Victorian Perinatal Data Collection Research Articles

Obesity in women giving birth in Victoria, 2010-2019: a retrospective cohort study.

To assess the prevalence of obesity in pregnant women in Victoria, 2010-2019. Retrospective cohort study; analysis of Victorian Perinatal Data Collection data. Women who gave birth in seventeen Victorian Department of Health areas (eight metropolitan, nine regional), 2010-2019. Proportions of births to women with obesity (body mass index ≥ 30 kg/m2), by Department of Health area and year. A total of 710 364 births with records that included the mothers' BMI were recorded in Victoria during 2010-2019. The proportion of births to women with obesity rose from 19.6% (95% confidence interval [CI], 19.3-19.9%) in 2010 to 21.5% (95% CI, 21.2-21.8%) in 2019; the proportion of births to women with normal weight declined from 49.0% (95% CI, 48.6-49.4%) to 46.8% (95% CI, 46.4-47.1%). In metropolitan areas, the proportion of births to women with obesity rose from 17.7% (95% CI, 17.7-17.8%) to 19.4% (95% CI, 19.3-19.4%); in regional areas, it increased from 25.0% (95% CI, 25.0-25.1%) to 29.1% (95% CI, 29.0-29.2%). The increase in prevalence of obesity was greater among women living in the lowest socio-economic standing (Index of Relative Socio-Economic Disadvantage) quintile than for those residing in the quintile of least disadvantage (adjusted rate ratio, 2.16; 95% CI, 2.12-2.20). The proportion of births to Victorian women with obesity rose during 2010-2019, particularly in regional areas. Ensuring that regional health services are adequately resourced to meet the needs of the increasing number of women at risk of obesity during pregnancy is vital.

The prevalence of and factors associated with prior induced abortion among women who gave birth in Victoria, 2010-2019.

To assess the prevalence of a history of induced abortion among women who gave birth in Victoria during 2010-2019; to assess the association of socio-demographic factors with a history of induced abortion. Retrospective cohort study; analysis of cross-sectional perinatal data in the Victorian Perinatal Data Collection (VPDC). All women who gave birth (live or stillborn) in Victoria, 1 January 2010 - 31 December 2019. Self-reported induced abortions prior to the index birth; outcome of the most recent pregnancy preceding the index pregnancy. Of the 766 488 women who gave birth during 2010-2019, 93 251 reported induced abortions (12.2%), including 36 938 of 338 547 nulliparous women (10.9%). Women living in inner regional (adjusted odds ratio [aOR], 0.94; 95% confidence interval [CI], 0.93-0.96) or outer regional/remote/very remote areas (aOR, 0.86; 95% CI, 0.83-0.89) were less likely than women in major cities to report induced abortions. The likelihood increased steadily with age at the index birth and with parity, and was also higher for women without partners at the index birth (aOR, 2.20; 95% CI, 2.16-2.25) and Aboriginal and Torres Strait Islander women (aOR, 1.32; 95% CI, 1.25-1.40). The likelihood was lower for women born in most areas outside Australia than for those born in Australia. The likelihood of a history of induced abortion declined across the study period overall (2019 v 2010: 0.93; 95% CI, 0.90-0.96) and for women in major cities (0.88; 95% CI, 0.84-0.91); rises in inner regional and outer regional/remote/very remote areas were not statistically significant. Access to abortion care in Victoria improved during 2010-2019, but the complex interplay between contraceptive use, unintended pregnancy, and induced abortion requires further exploration by remoteness of residence. Robust information about numbers of unintended pregnancies and access to reproductive health services are needed to guide national sexual and reproductive health policy and practice.

Factors Associated with Early Versus Late Uptake of the COVID-19 Vaccine during Pregnancy over Time in Australia: A Population-Based Cohort Study.

