136 results on '"Torvaldsen S"'
Search Results
2. Blood Transfusion Following Intended Vaginal Birth After Cesarean Versus Elective Repeat Cesarean Section in Women With a Prior Primary Cesarean: A Population‐based Record Linkage Study
- Author
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Pont, S., Austin, K., Ibiebele, I., Torvaldsen, S., Patterson, J., and Ford, J.
- Published
- 2019
- Full Text
- View/download PDF
3. Childhood outcomes following preterm prelabor rupture of the membranes (PPROM): a population-based record linkage cohort study
- Author
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Roberts, C L, Wagland, P, Torvaldsen, S, Bowen, J R, Bentley, J P, and Morris, J M
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- 2017
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4. Maternal and Neonatal Outcomes Following Abnormally Invasive Placenta: A Population-based Record Linkage Study
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Baldwin, H.J., Patterson, J.A., Nippita, T.A., Torvaldsen, S., Ibiebele, I., Simpson, J.M., and Ford, J.B.
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- 2018
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- View/download PDF
5. Observational methods in epidemiologic assessment of vaccine effectiveness
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Torvaldsen, S and McIntyre, PB
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- 2002
6. Using the Australian Childhood Immunisation Register to track the transition from whole-cell to acellular pertussis vaccines
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McIntyre, PB, Torvaldsen, S, and Hull, BP
- Published
- 2002
7. Two-year outcomes of an adjunctive telephone coaching and electronic contact intervention for adolescent weight-loss maintenance: the Loozit randomized controlled trial
- Author
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Nguyen, B, Shrewsbury, V A, OʼConnor, J, Steinbeck, K S, Hill, A J, Shah, S, Kohn, M R, Torvaldsen, S, and Baur, L A
- Published
- 2013
- Full Text
- View/download PDF
8. Emerging sodium fusidate resistance in Western Australian methicillin- resistant Staphylococcus aureus
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Riley, T and Torvaldsen, S
- Published
- 1996
9. TWO-YEAR OUTCOMES OF AN EXTENDED ADOLESCENT WEIGHT-LOSS MAINTENANCE INTERVENTION INVOLVING NOVEL ADDITIONAL THERAPEUTIC CONTACT: THE LOOZIT® RANDOMISED CONTROLLED TRIAL: 701 accepted poster
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Nguyen, B., Shrewsbury, V., OʼConnor, J., Steinbeck, K., Hill, A., Shah, S., Kohn, M., Torvaldsen, S., and Baur, L.
- Published
- 2012
10. The role of parents in pre-adolescent and adolescent overweight and obesity treatment: a systematic review of clinical recommendations
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Shrewsbury, V. A., Steinbeck, K. S., Torvaldsen, S., and Baur, L. A.
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- 2011
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- View/download PDF
11. Perinatal outcomes following bariatric surgery between a first and second pregnancy: a population data linkage study
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Ibiebele, I, primary, Gallimore, F, additional, Schnitzler, M, additional, Torvaldsen, S, additional, and Ford, JB, additional
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- 2019
- Full Text
- View/download PDF
12. Intrapartum Epidural Analgesia and Breastfeeding: A Prospective Cohort Study
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Torvaldsen, S, Roberts, C, Simpson, J, Thompson, J, and Ellwood, D
- Published
- 2006
13. Under-estimation of maternal and perinatal mortality revealed by an enhanced surveillance system: Enumerating all births and deaths in Pakistan
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Anwar, J, Torvaldsen, S, Sheikh, M, Taylor, R, Anwar, J, Torvaldsen, S, Sheikh, M, and Taylor, R
- Abstract
Background: Reliable and timely data on maternal and neonatal mortality is required to implement health interventions, monitor progress, and evaluate health programs at national and sub-national levels. In most South Asian countries, including Pakistan, vital civil registration and health information systems are inadequate. The aim of this study is to determine accurate maternal and perinatal mortality through enhanced surveillance of births and deaths, compared with prior routinely collected data. Methods: An enhanced surveillance system was established that measured maternal, perinatal and neonatal mortality rates through more complete enumeration of births and deaths in a rural district of Pakistan. Data were collected over a period of 1 year (2015/16) from augmentation of the existing health information system covering public healthcare facilities (n = 19), and the community through 273 existing Lady Health Workers; and with the addition of private healthcare facilities (n = 10), and 73 additional Community Health Workers to cover a total study population of 368,454 consisting of 51,690 eligible women aged 18 to 49 years with 7580 pregnancies and 7273 live births over 1 year. Maternal, neonatal, perinatal and stillbirth rates and ratios were calculated, with comparisons to routine reporting from the previous period (2014-15). Results: Higher maternal mortality, perinatal mortality and neonatal mortality rates were observed through enhanced surveillance compared to mortality rates in the previous 1.5 years from the routine monitoring system from increased completeness and coverage. Maternal mortality was 247 compared to 180 per 100, 000 live births (p = 0.36), neonatal mortality 40 compared to 20 per 1, 000 live births (p < 0.001), and perinatal mortality 60 compared to 47 per 1000 live births (p < 0.001). All the mortality rates were higher than provincial and national estimates proffered by international agencies based on successive Pakistan Demographic and Hea
- Published
- 2018
14. Perinatal outcomes following bariatric surgery between a first and second pregnancy: a population data linkage study.
