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ObjectiveTo identify effects on health outcomes from implementing new criteria diagnosing gestational diabetes mellitus(GDM) and to analyse costs-of-care associated with this change.DesignQuasi-experimental study comparing data from the calendar year before (2014) and after (2016) the change.SettingSingle, tertiary-level, university-affiliated, maternity hospital.ParticipantsAll women giving birth in the hospital, excluding those with pre-existing diabetes or multiple pregnancy.Main outcome measuresPrimary outcomes were caesarean section, birth weight >90th percentile for gestation, hypertensive disorder of pregnancy and preterm birth less than 37 weeks. A number of secondary outcomes reported to be associated with GDM were also analysed.Care packages were derived for those without GDM, diet-controlled GDM and GDM requiring insulin. The institutional Business Reporting Unit data for average occasions of service, pharmacy schedule for the costs of consumables and medications, and Medicare Benefits Schedule ultrasound services were used for costing each package. All costs were estimated in figures from the end of 2016 negating the need to adjust for Consumer Price Index increases.ResultsThere was an increase in annual incidence of GDM of 74% without overall improvements in primary health outcomes. This incurred a net cost increase of AUD$560 093. Babies of women with GDM had lower rates of neonatal hypoglycaemia and special care nursery admissions after the change, suggesting a milder spectrum of disease.ConclusionNew criteria for the diagnosis of GDM have increased the incidence of GDM and the overall cost of GDM care. Without obvious changes in short-term outcomes, validation over other systems of diagnosis may require longer term studies in cohorts using universal screening and treatment under these criteria.

Laparoscopic transabdominal cerclage is a safe and effective procedure resulting in favourable obstetric outcomes in women with a poor obstetric history. Success rates compare favourably to the laparotomy approach.

Objective Premenopausal women with early endometrial cancer may wish to maintain their fertility, and for some patients nonsurgical treatment options may be attractive. We have examined our own experience with such patients, as there are limited published data so far to support clear guidelines in this area.Design Retrospective analysis of a case series.Setting Case series from a specialist gynaecological oncology unit in a major tertiary referral hospital.Sample Sixteen patients receiving progestogen therapy for stage-1 endometrial cancer.Methods We reviewed our experience of all patients receiving progestogen therapy for stage-1 endometrial cancer, and we particularly examined their cancer-free outcome and fertility potential.Main outcome measures Response to treatment, duration of response, and subsequent pregnancies.Results Of the 16 patients investigated, four received an oral progestogen, five received the levonorgestrel-releasing intrauterine system (Mirena), and seven received both forms of treatment. Ten patients (63%) responded to treatment, with a median time to response of 5.5 months. Six patients did not respond to treatment, but all were either early in treatment or opted for surgical management before the average time of response. No patient who responded had a later recurrence. The mean total follow-up time was 27 months (range 3-134 months), with no patient deaths. Three patients had successful pregnancies, with one patient having two children.Conclusions This form of treatment appears to be a realistic treatment option in selected patients in the closely supervised environment of a specialist gynaecological oncology unit.

The urine PCR is highly accurate in predicting significant proteinuria in women with pre-eclampsia using the recommended cut-off of 30 mg/mmol. Our findings support current guidelines suggesting the use of a 24-h urine collection is now rarely required.