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ABSTRACT: To describe the Australian perinatal mental health reforms and explore ways of improving surveillance of maternal mental health morbidity and mortality in this context. APPROACHES: We reviewed the Australian perinatal (defined as conception to one year postpartum) mental health reforms, in association with an appraisal of the population health methods that could be used for their evaluation.
Despite the increasing focus of public health reforms on maternal mental health in the perinatal period, there is currently no national data available to evaluate these reforms or to provide an evidence base for improved health outcomes. National data development and linkage of relevant datasets would go a long way towards enabling such an endeavour.
Inclusion of key mental health items in the Perinatal National Minimum Dataset and use of data linkage techniques will allow for monitoring of trends in maternal mental health morbidity and mortality in response to the Australian reforms. Once this is implemented, cost-benefit analyses can be undertaken.
Australian and New Zealand Journal of Public Health 06/2012; 36(3):208-11. · 1.20 Impact Factor
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Rebecca J Guy,
Fabian Kong,
Jane Goller,
Neil Franklin,
Isabel Bergeri,
Wayne Dimech,
Nicole Reilly, Elizabeth Sullivan,
James Ward,
John M Kaldor,
Margaret Hellard,
Basil Donovan
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ABSTRACT: The Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) was established with funding from the Department of Health and Ageing to trial the monitoring of the uptake and outcome of chlamydia testing in Australia. ACCESS involved 6 separate networks; 5 clinical networks involving sexual health services, family planning clinics, general practices, antenatal clinics, Aboriginal community controlled health services, and 1 laboratory network. The program ran from May 2007 to September 2010. An evaluation of ACCESS was undertaken in early 2010, 2 years after the program was funded. At the time of the evaluation, 76 of the 91 participating sites were contributing data. The jurisdictional distribution of the 76 sites generally matched the jurisdictional distribution of the Australian population. In 2008, the chlamydia testing rates in persons aged 16-29 years attending the 26 general practices was 4.2% in males and 7.0% in females. At the 25 sexual health services, the chlamydia testing rates in heterosexuals aged less than 25 years in 2008 was 77% in males and 74% in females. Between 2004 and 2008, the chlamydia positivity rate increased significantly in heterosexual females aged less than 25 years attending the sexual health services, from 11.5% to 14.1% (P < 0.01). Data completeness was above 85% for all core variables except Aboriginal and/or Torres Strait Islander status and country of birth, which ranged from 68%-100%, and 74%-100%, respectively, per network. There were delays in establishment of the system due to recruitment of 91 sites, multiple ethics applications and establishment of automated extraction programs in 10 different database systems, to transform clinic records into a common, pre-defined surveillance format. ACCESS has considerable potential as a mechanism toward supporting a better understanding of long-term trends in chlamydia notifications and to support policy and program delivery.
Communicable diseases intelligence 09/2010; 34(3):319-28.
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ABSTRACT: MotherSafe was established in January 2000 at the Royal Hospital for Women as Australia's first 'purpose-built' Teratogen Information Service and since then has received over 75,000 calls regarding exposures during pregnancy and lactation.
To describe the patterns of use of MotherSafe over a three-year period.
Retrospective descriptive epidemiological study using data from the database established at MotherSafe. Records from all the calls logged at MotherSafe between January 2005 and December 2007 were analysed to determine total number of calls, demographic characteristics of callers, including age, caller category and postcode, reason for call, source of referral and type of exposure.
A total of 47,138 calls were recorded to the MotherSafe service from January 2005 to December 2007. The majority of calls were regarding exposures in pregnancy (55%) and breast-feeding (38%). Average age of patients was 32.3 years. Of the calls made, 81.9% (38,485 of 46,968) were by consumers (the pregnant or lactating woman herself or a relative). The most common primary exposure categories were: over-the-counter medications (11.3%), psychotropic medication (9.0%), herbal or vitamin products (8.2%), antibiotics (7.0%), gastrointestinal medications (6.8%) and topical products (6.6%). Forty per cent of callers enquired about multiple exposures.
