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Objective: The aim of this study was to evaluate the indications for maternal TORCH (Toxoplasma gondii, rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV)) serology, with a focus on the yield in isolated fetal growth restriction (FGR). Materials and Methods: A retrospective review of antenatal TORCH testing between January 2014 and December 2018 was carried out at two hospitals in Melbourne, Australia. TORCH testing ordered for pregnancy losses and stillbirth was excluded. Results: Medical records of 718 pregnancies were reviewed, representing 760 fetuses. Isolated FGR was the indication for TORCH screening in 71.2% of pregnancies. Screens ordered for isolated FGR were positive in 7.4% (95% CI 5.5–10.0%). There were 49 positive maternal immunoglobulin M (CMV = 34, Toxoplasma = 15). Two acute maternal infections during pregnancy were diagnosed (CMV = 1, Toxoplasma = 1), with both screens ordered to assess symptomatic maternal illness. There was one neonatal CMV infection, born to a woman with symptomatic primary CMV. No maternal or neonatal rubella or HSV infections were identified. We found a diagnostic yield of TORCH screening for isolated FGR of 0.0% (95% CI 0.00–0.8%). An estimated AUD$64 269.75 was expended on maternal TORCH screens in this study. Conclusion: Maternal TORCH testing for isolated FGR is of no diagnostic yield and should be abandoned. [ABSTRACT FROM AUTHOR]

Aims: To explore the incidence and complexity of women presenting for maternity care who require concurrent cancer care, and to report the birth outcomes of these women. Materials and Methods: A retrospective audit of women attending a 'high risk' maternal medicine clinic at an Australian tertiary maternity hospital between 1 October 2021 and 30 April 2023 was conducted. The inclusion criteria were a diagnosis of cancer and a concurrent pregnancy, or a diagnosis of cancer prior to the current pregnancy. Clinic lists and coding data were screened via the electronic medical record to identify potential subjects. Data were collected from the individual maternity and neonatal records. Results: Forty of 705 (5.7%) women attending the maternal medicine clinic met the inclusion criteria, of which ten had a new diagnosis of cancer in pregnancy and 30 presented for maternity care after a previous diagnosis of cancer. Cancer therapy during pregnancy included surgery and chemotherapy. Most pregnancies (92.5%) resulted in term deliveries (≥37 weeks gestation). Four neonates were preterm, and one was small‐for‐gestational‐age. Caesarean section delivery and post‐partum haemorrhage were more common than expected, but the rate of other adverse pregnancy outcomes was consistent with the background population. Over half of neonates required neonatal intensive care unit / special care nursery admission but the indications for admission were common, self‐limiting conditions, and the length of stay was short (mean <5.0 days). Conclusions: Approximately 6% of women attending the maternal medicine clinic had a current or previous diagnosis of cancer. Most pregnancies resulted in term deliveries and neonatal outcomes were excellent. [ABSTRACT FROM AUTHOR]

Objective: To identify perceived barriers and enablers for rural women in accessing perinatal care within their own community from the perspective of perinatal health care providers. Design: A qualitative descriptive study design utilising reflexive thematic analysis, using the socioecological framework to organise and articulate findings. Setting: Victoria, Australia. Participants: Semi‐structured interviews were conducted with nine perinatal health care providers who provide care to pregnant women or new mothers in rural communities. Participants were recruited across Victoria in 2023. Results: Providers reported multi‐level barriers and enablers that exist for rural women in accessing perinatal care within their communities. Barriers included women's personal circumstances, challenging professional relationships, inequitable service provision, ineffective collaboration between services and clinicians and government funding models and policies. Enablers included strength and resilience of rural women, social capital within rural communities, flexible care delivery and innovative practice, rural culture and continuity of care models. Conclusion: Rural perinatal health care providers perceived that rural women face multiple barriers that are created or sustained by complex interpersonal, organisational, community and policy factors that are intrinsic to rural health care delivery. Several addressable factors were identified that create unnecessary barriers for rural women in engaging with perinatal care. These included education regarding health systems, rights and expectations, equitable distribution of perinatal services, improved interprofessional relationships and collaborative approaches to care and equity‐based funding models for perinatal services regardless of geographical location. [ABSTRACT FROM AUTHOR]

It is estimated that over 1 billion people worldwide have a disability. In Australia, 9% of women of childbearing age have a disability, but data on disability status for women accessing maternity services are not routinely collected and data collection processes are inconsistent. Maternal disability may affect perinatal outcomes, but to understand what factors might be amenable to interventions to improve outcomes, accurate data collection on disability status is essential. This opinion piece reflects on disability identification within maternity services in Australia, identifying areas for policy and practice change. [ABSTRACT FROM AUTHOR]

Background: Economic evaluations are being conducted with increasing frequency in the maternity care setting, with more randomized controlled trials containing a health economic component. Key emerging criticisms of economic evaluation in maternity care are lack of robust data collection and measurement, inconsistencies in methodology, and lack of adherence to reporting guidelines. Methods: This article provides a guide to the design of economic evaluations alongside clinical trials in maternal health. We include economic concepts and considerations for the maternity setting and provide examples from the UK and Australia. Results: There are many important considerations for the design of economic evaluations alongside clinical trials. To be effective, researchers must select types of economic evaluation, which align with their study objectives; choose an appropriate evaluation perspective, time horizon, and discount rate; and identify accurate ways to measure and evaluate health outcomes and costs. Discussion: This guide is written for noneconomists and can be used for designing economic evaluations to be conducted as a part of clinical trials. We seek to improve the quality, consistency, and transparency of economic evaluations in maternal health. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: To use co‐design principles to design a nationwide maternity experiences survey and to distribute the survey through social media. Design: A co‐designed, cross sectional, and national online survey. Methods: Using co‐design principles from study design and throughout the research process a cross‐sectional, online, national survey of Australian women's experiences of maternity care was designed. Four validated survey instruments were included in the survey design. Results: An extensive social media strategy was utilized, which included paid advertising, resulting in 8804 surveys for analysis and 54,896 comments responding to open text questions. Discussion: The inclusion of co‐design principles contributed to a well‐designed survey and consumer involvement in distribution and support of the online survey. The social media distribution strategy contributed to high participation rates with overall low marketing costs. Clinical Relevance: Maternity services should be designed to provide woman‐centered, individualized care. This survey was co‐designed with maternity users and maternity organizations to explore women's recent experiences of maternity care in Australia. The outcomes of this study will highlight the factors that contribute to positive and negative experiences in maternity services. Patient or Public Contribution: As a co‐designed study, there was consumer engagement from the design of the study, throughout the research process. [ABSTRACT FROM AUTHOR]