Pregnant women are at an increased risk of hospitalisation, admission to the intensive care unit, mechanical ventilation, and death from SARS-CoV-2 infection. The aim of this study is to determine the predictive factors associated with COVID-19 vaccine uptake during pregnancy over time in a population with a high background uptake of maternal influenza and pertussis vaccination. This is a population-based, cohort study of all pregnant women who gave birth in Victoria, Australia between 1 July 2021 and 30 June 2022. Data from the Victorian Perinatal Data Collection were analysed using univariable and multivariable logistic regression. This study reports on 77,719 women who gave birth over a 12 month period, of whom 49,281 (63.4%) received a COVID-19 vaccine, 54,887 (70.6%) received an influenza vaccination and 63,594 (81.8%) received a pertussis vaccine by the time of delivery. Pregnant women aged >30 years (aOR 1.31 CI 1.27, 1.36), who had >=8 antenatal visits (aOR 1.08 CI 1.04, 1.12), and those who received influenza vaccine (aOR 1.23 CI 1.19, 1.28) were more likely to have received a COVID-19 vaccine. Those who smoked (aOR 0.7 CI 0.66, 0.74), were First Nations (aOR 0.83 CI 0.74, 0.93) and those who gave birth in public hospitals (aOR 0.65 CI 0.63, 0.68) were less likely to receive COVID-19 vaccine in the first 12 months of the rollout. Maternal age, smoking, parity and Indigenous status were factors associated with delayed and sustained lower coverage, even in a population with background maternal influenza and pertussis coverage of 70.6% and 81.8%, respectively.

Primary postpartum haemorrhage adversely impacts breastfeeding initiation in Victoria, Australia

ProblemBreastfeeding has many important benefits for both mother and baby but sustained breastfeeding is sub-optimal. BackgroundIdentifying women who need increased support to establish breastfeeding has the potential to improve this. Analysis of the relationship between primary postpartum haemorrhage (PPH) and primary severe PPH and breastfeeding may prove informative as PPH has potentially negative impacts on breastfeeding. AimTo determine the relationship between PPH and severe PPH and breastfeeding at postnatal discharge and formula use for breastfed babies in hospital. MethodsPopulation-based retrospective cohort study using the Victorian Perinatal Data Collection for all liveborn singleton births at ≥ 37 weeks’ gestation (n = 339,854) for 2009–13 in Victoria. Estimated blood loss was categorised as PPH ≥ 500 mL and severe PPH ≥ 1500 mL. Descriptive analysis was conducted and multivariable logistic regression was used to determine the adjusted odds ratio for the relationship between PPH/severe PPH and breastfeeding outcomes after adjustment for relevant confounders. FindingsOverall, 94.9% of women initiated breastfeeding. Babies whose mother had a PPH or severe PPH were less likely than others to be exclusively breastfeeding at discharge (aOR 0.88; (95% CI 0.86, 0.90) and aOR 0.57; (95% CI 0.53, 0.61) respectively). Formula – given to 25.9% of all breastfed babies – was more likely for those whose mothers had a PPH or severe PPH (aOR 1.15; (95% CI 1.12, 1.17) and aOR 2.15; (95% CI 2.01, 2.29) respectively. ConclusionsWomen have greater challenges establishing exclusive breastfeeding following PPH and severe PPH. Improving support in hospital for women following PPH may increase breastfeeding success.

Accurate identification and documentation of First Nations women and babies attending maternity services: How can we 'close the gap' if we can't get this right?

Policies and strategies addressing the health inequities experienced by First Nations peoples are critical to ensuring the gap in outcomes between First Nations and non-Indigenous peoples is closed. The identification of First Nations peoples is vital to enable the delivery of culturally safe and sensitive health care. Complete and accurate health data are essential for funding and evaluation of such initiatives. To describe the processes used and accuracy of identification and documentation of First Nations mothers and babies during the period of the implementation of a culturally responsive caseload model of maternity care at three major metropolitan maternity services in Melbourne, Australia. A cross-sectional study was conducted using administrative and clinical data. There was variation in when and how First Nations identification was asked and documented for mothers and babies. Errors included 14% of First Nations mothers not identified at the first booking appointment, 5% not identified until after the birth and 11% of First Nations babies not identified in the Victorian Perinatal Data Collection documentation. Changes to documentation and staff education were implemented to improve identification and reduce inaccuracies. To improve disparities in health outcomes, mainstream health services must respond to the needs of First Nations peoples, but improved care first requires accurate identification and documentation of First Nations peoples. Implementing and maintaining accuracy in collection and documentation of First Nations status is essential for health services to provide timely and appropriate care to First Nations people and to support and grow culturally appropriate and safe services.