- Author
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Ibiebele, I, Gallimore, F, Schnitzler, M, Torvaldsen, S, Ford, JB, and Ford, J B
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BARIATRIC surgery ,PREGNANCY ,PREMATURE labor ,NEURODEVELOPMENTAL treatment for infants ,NEONATAL intensive care ,INFANT care ,NEONATAL surgery - Abstract
Objectives: To describe the population of women having bariatric surgery and compare the pregnancy outcomes for women having bariatric surgery with a non-bariatric surgery population having a first and second pregnancy.Design: Population-based record linkage study.Setting: New South Wales (NSW), Australia.Population: All women aged 15-45 years with a hospital record in NSW (2002-2014) and all women giving birth in NSW (1994-2015; n = 1 606 737 women).Methods: Pregnancy and birth outcomes were compared between first and second pregnancies using repeated-measures logistic regression and paired Student's t-tests. Bariatric and non-bariatric groups were also compared.Main Outcome Measures: Maternal diabetes, preterm birth (<37 weeks of gestation) and large for gestational age.Results: There was a 13-fold increase in hospitalisations for primary bariatric surgery during 2002-2014. Compared with the general birthing population, women who had bariatric surgery experienced higher rates of hypertension, diabetes, and preterm birth. Among women who had bariatric surgery between a first and second pregnancy, there were reduced rates of hypertension (OR 0.39, 95% CI 0.29-0.53), spontaneous preterm birth (OR 0.37, 95% CI 0.16-0.86), infants that were large for gestational age (OR 0.63, 95% CI 0.44-0.88), and the admission of infants to a special care nursery or neonatal intensive care (OR 0.64, 95% CI 0.46-0.90) in the second pregnancy. Rates for small-for-gestational age and gestational diabetes following surgery were 8.3 and 11.4%, respectively CONCLUSIONS: Bariatric surgery between a first and second pregnancy was associated with reductions in obesity-related adverse pregnancy outcomes. Bariatric surgery performed for the management of obesity in accordance with current clinical criteria is associated with improved pregnancy outcomes in a subsequent pregnancy.Tweetable Abstract: Bariatric surgery for obesity may improve pregnancy and birth outcomes in a subsequent pregnancy. [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
- View/download PDF
15. Therapeutic antibodies for infectious diseases
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Sparrow, E, Friede, M, Sheikh, M, Torvaldsen, S, Sparrow, E, Friede, M, Sheikh, M, and Torvaldsen, S
- Published
- 2017
16. Eye health services for Aboriginal people in the western region of NSW, 2010
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Maher, L, Brown, AM, Torvaldsen, S, Dawson, AJ, Patterson, JA, and Lawrence, G
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Ophthalmology ,Oceanic Ancestry Group ,Eye Diseases ,genetic structures ,Humans ,New South Wales ,Healthcare Disparities ,Ambulatory Care Facilities ,Health Services Accessibility ,eye diseases - Abstract
To assess the availability, accessibility and uptake of eye health services for Aboriginal people in western NSW in 2010. The use of document review, observational visits, key stakeholder consultation and service data reviews, including number of cataract operations performed, to determine regional service availability and use. Aboriginal people in western NSW have a lower uptake of tertiary eye health services, with cataract surgery rates of 1750 per million for Aboriginal people and 9702 per million for non-Aboriginal people. Public ophthalmology clinics increase access to tertiary services for Aboriginal people. Eye health services are not equally available and accessible for Aboriginal people in western NSW. Increasing the availability of culturally competent public ophthalmology clinics may increase access to tertiary ophthalmology services for Aboriginal people. The report of the review was published online, and outlines a list of recommendations.
