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Frost J, Weaver E, Callaway L. Severe acute maternal morbidity reporting in Australia: Why is it so hard? Aust N Z J Obstet Gynaecol 2024; 64:88-94. [PMID: 38214330 DOI: 10.1111/ajo.13787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024]
Abstract
Adverse outcomes associated with pregnancy, including severe acute maternal morbidity (SAMM) and mortality, are internationally regarded as important indicators of quality of maternity services. Varied definitions and processes are barriers for SAMM recording, reporting and review. Identifying and documenting these cases of SAMM is a critical first step. Case reviews allow exploration of factors contributing to SAMM. Translation of the lessons learnt into practice improvement strategies and dissemination of this knowledge is essential for continual quality improvement. This review will outline the current status of SAMM review internationally and in Australia.
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Affiliation(s)
- Joanne Frost
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Edward Weaver
- Department of Obstetrics and Gynaecology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Queensland, Australia
| | - Leonie Callaway
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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2
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Campion TSD, Daly JO, Wake M, Ahern S, Said JM. The role of Australian clinical quality registries in pregnancy care: A scoping review. Aust N Z J Obstet Gynaecol 2022; 62:472-482. [PMID: 35538882 PMCID: PMC9545682 DOI: 10.1111/ajo.13540] [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] [Received: 10/30/2021] [Accepted: 04/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pregnancy represents a time of increased morbidity and mortality for women and their infants. Clinical quality registries (CQRs) collect, analyse and report key healthcare quality indicators for patient cohorts to improve patient care. There are limited data regarding existing CQRs in pregnancy. This scoping review aimed to: (1) identify Australian CQRs specific to pregnancy care and describe their general characteristics; and (2) outline their aims and measured outcomes METHODS: The scoping review was undertaken according to Joanna Briggs Institute guidelines. CQRs were identified using a systematic approach from publications (Ovid MEDLINE, PubMed, Google Scholar), peer consultation, the Australian register of clinical registries and web searches. Details surrounding general characteristics, aims and outcomes were collated. RESULTS We identified two primary sources of information about pregnancy care. (1) Six CQRs are specific to pregnancy (Australia and New Zealand twin-twin transfusion syndrome registry, Australian Pregnancy Register for women with epilepsy and those taking anti-epileptic drugs, National Register of Antipsychotic Medication in Pregnancy, Australasian Maternity Outcomes Surveillance System, Neonatal Alloimmune Thrombocytopaenia Registry and the Diabetes in Pregnancy clinical register). (2) Fourteen observational cohort studies were facilitated by non-pregnancy-specific CQRs where a subsection of patients underwent pregnancy. CONCLUSIONS Australian CQRs currently report varied information regarding some selected conditions during pregnancy and offer therapeutic and epidemiological insight into their care. Further research into their effectiveness is warranted. We note the lack of a CQR spanning the common problems of pregnancy in general, where significant health, service and economic gains are possible.
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Affiliation(s)
- Tarun Sai David Campion
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - J Oliver Daly
- Joan Kirner Women's & Children's at Sunshine Hospital, Western Health, St Albans, Victoria, Australia
| | - Melissa Wake
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne M Said
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.,Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Maternal Fetal Medicine, Joan Kirner Women's & Children's at Sunshine Hospital, Western Health, St Albans, Victoria, Australia
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3
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McCall SJ, Henriquez D, Edwards HM, van den Akker T, Bloemenkamp KWM, van der Bom J, Bonnet MP, Deneux-Tharaux C, Donati S, Gillissen A, Kurinczuk JJ, Li Z, Maraschini A, Seco A, Sullivan E, Stanworth S, Knight M. A total blood volume or more transfused during pregnancy or after childbirth: Individual patient data from six international population-based observational studies. PLoS One 2021; 16:e0244933. [PMID: 33481835 PMCID: PMC7822517 DOI: 10.1371/journal.pone.0244933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background This study aimed to compare incidence, management and outcomes of women transfused their blood volume or more within 24 hours during pregnancy or following childbirth. Methods Combined analysis of individual patient data, prospectively collected in six international population-based studies (France, United Kingdom, Italy, Australia, the Netherlands and Denmark). Massive transfusion in major obstetric haemorrhage was defined as transfusion of eight or more units of red blood cells within 24 hours in a pregnant or postpartum woman. Causes, management and outcomes of women with massive transfusion were compared across countries using descriptive statistics. Findings The incidence of massive transfusion was approximately 21 women per 100,000 maternities for the United Kingdom, Australia and Italy; by contrast Denmark, the Netherlands and France had incidences of 82, 66 and 69 per 100,000 maternities, respectively. There was large variation in obstetric and haematological management across countries. Fibrinogen products were used in 86% of women in Australia, while the Netherlands and Italy reported lower use at 35–37% of women. Tranexamic acid was used in 75% of women in the Netherlands, but in less than half of women in the UK, Australia and Italy. In all countries, women received large quantities of colloid/crystalloid fluids during resuscitation (>3·5 litres). There was large variation in the use of compression sutures, embolisation and hysterectomy across countries. There was no difference in maternal mortality; however, variable proportions of women had cardiac arrests, renal failure and thrombotic events from 0–16%. Interpretation There was considerable variation in the incidence of massive transfusion associated with major obstetric haemorrhage across six high-income countries. There were also large disparities in both transfusion and obstetric management between these countries. There is a requirement for detailed evaluation of evidence underlying current guidance. Furthermore, cross-country comparison may empower countries to reference their clinical care against that of other countries.
