O Magazine&G Vol 16 No 2 Winter 2014 Pharmacology The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Contents Contents RANZCOG Regional Committees New Zealand The College Dr Ian Page Chair Pharmacology Jane Cumming Executive Officer 5 From the President Level 6 Featherson Tower 13 Editorial 23 Waring Taylor Street/ PO Box 10611 Michael Permezel Wellington 6011, NEW ZEALAND OMagazine& G John Schibeci (t) +64 4 472 4608 (f) +64 4 472 4609 (e) [email protected] 11 From the College O&G Magazine Advisory Group 14 Combined oral contraceptives Dr Gillian Gibson Fellows Rep, New Zealand Stephen Robson Australian Capital Territory Mary Stewart, Betty Chaar and Deborah Bateson TBA Chair A/Prof Stephen Robson Fellows Rep, ACT Dr John Schibeci Diplomates Rep, NSW 62 Intrapartum care in Kiribati 18 The enduring duo New South Wales Dr Brett Daniels Young Fellows Rep, TAS Prof Gabrielle Casper Chair Carmel Walker Dr Alexa Bendall Trainees Rep, QLD Elizabeth Todd and Brett Daniels Lee Dawson Executive Officer Suite 4, Level 5, 69 Christie Street Magazine Editors 64 The Skyline’s the limit ST LEONARDS, NSW 2065 O&G 20 Pharmacology of ART (t) +61 2 9436 1688 (f) +61 2 9436 4166 Penelope Griffiths (e) [email protected] Simon McDowell, Ben Kroon, Anush Yazdani Julia Serafin 65 Award-winning journalism Queensland Lisa Westhaven Dr Lee Minuzzo Chair 22 Uterotonics and tocolytics Lee-Anne Harris Executive Officer Designer and Production Editor 68 Research at the forefront Unit 22, Level 3, 17 Bowen Bridge Road Lisa Westhaven Lucy Bates HERSTON, QLD 4006 (t) +61 7 3252 3073 (f) +61 7 3257 2370 69 News from the Museum Editorial Communications (e) [email protected] 25 Hyperemesis gravidarum Magazine Advisory Group, Gráinne Murphy South Australia/Northern Territory O&G Dr Roy Watson Chair RANZCOG Heena Lakhdhir and Jenny McDougall Tania Back Executive Officer 254–260 Albert Street 69 RANZCOG Women’s Health Award 2013 1–54 Palmer Place/PO Box 767 EAST MELBOURNE, VIC 3002 Australia North ADELAIDE, SA 5006 27 Pre-eclampsia Julia Serafin (t) +61 8 8267 4377 (f) +61 8 8267 5700 (t) +61 3 9417 1699 Dean Fourie and Lucille Wilkinson (e) [email protected] (f) +61 3 9419 0672 Tasmania (e) [email protected] 70 Staff news Dr Emily Hooper Chair 30 Magnesium sulphate 70 Notice of deceased Fellows Mathew Davies Executive Officer Advertising Sales College House Stephen Robson Bill Minnis Director 72 Obituaries 254–260 Albert Street EAST MELBOURNE, VIC 3002 Minnis Journals (t) +61 3 9663 5606 (f) + 61 3 9662 3908 (t) +61 3 9836 2808 32 Prostaglandins (e) [email protected] (f) +61 3 9830 4500 John Schibeci Victoria (e) [email protected] A Pocket Guide to Dr Alison Fung Chair Mathew Davies Executive Officer 40 Anaesthetics College House Printer Medicines Your Patients Take 254–260 Albert Street Highway Press Martin Steynor and Kerry Holmes EAST MELBOURNE, VIC 3002 2 Respiratory medications (t) +61 3 9887 1388 (t) +61 3 9663 5606 (f) + 61 3 9662 3908 (e) [email protected] (f) +61 3 9800 2270 Lucille Wilkinson 42 Endometriosis Western Australia Graham Tronc Dr Tamara Walters Chair 3 Anticoagulants Janet Davidson Executive Officer O&G Magazine authorised by Level 1, 44 Kings Park Road Mr James McAdam © 2014 The Royal 44 Recurrent miscarriage Alexa Bendall WEST PERTH, WA 6005/PO Box 6258 Australian and New Zealand College EAST PERTH, WA 6892 (t) +61 8 9322 1051 (f) +61 8 6263 4432 of Obstetricians and Gynaecologists Stephen Robson 4 A shrink’s shrunken guide to psychopharmacology (e) [email protected] (RANZCOG). All rights reserved. No part The Royal Australian of this publication may be reproduced or 47 The safety of drugs in pregnancy and breastfeeding Yvette A Kelly and New Zealand College of Obstetricians copied in any form or by any means without Debra Kennedy and Gynaecologists the written permission of the publisher. The 6 Drugs for inflammatory bowel disease during pregnancy College House submission of articles, news items and letters is 254–260 Albert Street 50 Perinatal mental health Bruce McGarity EAST MELBOURNE, VIC 3002 encouraged. (t) +61 3 9417 1699 (f) +61 3 9417 0672 Vijay Roach, Marie-Paule Austin and Debra Kennedy (e) [email protected] For further information about contributing to 7 Rheumatology medications (w) www.ranzcog.edu.au Magazine visit: www.ranzcog.edu.au/ O&G 53 Menopause pharmacology San Wong publications/oandg-magazine.html Michele Kwik and Rod Baber The statements and opinions expressed in 9 Hypertension articles, letters and advertisements in President O&G Emma Skowronski Magazine are those of the authors and, unless Women’s health Prof Michael Permezel specifically stated, are not necessarily the 56 Saved by fetal surveillance Vice Presidents Board Members views of RANZCOG. 