- Published
- 2012
17. Short-term outcomes of community-based adolescent weight management: The Loozit (R) Study
- Author
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Shrewsbury, VA, Nguyen, B, O'Connor, J, Steinbeck, KS, Lee, A, Hill, AJ, Shah, S, Kohn, MR, Torvaldsen, S, and Baur, LA
- Abstract
Background: The Loozit® Study is a randomised controlled trial investigating extended support in a 24 month community-based weight management program for overweight to moderately obese, but otherwise healthy, 13 to 16 year olds. Methods: This pre-post study examines the two month outcomes of the initial Loozit® group intervention received by both study arms. Adolescents (n = 151; 48% male) and their parents separately attended seven weekly group sessions focused on lifestyle modification. At baseline and two months, adolescents’ anthropometry, blood pressure, and fasted blood sample were assessed. Primary outcomes were two month changes in body mass index (BMI) z-score and waist-to-height-ratio (WHtR). Secondary outcomes included changes in metabolic profile, selfreported dietary intake/patterns, physical and sedentary activities, psychological characteristics and social status. Changes in outcome measures were assessed using paired samples t-tests for continuous variables or McNemar’s test for dichotomous categorical variables. Results: Of the 151 adolescents who enrolled, 130 (86%) completed the two month program. Among these 130 adolescents (47% male), there was a statistically significant (P < 0.01) reduction in mean [95% CI] BMI (0.27 kg/m2 [0.41, 0.13]), BMI z-score (0.05 [0.06, 0.03]), WHtR (0.02 [0.03, 0.01]), total cholesterol (0.14 mmol/L [0.24, 0.05]) and low-density lipoprotein cholesterol (0.12 mmol/L [0.21, 0.04]). There were improvements in all psychological measures, the majority of the dietary intake measures, and some physical activities (P < 0.05). Time spent watching TV and participating in non-screen sedentary activities decreased (P < 0.05). Conclusions: The Loozit® program may be a promising option for stabilizing overweight and improving various metabolic factors, psychological functioning and lifestyle behaviors in overweight adolescents in a community setting.
- Published
- 2011
18. Factors associated with the use and quality of antenatal care in Nepal: A population-based study using the demographic and health survey data
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Joshi, C, Torvaldsen, S, Hodgson, R, Hayen, A, Joshi, C, Torvaldsen, S, Hodgson, R, and Hayen, A
- Abstract
Background: Good quality antenatal care (ANC) reduces maternal and neonatal mortality and improves health outcomes, particularly in low-income countries. Quality of ANC is measured by three dimensions: number of visits, timing of initiation of care and inclusion of all recommended components of care. Although some studies report on predictors of the first two indicators, no studies on the third indicator, which measures quality of ANC received, have been conducted in Nepal. Nepal follows the World Health Organization's recommendations of initiation of ANC within the first four months of pregnancy and at least four ANC visits during the course of an uncomplicated pregnancy. This study aimed to identify factors associated with 1) attendance at four or more ANC visits and 2) receipt of good quality ANC.Methods: Data from Nepal Demographic and Health Survey 2011 were analysed for 4,079 mothers. Good quality ANC was defined as that which included all seven recommended components: blood pressure measurement; urine tests for detecting bacteriuria and proteinuria; blood tests for syphilis and anaemia; and provision of iron supplementation, intestinal parasite drugs, tetanus toxoid injections and health education.Results: Half the women had four or more ANC visits and 85% had at least one visit. Health education, iron supplementation, blood pressure measurement and tetanus toxoid were the more commonly received components of ANC. Older age, higher parity, and higher levels of education and household economic status of the women were predictors of both attendance at four or more visits and receipt of good quality ANC. Women who did not smoke, had a say in decision-making, whose husbands had higher levels of education and were involved in occupations other than agriculture were more likely to attend four or more visits. Other predictors of women's receipt of good quality ANC were receiving their ANC from a skilled provider, in a hospital, living in an urban area and being expo
- Published
- 2014
19. Influenza vaccination during pregnancy: A qualitative study of the knowledge, attitudes, beliefs, and practices of general practitioners in Central and South-Western Sydney
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Maher, L, Dawson, A, Wiley, K, Hope, K, Torvaldsen, S, Lawrence, G, Conaty, S, Maher, L, Dawson, A, Wiley, K, Hope, K, Torvaldsen, S, Lawrence, G, and Conaty, S
- Abstract
