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college statements update

C-Gen 13

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Alcohol in Pregnancy

C-Gyn 24

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Vaginal 'Rejuvenation' and Cosmetic Vaginal Procedures

C-Obs 24

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Warm Water Immersion in Labour and Birth

C-Obs 25

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Mineral and Vitamin Supplementation in Pregnancy

C-Obs 2

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Home Births

Several amendments were made within this statement. The word ‘NOT’ was bolded to emphasis the college stance on home births.

Also changes occurred regarding the points in the statement. In point one, dot point one ‘and their babies’ was included. In point one, dot point three the word ‘suitable’ was inserted in describing a preferable hospital environment.

Point two, words have been included to stress the importance of having experienced and consented medical personnel care for women who choose home birth.

Point three was extensively added to and now reads as follows:
It is recommended that women considering home birth should seek information from their home birth provider about the provider’s experience in home birth, their contingency plan in the event of an emergency including options for hospital transfer. Details of medical indemnity cover should also be ascertained.

Point four, the second sentence was changed to included the word ‘and care provider’ as patients may not inform The Health Authority of their intensions of having a home birth.

Point five, ‘an obligation to ensure’ was added in emphasising Health professionals responsibilities in covering all bases in the care of the patient/s in an event of an emergency.

C-Obs 3

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Antenatal Screening Tests

Significant amendments were undertaken in the review of Antenatal Screen Tests. First sentence in paragraph two was amended to make a bolder statement. It reads: 
The initial antenatal visit is often the first time an apparently 'healthy' woman has had a detailed medical history and physical examination performed, with specific laboratory testing for a range of conditions.

Point four was extended.

Point six was divided in to five parts and now appears as follows:
6. Screening for Viral Infections in Pregnancy
Before instituting screening for any viral infection in pregnancy, it is imperative that the woman is provided with appropriate counselling as to the limitations of screening for viral infections in pregnancy and the implications of both positive and negative findings.

6a. Hepatitis B Serology - All pregnant women should be recommended to have Hepatitis B screening in pregnancy.

6b. HIV - All pregnant women should be recommended to have HIV screening at the first antenatal visit and at 28 weeks.

6c. Hepatitis C Serology - All pregnant women should be recommended to have Hepatitis C screening in pregnancy. 
However it is acknowledged that this is a contentious area of practice.

6d. CMV Serology - Screening for CMV infection in pregnancy is currently not recommended as a routine. (A link to the Consensus Statement Prepared by the CMV in Pregnancy Working Group will be added when available. Jul 08)

The paragraph on Vitamin D was extended and was inserted under sub-heading of ‘Other tests that may be considered’ as point two.

C-Obs 7

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Diagnosis of Gestational Diabetes Mellitus

This statement was re-endorsed with one major change. The following paragraph was inserted after paragraph three:

Some clinicians may choose to omit the GCT and recommend a full GTT. They may so recommend for all pregnant women or only those with a high likelihood of recall after a GCT. These clinicians may feel that a dual testing regimen (GCT then GTT if GCT abnormal) is inconvenient for the women involved, increases the administrative workload (recall processes) and inevitably delays the commencement of therapy.

No other changes occurred.

C-Obs 15

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The Use of Nifedipine in Obstetrics

Editing throughout the statement occurred with the shortening of some paragraphs and minor wording changes. Paragraphs two and five were condensed plus paragraph five’s leading sentence underwent minor word changes.

C-Gyn 2

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C-Gyn 2 Ovarian stimulation in infertility

The statement was re-endorsed with a minor amendment. Paragraph five on morbid obesity was extended. It now reads:
Morbid obesity (BMI greater than or equal to 35) is a recognised risk factor in pregnancy and delivery and should be regarded as a contra indication to assisted fertility.

C-Gyn 5

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Screening for the Prevention of Cervical Cancer

Several changes occurred in this statement due to the following factors:

• The differences in Cervical Screening programs between New Zealand and Australia
• New Zealand currently updating their guidelines in Cervical Screening

The paragraph following the ‘Note’ was extended to read (change in italics):

In both Australia and New Zealand guidelines are available for the Management of Women with Screen Detected Abnormalities. The New Zealand guidelines were last updated in 1999.Revised guidelines are due to be implemented in 2008. The Australian guidelines were revised in 2005.

An extra dot point was added with a web link to the Australian guidelines: Cervical screening in Australia  2005–2006

The Australian Government funded National HPV vaccination program commenced in Australia in April 2007. Vaccination of girls aged 12 -13 is recommended.  Until July 2009 Government funded vaccination is available to women under the age of 27.  In New Zealand a Government funded HPV vaccination program is in the process of being implemented.

The above was inserted in the middle of the second last paragraph and the following sentence was attached at the end of the last paragraph:

There is some concern regarding the decline in the participation rates of women less than 40 yrs of age but there has been an increase in participation among women aged 55 years and over.

All mentions of ‘pap smear/s’ with in the body of text were replaced by ‘cervical smear/s’ to ensure consistency between Australia and New Zealand.

C-Gyn 22

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Filshie Clip Sterilisation

One minor amendment occurred. Dot point six, under the sub-heading ‘Suggested Technique’, the manufacture’s guidelines of the positioning of the filshie clip was inserted, it now reads as follows:

• Apply the clip to the tube, ensuring the jaws of the clip completely enclose the tube.  The manufacturer’s guidelines currently recommend placement of the clip on the isthmic portion of the tube.

WPI 13

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Re-entry Guidelines Following a Prolonged Period of Absence from Practice and Retraining Programs for Fellows

The Review Due date was revised to March 2009.