Prenatal and early postnatal exposure to air pollution associations with primary care and prescription usage

BACKGROUND AND AIM: Health consequences of air pollution in early life have been mostly studied in hospital settings, with less focus put on primary care and prescribed medications. The aim of this study was to investigate general practitioner (GP) consultations and prescriptions dispensed following exposure in utero and in the first year of life to the Hazelwood coal mine fire, a severe air pollution episode lasting six weeks. METHODS: The Victorian Perinatal Data Collection was linked to the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme for a cohort of children born in the Latrobe Valley, Australia between March 2012 and December 2015. Modelled estimates of fire-related PM2.5 exposure were assigned at the residential address at birth. The total numbers of GP visits and of prescriptions of antibiotics, asthma inhalers and steroid skin creams dispensed in the first year of life or in the year following the fire were extracted for children exposed in utero and in infancy (<1 year old), respectively. Negative binomial regression models estimated associations between each outcome and exposure to fire-related PM2.5, with adjustment made for potential confounders. RESULTS: Higher levels of PM2.5 in utero were associated with increased asthma inhalers dispensed (IRR=1.07, 95%CI=1.00-1.14 per 100µg/m³ of cumulative PM2.5; IRR=1.27, 95%CI=1.01-1.58 per 50µg/m3 of peak 24-h PM2.5) in infancy. Surprisingly, a cumulative exposure >25 µg/m³ in infancy was linked to fewer GP visits (IRR=0.83, 95%CI=0.68-0.99) in the year following the fire. CONCLUSIONS: Our findings indicate that prenatal exposure to time-limited severe air pollution could be linked with increased need of asthma medications in infancy. They also suggest that such exposure in infancy could be associated with less GP consultations following extreme events, which could be due to increased needs of specialised and hospital care. KEYWORDS: Particulate matter; Long-term exposure; Infections; Asthma

The association between intrapartum interventions and immediate and ongoing breastfeeding outcomes: an Australian retrospective population-based cohort study

BackgroundThe use of intrapartum interventions is becoming increasingly common globally. Interventions during birth, including caesarean section (CS), epidural analgesia and synthetic oxytocin infusion, can be important in optimizing obstetric care, but have the potential to impact breastfeeding. This study aimed to identify whether women who have certain intrapartum interventions have greater odds of unfavourable breastfeeding outcomes, both the immediate post-partum period and in the months after birth.MethodsThis was a population-based cohort study of singleton livebirths at ≥37 weeks’ gestation between 2010 and 2018 in Victoria, Australia using routinely-collected state-wide data from the Victorian Perinatal Data Collection (VPDC) and the Child Development Information System (CDIS). The interventions included were pre-labour CS, in-labour CS, epidural analgesia, and synthetic oxytocin infusion (augmentation and/or induction of labour). Outcomes were formula supplementation in hospital, method of last feed before hospital discharge and breastfeeding status at 3-months and 6-months. Descriptive statistics and multivariable logistic regression models adjusting for potential confounders were employed.ResultsIn total, 599,191 women initiated breastfeeding. In-labour CS (aOR 1.96, 95%CI 1.93,1.99), pre-labour CS (aOR 1.75, 95%CI 1.72,1.77), epidural analgesia (aOR 1.45, 95%CI 1.43,1.47) and synthetic oxytocin infusion (aOR 1.24, 95%CI 1.22,1.26) increased the odds of formula supplementation in hospital. Long-term breastfeeding data was available for 105,599 infants. In-labour CS (aOR 0.79, 95%CI 0.76,0.83), pre-labour CS (aOR 0.73, 95%CI 0.71,0.76), epidural analgesia (aOR 0.77, 95%CI 0.75,0.80) and synthetic oxytocin infusion (aOR 0.89, 95%CI 0.86–0.92) decreased the odds of exclusive breastfeeding at 3-months post-partum, which was similar at 6-months. There was a dose-response effect between number of interventions received and odds of each unfavourable breastfeeding outcome.ConclusionCommon intrapartum interventions are associated with less favourable breastfeeding outcomes, both in hospital and in the months after birth. This confirms the importance of only undertaking interventions when necessary. When interventions are used intrapartum, an assessment and identification of women at increased risk of early discontinuation of breastfeeding has to be performed. Targeted breastfeeding support for women who have intrapartum interventions, when they wish to breastfeed, is important.

