A 44-year-old nulliparous woman was transferred to a tertiary obstetric hospital for investigation of acute onset abdominal pain. She was at gestation of 32 weeks and 2 days with a history of previous laparoscopic fundal myomectomy. An initial bedside ultrasound demonstrated oligohydramnios. Following an episode of increased pain early the following morning, a formal ultrasound diagnosed a uterine rupture with the fetal arm extending through a uterine rent. An uncomplicated classical caesarean section was performed and the neonate was delivered in good condition but with a bruised and oedematous right arm. The neonate was transferred to the Special Care Nursery for neonatal care. The patient had an uncomplicated postoperative course and was discharged home three days following delivery. This is an unusual presentation of uterine rupture following myomectomy where the fetal arm had protruded through the uterine wall.

Fatigue was frequently reported by RANZCOG trainees with increased working hours and long shifts being significant factors in fatigue levels. Strategies should be developed and trialled to enable trainees to obtain adequate case exposure and teaching without compromising patient and doctor safety.

No abstract

The role of the gynaecologic oncologist within a tertiary centre is expanding to include the provision of support to general gynaecologists and obstetricians. There is increasing utilisation of the gynaecologic oncologist whereby their attendance is often pre-arranged prior to the surgery. However, emergency cases requiring their assistance are not uncommon.

While 53.1 h/week at work is similar to the average Australian hospital doctor, high rates of long days and 24-h shifts with minimal sleep were reported by RANZCOG trainees in this survey.