Final thoughts from <i>ANZJOG</i> in 2023

Welcome to the final issue of ANZJOG Volume 63. Another year rapidly draws to a close and most of us find ourselves busy in the lead up to the end of year festivities and, hopefully, a rest. As healthcare workers in a field which lacks respect for office hours and holidays, many ANZJOG readers will again leave their own families at times of celebration to provide care for the families of others. I pay tribute to our colleagues who will be staffing labour wards, emergency departments, and other critical services over the holiday period. As I write, thinking of the upcoming festive period, my mind is constantly drawn to the current conflict in Israel and Palestine and the abhorrent violence and loss of life that has occurred and continues to occur. As the world watches a deep and disturbing humanitarian crisis evolve it is apparent that the burden of this crisis is felt disproportionately heavily by women. Even if casualties among frontline combatants are predominantly men, in a society where women have limited independent agency over their lives, thousands of newly widowed women face additional hardship due to barriers to accessing financial and material requirements of daily life as women who have lost their male supporter. Women in the conflict zone and almost half a million others internally displaced within Gaza include a large number of pregnant women unable to access basic maternity care, a situation which will inevitably see intolerable human suffering in the form of preventable maternal and perinatal morbidity and mortality. We must hope that this conflict is rapidly resolved as peacefully as possible such that the unimaginable suffering of innocent people on both sides is brought to an end. I am aware that there will be readers of ANZJOG with important personal connections to this region and this conflict and my thoughts are with them and their loved ones. This issue begins with an editorial by Calvert and Symonds discussing education in the Journal and in RANZCOG.1 The authors discuss historical views of education in our discipline and outline recent strategies employed in the ongoing quest to produce skilled and well-rounded new obstetricians and gynaecologists as the primary focus of RANZCOG as an educational institution. They close with a call for education to be ‘front and centre of the priorities of the College and for ANZJOG’, the latter being a stated goal of mine as Editor-in-Chief.2 Bailey et al3 provide a systematic review of the use of existing smoking cessation services aimed at reducing the rate of tobacco use in pregnancy. Smoking has a substantial impact on serious adverse pregnancy outcomes, including stillbirth and preterm birth, and is therefore a key target of programs to prevent these outcomes. Pregnant women who smoke do not typically respond to cessation strategies designed for the general population and require a pregnancy-specific approach. Also, First Nations people, who use tobacco in pregnancy at markedly higher rates than other population groups, also appear more likely to respond to specifically tailored cessation strategies. This review found limited evidence to define how women who smoke in pregnancy should best be supported to engage in external smoking cessation services. Further obstetric-themed articles cover issues including cannabis hyperemesis in pregnancy,4 induction of labour guideline development,5 placenta accreta spectrum management,6 gestational diabetes management and outcomes,7, 8 and perinatal mental health trends.9 Melville et al present their study of the first use of low-sensitivity urine pregnancy tests in follow up of early medical abortion.10 This follow up protocol allowed 90% of follow up appointments to be conducted remotely via Telehealth, improving efficiency and removing a potential barrier to abortion access, while maintaining a low rate of complications. Such initiatives are vital in ensuring equitable access for women to safe abortion care. Pittman et al describe deceased donor availability in uterine transplantation as this technique is developed locally, having been successfully pioneered internationally.11 Current protocols employ living altruistic uterine donation but alternative strategies to source suitable donor uteri may be required if this technique becomes more common. Other fertility-related articles discuss attitudes toward gamete donation in New Zealand and the use of controlled ovarian hyperstimulation in women with a history of breast cancer.12, 13 Endometriosis remains a topic of interest, with this issue including articles regarding the appendix in endometriosis and an analysis of geographic variation in endometriosis surgery in Canada.14, 15 Finally, Trostian et al discuss the trends in emergency department presentations and management for early pregnancy bleeding.16 This issue also recognises those who have made contributions to ANZJOG as peer reviewers in the past year. ANZJOG has seen a large increase in the number of submissions over recent years and while this is very much welcome, it does bring with it an increase in the burden upon peer reviewers. Scientific publishing relies heavily on the voluntary contributions of experts to ensure robust peer review and I am most grateful to those researchers and clinicians listed who have been gracious in sharing their valuable time and expertise. Thank you for your contributions and I hope that we may call upon you again in the future. I trust that you will find the articles in this issue of interest. Thank you for your support of ANZJOG in 2023. I wish you the very best for the holiday season and look forward to your continued support in the new year. The author reports no conflicts of interest.

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