Background Although prohibited by specific legislation in Australia, patterns of global migration underscore the importance for local clinicians to recognise and manage potential complications associated with female genital mutilation/cutting (FGM/C). The incidence of antenatal depression in Australia is 10% and may be higher among those with a history of FGM/C (RANZCOG 2 statement: Perinatal Anxiety and Depression, 2012). The phenomenon of cultural embedding could represent a protective factor against an increase in mental health problems among these women. Aim To determine whether women who have undergone FGM/C are at greater risk of depression in the antenatal period as defined by the Edinburgh Postnatal Depression Scale (EPDS). Materials and Methods A multicentre retrospective case‐control study was performed. Participants who had delivered at either of two hospitals, had migrated from FGM/C‐prevalent countries and who had undergone FGM/C were assessed and compared with the control group, case‐matched by language and religion. Results Eighty‐nine cases were included with an equal number of matched controls. No significant difference in the EPDS score was demonstrated when analysed as a continuous variable (P = 0.41) or as a categorical variable with a cut‐off score of 12 (P = 0.12). There was no difference in the number of women who identified as having thoughts of self‐harm between the two groups. Conclusion There was no identified increase in the risk of antenatal depression among women who have undergone FGM/C from high‐prevalence countries. Consideration must be given to the utility of the EPDS in this population, as well as factors such as cultural embedding.

Introduction: Evidence is lacking on the profile of gynaecological conditions affecting women in the Solomon Islands, including the availability and quality of surgical management.Methods: Prospective analysis of hospital records was undertaken on all patients who underwent gynaecological surgery at Gizo Hospital, Western Province during a 6-day program led by volunteer Australian surgeons. Patient data on pre-operative history, investigation results, performed surgical procedures and postoperative recovery were collected. Results: Of the 23 patients who presented with gynaecological problems requiring surgery, 20 underwent at least one surgical procedure during the study period. The most common presenting symptoms were pain and abnormal uterine bleeding. Median body mass index was 27, and 70% of patients were overweight or obese. Two surgeries were cancelled due to dengue fever. The surgeries performed were 12 vaginal operations, 8 laparoscopies and 9 laparotomies. Of surgical specimens collected, 61% were sent for histopathology testing. The median duration of postoperative hospital admission was 2 days (interquartile range, 1 day). Conclusion:The Solomon Islands presents a unique profile of challenges to surgical practice, including the impact of dengue infection on fitness for surgery, a mobile patient population dispersed across the islands, difficult access to pathology services, and increased length of stay. Despite this, most patients had surgical outcomes equivalent to those in a developed setting.

ObjectiveTo compare birth outcomes of women with gestational diabetes mellitus (GDM) with background obstetric population, stratified by models of care.DesignRetrospective cohort study.SettingA tertiary referral centre in Sydney, Australia.ParticipantsAll births 1 January 2018 to 30 November 2020. Births <24 weeks, multiple gestations and women with pre-existing diabetes were excluded.MethodsData were obtained from electronic medical records. Women were classified according to GDM status and last clinic attended prior to delivery. Model of care included attendance at dedicated GDM obstetric clinics, and routine antenatal care.Main outcome measuresHypertensive disorders of pregnancy (HDP), pre-term birth (PTB), induction of labour (IOL), operative delivery, small for gestational age (SGA), large for gestational age, postpartum haemorrhage, obstetric anal sphincter injury (OASIS), neonatal hypoglycaemia, neonatal hypothermia, neonatal respiratory distress, neonatal intensive care unit (NICU) admission.ResultsThe GDM rate was 16.3%, with 34.0% of women managed in dedicated GDM clinics. Women with GDM had higher rates of several adverse outcomes. Only women with GDM attending non-dedicated clinics had increased odds of HDP (adjusted OR (adj OR) 1.6, 95% CI 1.2 to 2.0), PTB (adj OR 1.7, 95% CI 1.4 to 2.0), OASIS (adj OR 1.4, 95% CI 1.0 to 2.0), similar odds of induction (adj OR 1.0, 95% CI 0.9 to 1.1) compared with non-GDM women. There were increased odds of NICU admission (adj OR 1.5, 95% CI 1.3 to 1.8) similar to women attending high-risk GDM clinics.ConclusionsWomen with GDM receiving care in lower risk clinics had similar or higher rates of adverse outcomes. Pathways of care need to be similar in all women with GDM.