College ConneXion

Women's Health

Items of interest

o	Consent and Confidentiality in Genetic Practice
o	Australian Indigenous Health Program (RACS and RANZCOG)
o	Termination of pregnancy: a resource for health professionals new RANZCOG publication
o	Food Standards Australia New Zealand Addition of calcium to ‘sugar-free' chewing gum
o	Intravenous immunoglobulin: information from the Australian Red Cross Blood Service
o	TGA alert on SSRIs in pregnancy
o	Implanon removals: list of referral centres for patients with rods that are not palpable - Prof Gab Kovacs
o	Roquefort cheese can now be sold in Australia: FSANZ
o	Isotretinoin - avoiding fetal abnormalities & suicidality - Australian Adverse Drug Reactions Bulletin articles
o	New RANZCOG patient information pamphlets on endometriosis and laparoscopic treatment of endometriosis

Consent and Confidentiality in Genetic Practice

Prepared by expertise from Royal College of Physicians (RCOP), Royal College of Pathologists (RCOP), British Society of Human Genetics (BSHG).

Recent scientific advances in genetics in clinical practice, affecting increasing numbers of medical specialties, have made guidance on obtaining, sharing and storing genetic information, particularly family trees and test results, essential reading for many of today's practitioners.

For further information please see the website: http://www.bshg.org.uk/documents/official_docs/Consent_and_confid_corrected_21[1].8.06.pdf

Australian Indigenous Health Program (RACS and RANZCOG)

The Royal Australasian College of Surgeons (RACS), in collaboration with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), are pleased to offer an exciting new learning opportunity for doctors, including inernational medical graduates (IMGs), caring for Australia's Indigenous population. This program is proudly supported by the Australian Government, Department of Health and Ageing.

For further information please see the flyer or go to the website http://www.surgeons.org/Content/NavigationMenu/FellowshipandStandards/ProfessionalDevelopment/IndigenousHealthProgram/default.htm

Indigenous Health flyer and registration ( 111KB)

Food Standards Australia New Zealand      

Addition of calcium to ‘sugar-free' chewing gum ( Application A577 – Initial Assessment)

Wrigley Company Pty Ltd has applied to have the Food Standards Code amended to allow the addition of up to 100 milligrams of calcium per serve to its ‘sugar-free' range of chewing gum. The company considers that the added calcium will have benefits for both dental and bone health. The level being requested constitutes 12.5 per cent of the RDI (Recommended Dietary Intake) for calcium. This amount would allow a nutrition content claim to be made on the product label. We seek public comment on this application, particularly from medical and dental professionals.

This information is reproduced with permission of Food Standards Australia New Zealand. Fellows and Diplomates may like to subscribe to this service. You can subscribe or unsubscribe to this service through their website, http://www.foodstandards.gov.au/ , under the ‘Subscription Service' button (if you have difficulty doing this contact info@foodstandards.gov.au ).

Termination of Pregnancy

A resource for health professionals

At November Council the RANZCOG publication Termination of pregnancy: a resource for health professionals was approved

This resource document for health professionals summarises current medical evidence and reference material about methods of termination of pregnancy prior to 20 weeks gestation More

Download Termination of pregnancy ( 193KB)

Australian Red Cross Blood Authority

Intravenous Immunoglobulin update

The National Blood Authority (NBA) has established a Standing Order for the supply of overseas-sourced Intravenous Immunoglobulin (IVIG) to meet any shortfalls in the supply of domestic IVIG, if and when required. The Australian Red Cross Blood Authority (ARCBS) has agreed to distribute these products on behalf of the NBA.

Currently

• SANDOGLOBULIN (manufactured by ZLB Bioplasma AG, a company of CSL Ltd) is being distributed by the ARCBS under this arrangement
• OCTAGAM (manufactured by OCTAPHARM Ltd) has also been purchased for the national reserve, and roll-out of this product commenced in October 2005

Support materials to assist with the introduction of these new products are available at the ARCBS website

TGA Alert on SSRIs in Pregnancy - 7 September 2005

Caution over antidepressant Paroxetine during pregnancy

The Therapeutic Goods Administration (TGA) advised pregnant women taking the antidepressant Paroxetine to discuss this treatment with their doctor following new information from overseas that suggests there may be a slight increased risk to their babies.

Preliminary analysis of data from a large study conducted in the United States indicate that there may be an increased risk of birth defects and cardiovascular malformation in babies whose mothers are taking Paroxetine.

Professor John Horvath, Australia's Chief Medical Officer, cautioned pregnant women not to suddenly discontinue use of the medicine as the withdrawal symptoms could be harmful.

