A/Prof Shavi Fernando - Obstetrician and Gynaecologist, PhD

This is a story about termination, placenta praevia, recurrent antepartum haemorrhage and fetal growth restriction.

After making the difficult decision to terminate their first pregnancy due to a significant fetal abnormality, Chaitali, 40, and Kosta were understandably nervous when they finally fell pregnant again after 6 cycles of IVF.

Her NIPT was normal. At 11 and 13/40 she had some vaginal spotting. Her cervix was short on her 13/40 scan and progesterone was continued. Her 20/40 scan showed that her placenta was covering her cervix. From here she experienced recurrent vaginal bleeds, varying in volume from 50-200ml approximately every 10 - 14 days. She was admitted to hospital from 29/40 in case of a heavier bleed with her low placenta. At 30/40 she developed cramping togewther with bleeding and was given steroid dosing in case labour eventuated. It was looking likely that her baby would be born early. Fortunately, both the bleeding and cramping settled soon after this. We discussed mode of delivery and Chaitali decided she would like to have a caesarean section.

At 29/40 her placenta was thought to be 21mm from the cervix (clear) and her baby measured on the 7th percentile. The baby’s umbilical cord blood flow also showed signs of flow restriction. Her regular bleeding stopped for the first time since 18/40. Fetal monitoring was commenced. At 34/40, her baby was on the 5th centile, cord blood flow still abnormal but stable. At 36/40, her baby’s growth velocity had slowed further and fetal size was now

Some may not be aware that part of my role involves the teaching of our future generation of doctors. Last night, I was privileged to host our third Mentor Award Dinner on behalf of the Department of Obstetrics and Gynaecology .

This dinner acknolwedges the doctors who voluntarily contribute to the education and improvement of our medical students in obstetrics and gynaecology. It was also wonderful to have one of my former students (now Paediatric Registrar), Dr India Marks, as a guest speaker, and to have two of my own mentors, Prof Beverley Vollenhoven and Prof Euan Wallace, present the awards.

Congratulations to our Award winners:
2024
Mentor of the Year - Dr Arm Sukjit
Registrar Educator of the Year - Dr Nik Sabhaya
Most Dedicated Mentor - A/Prof Pav Nanayakkara

2025
Mentor of the Year - Dr Peter Neil
Registrar Educator of the Year - Dr Ben Amberg
Most Dedicated Mentor - Dr Dinesh Epitawela

Thank you to Jaclyn Guzzardi, our Lead Administrator for her tireless efforts organising the event and to the Monash Medical Student orchestra for performing on the evening.

I am honoured to announce that, after teaching medical students officially for over 20 years (including when I, myself, was a student!), with 8 years as the curriculum and assessment director for Obstetrics and Gynaecology, I am now officially an Associate Professor of the Department of Obstetrics and Gynaecology, Monash University !

This achivement is not mine alone. Thank you to my wonderfully supportive wife, Dr Sharmayne Brady, and my children. Thanks to my parents who taught me to do what I love and to do it well. Thank you to my mentors and supervisors along the way in particular, Prof Euan Wallace and Prof Luk Rombauts (both supervised my PhD), Prof Beverley Vollenhoven (Head of Department, who suggested I apply) and the late Prof David Healy, who inspired me to pursue a career in Women's Health when I was just a medical student.

Thank you to my numerous academic (research and education) collaborators including, but not limited to, Prof Arunaz Kumar who roped me into this role in the first place!

Thanks, finally, to my students. My joy for teaching is maintained by seeing how successful you have become, and I LOVE bumping into you in the corridors and hearing of the amazing things you have achieved! I hope that I have played a very small role in your passion for medicine and in your future successes!

What a wonderful surprise to bump into this young gentleman!

When I was just 2 years into my specialty training, I met Tatum and Paul when Tatum developed severe chorioamnionitis (infection of the membranes and intraamniotic space) after rupturing her membranes early at 27 weeks. I performed her emergency caesarean under senior supervision at Monash Health . I felt absolutely horrible when, on entry to her uterus, I cut her baby boy, Tobias ('Tobey'), on the cheek with the scalpel. Both Tatum and her family were not overly concerned about this, as they knew that Tobey had many worse troubles to face in the upcoming months. But I felt horrible. Tatum and her sister, Sarah (at the time, a midwife at Monash Health ) affectionately nicknamed me 'Dr Sharpie'. I'm still not sure how I feel about this!

