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Background There is controversy about the interaction between melanoma and pregnancy. There is a lack of Australian data on pregnancy outcomes associated with melanoma in pregnancy, despite Australia having the highest incidence of melanoma in the world. Aims Describe trends, maternal characteristics and pregnancy outcomes associated with pregnancy-associated melanoma in New South Wales. Materials and Methods Population-based cohort study of all births ( n = 1 309 501) of at least 20-week gestation or 400 g birthweight in New South Wales, 1994-2008. Logistic regression was used to analyse the association between melanoma in pregnancy and adverse birth outcomes. Results 577 pregnancy-associated melanomas were identified, including 195 diagnosed during pregnancy and 382 diagnosed within 12 months postpartum. The crude incidence of pregnancy-associated melanoma increased from 37.1 per 100 000 maternities in 1994 to 51.84 per 100 000 maternities in 2008. Adjusting for maternal age accounted for the trend in pregnancy-associated melanoma. Melanomas diagnosed in pregnancy were thicker (median = 0.75 mm) than melanomas diagnosed postpartum (median = 0.60 mm) ( P = 0.002). Pregnancy-associated melanoma was associated with the increased risk of large-for-gestational-age infant but not preterm birth, planned birth, caesarean section or stillbirth. Parity was inversely associated with pregnancy-associated melanoma, as women with three or more previous pregnancies had 0.59 times the odds of pregnancy-associated melanoma compared to nulliparous women (95% CI 0.42-0.84, P = 0.003). Conclusions The incidence of pregnancy-associated melanoma has increased with increasing maternal age. The observation of thicker melanomas in pregnancy and increased risk of large-for-gestational-age infants may suggest a role for growth-related pregnancy factors in pregnancy-associated melanoma. [ABSTRACT FROM AUTHOR]

We determined recent trends and recurrence rates of placenta praevia in 790,366 deliveries in NSW. From 2001 to 2009, the rate of placenta praevia increased by 26%, from 0. 69% to 0. 87% (trend P < 0.001). The placenta praevia recurrence rate in a second birth was 4.8%. Two-thirds of the increase in placenta praevia was accounted for by trends in known risk factors, and the unexplained portion may reflect changes in unidentified risk factors or in the threshold for placenta praevia diagnosis. [ABSTRACT FROM AUTHOR]

This study investigated strategies for ascertaining pre-eclampsia, pregnancy hypertension and gestational diabetes mellitus from birth records and/or hospital discharge data. The results showed that ascertaining these conditions from a data set that linked birth records to the corresponding maternal hospital record for birth was sufficient for health outcomes research. Antenatal hospital records provided few extra cases and may be necessary only for the ascertainment when a very accurate estimate of the prevalence is required. [ABSTRACT FROM AUTHOR]

Background Cervical cerclage is used in an attempt to reduce recurrence risk of preterm birth, but evidence for use is limited. Aims To compare pregnancy outcomes among women with a single previous midtrimester delivery when managed with or without a cervical cerclage. Materials and methods Population-based cohort study of all women in New South Wales, Australia with a singleton pregnancy ending in birth/miscarriage ≥14 and <28 weeks, between 2003 and 2011. Modified Poisson regression was used to compare outcomes in the next subsequent pregnancy, for women with a cerclage inserted <14 weeks, and those without cerclage. The primary outcome was gestational age <37 weeks at birth/miscarriage in the next pregnancy. Secondary outcomes included: maternal morbidity, preterm prelabour rupture of membranes ( PPROM), stillbirth/neonatal death and composite neonatal morbidity for liveborn infants ≥28 weeks. Adjusted risk ratios ( ARR) and 95% confidence intervals ( CI) were determined. Results Five thousand, six hundred and ninety-eight births/miscarriages were potential index deliveries. Of these, 2175 women had an eligible subsequent pregnancy: 108 received cerclage at <14 weeks gestation, 2067 did not. Women with cerclage were significantly more likely to deliver <37 weeks than those without (39.8% vs 19.3%, ARR 1.92, 95% CI 1.48-2.48), and had increased risks of PPROM ( ARR 4.38, 95% CI 2.62-7.32) and stillbirth/neonatal death ( ARR 2.20, 95% CI 1.02-4.73). Following cerclage, liveborn infants ≥28 weeks had double the risk of severe morbidity ( ARR 2.54, 95% CI 1.55-4.16). Conclusions In women with a single previous midtrimester delivery, cervical cerclage <14 weeks gestation in subsequent pregnancy was associated with worse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background Changes in clinical practice and in the characteristics of childbearing women have the potential to influence the rate of obstetric anal sphincter injuries ( OASIS). To date, little investigation has been undertaken to assess the effect of risk factor trends for the Australian population on OASIS rates. Aims To ascertain the OASIS rates amongst singleton vaginal births ≥37 weeks gestation in NSW, 2001 - 2009; to determine risk factor effect sizes and trends; and to compare predicted with observed OASIS rates. Methods Using two linked population-based data sets, risk factors for OASIS were determined by logistic regression. Contingency tables and predictive modelling were used to determine trends and predicted rates of OASIS, respectively. Results The OASIS rate increased from 2.2% in 2001 to 2.9% in 2009. Highest risks were for forceps deliveries without episiotomy (primiparas aOR 6.10, multiparas aOR 6.15), followed by multiparas with no previous vaginal birth ( aOR 5.61). High birthweight, vacuum delivery and Asian country of birth posed risks for all women. The greatest risk factor trends were increases in Asian country of birth and vacuum delivery, while the greatest trend amongst protective factors was an increase in maternal age ≥35 years for primiparas. Predicted OASIS rates were lower than observed rates. Conclusion In an environment of changing demographic and clinical risk factors, the OASIS rate has increased. This increase is only minimally explained by the identified risk factors and may be related to other unmeasured risk factors or a possible increase in clinical ascertainment and/or documentation of OASIS. [ABSTRACT FROM AUTHOR]

