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White SW. Intrahepatic cholestasis of pregnancy: Contemporary management. Aust N Z J Obstet Gynaecol 2023; 63:623-624. [PMID: 37775914 DOI: 10.1111/ajo.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Scott W White
- The Western Australian Centre for Health Research for Women and Babies, The University of Western Australia, Perth, Western Australia, Australia
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
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2
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Mielewczyk FJ, Boyle EM. Uncharted territory: a narrative review of parental involvement in decision-making about late preterm and early term delivery. BMC Pregnancy Childbirth 2023; 23:526. [PMID: 37464284 DOI: 10.1186/s12884-023-05845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
Almost 30% of live births in England and Wales occur late preterm or early term (LPET) and are associated with increased risks of adverse health outcomes throughout the lifespan. However, very little is known about the decision-making processes concerning planned LPET births or the involvement of parents in these. This aim of this paper is to review the evidence on parental involvement in obstetric decision-making in general, to consider what can be extrapolated to decisions about LPET delivery, and to suggest directions for further research.A comprehensive, narrative review of relevant literature was conducted using Medline, MIDIRS, PsycInfo and CINAHL databases. Appropriate search terms were combined with Boolean operators to ensure the following broad areas were included: obstetric decision-making, parental involvement, late preterm and early term birth, and mode of delivery.This review suggests that parents' preferences with respect to their inclusion in decision-making vary. Most mothers prefer sharing decision-making with their clinicians and up to half are dissatisfied with the extent of their involvement. Clinicians' opinions on the limits of parental involvement, especially where the safety of mother or baby is potentially compromised, are highly influential in the obstetric decision-making process. Other important factors include contextual factors (such as the nature of the issue under discussion and the presence or absence of relevant medical indications for a requested intervention), demographic and other individual characteristics (such as ethnicity and parity), the quality of communication; and the information provided to parents.This review highlights the overarching need to explore how decisions about potential LPET delivery may be reached in order to maximise the satisfaction of mothers and fathers with their involvement in the decision-making process whilst simultaneously enabling clinicians both to minimise the number of LPET births and to optimise the wellbeing of women and babies.
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Affiliation(s)
- Frances J Mielewczyk
- Leicester City Football Club (LCFC) Research Programme, Department of Population Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - Elaine M Boyle
- Department of Population Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
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de Graaff EC, Leisher SH, Blencowe H, Lawford H, Cassidy J, Cassidy PR, Draper ES, Heazell AEP, Kinney M, Quigley P, Ravaldi C, Storey C, Vannacci A, Flenady V. Ending preventable stillbirths and improving bereavement care: a scorecard for high- and upper-middle income countries. BMC Pregnancy Childbirth 2023; 23:480. [PMID: 37391688 PMCID: PMC10311809 DOI: 10.1186/s12884-023-05765-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/07/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Despite progress, stillbirth rates in many high- and upper-middle income countries remain high, and the majority of these deaths are preventable. We introduce the Ending Preventable Stillbirths (EPS) Scorecard for High- and Upper Middle-Income Countries, a tool to track progress against the Lancet's 2016 EPS Series Call to Action, fostering transparency, consistency and accountability. METHODS The Scorecard for EPS in High- and Upper-Middle Income Countries was adapted from the Scorecard for EPS in Low-Income Countries, which includes 20 indicators to track progress against the eight Call to Action targets. The Scorecard for High- and Upper-Middle Income Countries includes 23 indicators tracking progress against these same Call to Action targets. For this inaugural version of the Scorecard, 13 high- and upper-middle income countries supplied data. Data were collated and compared between and within countries. RESULTS Data were complete for 15 of 23 indicators (65%). Five key issues were identified: (1) there is wide variation in stillbirth rates and related perinatal outcomes, (2) definitions of stillbirth and related perinatal outcomes vary widely across countries, (3) data on key risk factors for stillbirth are often missing and equity is not consistently tracked, (4) most countries lack guidelines and targets for critical areas for stillbirth prevention and care after stillbirth and have not set a national stillbirth rate target, and (5) most countries do not have mechanisms in place for reduction of stigma or guidelines around bereavement care. CONCLUSIONS This inaugural version of the Scorecard for High- and Upper-Middle Income Countries highlights important gaps in performance indicators for stillbirth both between and within countries. The Scorecard provides a basis for future assessment of progress and can be used to help hold individual countries accountable, especially for reducing stillbirth inequities in disadvantaged groups.
