NEWS 13
ausdoc. com. au 31 OCTOBER 2025
NEWS 13
‘ Shocking’ risks to pregnant surgeons
Carmel Sparke AS an orthopaedic trainee, Dr Kate Stannage says she just wanted to blend in with the blokes— even through her two pregnancies.
The gender bias in orthopaedics is notorious, of course, but it still comes as a shock to discover that she was just the third female orthopaedic surgeon in WA when she secured fellowship in 2008. As such, she is a trailblazer.
The consultant orthopaedic surgeon at Perth Children’ s Hospital has been in the news recently following the release of Australian Orthopaedic Association( AOA) guidelines on the risks to pregnant orthopaedic surgeons.
They cover exposure to bone cement and diathermy smoke, as well as limiting exposure to cadavers and anatomical laboratories because of formaldehyde. And they address those less tangible issues of on-call demands and excessive working hours.
“ It is not fun having morning sickness, which is actually all-day sickness, for seven months,” she tells
Why consider LAGEVRIO for your patients 70 + who test positive for COVID-19? 1, 3
Proven
*
In MOVe-OUT, LAGEVRIO reduced the risk for hospitalisation or death vs. placebo through Day 29 by 30 %( adjusted relative risk reduction) in adult patients with mild to moderate COVID-19 9
( 95 % CI: 1 %, 51 %; 6.8 %( 48 / 709 ] vs 9.7 %( 68 / 699). Adjusted risk difference-3.0%( 95 % CI-5.9%,-0.1%), p-value not available). Based on a planned interim analysis of LAGEVRIO vs placebo: The adjusted risk difference was-6.8%( 95 % CI:-11.3%,-2.4; 7.3 %( 53 / 377) vs 14.1 %( 28 / 385); p = 0.0024).
Real-world studies, 10-14 including the local Victorian study published in 2023, 10 also support the use of LAGEVRIO in treating older vaccinated patients with mild to moderate COVID-19.
Treatment-related adverse events ≥ 1 %( MOVe-OUT, LAGEVRIO vs placebo): 3 Diarrhoea( 2 % vs 2 %), nausea( 1 % vs 1 %), dizziness( 1 % vs 1 %)
No No to reduce risk of hospitalisation or death 3, 9
known drug interactions based on limited data available 3
dose adjustments required in patients with renal and / or hepatic impairment 3
Australian Doctor.
“ Standing for hours in a lead gown under hot operating lights, feeling nauseated, is a pretty unpleasant experience.
“ I do not want to be too personal about it, but it was hard for me. There was no support. I was on call until 37 weeks and had my first child at 37-anda-half weeks.
“ I do not think anyone was deliberately doing that to me.
“ It was just that no-one thought about these things, such as the hours
▼This medicine is subject to additional monitoring in Australia. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse events at www. tga. gov. au / reporting-problems.
SELECTED SAFETY INFORMATION 3
INDICATION: LAGEVRIO has provisional approval for the treatment of adults with COVID-19 who do not require initiation of oxygen due to COVID-19 and who are at increased risk for hospitalisation or death. The decision to approve this indication was based on efficacy and safety data from a Phase 3 trial. Continued approval of this indication depends on additional data.
CONTRAINDICATIONS: Hypersensitivity to the active substance or any of the excipients. Hypersensitivity reactions have been reported with LAGEVRIO. If signs or symptoms of a clinically significant hypersensitivity reaction occur, immediately discontinue LAGEVRIO and initiate appropriate medications and / or supportive care.
PRECAUTIONS:
Pregnancy Category D: The use of LAGEVRIO is not recommended during pregnancy. In women of childbearing potential, health care providers should discuss the chance that they may be pregnant and consider the need for a pregnancy test.
Contraception: Advise women of childbearing potential to use effective contraception for the duration of treatment and for 4 days after the last dose of LAGEVRIO. Sexually active men with a partner of childbearing potential should use contraception during and for 3 months after treatment. Based on animal data, LAGEVRIO may cause foetal harm when administered to pregnant women.
Breastfeeding: Based on the potential for adverse reactions on the infant from LAGEVRIO, breastfeeding is not recommended during treatment and for 4 days after the last dose of LAGEVRIO.
Paediatric patients: Use in patients under the age of 18 years is not recommended.
ADVERSE REACTIONS: Common: nausea, diarrhoea, dizziness. The following have been reported in post-marketing experience: hypersensitivity, angioedema, erythema, pruritus, rash, urticaria, vomiting.
Before prescribing, please review the full Product Information available at www. msdinfo. com. au / lagevriopi or by scanning the QR code.
Dr Kate Stannage.
Copyright © 2024 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved. Merck Sharp & Dohme( Australia) Pty Limited. Level 1 – Building A, 26 Talavera Road, Macquarie Park NSW 2113. MSDA0152. AU-ANV-00605 v3.0. Issued November 2024.
Scan to access study design for registration study 9
we were working. So we soldiered on.” With her two children now aged almost 22 and 19, Dr Stannage says her pregnancies were during a different era. It was a time when female orthopaedic surgeons were so vanishingly rare that they could not even stick together— there were not enough of them.
“ Our experience was more about trying to keep our heads down and justify our roles as women in surgery, as opposed to anything else,” she recalled.
“ We 100 % did not want to be different because we already stood out so much.”
Women accounted for just 5.4 % of the surgical workforce in Australia and New Zealand in 2023. And as of June this year, the AOA had 93 female fellows— 6.5 % of its membership.
But change is coming. Women account for 23 % of current trainees, and in the first round of offers for next year, 26 % of successful trainee applicants are female.
Although she encourages women to pursue the specialty, she says she was surprised while working on the guidelines about the risks to their fertility.
Based on a 2024 literature review, led by orthopaedic surgeon Dr Elizabeth Garcia, the guidelines reveal that 32 % of surgeons have fertility issues compared with 11 % of the general population.
The pregnancy complication rate among surgeons is 35 %, and 42 % of female surgeons have experienced pregnancy loss.
“ When we have presented this research, there has been a complete quiet in the room. People are shocked at the stats,” says Dr Stannage, president of the AOA’ s Orthopaedic Women’ s Link.
While risks for pregnancy from radiation and methacrylate have been well known for some decades, she says there has been growing awareness of more“ nebulous” factors, such as hours worked, time on feet and shift work.
The 2024 review in the ANZ Journal of Surgery noted that working more than 40 hours a week in the second and third trimesters had the same effect on fetal growth as maternal smoking and increased the risk of preterm labour.
“ These have been addressed in the pregnancy guidelines. So I think change is happening and will continue,” she said.
Dr Stannage said pregnant trainees still felt pressure to keep working at the same pace and without special allowances.
“ And that is the reason why we thought getting these guidelines out was so important. It takes away some of the need to explain yourself all the time as a female surgeon.
“ We are hopeful that just having the guidelines will change attitudes and enable a smoother path.”
She stressed they had developed guidelines rather than strict rules because of their acknowledgment that pregnancy is not a physical affliction and that every woman experiences pregnancy differently. AOA guidelines: bit. ly / 4gYFQTf ANZ J Surg 2024; 8 Apr: bit. ly / 4pXHc4H