Background: Perinatal mental health disorders affect up to 20% of all women. Women of refugee background are likely to be at increased risk, yet little research has explored this. This study aimed to assess if women of refugee background are more likely to screen risk positive for depression and anxiety than non‐refugee women, using the Edinburgh Postnatal Depression Scale (EPDS); and if screening in pregnancy using the EPDS enables better detection of depression and anxiety symptoms in women of refugee background than routine care. Methods: This implementation study was conducted at an antenatal clinic in Melbourne, Australia. Women of refugee and non‐refugee backgrounds were screened for depression using English or translated versions of the EPDS and a psychosocial assessment on a digital platform. The psychosocial assessment records of 34 women of refugee background receiving routine care (no screening) were audited. Results: Overall, 274 women completed the EPDS; 43% of refugee background. A similar proportion of women of refugee and non‐refugee backgrounds had EPDS scores of ≥9 (39% vs. 40% p = 0.93). Women receiving the combined EPDS and psychosocial screening were more likely to receive a referral for further support than women receiving routine care (41% vs. 18%, p = 0.012). Conclusion: Similarly, high proportions of women of refugee and non‐refugee backgrounds were at increased risk of experiencing a current depressive disorder in early pregnancy, suggesting pregnancy care systems should acknowledge and respond to the mental health needs of these women. Screening appeared to facilitate the identification and referral of women compared to routine care. [ABSTRACT FROM AUTHOR]

Background: Woman‐centered maternity service delivery is endorsed by Australian federal health policy. Despite this, little evaluation of maternity care is conducted through the lens of women. We examined the responses of women birthing in Australia to the international Babies Born Better 2018 (Version 2) open‐response survey. Methods: An online international survey was distributed primarily by means of social media for women who had given birth in the last 5 years. In addition to closed‐ended questions to describe the sample, a series of open‐ended questions recorded women's experiences and satisfaction with their maternity care and place of birth. Results: Of 1249 women who reported birthing their most recent baby in Australia and speaking English, 84% responded to at least one open‐ended evaluation question. We thematically analyzed the data to identify three related themes of safety, choice, and respect for women. Women's experiences of these were closely tied to their model of care; those birthing at home with a private midwife more so reported positive experiences than those discussing obstetric care or, to a lesser extent, midwifery‐led care in a hospital. There was a strong preference and need for (1) access to affordable care with a known practitioner from early pregnancy to postpartum, and (2) individualized care with the removal of restrictive hospital policies not aligned with woman‐centered practice. Discussion: This is the first Australian national study of women's maternity experiences and evaluations. Consistent with previous state‐based research, women birthing in Australia continue to report maternity "care" that is physically and emotionally harmful. They also stated a need to address the psychosocial aspects of becoming a mother, in addition to the biological ones. Women and other birthing people must be at the center of defining quality maternity health service delivery, and services must be accountable for preventing and addressing harm, as defined by all birthing people. [ABSTRACT FROM AUTHOR]

Perinatal mental health (PMH) disorders affect about one in seven women in the peripartum period with significant maternal and neonatal effects. It is important to understand trends in PMH to plan for necessary resource allocation. This study reviews the PMH trends in a major tertiary obstetric centre over 10 years from 2013 to 2022. Over this period there was a significant increase in the rates of anxiety from 7.4 to 18.4% (P < 0.001), depression from 13.6 to 16.3% (P < 0.001) and anxiety and/or depression from 16.5 to 22.6% (P < 0.001). These findings provide further information for resource allocation to improve long‐term outcomes. [ABSTRACT FROM AUTHOR]

Antenatal cannabis consumption is common and associated with adverse perinatal outcomes, including low birthweight, pre‐term birth and increased rates of admission to neonatal intensive care. Cannabinoid hyperemesis syndrome (CHS) comprises severe, cyclical episodes of vomiting, intractable nausea and abdominal pain observed in chronic cannabis users. CHS, particularly during pregnancy, poses a diagnostic dilemma with a tendency to be ineffectively managed secondary to reduced clinician awareness and a scarcity of available therapies. This clinical perspective explores the current literature on CHS in pregnancy, available pharmacotherapeutics, and recognises the current barriers to improving clinical care. [ABSTRACT FROM AUTHOR]

Background: Maternity care is a high‐volume and high‐cost area of health care, which entails various types of service use throughout the course of the pregnancy. Thus, the aim of this study was to explore the most common reasons and related costs of health services used by women and babies from pregnancy to 12‐month postbirth. Methods: We used linked administrative data from one state of Australia, which contained all births in Queensland between 01/07/2017 and 30/06/2018. Descriptive analyses were used to identify the 10 most frequent reasons and related costs for accessing inpatient, outpatient, emergency department, and Medicare services. These are reported separately for women and babies in different periods. Results: We included 58,394 births in our data set. The results have highlighted that there was relatively uniform use of inpatient, outpatient, and Medicare services by women and babies, with the 10 most common services accounting for more than half of the total services accessed. However, the emergency department service use was more diverse. Medicare services accounted for the greatest volume (79.21%) of service events but only 10.21% of the overall funding, compared with inpatient services, which accounted for less volume (3.62%) but the highest amount of overall funding (75.19%). Conclusion: Study findings provide empirical evidence about the full spectrum of services used by birthing families and their babies, and could assist health providers and managers to understand the services women and infants actually access during pregnancy, birth, and postbirth. [ABSTRACT FROM AUTHOR]

KEY POINTS: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy liver disease, characterised by pruritus and increased total serum bile acids (TSBA), Australian incidence 0.6–0.7%.ICP is diagnosed by non‐fasting TSBA ≥19 μmol/L in a pregnant woman with pruritus without rash without a known pre‐existing liver disorder.Peak TSBA ≥40 and ≥100 μmol/L identify severe and very severe disease respectively, associated with spontaneous preterm birth when severe, and with stillbirth, when very severe.Benefit‐vs‐risk for iatrogenic preterm birth in ICP remains uncertain.Ursodeoxycholic acid remains the best pharmacotherapy preterm, improving perinatal outcome and reducing pruritus, although it has not been shown to reduce stillbirth. [ABSTRACT FROM AUTHOR]

The views expressed here are based on my professional experience as a consultant obstetrician, and previous role as clinical head of service for a small (<1800 births/year) obstetric unit in Perth metro. The obstetric unit in which I work has no 24/7 on‐site staffed theatre capacity, no high dependency unit, and at night is staffed by a resident medical officer and junior obstetric registrar, with a consultant on‐call within 30 min travel time. Based on my review of the literature on obstetric services nationally and various state guidelines (see Sources section), other Australian metro‐located obstetric services appear to have similar challenges, but in this paper I focus on the health service models and patient safety systems that I am most familiar with (Perth metro) and ask why obstetric services in this, and by inference, other areas of the country which have similar high population density, would continue to have these staffing/service profiles. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to evaluate the association of a low cerebroplacental ratio (CPR) with hypoxic ischaemic encephalopathy (HIE), severe neonatal morbidity (SNM) and perinatal mortality (PNM). Methods: This was a retrospective cohort study of late‐preterm and term births at Mater Mothers' Hospital, Brisbane, between 2016 and 2020. Study outcomes were HIE, PNM and SNM (a composite of severe acidosis, Apgar score less than four at 5 min, severe respiratory distress or need for significant cardiopulmonary resuscitation at birth). Univariate and multivariable logistic regressions were used to determine if a low CPR was associated with HIE, SNM or PNM. Results: A total of 51 870 births met the inclusion criteria. Of these, 216 (0.42%) were complicated by HIE, 10 224 (19.7%) had SNM and 251 (0.48%) had PNM. Rates of low CPR (<10th and <5th centile) were significantly higher in the SNM cohort (20.1 and 13.2%, respectively) and PNM cohort (21.1 and 15.1%, respectively) compared to the overall cohort. A low CPR was associated with significantly increased adjusted odds for SNM but not for HIE or PNM. The area under the receiver operating characteristic curve for CPR <10th centile was greatest for SNM (0.768) and lowest for HIE (0.595). Predictive margins of a low CPR for HIE, SNM and PNM were significant only for SNM at late‐preterm gestations. Conclusions: A low CPR is associated with increased odds of SNM in infants born >34 weeks' gestation but not for HIE or PNM. [ABSTRACT FROM AUTHOR]