The utilisation of MotherSafe by consumers and general practitioners continues to increase, reflecting the strong demand for a teratogen counselling service that provides high-quality, evidence-based information on exposures during pregnancy and lactation.
Australian and New Zealand Journal of Obstetrics and Gynaecology 05/2009; 49(2):168-72. · 1.24 Impact Factor
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ABSTRACT: Death from pregnancy is rare in developed countries such as Australia but is still common in third world and developing countries. The investigation of each maternal death yields valuable information and lessons that all health care providers involved with the care of women can learn from. The aim of these investigations is to prevent future maternal morbidity and mortality. Obstetric haemorrhage remains a leading cause of maternal death internationally. It is the most common cause of death in developing countries. In Australia and the United Kingdom, obstetric haemorrhage is ranked as the 4th and 3rd most common cause of direct maternal death respectively. In a number of cases there are readily identifiable factors associated with the care that the women received that may have contributed to their death. It is from these identifiable factors that both midwives and doctors can learn to help prevent similar episodes from occurring. This article will identify some of the lessons that can be learnt from the recent Australian and UK maternal death reports. This paper presents an overview of the process and systems for the reporting of maternal death in Australia. It will then specifically focus on obstetric haemorrhage, with a focus on postpartum haemorrhage, for the 12-year period, 1994-2005. Vignettes from the maternal mortality reports in Australia and the United Kingdom are used to highlight the important lessons for providers of maternity care.
Women and Birth 04/2009; 22(3):97-104.
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ABSTRACT: The aim of this study was to calculate assisted reproductive technology (ART) success rates for fresh autologous and donor cycles in women aged > or = 45 and the resultant cost per live birth.
We performed a retrospective population-based study of 2339 ART cycles conducted in Australia, 2002-2004 to women aged > or = 45 years. The cost-outcome study was performed on fresh autologous treatment cycles.
There were 1101 fresh autologous cycles initiated in women aged > or = 45, with a pregnancy rate of 1.9 per 100 initiated cycles. There were 21 women who achieved a clinical pregnancy with 15 (71%) ending in early pregnancy loss and 6 in live singleton births. The live birth rate following fresh autologous initiated cycles was 0.5% [95% confidence interval (CI): 0.1-1.0%]. Fresh donor recipients had an higher live birth rate of 19.1% (95% CI: 15.1-23.2) (odds ratio 43.2; 95% CI: 18.6-100.3) compared with women having fresh autologous cycles. The average cost of a live birth following fresh autologous cycles was 753,107 euros.
The success rate of fresh autologous treatment for women aged > or = 45 years was < 1%. The very high cost of a live birth reflects a treatment failure rate of > 99%. The ART profession should counsel patients of the reality of the technology before the patients consent to treatment.
Human Reproduction 07/2008; 23(7):1639-43. · 4.47 Impact Factor
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ABSTRACT: Second generation surveillance of HIV infection and sexually transmitted infections (STIs) among pregnant women in 6 Pacific Island Countries and Territories were undertaken to improve knowledge and to make recommendations on future prevention and management of STIs.
Cross-sectional studies, using standardized questionnaire, laboratory tests, and protocols were undertaken in Fiji, Kiribati, Samoa, Solomon Islands, Tonga, and Vanuatu between 2004 and 2005. For each country, between 200 and 350 pregnant women aged 15 to 44 years were consecutively recruited from antenatal clinics located in the main hospital of the major urban centre of each Pacific Island Countries and Territories. Consenting participants were interviewed about their socio-demographic characteristics and their sexual behavior, and were tested for HIV, chlamydia, syphilis (Treponema pallidum antibody seroactivity), and gonorrhoea.
