COVID-19 Resources

Mon, 27 Apr 2020 16:19:54 +1000

This entry is perhaps a little overdue, but then it has been a few years since I last updated my site and have forgotten how to do it....

The following links may be of interest to anyone, not just my patients.

Up to date World COVID-19 Numbers

RANZCOG Information for Pregnant Women

Australian Government Department of Health

We Have Moved

Wed, 11 Sep 2013 11:46:39 +1000

At long last all the holes lined up and we were able to move....around 2 years after my initial plan, but only a week or so over the EDC.

There are still a few things to be done, and don’t ask us where anything is, but we have hit the ground running.

Feel free drop in and check out Bendigo’s newest medical centre.

We will soon be moving

Sun, 26 May 2013 15:51:53 +1000

We have long had the desire to upgrade to a new purpose built facility to enable a number of improvements to the services we can provide including:

• Parking for 20 vehicles,

• Private areas for patients to fill out paperwork,

• Pathology collection services on site, and

• Room to expand with areas for more health professionals.

The timeline for this has been epic. After three false starts in 2009 with properties that had promise we finally identified a property that fitted the brief. Discussions were undertaken with Bendigo Council in early 2010 and the property was bought on the basis of a favourable report.

The site chosen is described as 34-36 Uley St (corner of Bayne and Uley Streets) and is a mere block away from our existing location. It is the site of one of Bendigo’s earliest breweries and has had a number of names and operators over the years with building and demolition and rebuilding on the site since the 1850’s. There even exists a photograph of the earlier buildings of Sayer Brothers Norfolk Brewery from 1861 in the State Library of Victoria by Benjamin Batchelder. Whilst the 1940‘s and later building was sound, sadly the earliest buildings on the site were in a very poor shape and beyond repair.

Then followed detailed design and planning of the development by Glenn Eastwood and his team at Planwise Design with a Planning Permit being issued in December of 2010. There were some considerable restrictions in the permit, none the least of which included the need to perform site archeology and historical documentation of the areas of the building that were to be demolished. These were done and then detailed planning and specification was done to enable the job to be put out to tender in late 2011.

Luke Drummond Builders was the chosen as the contractor and final revisions and planning was conducted to enable the project to begin in late 2012.

All women having a baby are excited by their EDC, and we too are excited about our Estimated Date of Completion! Work is progressing in leaps and bounds and the building is now almost waterproof. Some of the architectural adornments are being attached and the building is taking on its final form. We do not have our hopes up too much and as always are aware of the potential for it to “go over”.

Walk on by one day and check on our progress.

Influenza in Pregnancy

Wed, 17 Apr 2013 14:52:14 +1000

The Australian Immunisation Handbook, 2008, recommended that influenza vaccine be “offered in advance to women planning a pregnancy, and to pregnant women who will be in the second or third trimester during the influenza season, including those in the first trimester at the time of vaccination”. US, UK and Canada experts, as well as the World Health Organization, all made similar recommendations.

Why?
Pregnant women infected with influenza have a hospitalisation rate 2–5 times that of non-pregnant women. This is particularly true for women with a pre-existing co-morbidity. Influenza also affects pregnancy outcomes, with lower birth weights, increased risk of fetal loss, and infant morbidity.

Fortunately, maternal vaccination prevents both maternal and infant disease, and this is particularly good news because babies less than 6 months old are too young for the flu vaccine. Maternal flu vaccine has been shown to reduce maternal febrile respiratory illnesses, lab-proven cases of influenza, and infant hospitalisations due to flu.

Additionally, the vaccine appears safe in pregnancy:
• Low grade fever is uncommon and anaphylaxis is also rare
• Between 1990 and 2009, the Vaccine Adverse Event Reporting System recorded no specific adverse events
• The UK, Yellow Card system had only eight reported reactions from 1994 to 2004, with no conclusions drawn
A Korean study of four prenatal clinics using monovalent H1N1 vaccine
reported no adverse events, including delivery complications and abnormal fetal outcomes

The vaccine does contain the mercury-based preservative thiomersal, but all the credible evidence suggests no issue with neurodevelopment, or any other major side effects. Even so, the thiomersal content has been reduced to trace amounts and is absent from childhood vaccines as “precautionary measure”.