Introduction: Current Australian guidelines differ in their recommendations on optimal iron deficiency anaemia screening and management during pregnancy. A more active approach to screening and treatment of iron deficiency in pregnancy has been beneficial within a tertiary population. However, this approach has not been evaluated within a regional healthcare setting. Objective: To evaluate the clinical impact of standardised screening and management for iron deficiency in pregnancy within a regional Australian centre. Design: Single centre, retrospective cohort observational study that audited medical records pre and post implementation of standardised screening and management for antenatal iron deficiency. We compared rates of anaemia at birth, rates of peripartum blood transfusions and rates of peripartum iron infusions. Findings: There were 2773 participants with 1372 participants in the pre‐implementation group and 1401 in the post‐implementation group. Participant demographics were similar. Anaemia at admission for birth decreased from 35% to 30% (RR 0.87, 95% CI (0.75, 1.00), p 0.043) Fewer blood transfusions were required (16 (1.2%) pre‐implementation, 6 (0.4%) post‐implementation, RR 0.40, 95% CI(0.16, 0.99), p 0.048). Antenatal iron infusions increased from 12% to 18% of participants post implementation (RR 1.47, 95% CI(1.22, 1.76), p 〈0.001).We audited compliance with the guidelines and found improvements post implementation. Discussion: This is the first study to show clinically useful and statistically significant reduction in rates of anaemia and blood transfusions, post implementation of routine ferritin screening and management within a regional Australian population. Conclusion: The results of this study suggest there is benefit to implementation of standardised ferritin screening and management packages in Australian antenatal care. It also encourages RANZCOG to review current recommendations on screening for iron deficiency anaemia during pregnancy. [ABSTRACT FROM AUTHOR]

Low‐carbohydrate diets (LCDs) are popular among people attempting weight loss and recommended for pregnant women with gestational diabetes (GDM), but they may increase health risks if nutritionally inadequate. We aimed to describe the dietary intake of post‐partum women according to their relative carbohydrate intake, overall, and among women attempting weight loss or diagnosed with GDM in their recent pregnancy. This cross‐sectional population‐based cohort study included 2093 post‐partum women aged 25–36 years who participated in the Australian Longitudinal Study on Women's Health. Dietary intake was assessed using a validated food frequency questionnaire. Relative carbohydrate intake was determined using a previously developed LCD score. Data were weighted to account for oversampling of women from rural/remote areas. More than half of women (n[weighted] = 1362, 66.3%) were trying to lose weight, and 4.6% (n[weighted]=88) had GDM in their recent pregnancy. Women with the lowest relative carbohydrate intake (LCD score quartile 4) consumed 36.8% of total energy intake from carbohydrates, and had a lower intake of refined grains, whole grains, fruit and fruit juice, and a higher intake of red and processed meat, compared with women with the highest relative carbohydrate intake (quartile 1). Different food groups, both healthy and unhealthy, were restricted depending on whether women were attempting weight loss and had recent GDM. These findings may reflect a lack of knowledge among post‐partum women on carbohydrates and dietary guidelines. Health professionals may have an important role in providing advice and support for post‐partum women who wish to restrict their carbohydrate intake, to ensure optimal diet quality. Key messages: Low‐carbohydrate diets have become increasingly popular, but they may increase health risks if nutritionally inadequate.In a national population‐based study of Australian post‐partum women, relatively low carbohydrate intake was associated with healthy and unhealthy food choices, including consumption of less refined grains and fruit juice, but also less whole grains and fruit and more red meat and processed meat.Given the critical role of carbohydrate quantity and quality in disease prevention, health professionals should inform and support women who wish to restrict their carbohydrate intake to consume a balanced diet in line with dietary guidelines. [ABSTRACT FROM AUTHOR]

Background: Childhood maltreatment (CM) is associated with both dietary fat intake and obesity in later life. There is less information on associations with metabolic risk factors and specific types of CM such as physical, sexual and emotional abuse, as well as neglect. Aims: To assess the association between five types of self‐reported CM and a range of obesity and metabolic indicators in a subsample of a birth cohort. Methods: This was a study of 1689 adults born in a major metropolitan maternity hospital in Australia and followed up 30 years later. Body mass index, bioimpedance and fasting lipid levels/insulin resistance were measured. Details on self‐reported CM were collected using the Child Trauma Questionnaire. We adjusted for birth weight, parental income and relationship at participants' birth, as well as maternal age and alcohol or tobacco use. We also adjusted for participants' smoking, depression, educational level, marital and employment status at follow up. Results: One‐fifth reported maltreatment (n = 362), most commonly emotional neglect (n = 175), followed by emotional abuse (n = 128), physical neglect (n = 123), sexual (n = 121) and physical abuse (n = 116). On adjusted analyses, there were significant associations for CM, particularly neglect or emotional abuse, and one or more of the following outcomes: obesity, the total cholesterol/high‐density lipoprotein cholesterol (TC/HDL‐C) ratio and HDL levels. Results for other outcomes were more equivocal. Conclusions: Of child maltreatment types, emotional abuse and neglect show the strongest associations with obesity and several cardiometabolic risk factors, therefore highlighting the public health importance of early intervention to reduce childhood adversity. [ABSTRACT FROM AUTHOR]

Background: Neonatal hypoxic ischaemic encephalopathy (HIE) is the most common cause of encephalopathy in the neonatal period and carries a high risk of mortality and long‐term morbidity. Aim: The aim of this study was to investigate key antecedents of moderate and severe HIE in a large contemporary birth cohort. Methods: A retrospective cohort study of births meeting criteria was conducted between 2016 and 2020 at the Mater Mothers' Hospital, Brisbane, Australia. This is a quaternary perinatal centre and Australia's largest maternity hospital. Univariate and multivariate Firth logistic regression were used to account for imbalanced frequency classes between non‐HIE and HIE groups. Maternal variables and intrapartum factors were investigated for associations with neonatal moderate and severe HIE. Results: Overall, 133 of 46 041 (0.29%) infants were diagnosed with HIE: 77 (0.17%) with mild HIE and 56 (0.12%) with moderate/severe HIE. Nulliparity, type 1 diabetes mellitus and maternal intensive care unit admission were associated with increased odds of moderate/severe HIE. Intrapartum risk factors included emergency caesarean birth, emergency caesarean for non‐reassuring fetal status or failure to process, intrapartum haemorrhage and an intrapartum sentinel event (shoulder dystocia, cord prolapse, uterine rupture and placental abruption). Neonatal risk factors included male sex, late preterm gestation (35+0–36+6 weeks), Apgar score less than four at 5 min, severe respiratory distress requiring ventilatory support and severe acidosis at birth. Conclusions: This cohort study identified a series of potentially modifiable maternal and obstetric risk factors for HIE. Risk factors for HIE do not appear to have changed significantly with evolution in modern obstetric care. [ABSTRACT FROM AUTHOR]

