https://dora.health.qld.gov.au/qldresearchjspui/handle/1/849 2026-05-23T03:09:21Z 2026-05-23T03:09:21Z Natalie Drever Sunthra Shanmuga Lingam Arnold, Joanna https://dora.health.qld.gov.au/qldresearchjspui/handle/1/10897 2026-04-29T04:17:17Z 2026-03-01T00:00:00Z

Title: Undiagnosed placenta accreta spectrum complicated by massive haemorrhage during mid-trimester medical termination of pregnancy: a case report Authors: Natalie Drever; Sunthra Shanmuga Lingam; Arnold, Joanna Abstract: Placenta accreta spectrum (PAS) is a well-recognised cause of severe obstetric haemorrhage in late pregnancy but is rarely encountered during abortion, particularly in the mid-trimester. Diagnosis in this setting is challenging, and unrecognised abnormal placentation may result in catastrophic maternal morbidity. We report the case of a 28-year-old multiparous woman with three prior caesareans who presented at 17 weeks of gestation with preterm prelabour rupture of membranes and placenta previa. Targeted mid-trimester ultrasound reviewed by a maternal-fetal medicine subspecialist demonstrated no sonographic features suggestive of PAS. Following counselling, medical termination of pregnancy was initiated using mifepristone and misoprostol. Uncontrolled bleeding led to timely transfer to the operating theatre for hysterotomy and management of haemorrhage. The procedure was complicated by sudden massive haemorrhage, haemodynamic collapse, and intraoperative cardiac arrest. Despite uterine evacuation and resuscitative measures, uncontrolled bleeding necessitated an emergency subtotal hysterectomy, complicated by dense vesicouterine adhesions and bladder injury. The patient survived following massive transfusion, intensive care admission, and multidisciplinary management. This case highlights the limitations of mid-trimester imaging in reliably excluding clinically significant PAS. It also underscores the potential for abrupt, life-threatening haemorrhage during medical termination of pregnancy in women with multiple previous caesarean deliveries. As caesarean rates rise, clearer guidance is needed regarding risk stratification, imaging pathways, and procedural planning for mid-trimester abortion to minimise maternal morbidity. Description: Cairns & Hinterland Hospital and Health Service (CHHHS) affiliated authors: Natalie Drever, Sunthra Shanmuga Lingam, Joanna Arnold

2026-03-01T00:00:00Z Meumann, Ella M Rajahram, Giri Woolley, Stephen D Smith, Simon Gassiep, Ian https://dora.health.qld.gov.au/qldresearchjspui/handle/1/10896 2026-04-29T04:04:06Z 2026-01-01T00:00:00Z

Title: Treatment of Melioidosis Authors: Meumann, Ella M; Rajahram, Giri; Woolley, Stephen D; Smith, Simon; Gassiep, Ian Abstract: Melioidosis is caused by Burkholderia pseudomallei, a Gram-negative environmental saprophyte found in tropical and subtropical regions globally. The aims of treatment for melioidosis are to prevent death and other complications of septic shock, and to eradicate B. pseudomallei and prevent relapse. To achieve these aims, treatment comprises an intensive phase involving minimum 10-14 days of intravenous ceftazidime, meropenem, or imipenem, and a prolonged eradication phase of at least 3 months of oral trimethoprim-sulfamethoxazole. Here, we review the clinical trial and other evidence that supports melioidosis treatment guidelines, and the approach to complications including treatment side effects, relapse, and antimicrobial resistance. Description: Cairns & Hinterland Hospital and Health Service (CHHHS) affiliated author: Simon Smith

2026-01-01T00:00:00Z Natalie Drever Gane, Chloe Bailey, Madison https://dora.health.qld.gov.au/qldresearchjspui/handle/1/10895 2026-04-29T03:43:33Z 2026-01-01T00:00:00Z

Title: Reproductive outcomes after surgical correction of congenital obstructive genital tract anomalies: A systematic review and quantitative pooled analysis of published data Authors: Natalie Drever; Gane, Chloe; Bailey, Madison Abstract: Congenital obstructive genital tract anomalies are rare but clinically significant causes of menstrual outflow obstruction, endometriosis, and subfertility. Surgical correction aims to restore reproductive potential, yet evidence to guide counselling on fertility and pregnancy outcomes remains fragmented. To synthesise and pool published data on fertility, obstetric, and neonatal outcomes following surgical correction of congenital obstructive anomalies, comparing outcomes across anomaly types to inform individualised counselling. A systematic review was conducted. PubMed, Emcare, CINAHL, and Scopus were searched from inception to May 2025. Studies reporting reproductive outcomes after surgical correction of imperforate hymen, transverse vaginal septum, OHVIRA-spectrum, functional non-communicating uterine horns, or cervicovaginal atresia were included. Data were extracted independently and pooled by anomaly type. Study quality was assessed using Joanna Briggs Institute tools. Ninety-six studies (41 case reports, 41 case series, and 14 retrospective cohorts) were contributed 634 fertility-related events. Infertility rates were low following imperforate hymen (8.0%) and OHVIRA-spectrum anomalies (18.2%), intermediate in functional rudimentary horns (21.2%), and high following transverse vaginal septum (52.6%) and cervicovaginal atresia (55.4%). Among achieved pregnancies, livebirth rates exceeded 80%. Preterm birth occurred in 23.7% of pregnancies and did not differ significantly by anomaly type. Caesarean delivery was frequent (55.9%), particularly after cervicovaginal reconstruction (97.6%). Birthweight was lower following cervicovaginal atresia repair, with higher rates of small-for-gestational-age infants. Gestational hypertensive disorders were associated with co-existing renal agenesis. Reproductive outcomes after surgical correction are generally favourable but vary substantially by anomaly type. These findings support individualised counselling and targeted antenatal surveillance. Description: Cairns & Hinterland Hospital and Health Service (CHHHS) affiliated author: Natalie Drever

2026-01-01T00:00:00Z Franks, Nicola McDermott, Karl Carlisle, Karen Russell, Sarah Wallace, Valda Strivens, Edward https://dora.health.qld.gov.au/qldresearchjspui/handle/1/10894 2026-04-29T02:58:48Z 2026-01-01T00:00:00Z

Title: Potentially Suboptimal Prescribing for Older First Nations Peoples: A Scoping Review Authors: Franks, Nicola; McDermott, Karl; Carlisle, Karen; Russell, Sarah; Wallace, Valda; Strivens, Edward Abstract: To explore current literature regarding appropriate prescribing for older First Nations Peoples from Australia, the United States of America (USA), Canada and New Zealand residing in the community or residential care facilities (RACF). Electronic databases and grey literature sources were searched for literature that focussed on holistic appropriate prescribing and/or potential suboptimal prescribing. Inclusion criteria were First Nations Peoples aged 45 years or older who were community dwelling or residing in RACFs from Australia, the United States, Canada and New Zealand. Sixteen articles were included for analysis. Heterogeneity exists across the findings of potentially suboptimal prescribing concepts. Despite this heterogeneity, this review revealed that potential prescribing omissions appear to have the greatest impact on morbidity and mortality. Factors that increased the risk of potentially suboptimal prescribing included regionality, number of medical conditions, certain disease states and residing in a RACF. Health equity and 'closing the gap' for First Nations Peoples is a global issue. This scoping review has shown that potentially suboptimal prescribing and the associated morbidity and mortality are a concern for First Nations Peoples internationally. Description: Cairns & Hinterland Hospital and Health Service (CHHHS) affiliated authors: Nicola Franks, Karl McDermott, Sarah Russell, Edward Strivens

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