Source: Dr Nick Wood, Healthed Annual Women’s Health Update, Sydney 2013

How maternal BMI affects pregnancy outcomes

Fri, 29 Oct 2010 09:15:47 +1100

Source: European Journal of Obstetrics & Gynecology and Reproductive Biology 2010; in press

The new study, scheduled for publication in the European Journal of Obstetrics & Gynecology and Reproductive Biology, focuses on how BMI can influence risks in nulliparous women. Specialists from the Royal Hallamshire Hospital, in Sheffield, UK, retrospectively reviewed data on all nulliparous women who had their BMI recorded at antenatal booking between January 2001 and November 2008, and who went on to have singletons.

The total population of 6,509 women was divided into five groups according to their BMI: underweight (BMI below 19.9 kg/m2), normal (20.0-24.9 kg/m2), overweight (25-29.9 kg/m2), obese (30-40 kg/m2) and morbidly obese (above 40 kg/m2). The proportion of the study population in each group was 11.3 percent, 47.7 percent, 26.5 percent, 14.5 percent, and 1.6 percent, respectively.

In a new paper due for publication in the European Journal of Obstetrics & Gynecology and Reproductive Biology, the researchers report the following findings for each BMI group (using the normal-BMI group as the comparison group):

Underweight: a significantly reduced risk of post-term delivery, of cesarean section, and of emergency cesarean section; and a significantly increased risk of preterm delivery.
Overweight: a significantly reduced rate of vaginal delivery; and a significantly increased risk of induced labor, of post-term delivery, of shoulder dystocia, of cesarean section, of emergency cesarean section, and of birthweight greater than 4 kg.
Obese: a significantly reduced rate of vaginal delivery; and a significantly increased risk of induced labor, of shoulder dystocia, of cesarean section, of emergency cesarean section, of total blood loss above 1,000 mL, of birthweight greater than 4 kg, and of birthweight greater than 4.5 kg.
Morbidly obese: a significantly reduced rate of vaginal delivery; and a significantly increased risk of induced labor, of post-term delivery, of cesarean section, of emergency cesarean section, of total blood loss above 1,000 mL, of birthweight greater than 4 kg, of birthweight greater than 4.5 kg, and of stillbirth.

The reference rates of these adverse labor, intrapartum and perinatal outcomes in the normal-BMI group were as follows:

Induction of labor: 21.2 percent.
Post-term delivery: 28.5 percent.
Vaginal delivery: 51.5 percent.
Shoulder dystocia: 1.2 percent.
Cesarean section: 22.0 percent.
Emergency cesarean section: 18.2 percent.
Total blood loss above 1,000mL: 3.9 percent.
Pre-term delivery (gestational age below 37 weeks): 10.8 percent.
Birthweight greater than 4 kg: 5.9 percent.
Birthweight greater than 4.5 kg: 0.6 percent.
Stillbirth: 0.2 percent.

Discussing their findings, the researchers noted that although their findings demonstrated the higher risk of adverse pregnancy outcomes with increasing BMI, there were some differences from the results of previous studies. For example, they found no effect of high BMI on the risk of pre-term delivery.

The researchers highlighted the rise in the rate of emergency cesarean section with increasing BMI, from 18.2 percent in the normal-BMI group to 40.6 percent in the morbidly obese group. They also noted the high relative rates of macrosomia (relative risk 3.1) and of stillbirth (relative risk 16.7) in the morbidly obese group, compared with the normal-BMI group.

They concluded that increasing BMI was associated with an incremental increase in the rates of fetal macrosomia, shoulder dystocia, cesarean section, and late fetal death, adding: “Modification to the pregnancy care delivered to women with obesity would appear prudent”.

[This ORGYN.com Review article was provided by Excerpta Medica, an Elsevier business, 2010.]