Background: Familial hypercholesterolaemia (FH) is associated with a significant increase in the risk of premature coronary artery disease. Pregnancy is likely a vulnerable time for atherosclerosis progression, with a physiological rise in low‐density lipoprotein cholesterol (LDL‐C) further exaggerated by the discontinuation of cholesterol‐lowering therapy. Materials and Methods: A retrospective review was undertaken of 13 women with familial hypercholesterolemia who were managed during pregnancy between 2007 and 2021 by a multidisciplinary team following individualised risk assessment. Results: Overall, pregnancy outcomes were good, with no maternal or fetal complications, including congenital abnormalities, maternal cardiac events or hypertensive complications. Loss of statin treatment time ranged between 12 months and 3.5 years resulting from the accumulation of the preconception, pregnancy and lactation periods and was magnified in women having more than one pregnancy. Of seven women treated with cholestyramine, one developed abnormal liver function with an elevated international normalisation ratio which was corrected with vitamin K. Conclusion: Pregnancy is associated with prolonged cessation of cholesterol‐lowering therapy, a concern with respect to the risk of coronary artery disease in FH. Continuation of statin therapy up to conception and even during pregnancy in patients at higher risk of cardiovascular disease may be justified, especially with increasing evidence supporting the safety of statin therapy during pregnancy. However, more long‐term maternal and fetal data are required for the routine use of statins during pregnancy. Guideline‐informed models of care covering family planning and pregnancy should be implemented for all women with FH. [ABSTRACT FROM AUTHOR]

Little is published on cytomegalovirus (CMV) serological screening at the first antenatal visit or the contemporary CMV seroprevalence rates among the Australian pregnant population. We performed a retrospective analysis of public hospital births in a major tertiary centre (n = 840) over a two month period. We found that 13.6% (95% confidence interval (CI) 11.4–16.1%) of women had been screened for CMV at their first antenatal visit with their general practitioner. Of these, 43.0% (95% CI 34.3–52.1%) were CMV seronegative and therefore susceptible to primary infection. Seronegative women were also more likely to have been born in an economically developed country, to live in a socio‐economically advantaged postcode and to be nulliparous. The information from this study may help guide future studies of congenital CMV risk reduction strategies. [ABSTRACT FROM AUTHOR]

Access to postpartum contraception is critical for the health of the mother and subsequent pregnancies. However, the differential roles and responsibilities of maternity care providers in contraception discussions and provision are often unclear. Our study, part of a larger study on midwifery provision of contraceptive implants, presents the perspectives of hospital‐based maternity clinicians. Participants suggested that contraception discussions and provision are a shared responsibility of maternity care providers but identified inconsistencies and issues with current approaches. Access to contraception could be improved through more routine discussions antenatally and postnatally and greater collaboration between maternity care providers in hospital, community and primary care settings. [ABSTRACT FROM AUTHOR]

Background: Early warning systems (EWS) are used across health care settings as a tool for the early identification of clinical deterioration and to determine the need to escalate care. Early detection of clinical deterioration and appropriate escalation of care in maternity settings is critical to the safety of pregnant women and infants; however, underutilization of EWS tools and reluctance to escalate care have been consistently reported. Little is known about midwives' use of EWS in the Australian context. Methods: Using a cross‐sectional approach, we elicited the attitudes, beliefs, and behaviors of a purposive sample of Australian midwives (n = 87) with respect to the Maternal Early Warning Trigger Tool (MEWT). Participants answered a 25‐question Likert scale survey and one open‐ended question. Qualitative answers were analyzed using consensus coding. Results: Midwives reported positive attitudes toward the MEWT, describing it as a valuable tool for identifying clinical deterioration, especially when used as an adjunct to clinical judgment. However, midwives also identified training gaps; 25% had received no training, and only half of those who had received training felt it was effective. In addition, professional tension can create a significant barrier to the effective use of the MEWT. Midwives also reported feeling influenced by their peers in their decision‐making with respect to use of the MEWT and being afraid they would be chastised for escalating care unnecessarily. Conclusions: Although the MEWT is valued by Australian midwives as a useful tool, barriers exist to its effective use. These include a lack of adequate, ongoing training and professional tension. Improving interdisciplinary collaboration could enhance the use of this tool for the safety of birthing women and their infants. [ABSTRACT FROM AUTHOR]

Background: Peripartum antibiotics are commonly administered. Little is known of the attitudes of pregnant women toward peripartum antibiotics. Aim: We aimed to assess the awareness of and attitudes toward peripartum antibiotic use in Australian women. Materials and Methods: We surveyed post‐partum women at three hospitals over six months. Women reported if they received antibiotics 48 h either side of delivery and responded to statements assessing attitudes to peripartum antibiotic use. Administered antibiotics were recorded. We reported the proportion receiving antibiotics and the proportion aware of receiving them. Participants responded on five‐point Likert scales and selected side effects of concern. Results: Participants responding were 248 of 299 (83%, Royal Brisbane and Women's Hospital), 56 of 106 (53%, Caboolture Hospital) and 17 (Redcliffe Hospital, denominator not recorded). Of 183 (57%) receiving antibiotics, 134 (73%) received them pre‐delivery only, 18 (10%) post‐delivery only and 31 (17%) pre‐ and post‐delivery. Pre‐delivery, the most common indication was pre‐incisional prophylaxis for caesarean delivery (93 of 160 responses, 58%). Seventy‐nine (51%, 156 responses) of those receiving pre‐delivery antibiotics were aware. Of 49 women receiving post‐delivery antibiotics, 36 (73%) were aware. Most agreed they were worried that pre‐delivery antibiotics would affect their baby (198, 62%) and 160 (50%) were concerned about effects on their own microbiome. Most (204, 65%) agreed they would rather not take antibiotics while breastfeeding. Conclusion: Many women were unaware of receiving pre‐delivery antibiotics. Most had concerns about side effects. Improved communication regarding peripartum antibiotic use would improve patient‐centred care. [ABSTRACT FROM AUTHOR]

Objective: Perinatal emotional well‐being is more than the presence or absence of depressive and anxiety disorders; it encompasses a wide range of factors that contribute to emotional well‐being. This study compares perinatal well‐being between women living in metropolitan and rural regions. Design: Prospective, longitudinal cohort. Participants/setting: Eight hundred and six women from Victoria and Western Australia recruited before 20 weeks of pregnancy and followed up to 12 months postpartum. Main outcome measures: Rurality was assessed using the Modified Monash Model (MM Model) with 578 in metropolitan cities MM1, 185 in regional and large rural towns MM2‐MM3 and 43 in rural to remote MM4‐MM7. The Structured Clinical Interview for DSM‐IV (SCID‐IV) was administered at recruitment to assess depression, and symptoms of depression and anxiety were measured using the Edinburgh Post‐natal Depression Scale and the State and Trait Anxiety Scale, respectively. Other measures included stressful events, diet, exercise, partner support, parenting and sleep. Results: The prevalence of depressive disorders did not differ across rurality. There was also no difference in breastfeeding cessation, exercise, sleep or partner support. Women living in rural communities and who also had depression reported significantly higher parenting stress than metropolitan women and lower access to parenting activities. Conclusions: Our study suggests while many of the challenges of the perinatal period were shared between women in all areas, there were important differences in parenting stress and access to activities. Furthermore, these findings suggest that guidelines and interventions designed for perinatal mental health should consider rurality. [ABSTRACT FROM AUTHOR]