Toby went through multiple procedures under the watchful eyes of the NICU team at Monash Children's Hospital under the guidance of neonatologist, A/Prof Atul Malhotra and together with his parents' love, he thrived.

He is now an active spokesperson for the Monash Children's Hospital and is a brilliant representation of the importance of the care that can be provided to families in our enviable healthcare system.

So what a proud moment of mine, to bump into Tobey (Now 16 YEARS OLD!) and his unwavering family in the hallways of the . (And yes, he still has the scar).



www.drshavifernando.com

This is a story about vaginal birth after caesarean and bleeding in pregnancy.

Hasnaa and Cam’s first baby, daughter Eliana, was born by emergency caesarean when she presented at 38 weeks (38/40) with vaginal bleeding which was thought to represent a placental abruption (placenta separates from the uterus too early). Eliana was born in good condition.

Because of this, Hasnaa never had the chance to experience normal birth and was keen to try a vaginal birth after caesarean (VBAC). She had a history of Hashimotos thyroiditis which was stable without medication. She was otherwise fit and healthy and had a normal BMI.

I met her in her second pregnancy. We discussed the risks of VBAC in detail, but there was no reason why she could not attempt a VBAC. She had fresh bleeding occurring every week from 6 to 10 weeks. Each time I checked on the baby and the heartbeat remained normal. At 10 weeks, I examined her and discovered a large cervical polyp. I removed this in my office and it was confirmed to be benign. From here, her bleeding stopped completely.

At her 20/40 scan, it was found that she had an anterior placenta previa, meaning the placenta was attached to the front wall of the uterus and was covering her cervix. If the placenta is covering the cervix by the time you are in labour, a vaginal birth is not possible. However, a significant proportion of these will resolve by term, so we were cautiously optimistic.

Fortunately, a repeat scan at 32/40 confirmed that her placenta was now clear of her cervix. A VBAC was still a possibility.

The remainder of her pregnancy progressed normally. At 39+2/40, the symptoms of pregnancy were weighing her down so I offered a vaginal examination (VE) and membrane sweep. Her cervix was 3cm dilated, 1cm long and soft – ready for labour. I performed a membrane sweep at her request.

At 40/40 she presented in early labour to . 4 hours later, VE showed her cervix was 4cm dilated, fully effaced (thin cervix), marking the beginning of her ‘active phase’ of labour. She had a 50ml intrapartum haemorrhage and the bleeding continued slowly, though her CTG (fetal heart rate tracing) remained normal. Three hours later, she had another larger gush of blood but she was now 7cm dilated. Because of her ongoing bleeding, I ruptured her membranes to expedite labour. 5 minutes later she was fully dilated. She was in the zone, had her music playing and lighting set up. She was provided the best possible care by Midwives Ella and Lizzie (who also doubled as photographer!). She pushed standing and on all fours for 40 minutes, culminating in the normal birth of baby Raphael (3100g) who was born healthily to the song ‘Now We Are Free’, from the movie Gladiator. At her request, cord clamping was delayed until cessation of pulsation (7 mins). Once the placenta was born, she had an 800ml postpartum haemorrhage which was successfully treated with medications and uterine pressure. A small first degree tear was repaired.

Hasnaa and Cam were delighted to meet baby Raphael. Hasnaa was proud that she was able to experience the birth she missed out on in her first pregnancy. Congratulations Hasnaa and Cam on the safe arrival of baby Raphael. I wish you all the best as the kids grow up together!

Another wonderful night celebrating the achievements of award winners from the Faculty of Medicine, Nursing and Health Sciences at Monash University for 2025!! Congratulations Thea, Tai and Wajeeha (in absentia) on winning the David Healy, Carl Wood and Euan Wallace prizes in Obstetrics and Gynaecology respectively.

It was an added bonus to bump into one of my patient's (Davina) husband, Andrew, who was also presenting an award on the night!