Amongst the 1618 pregnant women studied, the most prevalent STI was chlamydia with 26.1% of women under 25 and 11.9% of women aged 25 years and over being positive. Highest infection was detected in single teenage women with 38.1% positive for chlamydia. The overall prevalence of gonorrhoea and syphilis was 1.7% and 3.4%, respectively. No case of HIV was detected. Chlamydia infection was independently associated with younger age, being nulliparous, single status, multiple lifetime sexual partners, and commercial sex activity.
In a population of young women, chlamydia infection was endemic. Regional leadership is needed to implement strategies to prevent the spread of chlamydia and to implement HIV and STI prevention and management.
Sexually transmitted diseases 07/2008; 35(9):801-6. · 2.58 Impact Factor
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ABSTRACT: The magnitude of maternal mortality is underestimated as deaths occurring beyond the traditional 42-day time period after the pregnancy ending ('late death') have not been reported routinely in Australia. Aims: The aims of this study were to undertake a data linkage study to improve the ascertainment of maternal deaths and to determine the number of deaths occurring 43-365 days after the pregnancy ended ('late maternal death').
Data from the New South Wales Midwives Data Collection were linked with the Australian Institute of Health and Welfare National Death Index. Australian identified pregnancy-related deaths were then coded as direct, indirect and incidental to the pregnancy.
During the period 1994-2001, 173 maternal deaths were identified. Of these, 97 were classified as occurring up to 42 days of the pregnancy ending, 15 (15.5%) of which were previously unknown to the maternal mortality committee. In addition, 76 deaths were classified as occurring between 43 and 365 days after the pregnancy ended. The majority (70 of 76) of these late deaths were only identified through the linkage study. Most (73 of 76) of these deaths were classified as indirect maternal deaths with the most common causes of deaths suicide (n= 23), cardiac disorders (n= 16) or accident/violence (n= 16).
The ascertainment of maternal and late maternal mortality was enhanced through data linkage of birth and mortality data. Data linkage is a viable method for monitoring late maternal deaths.
Australian and New Zealand Journal of Obstetrics and Gynaecology 07/2008; 48(3):255-60. · 1.24 Impact Factor
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ABSTRACT: Neonatal intensive care and special care nurseries provide a level of care that is both high in cost and low in volume. The aim of our study was to determine the rate of admission of term babies to neonatal intensive care in association with each method of giving birth among low-risk women.
We examined the records of 1,001,249 women who gave birth in Australia during 1999 to 2002 using data from the National Perinatal Data Collection. Among low-risk women, we calculated the adjusted odds of admission to neonatal intensive care at term separated for each week of gestational age between 37 and 41 completed weeks. We also calculated the odds of admission to neonatal intensive care in association with cesarean section before or after the onset of labor, and vacuum or instrumental birth compared with unassisted vaginal birth at 40 weeks' gestation.
The overall rate of admission to neonatal intensive care of term babies was 8.9 percent for primiparas and 6.3 percent for multiparas. After a cesarean section before the onset of labor, the adjusted odds of admission among low-risk primiparas at 37 weeks' gestation were 12.08 (99% CI 8.64-16.89); at 38 weeks, 7.49 (99% CI 5.54-10.11); and at 39 weeks, 2.80 (99% CI 2.02-3.88). At 41 weeks, the adjusted odds were not significantly higher than those at 40 weeks' gestation. Among low-risk multiparas who had a cesarean section before the onset of labor, the adjusted odds of admission to neonatal intensive care at 37 weeks' gestation were 15.40 (99% CI 12.87-18.43); at 38 weeks, 12.13 (99% CI 10.37-14.19); and at 39 weeks, 5.09 (99% CI 4.31-6.00). At 41 weeks' gestation, the adjusted odds of admission were significantly lower than those at 40 weeks (AOR 0.64, 99% CI 0.47-0.88). Babies born after any operative method of birth were at increased odds of being admitted to neonatal intensive care compared with those born after unassisted vaginal birth at 40 weeks' gestation.