Aims: The primary aim of the review was to provide an overall assessment of residential parenting services in Australia, by describing the characteristics of infants and parents using residential parenting services, their prior service use and reasons for admission, referral pathways for access and parenting and infant outcomes. The secondary aims were to explore parent and staff perception of the programmes. Design: An integrative literature review. Methods: A systematic and comprehensive search of health and social sciences databases was conducted for studies related to residential parenting services (published between 1st January 1990–31st December 2019). Six hundred and eleven peer‐reviewed papers were identified, after which 301 duplicates were removed and an additional 256 papers excluded after titles/abstracts were read. Of the remaining 54 abstracts/papers, a further 14 were omitted as not relevant. Forty papers were independently reviewed by four authors. ENTREQ and MOOSE checklists were applied. Results: Thirty studies were quantitative, nine were qualitative, and one was mixed methods. All studies originated from in Australia. Women and babies admitted to residential parenting services were found more likely to be: older, Australian born, from higher socio‐economic groups, and first‐time mothers, and having labour and birth interventions and a history of mental health disorders. The babies were more likely to be twins, male and admitted with sleep disorders and dysregulated behaviour. Studies reporting postintervention outcomes demonstrated improvements to maternal mental health, breastfeeding, parenting confidence and sleep quality, and infant sleeping and behaviour. [ABSTRACT FROM AUTHOR]

Background: Women with rheumatic heart disease (RHD) can have a lower cardiac reserve to cope with pregnancy and labour, leading to increased obstetric and cardiac risks. The Northern Territory has been repeatedly reported to have the highest prevalence of RHD in Australia, yet evidence specific to pregnancy is scarce in the literature. Aims: The primary aim of this paper is to describe the baseline characteristics and maternal outcomes of pregnant women with RHD presenting to the largest obstetrics referral hospital in the Northern Territory. The secondary aim is to evaluate the current model of care in relation to their cardiac status. Methods: A retrospective observational study was conducted over a 9.5‐year period. Demographics, cardiac, obstetrics and anaesthetics data were collected for analysis. Results: One hundred and twenty‐nine pregnancies were included for analysis. All women were identified as Aboriginal or Torres Strait Islander, and 85% were of a RHD priority of 2 or 3. Of all 28 patients who had an emergency caesarean section, only one patient was indicated for cardiac reasons. There was no maternal or neonatal death reported. Three preterm births were induced secondary to maternal concerns related to RHD cardiac decompensation. There were no major adverse neonatal outcomes, including neonatal death, intraventricular haemorrhage or respiratory distress syndrome. Multidisciplinary care was also evaluated. Conclusion: We observed a low rate of maternal and fetal morbidity and no mortality in a cohort of women with mild to severe RHD. These favourable outcomes have occurred in a multidisciplinary centre with significant experience in managing the medical and cultural complexities of this group. [ABSTRACT FROM AUTHOR]

Background: New South Wales Health introduced the new Tiered Networking Arrangements for Perinatal Care in New South Wales policy directive (TPN Policy), which defined key performance and quality indicators after implementation. Aims: This study aims to assess the success of the TPN Policy implementation in the Western Sydney TPN in accordance with key performance indicators. Materials and Methods: This is a retrospective cohort study of acute perinatal transfers within the Western Sydney TPN between 1 December 2019 to 31 December 2020. The primary outcome is compliance with objectives of the TPN Policy, as measured as an Aggregate Compliance Score comprising the five measures. Secondary outcomes include clinical, neonatal and logistics outcomes. Results: There were 181 acute perinatal transfers within, into or out of the Western Sydney TPN between 1 December 2019 to 31 December 2020. There were 122 transfers within the network, 40 into the TPN and 19 were out of the TPN. All groups were at least partially compliant with the TPN Policy. No transfers in any of groups scored below three ('partially compliant'). A quarter of transfers gave birth within 24 h of transfer. Over half of those who were transferred and admitted went on to give birth prior to discharge or transfer. Conclusions: Overall, the TPN Policy met its objectives after implementation in the Western Sydney TPN, while maintaining appropriate neonatal outcomes. All women arrived at an appropriate facility prior to giving birth, although the majority did not give birth within 24 h. Neonatal intensive care unit bed availability is a key limitation to future improvement. [ABSTRACT FROM AUTHOR]

Objective: To determine the epidemiology, clinical management, and outcomes of women with gestational breast cancer (GBC). Methods: A population‐based prospective cohort study was conducted in Australia and New Zealand between 2013 and 2014 using the Australasian Maternity Outcomes Surveillance System (AMOSS). Women who gave birth with a primary diagnosis of breast cancer during pregnancy were included. Data were collected on demographic and pregnancy factors, GBC diagnosis, obstetric and cancer management, and perinatal outcomes. The main outcome measures were preterm birth, maternal complications, breastfeeding, and death. Results: Forty women with GBC (incidence 7.5/100 000 women giving birth) gave birth to 40 live‐born babies. Thirty‐three (82.5%) women had breast symptoms at diagnosis. Of 27 women diagnosed before 30 weeks' gestation, 85% had breast surgery and 67% had systemic therapy during pregnancy. In contrast, all 13 women diagnosed from 30 weeks had their cancer management delayed until postdelivery. There were 17 preterm deliveries; 15 were planned. Postpartum complications included the following: hemorrhage (n = 4), laparotomy (n = 1), and thrombocytopenia (n = 1). There was one late maternal death. Eighteen (45.0%) women initiated breastfeeding, including 12 of 23 women who had antenatal breast surgery. There were no perinatal deaths or congenital malformations, but 42.5% of babies were preterm, and 32.5% were admitted for higher‐level neonatal care. Conclusions: Gestational breast cancer diagnosed before 30 weeks' gestation was associated with surgical and systemic cancer care during pregnancy and planned preterm birth. In contrast, cancer treatment was deferred to postdelivery for women diagnosed from 30 weeks, reflecting the complexity of managing expectant mothers with GBC in multidisciplinary care settings. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Blended teaching combines traditional in‐person components (simulation‐based training and clinical‐based placement) with online resources. Due to the COVID‐19 pandemic, we modified our Women's Health Interprofessional Learning through Simulation (WHIPLS) program – to develop core obstetric and gynaecological skills – into a blended teaching program. There is limited literature reporting the observations of blended teaching on learning. Aims: To qualitatively evaluate the blended teaching program and explore how it contributes to learning. Materials and Methods: This study was performed at Monash University in Melbourne, Australia. A total of 98 medical students and 39 midwifery students participated. Data were collected by written survey and analysed by authors using a thematic analysis framework. Results: Students reported that in‐person teaching remains a vital aspect of their curriculum, contributing an averaged 63.2% toward an individual's learning, compared with online. Five substantial themes demonstrate how students learnt and maximised education opportunities using a blended teaching program: 'low‐pressure simulation environments', 'peer‐assisted learning', 'haptic learning', 'scaffolded learning' and 'the impact of online discourse'. Discussion: In‐person teaching remains a cornerstone of obstetric and gynaecological clinical skills education, of which interprofessional simulation and clinical‐based placement are key components. Teaching via online discourse alone, is not sufficient to completely replace and provide comparable learning outcomes, but certainly plays an important role to prime students' learning and to maximise in‐person opportunities and resources. Our study reveals key pedagogies of a blended (online and in‐person) learning program, providing further evidence to support its ongoing utility as a feasible and warranted approach to learning. [ABSTRACT FROM AUTHOR]