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Affiliation(s)
- Esti Charlotte de Graaff
- Mater Research Institute, NHMRC Centre of Research Excellence in Stillbirth, University of Queensland, Brisbane, Australia
| | - Susannah Hopkins Leisher
- Mater Research Institute, NHMRC Centre of Research Excellence in Stillbirth, University of Queensland, Brisbane, Australia
- International Stillbirth Alliance, Millburn, USA
- University of Utah School of Medicine, Salt Lake City, USA
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Harriet Lawford
- Mater Research Institute, NHMRC Centre of Research Excellence in Stillbirth, University of Queensland, Brisbane, Australia
| | | | | | - Elizabeth S Draper
- MBRRACE-UK, Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Alexander E P Heazell
- Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mary Kinney
- School of Public Health, University of the Western Cape, Belville, South Africa
| | | | - Claudia Ravaldi
- PeaRL Perinatal Research Laboratory, CiaoLapo Foundation for Perinatal Health, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | | | - Alfredo Vannacci
- PeaRL Perinatal Research Laboratory, CiaoLapo Foundation for Perinatal Health, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Vicki Flenady
- Mater Research Institute, NHMRC Centre of Research Excellence in Stillbirth, University of Queensland, Brisbane, Australia.
- International Stillbirth Alliance, Millburn, USA.
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4
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Tindal K, Bimal G, Flenady V, Gordon A, Farrell T, Davies-Tuck M. Causes of perinatal deaths in Australia: Slow progress in the preterm period. Aust N Z J Obstet Gynaecol 2022; 62:511-517. [PMID: 35238402 PMCID: PMC9545743 DOI: 10.1111/ajo.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The majority of perinatal deaths occur in the preterm period; however, current approaches predominantly focus on prevention in the term period. Reducing perinatal deaths in the preterm period is, therefore, key to reducing the rates of perinatal death overall in Australia. The aim was to understand the classifications of causes of preterm stillbirth and neonatal death in Victoria over time and by gestation. MATERIALS AND METHODS Retrospective study using state-wide, publicly available data. All births in Victoria between 2010 and 2018 included in the Victorian Perinatal Data Collection, excluding terminations of pregnancy for maternal psychosocial indications, were studied. Differences in causes of preterm perinatal mortality gestation group and over time were determined. RESULTS Out of 7977 perinatal deaths reported, 85.9% (n = 6849) were in the preterm period. The most common cause of preterm stillbirths was congenital anomalies (n = 1574, 29.8%), followed by unexplained antepartum deaths (n = 557, 14.2%). The most common cause of preterm neonatal death was spontaneous preterm birth (sPTB; n = 599, 38.2%), followed by congenital anomalies (n = 493, 31.4%). The rate of preterm stillbirths due to hypertension (-14.9% (95% CI -27.1% to -2.7%; P = 0.02)), maternal conditions (-24.1% (95% CI -44.2% to -4.0%; P = 0.03)) and those that were unexplained (-5.4% (95% CI -9.8% to -1.2%; P = 0.02)) decreased per annum between 2010 and 2018. All other classifications did not change significantly over time. CONCLUSION Prevention of congenital anomalies and sPTB is critical to reducing preterm perinatal mortality. Greater emphasis on understanding causes of preterm deaths through mortality investigations may reduce the proportion of those considered 'unexplained'.
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Affiliation(s)
- Kirstin Tindal
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Gayathri Bimal
- Monash University Obstetrics and Gynaecology, Melbourne, Victoria, Australia
| | - Vicki Flenady
- Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.,NHMRC Centre for Research Excellence in Stillbirth, Brisbane, Queensland, Australia
| | - Adrienne Gordon
- University of Sydney, Sydney, New South Wale, Australia.,NHMRC Centre for Research Excellence in Stillbirth, Brisbane, Queensland, Australia
| | | | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,NHMRC Centre for Research Excellence in Stillbirth, Brisbane, Queensland, Australia
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Newnham JP, Schilling C, Petrou S, Morris JM, Wallace EM, Brown K, Edwards L, Skubisz MM, White SW, Rynne B, Arrese CA, Doherty DA. The health and educational costs of preterm birth to 18 years of age in Australia. Aust N Z J Obstet Gynaecol 2021; 62:55-61. [PMID: 34268727 DOI: 10.1111/ajo.13405] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preterm birth is the greatest cause of death up to five years of age and an important contributor to lifelong disability. There is increasing evidence that a meaningful proportion of early births may be prevented, but widespread introduction of effective preventive strategies will require financial support. AIMS This study estimated the economic cost to the Australian government of preterm birth, up to 18 years of age. MATERIALS AND METHODS A decision-analytic model was developed to estimate the costs of preterm birth in Australia for a hypothetical cohort of 314 814 children, the number of live births in 2016. Costs to Australia's eight jurisdictions included medical expenditures and additional costs to educational services. RESULTS The total cost of preterm birth to the Australian government associated with the annual cohort was estimated at $1.413 billion (95% CI 1047-1781). Two-thirds of the costs were borne by healthcare services during the newborn period and one-quarter of the costs by educational services providing special assistance. For each child, the costs were highest for those born at the earliest survivable gestational age, but the larger numbers of children born at later gestational ages contributed heavily to the overall economic burden. CONCLUSION Preterm birth leaves many people with lifelong disabilities and generates a significant economic burden to society. The costs extend beyond those to the healthcare system and include additional educational needs. Assessments of economic costs should inform economic evaluations of interventions aimed at the prevention or treatment of preterm birth.
