Lessons from the RANZCOG Annual Scientific Meeting

I recently attended the Queensland and New South Wales RANZCOG ASM (Royal Australian College of Obstetricians and Gynaecologists Annual Scientific Meeting) at The Marriott, Surfers Paradise. Apart from being a time to enjoy the fabulous food and environment, it was a great weekend of learning and hearing about new research. Discussions over lunch and tea with colleagues about challenging cases is always beneficial.

There was an excellent attendance overall and many presentations by training doctors and eager doctors hoping to enter the training program.

A few of the topics covered that were particularly meaningful for myself at this time in my practice included Mirena insertion at the time of elective caesarean section, rectus muscle diastasis and the non-invasive prenatal screening test.

There are only small studies on Mirena (Levonorgestrel intrauterine contraceptive device) insertion at the time of elective caesarean section. One study had 24 patients and was performed in South Africa. The study presented on the weekend is the second of its kind, performed in Mackay and containing 25 patients – cases and controls. There was no increase in bleeding, infection or perforation. Due to the technique of placement, however, the strings were only visible in 30% of cases. This may result in difficulties ascertaining if the Mirena is still in place and at the time of removal.

In our practice at eXXpectations, after involved and detailed discussion with some patients I have placed a Mirena at the time of elective caesarean section. The majority of the time the decision to proceed is made in the hope to avoid potential pain with insertion 6 weeks post partum and provide convenient contraception at a challenging time in a woman’s life. From a medical perspective, women who have only had caesarean sections may have an increased incidence of requiring a general anaesthetic to place the device. All, bar one, have been delighted with the decreased bleeding post partum and knowledge that contraception is not something they have to think about for the near future. They can enjoy their time with their newly expanded family and relax as intimacy resumes.

Rectus muscle separation or diastasis post partum is something that concerns a lot of women. It does appear to be slightly more significant after caesarean section than vaginal delivery. Contrary to popular belief, the muscles are not cut or incised during a routine caesarean section. They are separated to gain access to the abdominal cavity and the uterus. Diastasis can and does happen even if a woman has a vaginal delivery, purely from the abdominal stretching to accommodate the growing fetus and uterus. The study presented suggested that it is an issue that concerns most women post partum. It was reassuring in that the separation could be minimised with physiotherapy support and exercise. Under discussion was – and continues to be – muscle closure with sutures at the time of caesarean. Every obstetrician has a different opinion and technique. I have decided to ponder this more and look forward to future studies and guidelines.

The third topic was the latest available prenatal screening, particularly the non-invasive prenatal test (NIPT) on offer. It was wonderful to hear from a materno-fetal medicine specialist and his thoughts on how to fit this new screening test in to the armamentarium already at our disposal. It is a valuable option that does need to be discussed individually with each couple and has different applications for each pregnancy. It has not negated the recommended combined first trimester screen that involves an ultra sound of the fetus, or at times, the need for invasive and diagnostic testing.

In all, it was a fabulous, thought provoking weekend.