Ambivalence in Australian thought on induction of labour, despite recent evidence, stands out in contrast to ever‐increasing rates of this intervention. As consent obligations on information provision have crystallised in maternity care, this article examines whether consumer‐led expectations and legal obligations may precipitate change to end the cultural stigma around induction of labour. [ABSTRACT FROM AUTHOR]

Background: The World Health Organisation recommends that induction of labour (IOL) be performed only with a clear medical indication. Australian rates of IOL appear to be rising, with more than one‐third of women having labour induced. This may reflect changing clinician and consumer perceptions of the benefits and potential harms of term IOL. Aims: To understand recent trends in the rates and indications for IOL. Materials and Methods: A retrospective cohort study was undertaken in a Level 6 maternity facility, in metropolitan South‐East Queensland, Australia. Routinely collected data were gathered between 2015 and 2020. Exclusion criteria were multiple pregnancies, stillbirth and pre‐labour rupture of membranes. Pre‐labour rupture of membranes was excluded due to inability to assess if IOL for this indication was a true induction or augmentation of labour. Indications for induction were grouped into maternal, fetal, elective indications, 'post‐dates' and decreased fetal movements (DFM). Rates of IOL and frequency of the various indications were compared over time. Results: About 46 530 livebirths occurred during the study period, with labour induced in 31.7%. The proportion of women undergoing IOL increased from 29.8% in 2015 to 33.4% in 2019 (P < 0.001). The proportion of inductions for DFM and elective indications increased over time, with a substantial decrease in 'post‐dates' IOL. Conclusions: This large contemporary analysis of IOL trends in Australia has demonstrated rising rates and changing indications for IOL. There remain large knowledge gaps in areas such as care of women with DFM, definitions and management of 'post‐term pregnancy', and the economic and service impacts of rising trends in the rate of IOL. [ABSTRACT FROM AUTHOR]

Background: Severe maternal morbidity or maternal near miss (MNM) events can have significant consequences for individuals, their families and society and the study of these events may inform practices to reduce future adverse pregnancy outcomes. Aims: To review the scope of MNM studies undertaken in Australia, New Zealand, South‐East Asia and the South Pacific region. Materials and Methods: A systematic search of four online databases (MEDLINE, EMBASE, SCOPUS and CINAHL) and the World Health Organization Library was conducted to identify all relevant studies published between 1 January 2011 and 31 December 2020. The studies were reviewed and included if they assessed MNM using a composite outcome or a predefined set of indicators. Results: The literature search yielded 143 articles of which 49 are included in this review. There were substantial differences in the monitoring approach to MNM in the Australasian region. Overall rates of MNM in the region ranged from two to 100/1000 births and the most common aetiologies identified were direct obstetric causes such as postpartum haemorrhage, pre‐eclampsia and sepsis. Multidisciplinary review indicated a substantial number of MNM cases were preventable or amenable to improved management, mostly from a provider perspective. Conclusions: Assessment of MNM is an important part of the evaluation of maternity care provision. Reaching a consensus on indicators and how best to collect information will allow a more discerning assessment of MNM including longer‐term health outcomes, aspects of preventability and financial implications for health services. [ABSTRACT FROM AUTHOR]

This study explored clinician perceptions of women's participation in decision‐making about antiemetic treatments during pregnancy, and the suitability of the five Choosing Wisely questions to increase women's involvement. The qualitative interpretive descriptive design used semi‐structured interviews to capture data. Participants were six obstetricians and six midwives experienced in providing care for pregnant women seeking support for nausea and vomiting at a single private, obstetrician‐led maternity health service in Australia. Thematic analysis revealed four themes that captured clinician perspectives about women's participation in decision‐making about antiemetic treatments: (i) information gathering; (ii) developing an understanding; (iii) using knowledge; and (iv) making decisions. Clinician attitudes and perspectives, as well as their self‐reported styles of communication and negotiation, influenced how they engaged with women during decision‐making. While unfamiliar with the five Choosing Wisely questions, almost all participants considered them potentially useful, but for other clinicians. Strategies to actively involve women in decision‐making about antiemetics were inconsistently used. The five Choosing Wisely questions may provide a useful tool for clinicians, but further research is needed to better understand women's perspectives and clinician‐related barriers to shared decision‐making. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has led to multiple changes in maternity services worldwide. Systems rapidly adapted to meet public health requirements aimed at preventing transmission of SARS‐CoV‐2, including quarantine procedures, travel restrictions, border closures, physical distancing and "stay‐at‐home" orders. Although these changes have impacted all stakeholders in maternity services, arguably the women at the center of this care have been most affected. This study aimed to explore women's experiences of receiving maternity care during the COVID‐19 pandemic in Australia. Methods: A national cross‐sectional online survey, including fixed choice and open‐ended questions, was conducted during the first wave of the COVID‐19 pandemic in Australia; pregnant and postnatal women were recruited through social media networks. Results: The survey was completed by 3364 women. Women felt distressed and alone due to rapid changes to their maternity care. Limited face‐to‐face contact with health practitioners and altered models of care often required women to accommodate significant changes and to coordinate their own care. Women felt that they were often "doing it alone," due to public health restrictions on support people and visitors, both within and outside health services. Women described some benefits of visitor restrictions, such as, more time for rest, breastfeeding establishment, and bonding with their baby. Conclusions: This large nationwide Australian study provides unique data on women's experiences of receiving maternity care during the COVID‐19 pandemic. Lessons learned provide an opportunity to rebuild and reshape the maternity sector to best meet the needs of women and their families during current and future public health crises. [ABSTRACT FROM AUTHOR]