Mode of Birth Is Not Associated With Food Allergy Risk in Infants

The association between mode of delivery and the risk of food allergy remains unclear due to the absence of studies with both challenge-proven food allergy outcomes and detailed information on the type of caesarean delivery. We assessed whether emergency or elective caesarean, or caesarean delivery in the presence or absence of labor initiation, is associated with the risk of food allergy. The HealthNuts study recruited 5276 12-month-old infants who underwent skin prick testing and oral food challenge to ascertain food allergy status, and linked the child's study data to additional birth data from the Victorian Perinatal Data Collection. Parents of 3006 children consented to data linkage, and birth data were obtained on 2045. In this subgroup, 30% were born by caesarean and 13% had food allergy. Caesarean delivery, compared with vaginal birth, was not associated with the risk of food allergy (adjusted odds ratio [aOR]: 0.95, 95% confidence interval [CI]: 0.70, 1.30). Neither caesarean delivery before the onset of labor, nor after the onset of labor, was associated with the risk of food allergy (aOR: 0.83, 95% CI: 0.55-1.23 and aOR: 1.13, 95% CI: 0.75-1.72, respectively). Delivery by elective or emergency caesarean, compared with vaginal delivery, was not associated with risk of food allergy (aOR: 1.05, 95% CI: 0.71-1.55 and aOR: 0.86, 95% CI: 0.56-1.31). There was no evidence of effect modification by breastfeeding, older siblings, pet dog ownership, or maternal allergy. Caesarean delivery, either with or without labor, or elective or emergency, was not associated with the risk of food allergy in a population-based cohort of 12-month-old infants.

Causes of perinatal deaths in Australia: Slow progress in the preterm period.

AimThe 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 methodsRetrospective 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.ResultsOut 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.ConclusionPrevention 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’.

