Mater Mothers Research Articles

Prenatal extra-abdominal bowel dilatation is a risk factor for intrapartum fetal compromise for fetuses with gastroschisis.

The aim of this study was to investigate the prenatal ultrasound features that were associated with intrapartum fetal distress in fetuses with gastroschisis. This was a retrospective observational study of all cases of gastroschisis referred to and delivering at the Mater Mothers' Hospital in Brisbane, Australia. Maternal demographics, prenatal ultrasound features including the presence of bowel dilatation, umbilical artery and middle cerebral artery Doppler indices and amniotic fluid volume as well as intrapartum outcome details were analysed using univariate and multivariate logistic regression to ascertain factors predictive of intrapartum compromise. The study cohort included 155 cases of gastroschisis over a 16-year period. The overall perinatal loss rate was 5.9% (four intrauterine fetal deaths, four neonatal deaths and one termination of pregnancy). The live birth rate was 96.8% (150/155). Fetal heart rate abnormalities occurred in 55.1% of cases. The overall caesarean section rate was 40.9% (63/154), of which 63.5% (40/63) was emergency procedures. Both univariate and multivariate analysis confirmed that only extra-abdominal bowel dilatation was a risk factor for intrapartum fetal compromise necessitating emergency delivery. Extra-abdominal bowel dilatation is a risk factor for intrapartum fetal compromise (OR 2.2; 95%CI 1.03-4.7) and emergent delivery.

E‐Posters

with unexplained subfertility Luke McLINDON1, Michael BECKMANN2, Michael CHAPMAN3, Vicki FLENADY4, H David McINTYRE5 1Gynaecology Fellow, Mater Mothers’ Hospital, Brisbane, Australia 2 Director of Obstetrics and Gynaecology, Mater Mothers’ Hospital, 3 Head of Obstetrics and Gynaecology, St George’s, University of New South Wales, Sydney, Australia 4 Director, Translating Research into Practice Centre, Mater Research , Brisbane 5 Head, Mater School of Medicine, University of Queensland.

Maternity Patients' Access to Their Electronic Medical Records: Use and Perspectives of a Patient Portal

Patients have been able to access clinical information from their paper-based health records for a number of years. With the advent of Electronic Medical Records (EMRs) access to this information can now be achieved online using a secure electronic patient portal. The purpose of this study was to investigate maternity patients' use and perceptions of a patient portal developed at the Mater Mothers' Hospital in Brisbane, Australia. A web-based patient portal, one of the first developed and deployed in Australia, was introduced on 26 June 2012. The portal was designed for maternity patients booked at Mater Mothers' Hospital, as an alternative to the paper-based Pregnancy Health Record. Through the portal, maternity patients are able to complete their hospital registration form online and obtain current health information about their pregnancy (via their EMR), as well as access a variety of support tools to use during their pregnancy such as tailored public health advice. A retrospective cross-sectional study design was employed. Usage statistics were extracted from the system for a one year period (1 July 2012 to 30 June 2013). Patients' perceptions of the portal were obtained using an online survey, accessible by maternity patients for two weeks in February 2013 (n=80). Descriptive statistics were employed to analyse the data. Between July 2012 and June 2013, 10,892 maternity patients were offered a patient portal account and access to their EMR. Of those 6,518 created one (60%; 6,518/10,892) and 3,104 went on to request access to their EMR (48%; 3,104/6,518). Of these, 1,751 had their access application granted by 30 June 2013. The majority of maternity patients submitted registration forms online via the patient portal (56.7%). Patients could view their EMR multiple times: there were 671 views of the EMR, 2,781 views of appointment schedules and 135 birth preferences submitted via the EMR. Eighty survey responses were received from EMR account holders, (response rate of 8.1%; 80/985). The majority of respondents indicated they would use the portal and access their EMR for future pregnancies (86.2%; 69/80). Approximately half looked at their EMR after a visit with their care provider (51.3%); 41/80) and 37.5% (30/80) viewed their EMR before, to prepare for their visit. The majority (65.8%) thought that the EMR improved their ability to understand and recall appointments and almost half (48.1%) thought that with the EMR they were less likely to repeat pregnancy information to caregivers. This study provides the first Australian evidence of a patient portal system, tied to an EMR, working effectively in a maternity care context. It provides new evidence that portals can deliver benefits to maternity patients in terms of providing quick and easy access to current personal and general health information and support patients in their ability to recall and prepare for appointments.

