outcome measures were the proportions of live births surviving to 5 years of age, rates of cranial ultrasound abnormalities, and rates of cerebral palsy at 5 years of age. Over the 18 months from 1 October 1980, 68% (150/222) VLBW live births survived to 5 years of age. The survival rate rose substantially to 82% (165/202) during 1992 (odds ratio 2.1, 95% confidence interval 1.4-3.2). The survival rate increased over time more for those of 500-999 g birthweight than for those of 1000-1499 g birthweight. The rates of cerebroventricular haemorrhage (CVH) were similar inlive births and survivors from both eras, as were the rates of cerebral palsy (7.5% in 1980-82; 7.8% in 1992) in survivors seen at 5 years of age. The positive predictive value of CVH for cerebral palsy was low, but cystic periventricular leucomalacia was followed by cerebral palsy in seven of eight survivors from the 1992 cohort. Despite the increasing survival rate with improvements in perinatal care, including more antenatal steroid therapy and the introduction of exogenous surfactant, the rates of CVH and of cerebral palsy in survivors have not diminished.

Antenatal corticosteroid therapy and blood pressure at 14 years of age in preterm children

Antenatal corticosteroid therapy substantially improves the survival rate of preterm infants, with few side effects. Higher blood pressure in adulthood has been described in several animal species after exposure to antenatal corticosteroids, but there are no similar reports in humans. The objective of the present study was to determine the relationship between exposure to antenatal corticosteroid therapy and blood pressure at 14 years of age. This was a cohort study of 210 preterm survivors with birthweights of <1501 g born in the Royal Women's Hospital, Melbourne, between 1 January 1977 and 31 March 1982. Blood pressure was measured in 177 subjects (84.3%) at 14 years of age with a standard mercury sphygmomanometer. Children exposed to antenatal corticosteroids (n=89) had higher systolic and diastolic blood pressures than those not exposed to corticosteroids (n=88) [mean difference (95% confidence interval) (mmHg): systolic, 4.1 (0.1-8.0); diastolic, 2.8 (0.05-5.6)]. However, few had blood pressure in the hypertensive range. It is concluded that antenatal corticosteroid therapy is associated with higher systolic and diastolic blood pressures in adolescence, and might lead to clinical hypertension in survivors well beyond birth.

A daughter's tribute

Margaret and her 2 brothers grew up in the small township of Robinvale, which is a soldier settlement area on the Murray River near Mildura. During their childhood years they frequently holidayed with the families of the women who, with their mum, shared 3 1/2 years as Japanese Prisoners of War. It was not until Margaret was in her teenage years that she began to understand the horrors these women had endued. Margaret has travelled with her mother to reunions around Australia, New Zealand and Asia. Their common nursing backgrounds and this understanding added additional bonds to their mother/daughter relationship. Like her mother almost 40 years earlier, Margaret trained as a nurse at Mildura Base Hospital between 1967–69. She completed her Midwifery in 1970 at the Royal Women's Hospital, Brisbane and has worked exclusively in this field since then. She completed her Nursing Degree at Curtin University WA, her Graduate Diploma Nurse Education and Masters in Health Management at the University of New England in Armidale NSW. She was also a Army Reserve Nursing Officer from 1980 to 1991. Margaret has worked in most Australian States due to her husband's military career including 15 months living in Singapore in the mid 70s. They moved to Canberra in 1989 and Margaret has worked in the Maternity Unit as Educator, & Manager before being appointed to her current position as Clinical Midwife Consultant for Maternity and Gynaecology Outpatient Services at The Canberra Hospital in 1994.

More on management of choroid plexus cysts in the mid-trimester fetus.

EDITORIAL COMMENT: We have published this pair of letters as a feature rather than in the correspondence column so it will not be lost to reference in the literature. Readers are also referred to a recently published review of the world literature concerning the risks of trisomies 18 and 21 in the second‐trimester fetus with an isolated choroid plexus cyst (A). This study concluded that ‘the likelihood of trisomy 18 was 13.8 times greater than the a priori risk in fetuses with isolated choroid plexus cysts diagnosed in the second trimester. However, the likelihood of trisomy 21 was not significantly greater than the a priori risk with isolated choroid plexus cysts.’ N.B.(A) Yoder PR, Sabbagha RE, Gross SJ, Zelop CM. The second‐trimester fetus with isolated choroid plexus cysts: A meta‐analysis of risk of trisomies 18 and 21. Obstet Gynecol 1999; 93: 869–8721. Choong S, Meagher S, Management of choroid plexus cysts in the mid‐trimester fetus Aust NZ J Obstet Gynecol 1999; 39: 7–112. Goldstein H, Philip J. A cost‐benefit analysis of prenatal diagnosis by amniocentesis in Denmark. Clinical Genetics 1990; 37: 24–2633. Gupta J, Thornton J, Lilford R. Management of fetal choroid plexus cyst. Br J Obstet Gynaecol 1997; 104: 881–886.4. Gratton R, Hogge W, Ashton C. Choroid plexus cysts and Trisomy 18: Risk modification based on maternal age and multiple‐marker screening. Am J Obstet Gynecol 1996; 175: 1493–1497Associate Professor Lachlan de Crespigny, Head of Ultrasound, Royal Women's Hospital, Carlton, Melbourne and Associate Professor Julian Savulescu Director, Ethics Unit, The Murdoch Institute, Royal Children's Hospital, Parkville, Melbourne and Dr Leslie J Sheffield, Director of Education and Training, Victorian Clinical Genetic Services, Royal Children's Hospital, Parkville, Melbourne.

Prenatal diagnosis and management of sacrococcygeal teratoma.

Five fetuses, each with a sacrococcygeal teratoma (SCT) were delivered at the Royal Women's Hospital while 2 fetuses, each with a SCT were delivered at Monash Medical Centre in 1998. The number of cases reported in this series is higher than expected but it most likely occurred due to chance. The diagnosis was made prenatally in all cases. Three of the SCT were entirely external while the remaining 4 were external with intrapelvic extension. Rapid growth of the SCT occurred in 3 fetuses. This was associated with polyhydramnios in 2 fetuses. No fetus developed nonimmune hydrops. Six infants were liveborn (perinatal mortality rate of 14%), 3 of whom were delivered prior to 37 weeks' gestation. Two infants were delivered by classical Caesarean section. The remaining 4 infants were delivered by lower uterine segment Caesarean section. There was 1 perinatal death. This stillborn infant was delivered vaginally. The 6 surgical resections were performed between the 4th and 10th postnatal days. Histological examination confirmed the diagnosis of benign SCT in each. One infant developed a recurrence at 2 months of age and required chemotherapy.