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Affiliation(s)
- Stephen J. McCall
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, United Kingdom
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
- * E-mail:
| | - Dacia Henriquez
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin Research & Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Hellen McKinnon Edwards
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Thomas van den Akker
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, United Kingdom
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Kitty W. M. Bloemenkamp
- Department of Obstetrics, Birth Centre Wilhelmina’s Children Hospital, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Johanna van der Bom
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin Research & Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Marie-Pierre Bonnet
- Department of Anaesthesiology and Critical Care, Armand Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and Biostatistics (CRESS), Paris University, Paris, France
| | - Catherine Deneux-Tharaux
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and Biostatistics (CRESS), Paris University, Paris, France
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Ada Gillissen
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin Research & Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, United Kingdom
| | - Zhuoyang Li
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Institute of Health, Rome, Italy
| | - Aurélien Seco
- Department of Anaesthesiology and Critical Care, Armand Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
- Clinical Research Unit of Paris Descartes Necker Cochin, APHP, Paris, France
| | - Elizabeth Sullivan
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Simon Stanworth
- Oxford University Hospitals NHS Trust, Department of Haematology, Oxford, United Kingdom
- NIHR BRC Blood Theme, University of Oxford, Oxford, United Kingdom
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Headington, Oxford, United Kingdom
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Mengistu TS, Turner JM, Flatley C, Fox J, Kumar S. The Impact of Severe Maternal Morbidity on Perinatal Outcomes in High Income Countries: Systematic Review and Meta-Analysis. J Clin Med 2020; 9:E2035. [PMID: 32610499 PMCID: PMC7409239 DOI: 10.3390/jcm9072035] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/10/2020] [Accepted: 06/23/2020] [Indexed: 12/27/2022] Open
Abstract
While there is clear evidence that severe maternal morbidity (SMM) contributes significantly to poor maternal health outcomes, limited data exist on its impact on perinatal outcomes. We undertook a systematic review and meta-analysis to ascertain the association between SMM and adverse perinatal outcomes in high-income countries (HICs). We searched for full-text publications in PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Scopus databases. Studies that reported data on the association of SMM and adverse perinatal outcomes, either as a composite or individual outcome, were included. Two authors independently assessed study eligibility, extracted data, and performed quality assessment using the Newcastle-Ottawa Scale. We used random-effects modelling to calculate odds ratios (ORs) with 95% confidence intervals. We also assessed the risk of publication bias and statistical heterogeneity using funnel plots and Higgins I2, respectively. We defined sub-groups of SMM as hemorrhagic disorders, hypertensive disorders, cardiovascular disorders, hepatic disorders, renal disorders, and thromboembolic disorders. Adverse perinatal outcome was defined as preterm birth (before 37 weeks gestation), small for gestational age (SGA) (birth weight (BW) < 10th centile for gestation), low birthweight (LBW) (BW < 2.5 kg), Apgar score < 7 at 5 min, neonatal intensive care unit (NICU) admission, stillbirth and perinatal death (stillbirth and neonatal deaths up to 28 days). A total of 35 studies consisting of 38,909,426 women were included in the final analysis. SMMs associated with obstetric hemorrhage (OR 3.42, 95% CI: 2.55-4.58), severe hypertensive disorders (OR 6.79, 95% CI: 6.06-7.60), hepatic (OR 3.19, 95% CI: 2.46-4.13) and thromboembolic disorders (OR 2.40, 95% CI: 1.67-3.46) were significantly associated with preterm birth. SMMs from hypertensive disorders (OR 2.86, 95% CI: 2.51-3.25) or thromboembolic disorders (OR 1.48, 95% CI: 1.09-1.99) were