The adjusted odds of admission to neonatal intensive care for babies of low-risk women were increased after birth at 37 weeks' gestation. In a climate of rising cesarean sections, this information is important to women who may be considering elective procedures.
Birth 01/2008; 34(4):301-7. · 2.18 Impact Factor
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ABSTRACT: Perinatal mortality is a rare outcome among babies born at term in developed countries after normal uncomplicated pregnancies; consequently, the numbers involved in large databases of routinely collected statistics provide a meaningful evaluation of these uncommon events. The National Perinatal Data Collection records the place of birth and information on the outcomes of pregnancy and childbirth for all women who give birth each year in Australia. Our objective was to describe the perinatal mortality associated with giving birth in "alongside hospital" birth centers in Australia during 1999 to 2002 using nationally collected data.
This population-based study included all 1,001,249 women who gave birth in Australia during 1999 to 2002. Of these women, 21,800 (2.18%) gave birth in a birth center. Selected perinatal outcomes (including stillbirths and neonatal deaths) were described for the 4-year study period separately for first-time mothers and for women having a second or subsequent birth. A further comparison was made between deaths of low-risk term babies born in hospitals compared with deaths of term babies born in birth centers.
The total perinatal death rate attributed to birth centers was significantly lower than that attributed to hospitals (1.51/1,000 vs 10.03/1,000). The perinatal mortality rate among term births to primiparas in birth centers compared with term births among low-risk primiparas in hospitals was 1.4 versus 1.9 per 1,000; the perinatal mortality rate among term births to multiparas in birth centers compared with term births among low-risk multiparas in hospitals was 0.6 versus 1.6 per 1,000.
This study using Australian national data showed that the overall rate of perinatal mortality was lower in alongside hospital birth centers than in hospitals irrespective of the mother's parity.
Birth 10/2007; 34(3):194-201. · 2.18 Impact Factor
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ABSTRACT: Background: Perinatal mortality is a rare outcome among babies born at term in developed countries after normal uncomplicated pregnancies; consequently, the numbers involved in large databases of routinely collected statistics provide a meaningful evaluation of these uncommon events. The National Perinatal Data Collection records the place of birth and information on the outcomes of pregnancy and childbirth for all women who give birth each year in Australia. Our objective was to describe the perinatal mortality associated with giving birth in “alongside hospital” birth centers in Australia during 1999 to 2002 using nationally collected data. Methods: This population-based study included all 1,001,249 women who gave birth in Australia during 1999 to 2002. Of these women, 21,800 (2.18%) gave birth in a birth center. Selected perinatal outcomes (including stillbirths and neonatal deaths) were described for the 4-year study period separately for first-time mothers and for women having a second or subsequent birth. A further comparison was made between deaths of low-risk term babies born in hospitals compared with deaths of term babies born in birth centers. Results: The total perinatal death rate attributed to birth centers was significantly lower than that attributed to hospitals (1.51/1,000 vs 10.03/1,000). The perinatal mortality rate among term births to primiparas in birth centers compared with term births among low-risk primiparas in hospitals was 1.4 versus 1.9 per 1,000; the perinatal mortality rate among term births to multiparas in birth centers compared with term births among low-risk multiparas in hospitals was 0.6 versus 1.6 per 1,000. Conclusions: This study using Australian national data showed that the overall rate of perinatal mortality was lower in alongside hospital birth centers than in hospitals irrespective of the mother’s parity. (BIRTH 34:3 September 2007)
Birth 08/2007; 34(3):194 - 201. · 2.18 Impact Factor
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ABSTRACT: Despite concern over high rates of operative birth in many countries, particularly amongst low risk healthy women, the obstetric antecedents of operative birth are poorly described. We aimed to determine the association between interventions introduced during labour with interventions in the birth process amongst women of low medical risk.