Background: Reports from around the world suggest that rates of preterm birth decreased during COVID‐19 lockdown measures. Aims: To compare the prevalence of preterm birth and stillbirth rates during COVID‐19 restriction measures with infants born at the same maternity centre during the same weeks in 2013–2019. Materials and Methods: Deidentified data were extracted from the Mater Mothers' healthcare records database. This is a supra‐regional tertiary perinatal centre. Logistic regressions were used to examine singleton live preterm birth rates during the beginning of COVID‐19 restrictions (16 March‐17 April; 'early'; 6955 births) and during the strictest part of COVID‐19 restrictions (30 March‐1 May; 'late'; 6953 births), according to gestational age subgroups and birth onset (planned or spontaneous). We adjusted for multiple covariates, including maternal age, body mass index, ethnicity, parity, socioeconomic status, maternal asthma, diabetes mellitus and/or hypertensive disorder. Singleton stillbirth rates were also examined between 16 March–1 May. Results: Planned moderate/late preterm births declined by more than half during early COVID‐19 restrictions compared with the previous seven years (29 vs an average of 64 per 1000 births; adjusted odds ratio 0.39, 95% CI 0.22–0.71). There was no effect on extremely or very preterm infants, spontaneous preterm births, or stillbirth rates. Rolling averages from January to June revealed a two‐week non‐significant spike in spontaneous preterm births from late April to early May, 2020. Conclusions: Together with evidence from other nations, the pandemic provides a unique opportunity to identify causal and preventative factors for preterm birth. [ABSTRACT FROM AUTHOR]

Data regarding transthoracic echocardiography (TTE) application to obstetric patients are scant. Often, anaesthetists preparing for caesarean section are unaware of the proportion of obstetric patients who have relevant cardiac disease. This audit aimed at undertaking a retrospective analysis of TTE performed in intensive care unit patients after caesarean section. Over five years, 56 women were eligible. Echocardiographic abnormalities were deemed relevant if graded as of moderate severity. The most common reason was dyspnoea (41%). Echocardiography demonstrated structural abnormality in 29% or functional abnormality in 38%. It may be appropriate to undertake preoperative echocardiography more commonly in high‐risk obstetric patients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the variations in care received by mothers and families within a sustained home visiting program. We sought to identify the extent to which there were variations in home visiting care in response to the program schedule and families' risk factors. Design and sample: Data collected within the right@home program, a randomized controlled trial (RCT) for a sustained nurse home visiting intervention in Australia, were analyzed. A total of 352 women comprised the intervention arm of the trial. Measurements: Visit content in the home visiting program, sociodemographic data, and families' risk factors were used for analysis. Results: Our results confirmed that the majority of women received scheduled content on time or within an acceptable timeframe, except for the sleeping program. Women with identified risks were significantly more likely to receive content related to those risks than women without those risks (smoking: Odds Ratio [OR] = 15.39 [95%CI 3.7–64.7], mental health: OR = 15.04 [1.8–124.0], domestic violence: OR = 4.07 [2.0–8.3], and drugs and alcohol: OR = 1.81 [1.1–3.0]). Conclusions: The right@home program had high compliance with the scheduled content. Capacity development in responding to mothers with the risk of domestic violence and drugs and alcohol is recommended. Further research is required to explore the relationship between variations in care and critical outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the potential implications for obstetric and gynaecological practice in Australia with managed care. Topics include Australia Competition and Consumer Commission (ACCC) released a ‘draft determination' regarding a proposal from a commercial group known as Honeysuckle Health; and Concerns about buying-group mediated ‘managed care' have also come from diverse medical specialties such as anaesthetists and psychiatrists.

In this clinical review we highlight aspects of the diagnosis and management of pulmonary embolism (PE) in pregnancy and post‐partum and how this may impact on antenatal and postnatal management. Investigation for PE in pregnancy is challenging and includes appropriate patient selection and knowledge of the risks and benefits of pulmonary imaging modalities. The complete Society of Obstetric Medicine of Australia and New Zealand Position Statement on Pulmonary Embolism in Pregnancy and Post‐Partum comprehensively reviews all aspects of diagnosis, investigation and management and is accessible at https://www.somanz.org/guidelines.asp. It includes a summary of all recommendations and a guide to developing a management plan for birth in women on anticoagulation. [ABSTRACT FROM AUTHOR]

Background: The Safer Baby Bundle (SBB) eLearning is an online education module that addresses practice gaps in stillbirth prevention in Australia. It provides healthcare professionals with evidence‐based resources for: smoking cessation; fetal growth restriction; decreased fetal movements; maternal safe going‐to‐sleep position; and timing of birth for women with risk factors for stillbirth. Aims: To determine whether participants' reported knowledge and confidence in providing care designed to reduce stillbirth changed following completion of the module. To assess the module's suitability and acceptability, and participants' reported likelihood to change practice. Materials and methods: In‐built surveys undertaken pre‐ and post‐eLearning module assessed participant knowledge and confidence, module suitability and acceptability, and likelihood of practice change using Likert items. Responses were dichotomised. Differences pre‐ and post‐module were tested using McNemar's test and differences by profession were examined using descriptive statistics and Pearson's χ2 test. Results: Between 15 October 2019 and 2 November 2020, 5223 participants across Australia were included. Most were midwives (82.0%), followed by student midwives (4.6%) and obstetricians (3.3%). Reported knowledge and confidence improved in all areas (P < 0.001). Post‐module 96.7–98.9% 'agreed' they had a sound level of knowledge and confidence across all elements of the SBB. Over 95% of participants agreed that the module was helpful and relevant, well organised, and easy to access and use. Eighty‐eight percent reported they were likely to change some aspect of their clinical practice. Conclusions: The SBB eLearning module is a valuable education program that is well‐received and likely to result in improvements in practice. [ABSTRACT FROM AUTHOR]

The article discusses the need for coordinated action to boost rural women's access to maternity services in Australia in 2022. Topics covered include such women's need of high quality care in the perinatal period, very remote communities' lesser likelihood of having birthing service, and the relocation and away-from-home birth options of expecting women in remote locations. Also noted is the lack of a consistent national strategy on the issue despite support by major stakeholders.

Background: In Australia, it is estimated that 9.5% of women of childbearing age have a disability; however, little is known about their perinatal outcomes. Disability status is not routinely recorded in perinatal datasets. Aims: To compare the outcomes of women with a disability who received pregnancy care through a specialised disability clinic at the Royal Women's Hospital (the Women's) in Melbourne, Australia with hospital‐wide perinatal outcome data. Materials and Methods: Routinely collected perinatal data for women who received pregnancy care from the 'Women with Individual Needs' (WIN) clinic from 2014‐2018 (N = 111) were analysed and then compared with routinely collected electronic hospital data obtained from all women who had given birth at the Women's in 2017 and 2018 (N = 15 024). Results: Women who attended the WIN clinic were more likely to have a caesarean section birth (52% vs 32%; P < 0.001) and give birth preterm (17% vs 4%; P < 0.001) than those in the hospital‐wide cohort. Their infants were more likely to be low birthweight (20% vs 9%; P < 0.001), require resuscitation (35% vs 11%; P < 0.001), be admitted to the Neonatal Intensive Special Care Unit (29% vs 13%; P < 0.001) and receive formula in hospital (54% vs 28%; P < 0.001) compared to infants in the other group. Conclusions: Routine maternity data collection should include identification of women with a disability to enable appropriate support and to allow further exploration of potential poorer outcomes on a larger sample, to help identify factors amenable to interventions that may improve outcomes. [ABSTRACT FROM AUTHOR]