Aim To determine the trends in oxytocin use at a population level within New South Wales and to assess the maternal and neonatal morbidities associated with the use of oxytocin. Methods Trends in oxytocin use were assessed for women in NSW who were nulliparas at term with a singleton, cephalic fetus between 1998 and 2008. Maternal and neonatal morbidities were assessed in 2007-2008 using linked hospital and birth data with regression analysis. Oxytocin was also assessed by indication for use being either induction or augmentation of labour. Results The overall use of oxytocin increased from 10 291 (36.5%) of births in 1998 to 14 440 (45.4%) of births in 2008 ( P < 0.0001) with the increase entirely because of the increased use for induction of labour. The use of oxytocin was associated with an increase in regional analgesia (65 to 22%), instrumental delivery (21 to 18%) and caesarean section (29 to 14%) as compared to women who did not receive oxytocin in labour. Oxytocin was also associated with an increase in severe maternal adjusted odds ratios (( aOR) 1.48, 95% CI 1.30-1.68) and neonatal morbidity ( aOR 1.29, 95% CI 1.17-1.41). This increase in morbidity was maintained when both augmentation and induction were assessed separately. Conclusion Oxytocin has an important role in the management of labour. However, its use should be carefully monitored with standardised treatment regimes to minimise maternal and neonatal morbidity. [ABSTRACT FROM AUTHOR]

Background: As age is not modifiable, pregnancy risk information based on age alone is unhelpful for older women. Aim: To determine severe morbidity/mortality rates for women aged ≥35 years according to maternal profile based on parity, pre‐existing medical conditions and prior pregnancy complications, and to assess the independent contribution of age. Materials and methods: Population‐based record‐linkage study using NSW hospitalisation and birth records 2006–2012. Maternal and perinatal mortality/morbidity were assessed for non‐anomalous singleton births to women aged ≥35 years. Results: For 117 357 pregnancies among 99 375 women aged ≥35 years, the median age at delivery was 37 years (range 35–56 years), including: 35 652 (30.4%) multiparae without pre‐existing medical or obstetric complications, 33,058 (28.2%) nulliparae without pre‐existing medical conditions and 30 325 (25.8%) multiparae with prior pregnancy complications. Maternal and perinatal mortality/morbidity varied by maternal profile with ranges of 0.9–3.5% and 2.4–11.9%, respectively. For nulliparae, each five‐year increase in age did not contribute significantly to maternal risk after controlling for medical conditions (adjustedodds ratio 1.08, 95% CI 0.93–1.25), but did confer perinatal risk (1.14; 1.05–1.25). For multiparae, each five‐year increase in age beyond 35 years was independently associated with adverse maternal (1.23; 1.09–1.39) and perinatal outcomes (1.23; 1.09–1.39). Conclusions: For women aged ≥35 years, presence of medical conditions conferred a greater risk for morbidity/mortality than age itself. For multiparous women, the effects of medical and obstetric history were additive. The contribution of maternal age to adverse outcomes in pregnancies without significant medical and obstetric history is modest. [ABSTRACT FROM AUTHOR]