O Magazine&G Vol 15 No 4 Summer 2013 Stillbirth and perinatal death The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Contents Stillbirth and perinatal death OMagazine& G 12 Editorial Stephen Robson Magazine Advisory Group O&G 13 The stillbirth scandal Prof Caroline de Costa Council Rep, QLD Ruth C Fretts Dr Gillian Gibson Fellows Rep, New Zealand A/Prof Stephen Robson Fellows Rep, ACT 16 Prevention is cure Lindsay Edwards and Sue Walker Dr John Schibeci Diplomates Rep, NSW Dr Brett Daniels Young Fellows Rep, TAS Dr Alexa Bendall Trainees Rep, QLD 20 Looking for answers Ngaire Anderson and Lesley McCowan O&G Magazine Editors Penelope Griffiths 25 A major public-health issue Julia Serafin Alice Ayres and David A Ellwood Lisa Westhaven Designer and Production Editor 28 Improving outcomes Lisa Westhaven Deon York, Cindy Farquhar, Lynn Sadler, Vicki Masson and Sue Belgrave Editorial Communications O&G Magazine Advisory Group, 30 Obesity and stillbirth RANZCOG Simon Craig 254–260 Albert Street EAST MELBOURNE, VIC 3002 Australia 34 Older mothers (t) +61 3 9417 1699 Michael Beckmann (f) +61 3 9419 0672 (e) [email protected] 36 Diabetes and stillbirth Stephen Robson and Chris Nolan Advertising Sales Bill Minnis Director Minnis Journals 39 Managing multiples Renuka Sekar (t) +61 3 9836 2808 (f) +61 3 9830 4500 (e) [email protected] 41 Investigation and management of stillbirth Katrina Vogler Printer Highway Press 44 Reporting and investigating (t) +61 3 9887 1388 Neil MacLean (f) +61 3 9800 2270 46 A pathologist’s perspective O&G Magazine authorised by Christine Loo James McAdam © 2013 The Royal Australian and New Zealand College of Obstetricians 49 An essential investigation and Gynaecologists (RANZCOG). All rights Namita Mittal and Jane E Dahlstrom reserved. No part of this publication may be reproduced or copied in any form or by any 51 Through tears and heartache means without the written permission of the Morwenna Williams publisher. The submission of articles, news items and letters is encouraged. 53 Care for grieving families Cathy Buntting and Vicki Culling For further information about contributing to Magazine visit: www.ranzcog.edu.au/ O&G 55 Reduced fetal movements publications/oandg-magazine.html John Regan The publisher, College and editors cannot be held responsible for errors or any conse- 57 After stillbirth, what next? quences arising from the use of information Charlotte Paull and Stephen Robson contained in this magazine. The views and opinions expressed do not necessarily reflect 60 Interventions that save lives those of the publisher, College and editors. Rhoda Kini Ila Neither does the publication of advertisements constitute any endorsement by the publisher, 62 The power of audit College and editors of the products advertised. Siaki Ela Fakauka, Ulai Tapa Fidow, Josephine Poulter and Rajat Gyaneshwar ISSN 1442-5319 Cover image 103067198 64 Of Kell and kings Zsschreiner ©Shutterstock Lauren Tapper 2 O&G Magazine Contents RANZCOG Regional Committees New Zealand Dr Ian Page Chair Jane Cumming Executive Officer Level 6 Featherson Tower 23 Waring Taylor Street/ PO Box 10611 Wellington 6011, NEW ZEALAND Letters to the editor (t) +64 4 472 4608 (f) +64 4 472 4609 (e) [email protected] 66 A gravid issue: a case for the omission of a woman’s gravidity from Australian Capital Territory her antenatal record TBC Chair Alexander M Owen and Charles P McCusker Deakin Gynaecology Centre 39 Grey Street DEAKIN, ACT 2600 67 Vaginal birth after caesarean – meeting half way (t) +61 2 6273 3102 (f) +61 2 6273 3002 Rhonda Tombros (e) [email protected] New South Wales Prof Gabrielle Casper Chair 68 Global challenges Lee Dawson Executive Officer Marilla Druitt Suite 4, Level 5, 69 Christie Street ST LEONARDS, NSW 2065 (t) +61 2 9436 1688 (f) +61 2 9436 4166 (e) [email protected] Queensland Dr Lee Minuzzo Chair Women’s health Lee-Anne Harris Executive Officer 69 Delivery dilemma in maternal spina bifida Unit 22, Level 3, 17 Bowen Bridge Road Matthew McKnoulty HERSTON, QLD 4006 (t) +61 7 3252 3073 (f) +61 7 3257 2370 (e) [email protected] 71 Q&a: Gastroenteritis in pregnancy South Australia/Northern Territory Brett Daniels Dr Roy Watson Chair Tania Back Executive Officer 1–54 Palmer Place/PO Box 767 72 When breastfeeding fails North ADELAIDE, SA 5006 Brett Daniels (t) +61 8 8267 4377 (f) +61 8 8267 5700 (e) [email protected] Tasmania 74 Learning laparoscopy A/Prof Boon Lim Acting Chair Martin Ritossa Mathew Davies Executive Officer College House 254–260 Albert Street EAST MELBOURNE, VIC 3002 (t) +61 3 9663 5606 (f) + 61 3 9662 3908 (e) [email protected] The College Victoria 5 From the President Dr Alison Fung Chair Mathew Davies Executive Officer Michael Permezel College House 254–260 Albert Street EAST MELBOURNE, VIC 3002 9 From the CEO (t) +61 3 9663 5606 (f) + 61 3 9662 3908 James