associated with greater odds of having SGA infant. Women with severe hemorrhage had increased odds of LBW infant (OR 2.31, 95% CI: 1.57-3.40). SMMs from obstetric hemorrhage (OR 4.16, 95% CI: 2.54-6.81) or hypertensive disorders (OR 4.61, 95% CI: 1.17-18.20) were associated with an increased odds of low 5-min Apgar score and NICU admission (Severe obstetric hemorrhage: OR 3.34, 95% CI: 2.26-4.94 and hypertensive disorders: OR 3.63, 95% CI: 2.63-5.02, respectively). Overall, women with SMM were 4 times more likely to experience stillbirth (OR 3.98, 95%C 3.12-7.60) compared to those without SMM with cardiovascular disease (OR 15.2, 95% CI: 1.29-180.60) and thromboembolic disorders (OR 9.43, 95% CI: 4.38-20.29) conferring greatest risk of this complication. The odds of neonatal death were significantly higher in women with SMM (OR 3.98, 95% CI: 2.44-6.47), with those experiencing hemorrhagic (OR 7.33, 95% CI: 3.06-17.53) and hypertensive complications (OR 3.0, 95% CI: 1.78-5.07) at highest risk. Overall, SMM was also associated with higher odds of perinatal death (OR 4.74, 95% CI: 2.47-9.12) mainly driven by the increased risk in women experiencing severe obstetric hemorrhage (OR 6.18, 95% CI: 2.55-14.96). Our results highlight the importance of mitigating the impact of SMM not only to improve maternal health but also to ameliorate its consequences on perinatal outcomes.
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Affiliation(s)
- Tesfaye S. Mengistu
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia; (T.S.M.); (J.M.T.); (C.F.)
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, P.O. Box 79, Ethiopia
- Faculty of Medicine, The University of Queensland, Herston, QLD 4072, Australia;
| | - Jessica M. Turner
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia; (T.S.M.); (J.M.T.); (C.F.)
- Faculty of Medicine, The University of Queensland, Herston, QLD 4072, Australia;
| | - Christopher Flatley
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia; (T.S.M.); (J.M.T.); (C.F.)
| | - Jane Fox
- Faculty of Medicine, The University of Queensland, Herston, QLD 4072, Australia;
| | - Sailesh Kumar
- Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia; (T.S.M.); (J.M.T.); (C.F.)
- Faculty of Medicine, The University of Queensland, Herston, QLD 4072, Australia;
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Pollock W, Peek MJ, Wang A, Li Z, Ellwood D, Homer CSE, Jackson Pulver L, McLintock C, Vaughan G, Knight M, Sullivan EA. Eclampsia in Australia and New Zealand: A prospective population-based study. Aust N Z J Obstet Gynaecol 2019; 60:533-540. [PMID: 31840809 DOI: 10.1111/ajo.13100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 10/10/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Eclampsia is a serious consequence of pre-eclampsia. There are limited data from Australia and New Zealand (ANZ) on eclampsia. AIM To determine the incidence, management and perinatal outcomes of women with eclampsia in ANZ. MATERIALS AND METHODS A two-year population-based descriptive study, using the Australasian Maternity Outcomes Surveillance System (AMOSS), carried out in 263 sites in Australia, and all 24 New Zealand maternity units, during a staggered implementation over 2010-2011. Eclampsia was defined as one or more seizures during pregnancy or postpartum (up to 14 days) in any woman with clinical evidence of pre-eclampsia. RESULTS Of 136 women with eclampsia, 111 (83%) were in Australia and 25 (17%) in New Zealand. The estimated incidence of eclampsia was 2.2 (95% confidence interval (CI) 1.9-2.7) per 10 000 women giving birth. Aboriginal and Torres Strait Islander women were over-represented in Australia (n = 9; 8.1%). Women with antepartum eclampsia (n = 58, 42.6%) were more likely to have a preterm birth (P = 0.04). Sixty-three (47.4%) women had pre-eclampsia diagnosed prior to their first eclamptic seizure of whom 19 (30.2%) received magnesium sulphate prior to the first seizure. Nearly all women (n = 128; 95.5%) received magnesium sulphate post-seizure. No woman received prophylactic aspirin during pregnancy. Five women had a cerebrovascular haemorrhage, and there were five known perinatal deaths. CONCLUSIONS Eclampsia is an uncommon consequence of pre-eclampsia in ANZ. There is scope to reduce the incidence of this condition, associated with often catastrophic morbidity, through the use of low-dose aspirin and magnesium sulphate in women at higher risk.