Background: Pregnant women have an increased risk of influenza complications. Influenza vaccination during pregnancy is safe and effective, however coverage in Australia is less than 40%. Pregnant women who receive a recommendation for influenza vaccination from a health care provider are more likely to receive it, however the perspectives of Australian general practitioners has not previously been reported. The aim of the study was to investigate the knowledge, attitudes, beliefs, and practices of general practitioners practicing in South-Western Sydney, Australia towards influenza vaccination during pregnancy. Methods. A qualitative descriptive study was conducted, with semi-structured interviews completed with seventeen general practitioners in October 2012. A thematic analysis was undertaken by four researchers, and transcripts were analysed using N-Vivo software according to agreed codes. Results: One-third of the general practitioners interviewed did not consider influenza during pregnancy to be a serious risk for the mother or the baby. The majority of the general practitioners were aware of the government recommendations for influenza vaccination during pregnancy, but few general practitioners were confident of their knowledge about the vaccine and most felt they needed more information. More than half the general practitioners had significant concerns about the safety of influenza vaccination during pregnancy. Their practices in the provision of the vaccine were related to their perception of risk of influenza during pregnancy and their confidence about the safety of the vaccine. While two-thirds reported that they are recommending influenza vaccination to their pregnant patients, many were adopting principles of patient-informed choice in their approach and encouraged women to decide for themselves whether they would receive the vaccine. Conclusions: General practitioners have varied knowledge, attitudes, and beliefs about influenza vaccination during preg
- Published
- 2014
20. Influenza vaccination during pregnancy: Coverage rates and influencing factors in two urban districts in Sydney
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Maher, L, Hope, K, Torvaldsen, S, Lawrence, G, Dawson, A, Wiley, K, Thomson, D, Hayen, A, Conaty, S, Maher, L, Hope, K, Torvaldsen, S, Lawrence, G, Dawson, A, Wiley, K, Thomson, D, Hayen, A, and Conaty, S
- Abstract
Background: Pregnant women have an increased risk of complications from influenza. Influenza vaccination during pregnancy is considered effective and safe; however estimates of vaccine coverage are low. This study aimed to determine influenza vaccination coverage and factors associated with vaccine uptake in pregnant women in two Sydney-based health districts. Methods: A random sample of women who delivered a baby in a public hospital in Sydney and South-Western Sydney Local Health Districts between June and September 2012 were surveyed using a computer assisted telephone interviewing service. Results: Of the 462 participants (participation rate 92%), 116 (25%) reported receiving the influenza vaccine during their pregnancy. In univariate analysis, vaccination coverage varied significantly depending on antenatal care type, hospital of birth, and parity (p<0.05), but not for age category, highest level of education, country of birth, language spoken at home, or Aboriginal status. Women who received antenatal care through a general practitioner (GP) had 2.3 (95% CI 1.4-3.6) times the odds (unadjusted) of receiving the influenza vaccination than those who received their antenatal care through a public hospital. The main reason cited for vaccination was GP recommendation (37%), while non-recommendation (33%) and lack of knowledge (26%) were cited as main reasons for not receiving the vaccination. 30% of women recalled receiving a provider recommendation for the vaccination and these women had 33.0 times the odds (unadjusted) of receiving the vaccination than women who had not received a recommendation. In a multivariate model a provider recommendation was the only variable that was significantly associated with vaccination (OR 41.9; 95% CI 20.7-84.9). Conclusion: Rates of influenza vaccination during pregnancy are low. There is a significant relationship between healthcare provider recommendation for the vaccination and vaccine uptake. Increasing provider recommendation
- Published
- 2013
21. The Early Childhood Oral Health Program: Promoting prevention and timely intervention of early childhood caries in NSW through shared care
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Maher, L, Phelan, C, Lawrence, G, Dawson, A, Torvaldsen, S, Wright, C, Maher, L, Phelan, C, Lawrence, G, Dawson, A, Torvaldsen, S, and Wright, C
- Abstract
Issue addressed: Early childhood caries (ECC) continues to have high prevalence worldwide, despite being largely preventable. The Early Childhood Oral Health (ECOH) Program was established in New South Wales (NSW) using a model of shared responsibility for oral health, which involves a partnership between child health professionals, oral health professionals and parents of young children, to facilitate the primary prevention, early identification and early intervention of ECC. Methods: An evaluation of the ECOH program was conducted, using mixed methods. Data were obtained through document review, surveys and interviews with program implementers, and analysis of the Information System for Oral Health (ISOH) database for public oral health services activity in NSW. Results: Key achievements of the ECOH program include the establishment of governance mechanisms, policy, structures and responsibilities for implementation, support mechanisms for child health professionals, referral processes, communications resources, and the delivery of training. Parents receive oral health information, education and support through written resources and contact with child health professionals. Child and family health nurses interviewed reported routinely incorporating oral health promotion and early identification for ECC into their practices. The referral rate to public oral health services for children under five years of age by community health professionals has increased steadily since the program began, with the rate in 2009 five times higher than in 2007. Conclusions: Models of shared responsibility for oral health between parents, child health professionals and oral health professionals can facilitate primary prevention and early intervention for ECC.