We undertook a population-based descriptive study of all low risk women amongst the 753,895 women who gave birth in Australia during 2000-2002. Adjusted odds ratios (AOR) were calculated using multinomial logistic regression to describe the association between mode of birth and each of four labour intervention subgroups separately for primiparous and multiparous women.
We observed increased rates of operative birth in association with each of the interventions offered during the labour process. For first time mothers the association was particularly strong.
This study underlines the need for better clinical evidence of the effects of epidurals and pharmacological agents introduced in labour. At a population level it demonstrates the magnitude of the fall in rates of unassisted vaginal birth in association with a cascade of interventions in labour and interventions at birth particularly amongst women with no identified risk markers and having their first baby. This information may be useful for women wanting to explore other methods of influencing the course of labour and the management of pain in labour, especially in their endeavour to achieve a normal vaginal birth.
Women and Birth 07/2007; 20(2):41-8.
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ABSTRACT: Maternal mortality associated with psychiatric illness in the perinatal period (pregnancy to the end of the first year postpartum) has until recently been under-reported in Australia due to limitations in the scope of the data collection and methods of detection. The recent United Kingdom report Why mothers die 2000-2002 identified psychiatric illness as the leading cause of maternal death in the UK. Findings from the last three reports on maternal deaths in Australia (covering the period 1994-2002) suggest that maternal psychiatric illness is one of the leading causes of maternal death, with the majority of suicides occurring by violent means. Such findings strengthen the case for routine perinatal psychosocial screening programs, with clear referral guidelines and assertive perinatal treatment of significant maternal psychiatric morbidity. Data linkage studies are needed to measure the full extent of maternal mortality associated with psychiatric illness in Australia.
The Medical journal of Australia 05/2007; 186(7):364-7. · 2.81 Impact Factor
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ABSTRACT: To study the association between volume of hospital births per annum and birth outcome for low risk women.
Population-based study using the National Perinatal Data Collection (NPDC).
Australia.
Of 750,491 women who gave birth during 1999-2001, there were 331,147 (47.14%) medically 'low risk' including 132,696 (40.07%) primiparae and 198,451 (59.93%) multiparae.
The frequency of each birth and infant outcome was described according to the size of the hospital where birth took place. We investigated whether unit size (defined by volume) was an independent risk factor for each outcome factor using public hospitals with greater than 2000 births per annum as a reference point.
Rates of intervention at birth and neonatal mortality for low risk women in relation to hospitals with <100, 100-500, 501-1000, 1001-2000 and >2001 births per annum.
Neonatal death was less likely in hospitals with less than 2000 births per annum regardless of parity. For multiparous low risk women in hospitals of 100 and 500 births per annum compared with hospitals of >2000 births per annum the adjusted odds of neonatal mortality [adjusted odds ratio (AOR) 0.36; 99% confidence interval (CI) 0.14-0.93]. For low risk primiparous women in hospitals with less than 100 births per annum, there were lower rates of induction of labour (AOR 0.62; 99% CI 0.54-0.73); intrathecal analgesia/anaesthesia (AOR 0.34; 99% CI 0.28-0.42); instrumental birth (AOR 0.80; 99% CI 0.69-0.93); caesarean section after labour (AOR 0.59; 99% CI 0.49-0.72) and admission to a neonatal unit (AOR 0.15; 99% CI 0.10-0.22) and for low risk multiparous women in hospitals with less than 100 births per annum: induction (AOR 0.69; 99% CI 0.62-0.76); intrathecal analgesia/anaesthesia (AOR 0.32; 99% CI 0.29-0.36); instrumental birth (AOR 0.52; 99% CI 0.41-0.67); caesarean section after labour (AOR 0.41; 99% CI 0.33-0.52); and admission to a neonatal unit (AOR 0.09; 99% CI 0.07-0.12).
In Australia, lower hospital volume is not associated with adverse outcomes for low risk women.
BJOG An International Journal of Obstetrics & Gynaecology 01/2006; 113(1):86-96. · 3.41 Impact Factor