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Affiliation(s)
- Wendy Pollock
- Maternal Critical Care, Melbourne, Victoria, Australia.,Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia.,School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Michael J Peek
- Obstetrics and Gynaecology, ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Alex Wang
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Zhuoyang Li
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David Ellwood
- Department of Obstetrics and Gynaecology, Griffiths University, Southport, Queensland, Australia
| | - Caroline S E Homer
- Maternal and Child Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Lisa Jackson Pulver
- Indigenous Strategy and Services, The University of Sydney, Sydney, New South Wales, Australia
| | - Claire McLintock
- National Women's Health, Auckland City Hospital, University of Auckland, Auckland, New Zealand
| | - Geraldine Vaughan
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Marian Knight
- Maternal and Child Population Health, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elizabeth A Sullivan
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Fitzpatrick KE, van den Akker T, Bloemenkamp KWM, Deneux-Tharaux C, Kristufkova A, Li Z, Schaap TP, Sullivan EA, Tuffnell D, Knight M. Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study. PLoS Med 2019; 16:e1002962. [PMID: 31714909 PMCID: PMC6850527 DOI: 10.1371/journal.pmed.1002962] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/09/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Amniotic fluid embolism (AFE) remains one of the principal reported causes of direct maternal mortality in high-income countries. However, obtaining robust information about the condition is challenging because of its rarity and its difficulty to diagnose. This study aimed to pool data from multiple countries in order to describe risk factors, management, and outcomes of AFE and to explore the impact on the findings of considering United Kingdom, international, and United States AFE case definitions. METHODS AND FINDINGS A population-based cohort and nested case-control study was conducted using the International Network of Obstetric Survey Systems (INOSS). Secondary data on women with AFE (n = 99-218, depending on case definition) collected prospectively in population-based studies conducted in Australia, France, the Netherlands, Slovakia, and the UK were pooled along with secondary data on a sample of control women (n = 4,938) collected in Australia and the UK. Risk factors for AFE were investigated by comparing the women with AFE in Australia and the UK with the control women identified in these countries using logistic regression. Factors associated with poor maternal outcomes (fatality and composite of fatality or permanent neurological injury) amongst women with AFE from each of the countries were investigated using logistic regression or Wilcoxon rank-sum test. The estimated incidence of AFE ranged from 0.8-1.8 per 100,000 maternities, and the proportion of women with AFE who died or had permanent neurological injury ranged from 30%-41%, depending on the case definition. However, applying different case definitions did not materially alter findings regarding risk factors for AFE and factors associated with poor maternal outcomes amongst women with AFE. Using the most liberal case definition (UK) and adjusting for the severity of presentation when appropriate, women who died were more likely than those who survived to present with cardiac arrest (89% versus 40%, adjusted odds ratio [aOR] 10.58, 95% confidence interval [CI] 3.93-28.48, p < 0.001) and less likely to have a source of concentrated fibrinogen (40% versus 56%, aOR 0.44, 95% CI 0.21-0.92, p = 0.029) or platelets given (24% versus 49%, aOR 0.23, 95% CI 0.10-0.52, p < 0.001). They also had a lower dose of tranexamic acid (median dose 0.7 g versus 2 g, p = 0.035) and were less likely to have had an obstetrician and/or anaesthetist present at the time of the AFE (61% versus 75%, aOR 0.38, 95% CI 0.16-0.90, p = 0.027). Limitations of the study include limited statistical power to examine factors associated with poor maternal outcome and the potential for residual confounding or confounding by indication. CONCLUSIONS The findings of our study suggest that when an AFE is suspected, initial supportive obstetric care is important, but having an obstetrician and/or anaesthetist present at the time of the AFE event and use of interventions to correct coagulopathy, including the administration of an adequate dose of tranexamic acid, may be important to improve maternal outcome. Future research should focus on early detection of the coagulation deficiencies seen in AFE alongside the role of tranexamic acid and other coagulopathy management strategies.