Predicting intrapartum fetal compromise using the fetal cerebro-umbilical ratio

IntroductionThe aim of this study was to explore the association between the cerebro-umbilical ratio measured at 35–37 weeks and intrapartum fetal compromise. MethodsThis retrospective cross sectional study was conducted at the Mater Mothers' Hospital in Brisbane, Australia. Maternal demographics and fetal Doppler indices at 35–37 weeks gestation for 1381 women were correlated with intrapartum and neonatal outcomes. ResultsBabies born by caesarean section or instrumental delivery for fetal compromise had the lowest median cerebro-umbilical ratio 1.60 (IQR 1.22–2.08) compared to all other delivery groups (vaginal delivery, emergency delivery for failure to progress, emergency caesarean section for other reasons or elective caesarean section). The percentage of infants with a cerebro-umbilical ratio <10th centile that required emergency delivery (caesarean section or instrumental delivery) for fetal compromise was 22%, whereas only 7.3% of infants with a cerebro-umbilical ratio between the 10th–90th centile and 9.6% of infants with a cerebro-umbilical ratio > 90th centile required delivery for the same indication (p < 0.001). A lower cerebro-umbilical ratio was associated with an increased risk of emergency delivery for fetal compromise, OR 2.03 (95% CI 1.41–2.92), p < 0.0001. DiscussionThis study suggests that a low fetal cerebro-umbilical ratio measured at 35–37 weeks is associated with a greater risk of intrapartum compromise. This is a relatively simple technique which could be used to risk stratify women in diverse healthcare settings.

Are obese children really less fit? Influences of body composition and physical activity on cardiorespiratory fitness in obese and healthy-weight children

Margarita D. Tsiros 1,∗, Alison M. Coates1, Peter R.C. Howe2, Jeff Walkley3, Andrew P. Hills 4, Rachel E. Wood5, Jonathann D. Buckley1 1 Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia 2 School of Biomedical Sciences & Pharmacy, University of Newcastle, Newcastle, NSW, Australia 3 School of Health Sciences, RMIT University, Bundoora, Vic, Australia 4 Mater Research Institute, Mater Mothers’ Hospital, South Brisbane, QLD, Australia 5 School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia

Cortisol response to food intake in men: Influence of overweight and obesity

Margarita D. Tsiros 1,∗, Alison M. Coates1, Peter R.C. Howe2, Jeff Walkley3, Andrew P. Hills 4, Rachel E. Wood5, Jonathann D. Buckley1 1 Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia 2 School of Biomedical Sciences & Pharmacy, University of Newcastle, Newcastle, NSW, Australia 3 School of Health Sciences, RMIT University, Bundoora, Vic, Australia 4 Mater Research Institute, Mater Mothers’ Hospital, South Brisbane, QLD, Australia 5 School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia

Lessons learned from the introduction of an electronic safety net to enhance test result management in an Australian mothers' hospital.

This study describes the implementation and impact of an electronic test result acknowledgement (RA) system in the Mater Mothers’ Hospital in Brisbane, Australia. The Verdi application electronically records clinicians’ acknowledgement of the review of results. Hospital data (August 2011–August 2012) were extracted to measure clinicians’ acknowledgement practices. There were 27 354 inpatient test results for 6855 patients. All test results were acknowledged. 60% (95% CI 59% to 61%) of laboratory and 44% (95% CI 40% to 48%) of imaging results were acknowledged within 24 h. The median time between report availability and acknowledgement was 18.1 h for laboratory and 1 day 18 h for imaging results. The median time from when a result was first viewed to its acknowledgement was 7 min for laboratory and 1 min for imaging results. The longest recorded time to acknowledgement was 38 days. Electronic RA provides a safety net to enhance test result management.

The timing of elective caesarean deliveries and early neonatal outcomes in singleton infants born 37-41weeks' gestation.