Maternal Vaccination Protects Infants Against Flu and Pertussis

Source: Rowe SL, Leder K, Perrett KP, et al. Maternal vaccination and infant influenza and pertussis. Pediatrics. 2021;148(3): e2021051076; doi.10.1542/peds.2021-051076Investigators from multiple institutions in Australia conducted a population-level inception cohort study to assess the effectiveness of maternal influenza and pertussis vaccination during pregnancy in preventing these diseases in their children during the first 6 months of life. For the study, they abstracted data from the Victorian Perinatal Data Collection (VPDC) on women whose pregnancies ended between September 2015 and December 2017. The VPDC includes information on all live births and stillbirths in Victoria, Australia, including demographic and clinical data related to pregnancy and birth. In addition, whether the mother received influenza and/or pertussis vaccine at any time during pregnancy is recorded. Data from multiple databases were reviewed to identify laboratory-confirmed cases of influenza and pertussis in infants <6 months old during the study period and record ED visits, hospital admissions, and deaths from influenza and pertussis. Information from these databases and VPDC were linked to identify mother-infant dyads.The primary study outcomes were laboratory-confirmed cases of influenza and pertussis in infants born to mothers included in the study, and secondary outcomes included cases of severe disease, defined as ED visit, hospitalization, or death from influenza or pertussis in study infants. Poisson regression was used to calculate the relative risk (RR) for influenza and pertussis in infants of mothers vaccinated during pregnancy vs not vaccinated, after adjusting for multiple confounders. Results were stratified in infants <2 months old, and those 2 to <6 months of age. Vaccine effectiveness (VE) of maternal immunization in preventing childhood illness was estimated as (1-RR) × 100.Data were analyzed on 186,962 mother-infant dyads. Overall, 45.9% of study women were vaccinated against influenza during pregnancy and 68.5% against pertussis. There were 185,404 and 184,194 infants, respectively, included in influenza and pertussis vaccination analyzes. The risk of influenza was significantly reduced in children whose mothers were vaccinated, both among children <2 months old (RR, 0.44; 95% CI, 0.25, 0.77), and in those 2 to <6 months of age (RR, 0.64; 95% CI, 0.42, 0.98), with VE estimated as 56.1% (95% CI, 23.3%, 74.9%) and 35.7% (95% CI, 2.2%, 57.7%), respectively. Maternal vaccination reduced the risk of pertussis in infants <2 months old (RR, 0.20; 95% CI, 0.06, 0.63), with an estimated VE of 80.1% (95% CI, 37.1%, 93.7%), but no significant effect was noted among infants 2 to <6 months old (RR, 0.68; 95% CI, 0.33, 1.39). Maternal pertussis immunization reduced the risk of severe pertussis in infants <2 months old (RR, 0.38; 95% CI, 0.16, 0.94). There were no significant effects from maternal vaccination on severe cases of pertussis in children 2 to <6 months old or on influenza among children <6 months old.The authors conclude that maternal vaccination during pregnancy reduces the risk of influenza and pertussis in infants <2 months old.Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The goal of maternal immunization is to provide infants with passive antibodies prior to their first dose of vaccines. In a previous study, Baxter et al1 noted that maternal Tdap during pregnancy significantly reduced pertussis risk during the entire first year of life (See AAP Grand Rounds. 2017;38[2]:15.)1 In the current study, which included infants born at ≥30 weeks’ gestation, this benefit was most notable only in infants <2 months. In contrast, Baxter et al1 enrolled only infants born at ≥37 weeks’ gestation, allowing more time for antibody transfer after maternal Tdap receipt (usually between 27–36 weeks’ gestation).2As demonstrated by the results of the current study, maternal vaccination during pregnancy also reduces the infant’s risk for influenza during the first 6 months of life. Tdap and influenza vaccination rates during pregnancy, however, remain suboptimal.3 To assess influenza and Tdap vaccination coverage among women pregnant during the 2020–21 influenza season, the Centers for Disease Control and Prevention (CDC) conducted a survey during April 2021.4 Among 1,795 survey respondents who were pregnant anytime during October 2020–January 2021, 54.5% reported receiving an influenza vaccine before or during pregnancy. Among 729 respondents, 53.5% reported receiving Tdap during pregnancy. Unfortunately, receipt of both influenza and Tdap vaccines was reported by only 30.7% of women.COVID-19 vaccines also are recommended for all pregnant women.5 Providers need to take every opportunity to recommend these vaccines for their pregnant patients.Vaccination of pregnant women with Tdap, influenza, and COVID-19 vaccines is safe and protects the mother and her young infant.As influenza vaccines are approved only for infants ≥6 months of age, the 6-month duration of immunity conferred by maternal influenza vaccination provides further support for maternal immunization.

Maternal Vaccination and Infant Influenza and Pertussis.

Infant influenza and pertussis disease causes considerable morbidity and mortality worldwide. We examined the effectiveness of maternal influenza and pertussis vaccines in preventing these diseases in infants. This inception cohort study comprised women whose pregnancies ended between September 1, 2015, and December 31, 2017, in Victoria, Australia. Maternal vaccination status was sourced from the Victorian Perinatal Data Collection and linked to 5 data sets to ascertain infant outcomes and vaccination. The primary outcome of interest was laboratory-confirmed influenza or pertussis disease in infants aged <2 months, 2 to <6 months, and <6 months combined. Secondary outcomes included infant hospitalization (emergency presentation or admission) and death. Risk ratios and 95% confidence intervals (CIs) were estimated by Poisson regression. Vaccine effectiveness (VE) was estimated as (1 minus the risk ratio) x 100%. Among 186 962 pregnant women, 85 830 (45.9%) and 128 060 (68.5%) were vaccinated against influenza and pertussis, respectively. There were 175 and 51 infants with laboratory-confirmed influenza and pertussis disease, respectively. Influenza VE was 56.1% (95% CI, 23.3% to 74.9%) for infants aged <2 months and 35.7% (2.2% to 57.7%) for infants aged 2 to <6 months. Pertussis VE was 80.1% (95% CI, 37.1% to 93.7%) for infants aged <2 months and 31.8% (95% CI, -39.1% to 66.6%) for infants aged 2 to <6 months. Our study provides evidence of the direct effectiveness of maternal influenza and pertussis vaccination in preventing these diseases in infants aged <2 months. The findings strengthen the importance of maternal vaccination to prevent these diseases in infants.