10 Common dermatological drugs in pregnancy A/Prof Stephen Robson Dr Vijay Roach Will Twycross Dr Sarah Tout Dr Gino Pecoraro Although all advertising material is expected Sonya Havill to conform to ethical and legal standards, Treasurer Chief Executive Officer 60 Journal Club Dr Martin Ritossa Mr James McAdam acceptance does not imply endorsement by 12 Thyroid medication Brett Daniels the College. AK Greenaway and TM Greenaway ISSN 1442-5319 Cover: Shutterstock 172490864 © Dima 61 Q&a: the small-for-dates fetus 14 Anti-epileptic medications Sobko. Pocket Guide cover: Shutterstock Chris Wilkinson 131830784 © Sinisa Botas. Penny Gordon 2 O&G Magazine Vol 16 No 2 Winter 2014 3 The College ® ™ Introducing Mirena EvoInserter From the President Mirena® already pre loaded in the correct horizontal position I write to you having recently attended Education and training an outstanding Indigenous Women’s Examinations Health Meeting in Adelaide. Much As this has to be written some weeks before publication, my registrars more needs to be done at all levels, are currently preparing for their May Structured Oral Examinations but many Fellows, Diplomates (SOE). The College is rightly proud that it has been a leader in Loading by pushing the slider and Trainees are making great examination processes such as the rigour employed in the reviewing contributions to Indigenous women’s and workshopping of cases and in our standard-setting procedures. forwards to its furthest position Double-sided health, both in Australia and New Further positive developments continue and the College will always centimetre scale Zealand. Indigenous women’s health strive for fair and transparent assessment processes that ensure new is embedded in the FRANZCOG Fellows achieve the standard necessary for best-practice outcomes in Curriculum and it is pleasing to note women’s health. Threads are inside the plans to further increase online Prof Michael Permezel resources and increased incorporation Examining for the College is one of the most rewarding ways for a the inserter handle into College assessments. Fellow or Diplomate to make a contribution; having a productive President exchange with senior colleagues in developing examination questions The highlight of the meeting was – while accruing significant CPD points. In encouraging colleagues to the launch of the College’s Reconciliation Action Plan (RAP). The become examiners, the response is often: I am a clinician, examining Ergonomic shape of development of a RAP was initiated by the Indigenous Women’s is for academics. Nothing could be further from the truth. The essence slider and handle Health Committee in 2012. Aboriginal Fellow Dr Marilyn Clarke of College examinations is assessment by contemporary peers. It chaired a Working Party that, in consultation with Reconciliation is precisely those who describe themselves as a clinician not an Australia, developed a plan that sets measurable and achievable academic who are most needed as examiners. goals, timelines and responsibilities to provide the necessary framework for that change to occur. Marilyn, Dr Jacquie Boyle (Chair What is the meaning of MRANZCOG? of the Indigenous Women’s Health Committee) and the Working Awarding MRANZCOG dates back to a time where many of the Party are to be congratulated on this important development towards specialist Colleges had Membership awarded during training, as a ultimately ‘Closing the Gap’ in Aboriginal and Torres Strait Islander staging point on the way to Fellowship. RANZCOG remains one of women’s health. The RAP is available on the College website at: www. the very few Colleges to retain a post-nominal (MRANZCOG) that ranzcog.edu.au/womens-health/reconciliation-action-plan.html . does not meaningfully translate to readiness for specialist practice. Mirena® Evoinserter™ introduces a “one-stop” loading system to prepare the device prior to patient insertion. ® 1 Level 7, 14 Martin Place Sydney NSW 2000 Importantly, Mirena itself remains unchanged. T +61 2 8248 2900 F +61 2 9475 4345 E [email protected] W www.globalmedics.com Please contact your Bayer Women’s healthcare representative or email Obstetrics & Gynaecology Registrars Urgently Needed [email protected] for further information. Due to a current shortage Global Medics are looking for Obstetrics & Gynaecology Registrars for short and long term locum positions to assist hospitals in Australia for the second half of 2014 MIRENA® Minimum Product Information Mirena®, levonorgestrel 52 mg, intrauterine drug delivery system. Indications: Contraception, idiopathic menorrhagia and prevention of endometrial hyperplasia during Global Medics has been assisting hospitals in Rural and Metro oestrogen replacement therapy. Contraindications: Known/suspected pregnancy; current or recurrent pelvic infl ammatory disease; lower genital tract infection; postpartum areas across Australia, New Zealand, UK, Ireland and Canada endometritis; infected abortion during the past three months; cervicitis; cervical dysplasia; uterine or cervical malignancy; progestogen-dependent tumours; undiagnosed for over 12 years. abnormal uterine bleeding; congenital or acquired uterine anomaly including fi broids if they distort the uterine cavity; conditions associated with increased infection susceptibility; Our personalised service with a dedicated specialist acute liver disease/ tumour; hypersensitivity to the constituents.