Read the TGA three fact sheets on SSRIs and Paroxetine:

• Advice for women taking paroxetine intending to become pregnant or in early pregnancy More
• General Information concerning use of SSRI antidepressants in pregnant women More
• Information for health professionals concerning use of SSRI antidepressants in pregnant women More

Further information from GlaxoSmithKline on Aropax and for prescribers is available More

GlaxoSmithKline

Information Line

The manufacturer of paroxetine has set up an information line for both women and health professionals:

(t) 1800 010 462

Implanon Removals

Some advice for when the Implanon rod is hard to palpate - Prof Gab Kovacs

Implanon has been available for patient use since May 2001. In the last four years over 271,000 women have chosen Implanon as their method of contraception.

As some of the rods have been in in-situ for more than three years, many of us will be asked to remove and change these over in the coming months.

It is estimated that in 2005 there will be nearly 35,000 women who will request having an Implanon rod removed from their arm following the technique taught in the Implanon insertion sessions.

As long as the rod is easily palpable this should be very simple, however our very strong advice is that if the rod cannot be palpated, do not attempt to remove it.

If the rod is not palpable, you should first advise the patient to use a back-up method of contraception until the presence of the implant can be confirmed. This, in the first instance should be done by an ultrasound examination, but it is important that the person who is doing this is someone with expertise with Implanon localisations.

Through our networks we have established a number of referral centres, which are “centres of experience” for localisation of Implanon in the forearm. The clinicians at these centres are either sub-specialist ultrasonologists, or radiologists with an interest in the removal of foreign bodies.

Download the list of Implanon referral centres ( 14 KB)

Attempts to remove an Implanon rod, which is not palpable, will result in a frustrating experience both for the patient and the operator. If you do not know who has special experience in Implanon removals in your particular area, the State office of Family Planning Australia will be able to assist or if you have queries, you can contact the Organon Implanon Information Line on: (t) 1800 644546.

In a case of an uncomplicated Implanon removal, a new Implanon rod can be inserted through the same incision at the very same time using the well recognised Implanon insertion techniques.

FSANZ Permits Sale of Roquefort in Australia

Roquefort cheese

Food Standards Australia New Zealand (FSANZ) has gazetted an amendment to the Food Standards Code that permits the sale of Roquefort cheese, a raw milk cheese made under specific conditions in France.

From the FSANZ media release:

“Before a raw milk cheese is approved, FSANZ must be satisfied that the cheese has a level of safety equivalent to cheeses made from heat-treated or pasteurised milk.

“This involves a scientific evaluation of the cheese manufacturing processes, followed by an examination of the regulatory environment and safety control measures under which sheep milk is produced and Roquefort cheese is made.

“Scientists from FSANZ and the Australian Quarantine and Inspection Service (AQIS) conducted on-site audits of cheese-making facilities in France as part of the approval process.

“FSANZ is part way through the development of a National Dairy Primary Production and Processing Standard. This will include permissions to domestically manufacture “Roquefort-like" cheeses, where safety can be assured.

Roquefort cheese will be subject to monitoring by AQIS on entry to Australia.

Under Australia’s food labelling laws, a statement will be required on Roquefort cheese to indicate that it has been manufactured from milk that is unpasteurised and sourced from sheep.

Roquefort cheese can be sold in Australia from 22 September 2005. A draft of the National Dairy Primary Production and Processing Standard will be release for public comment next year.

Food Standards Australia New Zealand FSANZ website More

Australian Adverse Drug Reactions Bulletin Items

Avoiding fetal abnormalities with isotretinoin

Australian Adverse Drug Reactions Bulletin
Volume 24, Number 1, February 2005

www.tga.gov.au/adr/aadrb/aadr0502.htm#2

Acne, isotretinoin and suicidality

Australian Adverse Drug Reactions Bulletin
Volume 24, Number 3, June 2005

www.tga.gov.au/adr/aadrb/aadr0506.htm#1

RANZCOG Patient Information Pamphlets

New patient information pamphlets

The College, with Mi-tec Publishing, has developed two new patient information pamphlets which are now available for order. The new titles are:

• Laparoscopic Treatment of Endometriosis - A Guide for Women.
• Understanding Endometriosis - A Guide for Women.

Fellows and Diplomates can order small quantities of the College's new patient information pamphlets from Mi-tec Publishing (not just bulk orders of the same pamphlet), along with small quantities of other titles.

For example, an obstetric pack could consist of the following:

• Ten copies of Instrument-assisted Delivery. The Use of Forceps or Vacuum - assistance during Labour – A Guide for Women.

• Ten copies of Caesarean Section – A Guide for Women.

• Ten copies of Amniocentesis and Chorionic Villus Sampling (CVS).

• Ten copies of Vaginal Birth After Caesarean Section – A Guide for Women.

• Ten copies of Exercise during Pregnancy – A Guide for Women.

The full list of RANZCOG patient information pamphlet titles is available on this website More

© RANZCOG 2005