McAdam (e) [email protected] 76 RANZCOG Research Foundation Western Australia Jonathan Morris and Caroline de Costa Dr Tamara Walters Chair Janet Davidson Executive Officer Level 1, 44 Kings Park Road 78 Staff news WEST PERTH, WA 6005/PO Box 6258 EAST PERTH, WA 6892 (t) +61 8 9322 1051 (f) +61 8 6263 4432 78 Notice of deceased Fellows (e) [email protected] The Royal Australian and New Zealand 79 Obituaries College of Obstetricians and Gynaecologists College House 254–260 Albert Street EAST MELBOURNE, VIC 3002 (t) +61 3 9417 1699 (f) +61 3 9417 0672 (e) [email protected] (w) www.ranzcog.edu.au President Prof Michael Permezel Vice Presidents Board Members A/Prof Stephen Robson Dr Vijay Roach Dr Sarah Tout Dr Gino Pecoraro Prof Ajay Rane Treasurer Chief Executive Officer Dr Martin Ritossa James McAdam Vol 15 No 4 Summer 2013 3 The College From the President The College enters a new era following How could Dr X possibly have missed out? The simple answer is, the departure of Dr Peter White, after although Dr X may well be very good, others have scored even more than 11 years with the College better in the selection process. As the infamous ‘tsunami’ of medical and eight years as CEO. He leaves students move into PGY1, PGY2 and beyond, such tales will become to assume a senior position with the even more common. To succeed in an application for FRANZCOG Australian Medical Council (AMC). I training, Dr X does not just have to be extremely good, Dr X has to am very pleased to announce, after a score better than his/her extremely good fellow applicants. rigorous selection process, the Board had appointed Mr James McAdam What counts towards selection? as the new CEO. James comes to In any appointment process, criteria for selection can be broadly RANZCOG from the Royal Australasian divided into references, résumé and an interview. To my knowledge, College of Surgeons, where he has held psychometric testing is used by only one of the 14 specialist medical Prof Michael Permezel a senior position for several years. We colleges and there is, as yet, no usable test of fine motor skills that all wish James a long and rewarding might predict future surgical aptitude. President tenure as CEO of the College. Within the résumé, academic performance was previously regarded Selection of the new Trainees as important, but can now only be used in a very limited way given Following on from the New Zealand selection process in May- that some medical courses no longer grade candidates or give June, the Australian process took place in August-September. honours. Clinical experience and research output are easily assessed Never has the number or quality of applications been so high. – but should research be the key determinant of entry to a surgical Many a Fellow, Trainee and (not surprisingly) unsuccessful clinical discipline? Should persistence in non-accredited positions of a applicant cannot understand how the superb Dr X has missed out lower ranking applicant be rewarded by eventual entry to training? on a training position. Gynalux Australian Medical Couches manufacture high quality, hand crafted products, with a vast range of colours to suit your taste and decor. The ergonomic solution for obstetrics and gynaecology. Motorised adjustment of all couch positions. Gynalux (AMC 2100) Unit 2, 2 Network Drive, Engineered Carrum Downs 3201, VIC AUS P: +61 (0)3 9708 2661 F: +61 (0)3 9708 2617 for Life E: [email protected] austmc.com Vol 15 No 4 Summer 2013 5 The College What discriminates? Why the objection from some physicians? The key to understanding selection is that the determinant with respect The College finds itself faced with two opposing camps of physician to who gets selected and who does not will be not be particularly opinion. Those that oppose the WHO criteria are concerned that influenced by a category awarded a large number of selection points more women may be diagnosed with GDM. Numbers will vary if nearly all applicants score similarly in that category; in contrast, a according to the ethnic mix, but resource implications could be selection item that may not be worth a large number of points, but significant in some centres. A second objection comes from those which differs substantially between applicants (for instance, research), physicians with a rigid view of what constitutes evidence. The new may prove to be an important discriminator. WHO-endorsed criteria are the product of observational data and two RCTs that use parallel, but not identical, threshold criteria. Are Criteria for the diagnosis of GDM limited research resources best allocated to yet another RCT exploring For over 20 years, the diagnosis of gestational diabetes mellitus threshold criteria? (GDM) in Australia has derived from an ad hoc 1991 consensus, which resulted from the very limited data available at that time.