Births by elective caesarean section (CS) are rising, particularly before 39weeks' gestation, which may be associated with unacceptably high risk of adverse neonatal outcomes. The optimal timing of these deliveries needs to be determined with recent recommendations to delay births by elective CS until 39weeks. To evaluate the association between gestational age (GA) at delivery and neonatal outcomes after elective CS between 37 and 41weeks. Retrospective cohort study of viable singleton neonates delivered by elective CS at Mater Mothers' Hospitals (1998-2009). Neonates were stratified into two GA groups with early term (ET, 37-38weeks) compared with the reference group of full and late term (FLT, 39-41weeks). The primary outcome examined was serious respiratory morbidity; secondary outcomes included depression at birth, nursery admission and assisted ventilation. Fourteen thousand and four hundred and forty-seven mother-baby pairs were included (59.9% delivered before 39weeks). There was a significantly decreasing risk of adverse neonatal outcomes with increasing GA. Compared to FLT, delivery at ET almost tripled the risk of the primary outcome (AOR 2.74; 95% CI 1.79-4.21). Rates of most secondary outcomes were at least doubled. Elective CS performed at 37-38weeks is associated with poorer neonatal outcomes compared to those delivered at 39-41weeks. This study supports recent recommendations to delay delivery by elective CS until week 39 if possible.

Why group &amp; save? Blood transfusion at low‐risk elective caesarean section

Women undergoing elective caesarean section (CS) routinely have a group and save ordered as part of their preoperative assessment, whereas women with expected vaginal birth do not. Our aim was therefore to determine the rate of blood transfusion at elective CS compared with vaginal birth in a large Australian maternity hospital. A retrospective cohort study was performed using routinely collected de-identified data of 35477 women, over 4years, who delivered at the Mater Mothers' Hospital, Brisbane, Australia. After excluding women with established risk factors for transfusion, the likelihood of blood transfusion following elective CS was significantly lower compared to vaginal birth (aOR 0.47 (0.29, 0.77)).

Predictors of successful external cephalic version in an Australian maternity hospital

There are minimal data involving predictors of success of external cephalic version (ECV) in an Australian healthcare setting. To determine the predictors of successful ECV as well as the success rate of ECV and the mode of, and presentation at, delivery for women undergoing ECV for breech presentation from 36-weeks gestation. A prospective review was carried out on all women who had undergone ECV from 36-weeks gestation at the Mater Mothers Hospital over an 8-year period from 2001 to 2008. Data were collected prospectively and were collated in conjunction with database review, chart review and telephonic patient interviews. A total of 355 women underwent ECV for breech presentation. The overall success rate was 66% (57% for nulliparous, 76% for multiparous). A woman who underwent ECV had a 46% chance of a vaginal birth. If the ECV was successful, she had a 70% chance of vaginal birth. From bivariate analysis, parity, amniotic fluid index (AFI) and estimated fetal weight (EFW) were determined to be possible predictors of success of ECV and were included in the logistic regression modelling. In the regression analysis, multiparity increased the odds of successful ECV by 2.18. For every one unit increase in AFI, the odds of successful ECV increased by 1.18. Multiparity and amniotic fluid volume as assessed by AFI were the significant predictors of immediate success of ECV. Conversely, lower AFI and nulliparity are factors that are likely to reduce the likelihood of successful ECV.

Derivation of anthropometric cut-offs to define obesity in Sri Lankan men

R. Jayawardena1,∗, S. Thennakoon1, N.M. Byrne2, M.J. Soares3, P. Katulanda1, A.P. Hills 4 1 Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka 2 Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia 3 Curtin Health Innovation Research Institute, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia 4 Mater Mothers’ Hospital, Mater Medical Research Institute and Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia

Effect of calcium against weight gain and improved histopathologic fatty liver on male Wistar rats that fed high fat food

R. Jayawardena1,∗, S. Thennakoon1, N.M. Byrne2, M.J. Soares3, P. Katulanda1, A.P. Hills 4 1 Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka 2 Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia 3 Curtin Health Innovation Research Institute, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia 4 Mater Mothers’ Hospital, Mater Medical Research Institute and Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia

Hospital Versus Outpatient Care for Preterm Pre-Labour Rupture of Membranes

Background To report the outcomes of women admitted following preterm pre-labour rupture of membranes (pPROM) and to determine whether the location of care (hospital vs outpatient) influences maternal and perinatal outcomes. Methods A retrospective cohort study was performed using routinely collected de-identified data of 144 women (between June 2007 and June 2011) who presented to the Mater Mother's Hospital, Brisbane, Australia, with pPROM (prior to 34weeks 0days gestation) and who remained undelivered after 72h from the time of ruptured membranes. Outcomes were compared for women who were subsequently managed as an outpatient (n=53) versus those who were managed in hospital (n=91). The two primary outcome measures were composite outcomes of (i) maternal morbidity and (ii) perinatal morbidity/mortality. The composite outcome of maternal morbidity comprised one or more of antepartum haemorrhage, clinical chorioamnionitis and/or endometritis, cord prolapse, blood transfusion, wound infection/haematoma/dehiscence/seroma. The composite outcome of perinatal morbidity/mortality comprised one or more of stillbirth, neonatal death, respiratory distress syndrome, neonatal infection, chronic neonatal lung disease, intraventricular haemorrhage, periventricular leukomalacia and necrotising enterocolitis. Results When adjusted for confounders, there was no difference between hospital care and outpatient care in the composite outcome measure of perinatal morbidity/mortality (aOR 1.37; 95%CI 0.553.47) or the composite outcome measure of maternal morbidity (aOR 1.62; 95%CI 0.673.89). Conclusions Women with pPROM who remain undelivered after 72h and are managed out of hospital do not appear to have significant differences in major adverse maternal or perinatal outcomes compared with those managed as inpatients.

Be wary of &ldquo;natural&rdquo; therapy in gynecological surgery

It is estimated that more than 4 billion people throughout the world use natural herbs for some aspect of primary health care. These over-the-counter medications, commonly referred to as “complementary and alternative medicines,” despite their proposed health benefits, may have serious and potentially fatal side effects. This paper presents the case of a patient who underwent a gynecological operation and suffered heavy postoperative bleeding as a result of her taking large doses of oral raw garlic in the weeks prior to her operation and discusses the issue of patients’ perioperative intake of herbal supplements. To our knowledge, this is the first paper to demonstrate the relationship between a natural therapy and postoperative bleeding in gynecological surgery. The patient presented with severe postoperative bleeding following a routine, unremarkable vaginal hysterectomy. The bleeding required a multidisciplinary management intervention involving gynecological surgeons, general surgeons, oncology surgeons, hematologists, anesthetists, and intensive care unit specialists. After careful history taking (unfortunately, undertaken postoperatively), it was unanimously agreed that the postoperative hemorrhage was due to the patient’s excessive preoperative oral ingestion of raw garlic. The case and brief literature review presented in this paper concern an area of paucity in gynecological surgery and highlight the relationship between a commonly taken over-the-counter herbal medication and postoperative hemorrhage.

Customised birthweight models: Do they increase identification of at‐risk infants?

The study aims to describe the cohort of women and babies who are classified as small-for-gestational age (SGA) at term by both an Australian customised birthweight model (CBM) and a commonly used population-based standard, and to investigate and compare the utility of these models in identifying babies at risk of experiencing adverse outcomes Routinely collected data on 54 890 singleton-term births at the Mater Mothers' Hospitals, Brisbane, with birthweight less than 4000 g between January 1997 and December 2008, was extracted. Each birth was classified as SGA (<10th centile) or not SGA by either and/or both methods: population-based standards (SGApop ) and CBM (SGAcust ). Babies classified as SGApop , SGAcust or SGAboth were compared with those not classified as SGA by both methods using relative risk and 95% confidence interval, and those only classified as SGAcust were compared with those only classified as SGApop . Maternal demographics, maternal risk factors for fetal growth restriction, pregnancy and labour complications and adverse neonatal outcomes are reported. A total of 4768 (8.7%) births were classified as SGApop , while 6479 (11.8%) were SGAcust of whom 4138 (63.9%) were also classified as SGApop . Maternal risk factors such as smoking and hypertension were statistically higher for the SGAcust group when compared with SGApop . For the majority of adverse neonatal outcomes, a trend was noted to increased identification using the CBM. The CBM provides a modest improvement when compared to a population-based standard to identity term infants at birth who are at risk of adverse neonatal outcomes.

