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Family planning clinics: These clinics developed in the 1960s but were able to offer much more effective management once the oral contraceptive pill became readily available. The clinics improved access to contraceptive advice and therapeutic abortion, particularly among women of lower socioeconomic background.

Cancer screening: Screening for cervical cancer has improved gradually over the past 50 years, initially with the use of routine Pap smears and colposcopy and, more recently, with human papillomavirus typing. Earlier detection of cancer of the uterine endometrium has been made possible by ultrasound scanning, endometrial sampling by intrauterine catheters and hysteroscopy with biopsy.

Treatment of rhesus iso-immunisation: In 1961, New Zealander A W Liley first published on the management of pregnancy complicated by rhesus sensitisation. His pioneering work on analysis of the amniotic fluid was used to assess the need for exchange transfusion, leading eventually to the development of cordocentesis for accurate measurement of fetal haemoglobin.

Sexual dysfunction clinics: The first Australian clinic for sexual dysfunction was founded by Elsie Koadlow at the Queen Victoria Memorial Hospital for Women, Melbourne, in the late 1960s.

Fetal monitoring during labour: Methods to monitor the health of the fetus during labour were introduced in the mid-1960s. It became possible to monitor fetal heart rate continuously and to measure metabolic parameters in fetal scalp blood. The success of these techniques in reducing death and brain damage from hypoxia and circulatory failure was demonstrated by the world's first randomised controlled trial of new techniques for fetal monitoring at the Queen Victoria Memorial Hospital in 1969.

Corticosteroid therapy for preterm delivery: In 1972, New Zealander G C Liggins found that exposing infants born between 24 and 34 weeks' gestation to corticosteroids before delivery halved the incidence of respiratory distress syndrome, protected against intraventricular haemorrhage and reduced mortality by 40%. It is now standard practice to give corticosteroids to women at 24-38 weeks' gestation at risk of preterm delivery.

Royal Australian and New Zealand College of Obstetricians and Gynaecologists: Before 1978, Australians travelled to the United Kingdom to study and take the Royal College of Obstetricians and Gynaecologists' examinations. Formation of the Australian College in 1978 led to increased postgraduate education and better clinical standards, and encouraged research. In 1998, the Australian and New Zealand Colleges combined as the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

In-vitro fertilisation: The world's first in-vitro fertilisation (IVF) pregnancy was achieved in Melbourne in 1973. Although it was sustained for only a week, it heralded the world's first IVF baby in the United Kingdom in 1978. IVF became more practicable in 1980, when ovarian stimulation was first used to produce multiple eggs (and resulted in several pregnancies) at the Queen Victoria Medical Centre, Melbourne. With the world's first frozen-embryo baby and first donor-egg baby, produced by the Monash IVF team in 1983 and 1984, respectively, IVF became more acceptable and applicable to a wider variety of infertility problems.

Ultrasound examination: Ultrasound has revolutionised obstetrics and gynaecology, with numerous diagnostic applications in pregnancy and labour, and in abnormalities of the ovaries, fallopian tubes and uterus. It has also made possible many operative procedures.

Epidural anaesthesia: This has made a major contribution to obstetrics, both relieving pain in labour and allowing women to be conscious during caesarean section. It has added humanity to the too often accepted notion that labour should be synonymous with suffering.

Prostaglandins: These drugs have altered management of second- and third-trimester pregnancies. Both gemeprost and dinoprostone vaginal gel can be used to induce labour. Misoprostol is an effective abortifacient, and is used increasingly in Australia as a cervical ripening agent before suction curettage in nulliparous women with a missed abortion.

Hormone replacement therapy: Managing menopause with hormone replacement therapy (HRT) has become a specialty of its own. Although the risk of breast cancer is slightly increased, it is minuscule compared with the risks of developing the complications of postmenopausal osteoporosis.

Endoscopic surgery: Operative laparoscopy has expanded to include techniques for nearly all procedures previously performed only by laparotomy. By the late 1990s, a small but increasing number of gynaecologists perform 90% or more of gynaecological surgery by laparoscopy.

Endometriosis: An awareness of the burden of this disease, which affects 600 000 Australian women, developed only in the 1990s. Recent studies have shown that 90% of women with severe menstrual pain affecting work or school attendance have endometriosis. Surgical treatment has been improved by applying the principles of cancer surgery, while a polygenetic basis for the disease has been discovered.

Subspecialty training: Over the past four years, obstetrics and gynaecology has been subdivided to produce subspecialists with particular expertise. Certification and accreditation is now available in Australasia in gynaecology, high-risk obstetrics, ultrasound, reproductive medicine and urogynaecology.

Carl E Wood
Emeritus Professor, Department of Obstetrics and Gynaecology
Monash University, Melbourne, VIC

Simon J Gordon
Gynaecologist, Mercy Hospital for Women, Melbourne, VIC

©MJA 2001
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