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Affiliation(s)
- Kathryn E. Fitzpatrick
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Kitty W. M. Bloemenkamp
- Birth Centre Wilhelmina Children Hospital, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Catherine Deneux-Tharaux
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, France
| | - Alexandra Kristufkova
- First Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Zhuoyang Li
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Timme P. Schaap
- Birth Centre Wilhelmina Children Hospital, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elizabeth A. Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Derek Tuffnell
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Maternal and perinatal outcomes in pregnant women with BMI >50: An international collaborative study. PLoS One 2019; 14:e0211278. [PMID: 30716114 PMCID: PMC6361432 DOI: 10.1371/journal.pone.0211278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/10/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine the association between maternal BMI>50kg/m2 during pregnancy and maternal and perinatal outcomes. MATERIALS AND METHODS An international cohort study was conducted using data from separate national studies in the UK and Australia. Outcomes of pregnant women with BMI>50 were compared to those of pregnant women with BMI<50. Multivariable logistic regression estimated the association between BMI>50 and perinatal and maternal outcomes. RESULTS 932 pregnant women with BMI>50 were compared with 1232 pregnant women with BMI<50. Pregnant women with BMI>50 were slightly older, more likely to be multiparous, and have pre-existing comorbidities. There were no maternal deaths, however, extremely obese women had a nine-fold increase in the odds of thrombotic events compared to those with a BMI<50 (uOR: 9.39 (95%CI:1.15-76.43)). After adjustment, a BMI>50 during pregnancy had significantly raised odds of preeclampsia/eclampsia (aOR:4.88(95%CI: 3.11-7.65)), caesarean delivery (aOR: 2.77 (95%CI: 2.31-3.32)), induction of labour (aOR: 2.45(95% CI:2.00-2.99)) post caesarean wound infection (aOR:7.25(95%CI: 3.28-16.07)), macrosomia (aOR: 8.05(95%CI: 4.70-13.78)) compared a BMI<50. Twelve of the infants born to women in the extremely obese cohort died in the early neonatal period or were stillborn. CONCLUSIONS Pregnant women with BMI>50 have a high risk of inferior maternal and perinatal outcomes.
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Ma S, Lawpoolsri S, Soonthornworasiri N, Khamsiriwatchara A, Jandee K, Taweeseneepitch K, Pawarana R, Jaiklaew S, Kijsanayotin B, Kaewkungwal J. Effectiveness of Implementation of Electronic Malaria Information System as the National Malaria Surveillance System in Thailand. JMIR Public Health Surveill 2016; 2:e20. [PMID: 27227156 PMCID: PMC4869224 DOI: 10.2196/publichealth.5347] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/20/2016] [Accepted: 03/21/2016] [Indexed: 11/13/2022] Open
Abstract
Background In moving toward malaria elimination, one strategy is to implement an active surveillance system for effective case management. Thailand has developed and implemented the electronic Malaria Information System (eMIS) capturing individualized electronic records of suspected or confirmed malaria cases. Objective The main purpose of this study was to determine how well the eMIS improves the quality of Thailand’s malaria surveillance system. In particular, the focus of the study was to evaluate the effectiveness of the eMIS in terms of the system users’ perception and the system outcomes (ie, quality of data) regarding the management of malaria patients. Methods A mixed-methods technique was used with the framework based on system effectiveness attributes: data quality, timeliness, simplicity, acceptability, flexibility, stability, and usefulness. Three methods were utilized: data records review, survey of system users, and in-depth interviews with key stakeholders. From the two highest endemic provinces, paper forms matching electronic records of 4455 noninfected and 784 malaria-infected cases were reviewed. Web-based anonymous questionnaires were distributed to all 129 eMIS data entry staff throughout Thailand, and semistructured interviews were conducted with 12 management-level officers. Results The eMIS is well accepted by system users at both management and operational levels. The data quality has enabled malaria personnel to perform more effective prevention and control activities. There is evidence of practices resulting in inconsistencies and logical errors in data reporting. Critical data elements were mostly completed, except for a few related to certain dates and area classifications. Timeliness in reporting a case to the system was acceptable with a delay of 3-4 days. The evaluation of quantitative and qualitative data confirmed that the eMIS has high levels of simplicity, acceptability, stability, and flexibility. Conclusions Overall, the system implemented has achieved its objective. The results of the study suggested that the eMIS helps improve the quality of Thailand’s malaria surveillance system. As the national malaria surveillance system, the eMIS’s functionalities have provided the malaria staff working at the point of care with close-to-real-time case management data quality, covering case detection, case investigation, drug compliance, and follow-up visits. Such features has led to an improvement in the quality of the malaria control program; the government officials now have quicker access to both individual and aggregated data to promptly react to possible outbreak. The eMIS thus plays one of the key roles in moving toward the national goal of malaria elimination by the next decade.