Issue addressed: Coverage of maternal influenza and pertussis vaccines remains suboptimal in Australia, and pockets of low childhood vaccine coverage persist nationwide. Maternal vaccine uptake is estimated to be between 35% and 60% for influenza vaccination and between 65% and 80% for pertussis vaccination. Australian midwives are highly trusted and ideally placed to discuss vaccines with expectant parents, but there are no evidence‐based interventions to optimise these discussions and promote maternal and childhood vaccine acceptance in the Australian public antenatal setting. Methods: We gathered qualitative data from Australian midwives, reviewed theoretical models, and adapted existing vaccine communication tools to develop the multi‐component P3‐MumBubVax intervention. Through 12 interviews at two Australian hospitals, we explored midwives' vaccination attitudes and values, perceived role in vaccine advocacy and delivery, and barriers and enablers to intervention implementation. Applying the theory‐based P3 intervention model, we designed intervention components targeting the Practice, Provider and Parent levels. Midwives provided feedback on prototype intervention features through two focus groups. Results: The P3‐MumBubVax intervention includes practice‐level prompts and identification of a vaccine champion. Provider‐level components are a vaccine communication training module, learning exercise, and website with printable fact sheets. Parent‐level intervention components include text message reminders to receive influenza and pertussis vaccines in pregnancy, as well as online information on vaccine safety, effectiveness and disease severity. Conclusions: The P3‐MumBubVax intervention is the first Australian antenatal intervention designed to support both maternal and childhood vaccine uptake. A pilot study is underway to inform a planned cluster randomised controlled trial. So what?: Barriers to vaccine acceptance and uptake are complex. The P3 model is a promising evidence‐informed multi‐component intervention strategy targeting all three levels influencing health care decision‐making. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic meant rapid changes to Australian maternity services. All maternity services have undertaken significant changes in relation to policies, service delivery and practices and increased use of personal protective equipment. Aims: The aim of this study was to explore and describe doctors' experiences of providing maternity care during the COVID‐19 pandemic in Australia. Methods: A national online survey followed by semi‐structured interviews with a cohort of participants was conducted during the first wave of the COVID‐19 pandemic in Australia (May–June 2020). Participants were recruited through social media networks. Eighty‐six doctors completed the survey, and eight were interviewed. Results: Almost all doctors reported rapid development of new guidelines and major changes to health service delivery. Professional colleges were the main source of new information about COVID‐19. Most (89%) doctors felt sufficiently informed to care for women with COVID‐19. Less than half of doctors felt changes would be temporary. Doctors described workforce disruptions with associated personal and professional impacts. The ability to access and process up‐to‐date, evidence‐based information was perceived as important. Doctors acknowledged that altered models of care had increased pregnant women's anxiety and uncertainty. All doctors described silver linings from sector changes. Conclusions: This study provides unique insights into doctors' experiences of providing maternity care during the COVID‐19 pandemic in Australia. Findings have immediate relevance to the maternity sector now and into the future. Lessons learnt provide an opportunity to reshape the maternity sector to better prepare for future public health crises. [ABSTRACT FROM AUTHOR]

Background: Pre‐existing diabetes in pregnancy is associated with an increased risk of complications. Likewise, living in rural, regional and remote Victoria, Australia, is also associated with poorer health outcomes. There is a gap in the literature with regard to whether Victorian women with pre‐existing diabetes experience a greater risk of adverse pregnancy outcomes compared to their metropolitan counterparts. Aim: Our objective is to compare obstetric and perinatal outcomes for women with pre‐existing diabetes delivering in rural vs metropolitan hospitals in Victoria, Australia. Materials and Methods: Retrospective population‐based study using routinely collected state‐based data of singleton births to women with type 1 and type 2 diabetes who delivered in metropolitan (n = 3233) and rural hospitals (n = 693) in Victoria, Australia, between 2006–2015. Pearson's χ2 test, Fisher's exact test and MannWhitney U‐test were used to compare obstetric and perinatal outcomes between metropolitan and rural locations. Results: Delivery in a rural hospital was associated with higher rates of stillbirth (2.3% vs 1.1%, P = 0.027), macrosomia (25.9% vs 16.9%, P < 0.001), shoulder dystocia (8.4% vs 3.5%, P < 0.001) and admission to the neonatal intensive care unit/special care nursery (73.2% vs 59.3%, P < 0.001). Smoking (18.0% vs 8.9%, P < 0.001), overweight/obesity (P = 0.047) and socioeconomic disadvantage (P < 0.001) were more common in rural women. Conclusions: Women with pre‐existing diabetes who deliver in rural hospitals experience a greater risk of adverse perinatal outcomes and present with increased maternal risk factors. These results suggest a need to improve care for women with pre‐existing diabetes in rural Victoria. [ABSTRACT FROM AUTHOR]

An editorial is presented on the improving maternity care in Victoria, Australian, an accidental learning healthcare system. Topics include the aim of delivering higher quality and safer care for all patients and the learning healthcare system has been proposed as a valuable structural reform to healthcare, and the progressive changes to Victorian maternity services have accidentally has delivered a learning system that is poised for formalising.

Background: In Australia, perinatal care is provided through a mix of government and private funding. Women who give birth in a private hospital are less likely to receive depression screening and psychosocial assessment and are less likely to access parenting services that support mental health outcomes, compared to women who give birth in a public hospital. Aim: The aim of this study was to determine the risk of one outcome of perinatal mental illness – hospital admission – for women who gave birth in private hospitals compared to women who gave birth in public hospitals. Methods: This population‐based cohort study employed binary regression analysis of state government data. Linkage of the Perinatal Data Collection, Registry of Births, Deaths and Marriages, and Admitted Patients Data Collection (2003–2009) has provided comparative information on women admitted to any hospital during the first year after birth with a primary diagnosis of mental illness. Results: In the first year after birth, women who gave birth in private hospitals were more likely to be admitted to a hospital with a primary diagnosis of mental illness (rate = 2.54%, 95% CI = 2.40–2.68%) than women who gave birth in public hospitals (rate = 1.68%, 95% CI = 1.61–1.75%). Conclusion: The increased likelihood of admission for postnatal mental illness may indicate increased risk of developing a mental illness for women who gave birth in a private hospital. [ABSTRACT FROM AUTHOR]

Perinatal depression can have enduring adverse effects on women and their children and families, incurring substantial ongoing economic and personal costs. A significant proportion of the cost of perinatal depression relates to adverse impacts on the child, most likely mediated through impairment to the mother‐infant relationship. In recognition of this problem, Australia has invested in routine perinatal depression screening. Our previous research produced convergent findings suggesting that expected benefits for children have not yet been realised through perinatal depression screening. We question the potential of including a measure of personality in current perinatal depression screening for identifying maternal mental health problems and suboptimal mother‐infant relationships. This paper reviews our previous research findings within the broader context of perinatal depression screening. We propose a position, that perinatal depression screening in Australia should be redesigned to more precisely detect vulnerable mother‐infant relationships, parenting, maternal mental health, and infant psychosocial and psychological development. Practice change to appropriately target antenatal interventions may more efficiently improve both maternal and child outcomes, thereby contributing to greater efficiency and cost savings for the health system. [ABSTRACT FROM AUTHOR]