Regionalisation of fetal medicine in Australia and New Zealand

Regionalisation of fetal medicine in <scp>A</scp>ustralia and <scp>N</scp>ew <scp>Z</scp>ealand

Hospital versus outpatient care for preterm pre‐labour rupture of membranes

To report the outcomes of women admitted following preterm pre-labour rupture of membranes (pPROM) and to determine whether the location of care (hospital vs outpatient) influences maternal and perinatal outcomes. A retrospective cohort study was performed using routinely collected de-identified data of 144 women (between June 2007 and June 2011) who presented to the Mater Mother's Hospital, Brisbane, Australia, with pPROM (prior to 34weeks 0days gestation) and who remained undelivered after 72h from the time of ruptured membranes. Outcomes were compared for women who were subsequently managed as an outpatient (n=53) versus those who were managed in hospital (n=91). The two primary outcome measures were composite outcomes of (i) maternal morbidity and (ii) perinatal morbidity/mortality. The composite outcome of maternal morbidity comprised one or more of antepartum haemorrhage, clinical chorioamnionitis and/or endometritis, cord prolapse, blood transfusion, wound infection/haematoma/dehiscence/seroma. The composite outcome of perinatal morbidity/mortality comprised one or more of stillbirth, neonatal death, respiratory distress syndrome, neonatal infection, chronic neonatal lung disease, intraventricular haemorrhage, periventricular leukomalacia and necrotising enterocolitis. When adjusted for confounders, there was no difference between hospital care and outpatient care in the composite outcome measure of perinatal morbidity/mortality (aOR 1.37; 95%CI 0.55-3.47) or the composite outcome measure of maternal morbidity (aOR 1.62; 95%CI 0.67-3.89). Women with pPROM who remain undelivered after 72h and are managed out of hospital do not appear to have significant differences in major adverse maternal or perinatal outcomes compared with those managed as inpatients.

Twelve‐year review of neonatal deaths in the delivery room in a perinatal tertiary centre

To describe decisions made for babies who died in the delivery room as a result of clinical practice of non-resuscitation or unsuccessful resuscitation. A retrospective study was conducted of neonatal deaths (NNDs) ≥ 400 g and/or ≥20 weeks' gestation born at Mater Mothers' Hospitals 1998-2009 who were not admitted to a neonatal nursery. Deaths were divided into not resuscitated and unsuccessful resuscitation and subdivided by cause of death as extremely preterm, congenital abnormality or 'other'. Of all 539 NNDs, 217 (40.3%) were not admitted to a neonatal nursery, comprising 174 (80.2%) not resuscitated and 41 (18.9%) unsuccessful resuscitation, while in a further two newborn infants resuscitation was not required. Only 13 of 123 (10.6%) extremely preterm infants who died in the delivery room had resuscitation attempted. Of 77 infants who died from congenital abnormalities in the delivery room 18 (23.3%) had resuscitation attempted. Fifteen babies with other diagnoses died in the delivery room; five with severe intrapartum asphyxia without resuscitation and a further 10 (8 preterm) with Apgar scores of 0-1 at 1 min and ≤3 at 5 min who did not respond to extensive resuscitation. A large proportion of NNDs occurred outside the neonatal nurseries involving end-of-life decision-making. Review of the circumstances of these NNDs in the subcategories of extreme prematurity, congenital abnormalities and 'other' raises different management dilemmas with the potential for clinical practice improvement in compassionate care and transparency in decision-making.

Implementation of an ankyloglossia assessment tool and parent education package for lactation consultants in the Mater Mothers’ Hospital

Implementation of an ankyloglossia assessment tool and parent education package for lactation consultants in the Mater Mothers’ Hospital

Birth outcomes associated with cannabis use before and during pregnancy

This study aimed to examine the association between cannabis use before and during pregnancy and birth outcomes. Overall, 26.3% of women reported previous use of cannabis and 2.6% reported current use. Multivariate analysis, controlling for potential confounders, including tobacco smoking, alcohol consumption, and use of other illicit drugs, showed that cannabis use in pregnancy was associated with low birth weight (odds ratio (OR) = 1.7; 95% confidence interval (CI): 1.3-2.2), preterm labor (OR = 1.5; 95% CI: 1.1-1.9), small for gestational age (OR = 2.2; 95% CI: 1.8-2.7), and admission to the neonatal intensive care unit (OR = 2.0; 95% CI: 1.7-2.4). The results of this study show that the use of cannabis in pregnancy is associated with increased risk of adverse birth outcomes. Prevention programs that address cannabis use during pregnancy are needed. Data were from women birthing at the Mater Mothers' Hospital in Brisbane, Australia, over a 7-y period (2000-2006). Women were interviewed in the initial antenatal visit about their use of cannabis and other substances. Records for 24,874 women who provided information about cannabis use, and for whom birth outcomes data were available, were included in the analysis.