Incidence, Trends and Severity of Primary Postpartum Haemorrhage in Australia: A Population-based Study Using Victorian Perinatal Data Collection Data for 764,244 Births

(Aust N Z J Obstet Gynaecol. 2019;59:228–234) Postpartum hemorrhage (PPH), a leading cause of maternal mortality, has reportedly increased in high resource countries such as Australia over the past few decades. Severe PPH has also become more prevalent. A detailed analysis of PPH in Victoria, Australia was last conducted with data up to 2002. This study analyzed PPH incidence data in Victoria from 2003-2013 and data on PPH severity from 2009-2013, with the aim to investigate trends and severe morbidity associated with PPH.

Risk factors for severe postpartum haemorrhage: A population-based retrospective cohort study.

Severe postpartum haemorrhage (PPH) is a serious clinical problem that is increasing in incidence. To identify risk factors for severe PPH. Population-based retrospective cohort study of all women who gave birth in Victoria in 2009-2013 using the validated Victorian Perinatal Data Collection. Three multivariable logistic regression models estimated the adjusted risk of severe PPH. Adjusted odds ratios (aOR) and their 95% confidence intervals are reported. The primary outcome was severe PPH (estimated blood loss of ≥1500mL). Severe PPH occurred in 1.4% of all births (n=5122). Maternal characteristics significantly associated with severe PPH included: multiple pregnancy; older maternal age; overweight/obesity; first births. Other risk factors included placental complications, macrosomia, instrumental vaginal birth, third and fourth degree perineal lacerations, in-labour caesarean section, birth at a gestation other than 37-41weeks, duration of labour 12 to <24h, and use of oxytocin infusions in labour. Planned pre-labour caesarean section was associated with reduced odds of severe PPH. Severe PPH also occurred in 0.7% (n=104) of women with none of the identified risk factors. Numerous risk factors for severe PPH are identified but some cases are not modifiable or predictable. Limiting use of oxytocin infusions in labour to cases with clear indications, and strategies to prevent severe perineal lacerations would prevent some severe PPHs. Close surveillance of all women in the hours immediately following birth is crucial to detect and manage excessive blood loss and reduce severe PPH and associated morbidity.

Influenza and pertussis vaccination of women during pregnancy in Victoria, 2015–2017

Objectives: To assess variations by time of year and hospital in the uptake of influenza and pertussis vaccinations by pregnant women in Victoria; to identify factors associated with vaccination uptake. Design, setting: Retrospective analysis of data in the Victorian Perinatal Data Collection (VPDC), a population surveillance system for obstetric conditions, procedures, and pregnancy and birth outcomes. Participants: Women whose pregnancies ended in a live or stillbirth during July 2015-June 2017. Main outcome measures: Influenza and pertussis vaccinations during pregnancy. Results: 153 980 pregnancies in 67 hospitals ended during July 2015-June 2017; 59 968 pregnant women (39.0%) were vaccinated against influenza and 98 583 (64.0%) against pertussis. Coverage varied by pregnancy end date, rising for influenza during winter and spring, but for pertussis rising continuously across the two years from 37.5% to 82.2%. Differences between hospitals in coverage were marked. Factors associated with vaccination included greater maternal age, primigravidity, early antenatal care, and GP-led care. The odds of vaccination were statistically significantly lower for women born overseas and those who smoked during pregnancy; the odds of vaccination were also lower for Aboriginal and Torres Strait Islander women. Conclusions: Pertussis vaccination of pregnant women in Victoria has increased, but influenza vaccination rates remain moderate and variable. Structural changes at the system level may improve maternal vaccination rates. Embedding the delivery of maternal vaccination programs in antenatal care pathways should be a priority.

Influenza and pertussis vaccination of women during pregnancy in Victoria, 2015-2017.