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Affiliation(s)
- Shaojin Ma
- Department of Tropical Hygiene (Biomedical and Health Informatics)Faculty of Tropical MedicineMahidol UniversityBangkokThailand
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene (Biomedical and Health Informatics)Faculty of Tropical MedicineMahidol UniversityBangkokThailand.,Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS)Faculty of Tropical MedicineMahidol UniversityBangkokThailand
| | - Ngamphol Soonthornworasiri
- Department of Tropical Hygiene (Biomedical and Health Informatics)Faculty of Tropical MedicineMahidol UniversityBangkokThailand
| | - Amnat Khamsiriwatchara
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS)Faculty of Tropical MedicineMahidol UniversityBangkokThailand
| | - Kasemsak Jandee
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS)Faculty of Tropical MedicineMahidol UniversityBangkokThailand
| | - Komchaluch Taweeseneepitch
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS)Faculty of Tropical MedicineMahidol UniversityBangkokThailand
| | - Rungrawee Pawarana
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS)Faculty of Tropical MedicineMahidol UniversityBangkokThailand
| | - Sukanya Jaiklaew
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS)Faculty of Tropical MedicineMahidol UniversityBangkokThailand
| | - Boonchai Kijsanayotin
- Thai Health Information Standards Development Center (THIS)Health Systems Research InstituteMinistry of Public HealthNonthaburiThailand
| | - Jaranit Kaewkungwal
- Department of Tropical Hygiene (Biomedical and Health Informatics)Faculty of Tropical MedicineMahidol UniversityBangkokThailand.,Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS)Faculty of Tropical MedicineMahidol UniversityBangkokThailand
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9
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McDonnell N, Knight M, Peek MJ, Ellwood D, Homer CSE, McLintock C, Vaughan G, Pollock W, Li Z, Javid N, Sullivan E. Amniotic fluid embolism: an Australian-New Zealand population-based study. BMC Pregnancy Childbirth 2015; 15:352. [PMID: 26703453 PMCID: PMC4690249 DOI: 10.1186/s12884-015-0792-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 12/11/2015] [Indexed: 11/18/2022] Open
Abstract
Background Amniotic fluid embolism (AFE) is a major cause of direct maternal mortality in Australia and New Zealand. There has been no national population study of AFE in either country. The aim of this study was to estimate the incidence of amniotic fluid embolism in Australia and New Zealand and to describe risk factors, management, and perinatal outcomes. Methods A population-based descriptive study using the Australasian Maternity Outcomes Surveillance System (AMOSS) carried out in 263 eligible sites (>50 births per year) covering an estimated 96 % of women giving birth in Australia and all 24 New Zealand maternity units (100 % of women giving birth in hospitals) between January 1 2010-December 31 2011. A case of AFE was defined either as a clinical diagnosis (acute hypotension or cardiac arrest, acute hypoxia and coagulopathy in the absence of any other potential explanation for the symptoms and signs observed) or as a post mortem diagnosis (presence of fetal squames/debris in the pulmonary circulation). Results Thirty-three cases of AFE were reported from an estimated cohort of 613,731women giving birth, with an estimated incidence of 5.4 cases per 100 000 women giving birth (95 % CI 3.5 to 7.2 per 100 000). Two (6 %) events occurred at home whilst 46 % (n = 15) occurred in the birth suite and 46 % (n = 15) in the operating theatre (location not reported in one case). Fourteen women (42 %) underwent either an induction or augmentation of labour and 22 (67 %) underwent a caesarean section. Eight women (24 %) conceived using assisted reproduction technology. Thirteen (42 %) women required cardiopulmonary resuscitation, 18 % (n = 6) had a hysterectomy and 85 % (n = 28) received a transfusion of blood or blood products. Twenty (61 %) were admitted to an Intensive Care Unit (ICU), eight (24 %) were admitted to a High Dependency Unit (HDU) and seven (21 %) were transferred to another hospital for further management. Five woman died (case fatality rate 15 %) giving an estimated maternal mortality rate due to AFE of 0.8 per 100 000 women giving birth (95 % CI 0.1 % to 1.5 %). There were two deaths among 36 infants. Conclusions A coordinated emergency response requiring resource intense multi-disciplinary input is required in the management of women with AFE. Although the case fatality rate is lower than in previously published studies, high rates of hysterectomy, resuscitation, and admission to higher care settings reflect the significant morbidity associated with AFE. Active, ongoing surveillance to document the risk factors and short and long-term outcomes of women and their babies following AFE may be helpful to guide best practice, management, counselling and service planning. A potential link between AFE and assisted reproductive technology warrants further investigation.