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Affiliation(s)
- John P Newnham
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Chris Schilling
- Economics and Modelling, KPMG, Melbourne, Victoria, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jonathan M Morris
- Sydney Medical School - Northern, University of Sydney, Sydney, New South Wales, Australia.,Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Safer Care Victoria, Melbourne, Victoria, Australia
| | - Kiarna Brown
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Lindsay Edwards
- Department of Obstetrics and Gynaecology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Monika M Skubisz
- Department of Obstetrics, Women's and Children's Hospital, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Brendan Rynne
- Economics and Modelling, KPMG, Melbourne, Victoria, Australia
| | - Catherine A Arrese
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
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6
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Orefice R, Smythe J, Doherty DA, Lim B. Preventing early births in a regional tertiary maternity unit: Evaluating preterm and early term birth rates before and after implementation of the Preterm Birth Prevention Initiative in the Australian Capital Territory. Aust N Z J Obstet Gynaecol 2021; 61:693-699. [PMID: 33759176 DOI: 10.1111/ajo.13328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND A multifaceted preterm birth (PTB) prevention initiative was launched in the Australian Capital Territory (ACT) in 2019. The aim of this initiative was to safely lower the rate of early births across the ACT and the surrounding areas in New South Wales. Modelled on the Western Australian PTB Prevention Initiative, the program included new clinical guidelines and a new PTB prevention clinic at the main tertiary hospital. AIM To evaluate the initiative and its effects on preterm and early term birth rates at the main tertiary hospital after 16 months of implementation. MATERIALS AND METHODS A before and after intervention study was conducted. Rates of preterm and early term birth before (previous five years) and after 16 months of implementation of the ACT PTB Prevention Initiative were evaluated. RESULTS At the main tertiary hospital in The Canberra Hospital, the rate of PTB was significantly reduced by 10% after 16 months of implementation of the initiative. Rates of PTB were lower than any of the preceding five years and resulted in 45 averted or delayed PTBs. The number of planned early term births with no medical indication was significantly reduced by 34.5% and resulted in 77 averted or delayed early term births. CONCLUSIONS The multifaceted PTB Prevention Initiative safely lowered the rates of early birth in the ACT context. These results highlight the importance of prioritising early birth prevention, education, research and expanding the initiative nationwide.
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Affiliation(s)
- Roberto Orefice
- Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia.,Australian National University, Canberra, Australian Capital Territory, Australia
| | - Julia Smythe
- Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Boon Lim
- Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australian Capital Territory, Australia.,Australian National University, Canberra, Australian Capital Territory, Australia
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7
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Newnham JP, White SW, Lee HS, Arrese CA, Watts JC, Pedretti MK, Dickinson JE, Doherty DA. The elements of success in a comprehensive state-wide program to safely reduce the rate of preterm birth. PLoS One 2020; 15:e0234033. [PMID: 32497072 PMCID: PMC7272053 DOI: 10.1371/journal.pone.0234033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background In 2014, a whole-of-population and multi-faceted preterm birth prevention program was introduced in Western Australia with the single aim of safely lowering the rate of preterm birth. The program included new clinical guidelines, print and social media, and a dedicated new clinic. In the first full calendar year the rate of preterm birth fell by 7.6% and the reduction extended from the 28–31 week gestational age group upwards. Objective The objective of this study was to evaluate outcomes in greater depth and to also include the first three years of the program. Study design This was a prospective population-based cohort study of perinatal outcomes in singleton pregnancies before and after commencement of the program. Results There was a significant reduction in preterm birth in the tertiary center which extended from 28 weeks gestation onwards and was ongoing. In non-tertiary centers there was an initial reduction, but this was not sustained past the first year. The greatest reduction was observed in pregnancies classified at first attendance as low risk. No benefit was observed in the private sector, but a significant reduction was seen in the remote region of the Kimberley where the program was first launched and vaginal progesterone had been made free-of-charge. Conclusion Preterm birth rates can be safely reduced by a multi-faceted and whole-of-population program but the effectiveness requires continuing effort and will be greatest where the strategies are most targeted.
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Affiliation(s)
- John P Newnham
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Scott W White
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Han-Shin Lee
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Catherine A Arrese
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Jared C Watts
- Department of Obstetrics and Gynaecology, WA Country Health Service, Kimberley, Western Australia, Australia.,Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia
| | - Michelle K Pedretti
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.,Department of Ultrasound, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Jan E Dickinson
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - Dorota A Doherty
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
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