To assess variations by time of year and hospital in the uptake of influenza and pertussis vaccinations by pregnant women in Victoria; to identify factors associated with vaccination uptake. Retrospective analysis of data in the Victorian Perinatal Data Collection (VPDC), a population surveillance system for obstetric conditions, procedures, and pregnancy and birth outcomes. Women whose pregnancies ended in a live or stillbirth during July 2015 - June 2017. Influenza and pertussis vaccinations during pregnancy. 153980 pregnancies in 67 hospitals ended during July 2015 - June 2017; 59968 pregnant women (39.0%) were vaccinated against influenza and 98583 (64.0%) against pertussis. Coverage varied by pregnancy end date, rising for influenza during winter and spring, but for pertussis rising continuously across the two years from 37.5% to 82.2%. Differences between hospitals in coverage were marked. Factors associated with vaccination included greater maternal age, primigravidity, early antenatal care, and GP-led care. The odds of vaccination were statistically significantly lower for women born overseas and those who smoked during pregnancy; the odds of vaccination were also lower for Aboriginal and Torres Strait Islander women. Pertussis vaccination of pregnant women in Victoria has increased, but influenza vaccination rates remain moderate and variable. Structural changes at the system level may improve maternal vaccination rates. Embedding the delivery of maternal vaccination programs in antenatal care pathways should be a priority.

Postnatal care in the home: assessment and care of the jaundiced newborn at home

Understanding the prevalence of, and factors associated with, caesarean birth among immigrant populations is essential for appropriate antenatal and postnatal resource allocation.To compare rates of caesarean birth between one of the largest immigrant populations of women giving birth in Australia (Vietnamese-born women) with those of Australian-born women and investigate the odds of unplanned caesarean in these women, controlling for maternal characteristics, pregnancy complications and labour management factors.Cross-sectional analysis of data on singleton births in Victoria, Australia; using data from the routinely collected Victorian Perinatal Data Collection. Descriptive analyses comparing maternal and obstetric factors for Vietnamese-born women with Australian-born women were undertaken. Using the more recent nine years of routinely collected data, multivariable logistic regression explored the association between unplanned caesarean birth and maternal country of birth, adjusted for maternal and obstetric factors, admission status and time (n = 468,131). This association was also explored for ‘standard primiparae’ (n = 69,039).Planned and unplanned caesarean births increased dramatically in both Australian-born and Vietnamese-born women between 1984 and 2007. After adjustment for obstetric and maternal factors, Vietnamese-born women were at greater odds of an unplanned caesarean birth compared to Australian-born women (adjusted odds ratio = 1.32, 95% confidence interval = 1.25–1.40). These greater odds were also found among the ‘standard primiparae’ (adjusted odds ratio = 1.22, 95% confidence interval = 1.07–1.40).Factors other than clinical risk appear to predispose Vietnamese-born women to unplanned caesarean birth. These may include intrapartum communication, length of residence and familiarity with care systems, and variations in care practices for Vietnamese women.

Incidence, trends and severity of primary postpartum haemorrhage in Australia: A population-based study using Victorian Perinatal Data Collection data for 764244 births.

Increasing incidence and severity of postpartum haemorrhage, together with postpartum haemorrhage-associated morbidities, have been reported in many high-resource countries. In-depth analysis of such factors in Victorian births since 2002 was lacking. Our aim was to determine the incidence and trends for primary postpartum haemorrhage (World Health Organization and International Classification of Diseases 10th revision, Australian Modification definitions) for all confinements in Victoria, Australia, for the years 2003-2013 and the incidence and trends for severe postpartum haemorrhage (≥1500mL) for 2009-2013. In this population-based cross-sectional study de-identified data from the Victorian Perinatal Data Collection were analysed for confinements (excluding terminations) from 2003 to 2013 (n=764244). Perinatal information for all births ≥20weeks (or of at least 400g birthweight if gestation was unknown) were prospectively collected. One in five women (21.8%) who gave birth between 2009 and 2013 experienced a primary postpartum haemorrhage and one in 71 women (1.4%) experienced a severe primary postpartum haemorrhage. The increasing trends in incidence of primary postpartum haemorrhage, severe primary postpartum haemorrhage, blood transfusion, admission to an intensive care or high dependency unit and peripartum hysterectomy were significant (P<0.001). Women who had an unassisted vaginal birth had the lowest incidence of primary postpartum haemorrhage. The highest incidence was experienced by women who had an unplanned caesarean section birth. Women who had a forceps birth had the highest incidence of severe primary postpartum haemorrhage. The incidence of primary postpartum haemorrhage, severe primary postpartum haemorrhage and associated maternal morbidities have increased significantly over time in Victoria.