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Affiliation(s)
- Nolan McDonnell
- School of Women's and Infants' Health and School of Medicine and Pharmacology, University of Western Australia, Perth, Australia. .,Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, WA, 6008, Australia. .,Department of Anaesthesia, St John of God Hospital (Subiaco), Perth, Australia.
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
| | - Michael J Peek
- Sydney Medical School Nepean, The University of Sydney, Sydney, Australia.
| | - David Ellwood
- School of Medicine, Gold Coast Campus, Griffith University, Gold Coast, Australia. .,Gold Coast University Hospital, Gold Coast, Australia.
| | | | - Claire McLintock
- National Women's Health, Auckland City Hospital, Auckland, New Zealand.
| | - Geraldine Vaughan
- University of Technology Sydney, Faculty of Health, Sydney, Australia.
| | - Wendy Pollock
- Judith Lumley Research Centre, La Trobe University, Melbourne, Australia. .,Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Zhuoyang Li
- University of Technology Sydney, Faculty of Health, Sydney, Australia.
| | - Nasrin Javid
- University of Technology Sydney, Faculty of Health, Sydney, Australia.
| | - Elizabeth Sullivan
- University of Technology Sydney, Faculty of Health, Sydney, Australia. .,School of Women's and Children's Health, The University of New South Wales, Sydney, Australia.
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10
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Sullivan EA, Dickinson JE, Vaughan GA, Peek MJ, Ellwood D, Homer CSE, Knight M, McLintock C, Wang A, Pollock W, Jackson Pulver L, Li Z, Javid N, Denney-Wilson E, Callaway L. Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study. BMC Pregnancy Childbirth 2015; 15:322. [PMID: 26628074 PMCID: PMC4667490 DOI: 10.1186/s12884-015-0693-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 10/05/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Super-obesity is associated with significantly elevated rates of obstetric complications, adverse perinatal outcomes and interventions. The purpose of this study was to determine the prevalence, risk factors, management and perinatal outcomes of super-obese women giving birth in Australia. METHODS A national population-based cohort study. Super-obese pregnant women (body mass index (BMI) >50 kg/m(2) or weight >140 kg) who gave birth between January 1 and October 31, 2010 and a comparison cohort were identified using the Australasian Maternity Outcomes Surveillance System (AMOSS). Outcomes included maternal and perinatal morbidity and mortality. Prevalence estimates calculated with 95% confidence intervals (CIs). Adjusted odds ratios (ORs) were calculated using multivariable logistic regression. RESULTS 370 super-obese women with a median BMI of 52.8 kg/m(2) (range 40.9-79.9 kg/m(2)) and prevalence of 2.1 per 1 000 women giving birth (95% CI: 1.96-2.40). Super-obese women were significantly more likely to be public patients (96.2%), smoke (23.8%) and be socio-economically disadvantaged (36.2%). Compared with other women, super-obese women had a significantly higher risk for obstetric (adjusted odds ratio (AOR) 2.42, 95% CI: 1.77-3.29) and medical (AOR: 2.89, 95% CI: 2.64-4.11) complications during pregnancy, birth by caesarean section (51.6%) and admission to special care (HDU/ICU) (6.2%). The 372 babies born to 365 super-obese women with outcomes known had significantly higher rates of birthweight ≥ 4500 g (AOR 19.94, 95 % CI: 6.81-58.36), hospital transfer (AOR 3.81, 95 % CI: 1.93-7.55) and admission to Neonatal Intensive Care Unit (NICU) (AOR 1.83, 95% CI: 1.27-2.65) compared to babies of the comparison group, but not prematurity (10.5% versus 9.2%) or perinatal mortality (11.0 (95% CI: 4.3-28.0) versus 6.6 (95% CI: 2.6- 16.8) per 1 000 singleton births). CONCLUSIONS Super-obesity in pregnancy in Australia is associated with increased rates of pregnancy and birth complications, and with social disadvantage. There is an urgent need to further address risk factors leading to super-obesity among pregnant women and for maternity services to better address pre-pregnancy and pregnancy care to reduce associated inequalities in perinatal outcomes.
