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Background Increasing the detection of fetal growth restriction (FGR), while reducing stillbirth, also leads to unnecessary early intervention, and associated morbidity, for normally grown babies who are incorrectly suspected of FGR. Aims We sought to design a balance measure that addresses the specificity of FGR detection. Methods A retrospective cohort study on all singleton births ≥32 weeks gestation in 2016 and 2017 in Victoria. We compared two balance measures for the detection of FGR, defined as the proportion of all babies iatrogenically delivered before 39 weeks gestation for suspected FGR that had a birthweight ≥10th centile (balance measure 1) or ≥25th centile (balance measure 2). Hospital level performance on each balance measure was derived and compared to an existing performance measure for severe FGR detection in Victoria. Results Of the 38 hospitals analysed, 12 (32%) had a favourable performance on an existing indicator of FGR detection, seven (18%) hospitals had a favourable performance on balance measure 1, and 15 (39%) had a favourable performance on balance measure 2. There was a moderate correlation between hospital performance on the existing indicator and on balance measure 1 (r = 0.447, P = 0.005) but not balance measure 2 (r = -0.063, P = 0.71). There was no difference in perinatal mortality between high performing hospitals and low performing hospitals. Conclusion Introducing a balance measure into routine reporting may bring greater awareness to the unintended harm associated with increased detection of FGR.

BACKGROUND: Severe postpartum haemorrhage (PPH) is a serious clinical problem that is increasing in incidence. AIM: To identify risk factors for severe PPH. MATERIALS AND METHODS: 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 ≥1500 mL). RESULTS: 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 37-41 weeks, duration of labour 12 to

BACKGROUND Caesarean section (CS) rates are known to vary by country, migration status and social group. However, little population-based, confounder adjusted evidence exists on caesarean rate for African immigrants in Australia. AIM To investigate disparities in first-time caesarean, mainly unplanned caesarean in labour for women born in Eritrea, Ethiopia, Somalia and Sudan relative to Australian-born women in public care. METHODS A population-based study of 237 943 Australian and 4057 Eastern African singleton births between 1999 and 2007, was conducted using Victorian Perinatal Data Collection. Descriptive and multivariable logistic regression analysis by parity, adjusting for confounders selected a priori, was performed for first-time unplanned caesarean in labour and overall caesarean. RESULTS Primiparae born in each of the Eastern African countries had elevated odds of unplanned caesarean in labour: Eritrea adjusted odds ratio (ORadj ) 2.04 95% CI (1.41, 2.97), Ethiopia ORadj 2.08 95% CI (1.62, 2.68), Somalia ORadj 1.62 95% CI (1.25, 2.10) and Sudan ORadj 1.39 95% CI (1.03, 1.87). Similarly, multiparae from Eastern African countries had elevated odds of unplanned caesarean in labour: Eritrea ORadj 2.13 95%CI(1.15, 3.97), Ethiopia ORadj 2.05 95% CI (1.38, 3.03), Somalia ORadj 2.16 95% CI (1.69, 2.77) and Sudan ORadj 1.81 95% CI (1.32, 2.49). The odds of any first-time caesarean (planned or unplanned) were elevated for primiparae born in all countries except Sudan and for multiparae born in Ethiopia and Somalia. CONCLUSIONS We observed substantial variations in a first-time CS between Eastern African and Australian-born women in Victoria, Australia. However, these disparities were unexplained by socio-demographic and clinical risks, suggesting the potential importance of other factors such as communication difficulties, support systems for immigrant pregnant women and possible differences in care.

Background As the proportions of older women giving birth increase, there is a growing body of evidence on the increased risks of poorer maternal and perinatal outcomes for this group. However, the associations are not completely understood. This study aimed to establish the prevalence of selected maternal morbidities and examine whether advanced maternal age is associated with a higher risk of morbidity for women giving birth in Victoria. Method Data on all births over 20 weeks‧ gestation for 2005 and 2006 were obtained from the Victorian Perinatal Data Collection. Unadjusted and adjusted analyses were undertaken using logistic regression to examine and quantify the association between advanced maternal age (35 years and older) and selected obstetric morbidities and complications. Results There was evidence of an association between older maternal age and selected morbidities and complications. Older nulliparous women were at highest odds of gestational diabetes (AdjOR, 1.83; 95% CI, 1.67–2.02), placenta praevia (AdjOR, 2.02; 95% CI, 1.68–2.44), multiple birth (AdjOR, 1.80; 95% CI, 1.58–2.06) and caesarean delivery (AdjOR, 1.93; 95% CI, 1.84–2.02). Older multiparous women were at highest odds of gestational diabetes (AdjOR, 2.01; 95% CI, 1.88–2.15) and placenta praevia (AdjOR, 2.11; 95% CI, 1.83–2.44). Conclusions Older women giving birth in Victoria are at an increased risk of a range of obstetric morbidities. Delayed childbearing for an increasing number of women has societal and public health ramifications and will potentially place greater demand on healthcare services.

Background: Women from South Asia have a high incidence of gestational diabetes mellitus (GDM) placing them at risk of adverse pregnancy outcomes. Despite the higher rates of GDM in this group, there are no studies of their experiences of living with GDM in Australia or elsewhere. Aims: We aimed to explore the experiences and understandings of South Asian women in Melbourne, Australia, after diagnosis with GDM. Methods: A qualitative approach was used. Face-to-face in-depth interviews were conducted with 17 immigrant women from South Asia recently diagnosed with GDM. They were interviewed in the language of their choice at two time points: in pregnancy after GDM diagnosis and at six weeks postpartum. Thematic analysis was conducted to identify common patterns and salient themes within and across narratives, also taking into account any divergent experiences. Results: Before the diagnosis of GDM, women’s knowledge and awareness of any diabetes were low. Women and their partners were upset by the diagnosis. Dietary advice received was seen to be challenging in the context of culturally different food habits and consequently managing diet after diagnosis proved difficult. Different attitudes to exercise in pregnancy also raised issues for women. Women said they would try their best to maintain lifestyle modifications postnatally, but were uncertain about sustaining these in the long term. Conclusion: South Asian women require culturally appropriate advice regarding strategies to reduce their risk of GDM as early as possible in pregnancy, ideally at the time pregnancy is confirmed.