A routine third trimester growth ultrasound in the obese pregnant woman does not reliably identify fetal growth abnormalities: A retrospective cohort study.

BACKGROUND: In response to the challenges of assessing fetal growth in obese women, guidelines recommend routine third trimester ultrasound scans. AIM: The aim of this study was to assess the diagnostic performance of this routine scan in obese women (body mass index (BMI) ≥ 35 kg/m2 ). METHODS: A retrospective cohort study of 1008 pregnancies with maternal BMI ≥ 35 kg/m2 born after 37 weeks gestation at a Victorian hospital from 2015 to 2017. Multiple pregnancies and those affected by diabetes were excluded. Growth ultrasounds were performed between 34 + 0 and 36 + 6 weeks gestation. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection of large for gestational age (LGA > 90%) and small for gestational age (SGA < 10%) were calculated using ultrasound estimated fetal weight (EFW) or abdominal circumference (AC) and compared with gestational age and gender-based birthweight percentiles. RESULTS: Using EFW, sensitivity for detecting SGA at birth was 8.1% (six of 74) with a PPV of 100%. Sensitivity for detecting LGA at birth was 61.0% (119 of 195), PPV 54.8%. Sensitivity, specificity, PPV and NPV percentages were all lower using AC. Only 40% of actual birthweight percentiles (405/1008) were within ±10 percentiles of their growth ultrasound EFW percentile. CONCLUSION: The performance of a routine third trimester ultrasound in women with BMI ≥ 35 kg/m2 suggests limited utility in helping identify aberrant fetal growth. This has important implications for the management of obese pregnant women.

A profile of body mass index in a large rural Victorian obstetric cohort.

OBJECTIVES: To report on the prevalence and implications of overweight and obesity in a rural maternity cohort. DESIGN, SETTING AND PARTICIPANTS: A retrospective 6-2013 cohort of 6138 pregnancies managed in a rural Victorian maternity service from 1 January 2005 to 31 December 2010. MAIN OUTCOME MEASURES: Maternal body mass index (BMI), prevalence of overweight and obesity, prevalence of pregnancy complications and their association with BMI class. RESULTS: A total of 65.6% of all women were overweight or obese. Only 32.7% of the women were of normal/healthy weight; 1.6% were underweight, 33.0% were overweight, 18.6% were obese class I, 8.3% obese class II and 5.7% were obese class III. Increased BMI was associated with increased rates of induction of labour, gestational diabetes mellitus, pregnancy-induced hypertension, operative vaginal deliveries, caesarean sections, invasive fetal monitoring, increased gestational age at delivery, increased birth weight, and increased maternal length of stay (P < 0.01 for all). Analysed separately, 60.5% of first-time mothers were overweight or obese. CONCLUSIONS: Almost two-thirds of this rural maternity cohort were overweight or obese; twice the level reported from metropolitan centres and higher than other Australian reports. The associations with complications are similar to those reported previously. This high rate of maternal overweight and obesity may have implications for rural maternity funding, outcomes and perinatal mortality rates.

A multi-university study of which factors medical students consider when deciding to attend a rural clinical school in Australia.

INTRODUCTION: As in many developed nations, there is a shortage in the rural medical workforce in Australia. Research indicates that a strong relationship exists between rural educational exposure and an increased interest in pursuing a rural career or selecting a rural internship. Accordingly, in 2000 the Australian Commonwealth Government established the Rural Clinical Schools (RCS) program. Under this program, 25% of parent medical schools' Commonwealth Supported Place (CSP) medical students must spend at least 1 year of their clinical medical education in a rural setting. Research indicates that positive experiences are of vital importance in determining future rural practice. Arguably, if students are conscripted to a RCS, they may view their overall experience negatively. Thus, the development and sustainability of an adequate future rural medical workforce depends on medical schools understanding and fostering the factors that encourage voluntary student recruitment to the RCSs. The aim of the present study was to determine which factors Australian medical students consider in their decision to attend RCSs. METHODS: This study employed survey research. The questionnaire, which used a 6 point Likert scale, addressed factors influencing students' decision to attend an RCS, including whether these factors were viewed as positive or negative. Open-ended questions provided students with an opportunity to make comments about their decision-making. The setting was the RCSs of six participating Australian universities. The participants were medical students enrolled at one of six Australian universities in 2006 (n=166) who had completed their RCS term; 125 students responded (75% response rate). RESULTS: At least three-quarters of the respondents considered the following when deciding whether to attend an RCS: patient access, academic reputation, their friends, the availability of subsidized accommodation provided by the clinical school, extra-curricular activities, social opportunities and transport costs. The majority of students considered the following as positive considerations: 'patient access', 'academic reputation', and 'subsidized accommodation'. However, for other students these same factors were negative considerations. CONCLUSION: Students consider both clinical and non-clinical factors in their decision to attend an RCS. The primary positive factor in the present study was patient access with 97% students (n=119) considering this to be important, and 84% students (n=81) stating that this was a positive factor in their decision-making. The other major factors, friends and academic reputation, appear equally considered. However, they differed in the degree to which they were regarded as a positive or negative consideration. Identifying and promoting positive factors is essential if the future rural medical workforce is to be enhanced. This study supports the importance of RCSs not being over-crowded and, thus, maintaining patient access, and also the importance of institutions having sufficient resources to support an excellent academic reputation. Interestingly, and perhaps somewhat contrary to expectations, students of metropolitan origin appear to be increasingly attracted to RCSs. Although numerous studies show that rural origin is a strong predictor of rural medical workforce membership, urban students who attend an RCS and have a positive experience may also be open to future rural practice.

Vitamin D deficiency is common among pregnant women in rural Victoria.

There is increasing evidence to implicate vitamin D deficiency in a variety of diseases. Previous advice has been to screen high-risk pregnant women. This study shows that, despite abundant sunshine and latitude consistent with year-long vitamin D synthesis, 65.5% of a largely low-risk antenatal population in rural Victoria have insufficient vitamin D. Over 5.0% of women have vitamin D levels that pose a significant neonatal and adult health risk. These findings support routine antenatal testing of vitamin D levels.