Is Prenatal Sex Selection An Issue in Australia? A Population‐Based Study of 1,191,250 Births 1999–2015 Using the Victorian Perinatal Data Collection

Is Prenatal Sex Selection An Issue in Australia? A Population‐Based Study of 1,191,250 Births 1999–2015 Using the Victorian Perinatal Data Collection

Risk of unplanned caesarean birth in Vietnamese-born women in Victoria, Australia: A cross-sectional study

BackgroundUnderstanding the prevalence of, and factors associated with, caesarean birth among immigrant populations is essential for appropriate antenatal and postnatal resource allocation. AimsTo compare rates of caesarean birth between one of the largest immigrant populations of women giving birth in Australia (Vietnamese-born women) with those of Australian-born women and investigate the odds of unplanned caesarean in these women, controlling for maternal characteristics, pregnancy complications and labour management factors. MethodsCross-sectional analysis of data on singleton births in Victoria, Australia; using data from the routinely collected Victorian Perinatal Data Collection. Descriptive analyses comparing maternal and obstetric factors for Vietnamese-born women with Australian-born women were undertaken. Using the more recent nine years of routinely collected data, multivariable logistic regression explored the association between unplanned caesarean birth and maternal country of birth, adjusted for maternal and obstetric factors, admission status and time (n=468,131). This association was also explored for ‘standard primiparae’ (n=69,039). FindingsPlanned and unplanned caesarean births increased dramatically in both Australian-born and Vietnamese-born women between 1984 and 2007. After adjustment for obstetric and maternal factors, Vietnamese-born women were at greater odds of an unplanned caesarean birth compared to Australian-born women (adjusted odds ratio=1.32, 95% confidence interval=1.25–1.40). These greater odds were also found among the ‘standard primiparae’ (adjusted odds ratio=1.22, 95% confidence interval=1.07–1.40). ConclusionFactors other than clinical risk appear to predispose Vietnamese-born women to unplanned caesarean birth. These may include intrapartum communication, length of residence and familiarity with care systems, and variations in care practices for Vietnamese women.

Accuracy of postpartum haemorrhage data in the 2011 Victorian Perinatal Data Collection: Results of a validation study

The postpartum haemorrhage (PPH) rate in Victoria in 2009 for women having their first birth, based on information reported to the Victorian Perinatal Data Collection (VPDC), was 23.6% (primiparas). Prior to 2009 PPH was collected via a tick box item on the perinatal form. Estimated blood loss (EBL) volume is now collected and it is from this item the PPH rate is calculated. Periodic assessment of data accuracy is essential to inform clinicians and others who rely on these data of their quality and limitations. This paper describes the results of a state-wide validation study of the accuracy of EBL volume and EBL-related data items reported to VPDC. PPH data from a random sample of 1% of births in Victoria in 2011 were extracted from source medical records and compared with information submitted to the VPDC. Accuracy was determined, together with sensitivity, specificity, positive predictive value and negative predictive value for dichotomous items. Accuracy of reporting for EBL ≥500mL was 97.2% and for EBL ≥1500mL was 99.7%. Sensitivity for EBL ≥500mL was 89.0% (CI 83.1-93.0) and for EBL≥1500mL was 71.4% (CI 35.9-91.8). Blood product transfusion, peripartum hysterectomy and procedures to control bleeding were all accurately reported in >99% of cases. Most PPH-related data items in the 2011 VPDC may be considered reliable. Our results suggest EBL≥1500mL is likely to be under-reported. Changes to policies and practices of recording blood loss could further increase accuracy of reporting.