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Affiliation(s)
- Elizabeth A Sullivan
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
- School of Women's and Children's Health, The University of New South Wales, Sydney, Australia.
| | - Jan E Dickinson
- School of Women's and Infants' Health, The University of Western Australia, Perth, Australia.
| | - Geraldine A Vaughan
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Michael J Peek
- Department of Obstetrics and Gynaecology Medical School College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia.
- Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Canberra, Australia.
| | - David Ellwood
- School of Medicine, Griffith University, Queensland, Australia.
- Gold Coast University Hospital, Queensland, Australia.
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
| | - Claire McLintock
- Obstetrics and Gynaecology, National Women's Health, Auckland City Hospital, Auckland, New Zealand.
| | - Alex Wang
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Wendy Pollock
- Judith Lumley Centre, La Trobe University, Melbourne, Australia.
- Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Lisa Jackson Pulver
- Muru Marri Indigenous Health Unit, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia.
| | - Zhuoyang Li
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Nasrin Javid
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Elizabeth Denney-Wilson
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Leonie Callaway
- Royal Brisbane and Women's Hospital, Brisbane, Australia.
- School of Medicine, The University of Queensland, Brisbane, Australia.
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11
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Monk A, Tracy M, Foureur M, Grigg C, Tracy S. Evaluating Midwifery Units (EMU): a prospective cohort study of freestanding midwifery units in New South Wales, Australia. BMJ Open 2014; 4:e006252. [PMID: 25361840 PMCID: PMC4216868 DOI: 10.1136/bmjopen-2014-006252] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in two freestanding midwifery units and two tertiary-level maternity units in New South Wales, Australia. DESIGN Prospective cohort study. PARTICIPANTS 494 women who intended to give birth at freestanding midwifery units and 3157 women who intended to give birth at tertiary-level maternity units. Participants had low risk, singleton pregnancies and were at less than 28(+0) weeks gestation at the time of booking. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were mode of birth, Apgar score of less than 7 at 5 min and admission to the neonatal intensive care unit or special care nursery. Secondary outcomes were onset of labour, analgesia, blood loss, management of third stage of labour, perineal trauma, transfer, neonatal resuscitation, breastfeeding, gestational age at birth, birth weight, severe morbidity and mortality. RESULTS Women who planned to give birth at a freestanding midwifery unit were significantly more likely to have a spontaneous vaginal birth (AOR 1.57; 95% CI 1.20 to 2.06) and significantly less likely to have a caesarean section (AOR 0.65; 95% CI 0.48 to 0.88). There was no significant difference in the AOR of 5 min Apgar scores, however, babies from the freestanding midwifery unit group were significantly less likely to be admitted to neonatal intensive care or special care nursery (AOR 0.60; 95% CI 0.39 to 0.91). Analysis of secondary outcomes indicated that planning to give birth in a freestanding midwifery unit was associated with similar or reduced odds of intrapartum interventions and similar or improved odds of indicators of neonatal well-being. CONCLUSIONS The results of this study support the provision of care in freestanding midwifery units as an alternative to tertiary-level maternity units for women with low risk pregnancies at the time of booking.
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Affiliation(s)
- Amy Monk
- Faculty of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Tracy
- Centre for Newborn Care, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health, Faculty of Health, The University of Technology Sydney, Sydney, Australia
| | - Celia Grigg
- Faculty of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
| | - Sally Tracy
- Centre for Midwifery & Women's Health Nursing Research Unit, The Royal Hospital for Women and the University of Sydney, Sydney, Australia
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12
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Lindquist A, Noor N, Sullivan E, Knight M. The impact of socioeconomic position on severe maternal morbidity outcomes among women in Australia: a national case-control study. BJOG 2014; 122:1601-9. [DOI: 10.1111/1471-0528.13058] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2014] [Indexed: 11/30/2022]
Affiliation(s)
- A Lindquist
- National Perinatal Epidemiology Unit; Nuffield Department of Population Health; University of Oxford; Oxford UK
- Department of Obstetrics and Gynaecology; Monash Health; Melbourne Vic. Australia
| | - N Noor
- National Perinatal Epidemiology Unit; Nuffield Department of Population Health; University of Oxford; Oxford UK
| | - E Sullivan
- Faculty of Health; University of Technology Sydney; Sydney NSW Australia
| | - M Knight
- National Perinatal Epidemiology Unit; Nuffield Department of Population Health; University of Oxford; Oxford UK
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