- Published
- 2012
22. Eye health services for Aboriginal people in the western region of NSW, 2010
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Maher, LM, Brown, AM, Torvaldsen, S, Dawson, A, Patterson, JA, Lawrence, G, Maher, LM, Brown, AM, Torvaldsen, S, Dawson, A, Patterson, JA, and Lawrence, G
- Abstract
Aim: To assess the availability, accessibility and uptake of eye health services for Aboriginal people in western NSW in 2010.
- Published
- 2012
23. Two-year outcomes of an extended adolescent weight-loss maintenance intervention involving novel additional therapeutic contact: The Loozit® randomised controlled trial
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Nguyen, B., primary, Shrewsbury, V., additional, O’Connor, J., additional, Steinbeck, K., additional, Hill, A., additional, Shah, S., additional, Kohn, M., additional, Torvaldsen, S., additional, and Baur, L., additional
- Published
- 2012
- Full Text
- View/download PDF
24. Two-year outcomes of an adjunctive telephone coaching and electronic contact intervention for adolescent weight-loss maintenance: the Loozit randomized controlled trial
- Author
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Nguyen, B, primary, Shrewsbury, V A, additional, O'Connor, J, additional, Steinbeck, K S, additional, Hill, A J, additional, Shah, S, additional, Kohn, M R, additional, Torvaldsen, S, additional, and Baur, L A, additional
- Published
- 2012
- Full Text
- View/download PDF
25. The continuing evolution of methicillin-resistant staphylococcus aureus in Western Australia
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Torvaldsen, S., Roberts, C., Riley, T.V., Torvaldsen, S., Roberts, C., and Riley, T.V.
- Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has been notifiable in Western Australia since 1985. This article reviews the notification data from 1994 to 1997, focusing on increases in MRSA notifications and the proportion that are local strains; changes in the geographical distribution of MRSA; and chances in antibiotic-resistance patterns.
- Published
- 1999
26. Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia
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Roberts, CL, primary, Torvaldsen, S, additional, Bell, JC, additional, and Raynes-Greenow, CH, additional
- Published
- 2003
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27. Twelve-month outcomes of the loozit randomized controlled trial: a community-based healthy lifestyle program for overweight and obese adolescents.
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Nguyen B, Shrewsbury VA, O'Connor J, Steinbeck KS, Lee A, Hill AJ, Shah S, Kohn MR, Torvaldsen S, and Baur LA
- Published
- 2012
28. 'It's good to have wheels!': Perceptions of cycling among homeless young people in Sydney, Australia
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Crawford, B., Rissel, C., Yamazaki, R., Franke, E., Amanatidis, S., Jioji Ravulo, Bindon, J., and Torvaldsen, S.
29. Vaccine preventable diseases and vaccination coverage in Australia, 1993-1998
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Mcintyre, P., Amin, J., Heather Gidding, Hull, B., Torvaldsen, S., Tucker, A., Turnbull, F., and Burgess, M.
30. Two-year outcomes of an extended adolescent weight-loss maintenance intervention involving novel additional therapeutic contact: The Loozit® randomised controlled trial.
- Author
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Nguyen, B., Shrewsbury, V., O’Connor, J., Steinbeck, K., Hill, A., Shah, S., Kohn, M., Torvaldsen, S., and Baur, L.
- Published
- 2012
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31. Relationship between the population incidence of febrile convulsions in young children in Sydney, Australia and seasonal epidemics of influenza and respiratory syncytial virus, 2003-2010: a time series analysis
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Lawrence Glenda L, MacIntyre C Raina, Muscatello David J, Polkinghorne Benjamin G, Middleton Paul M, and Torvaldsen Siranda
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Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background In 2010, intense focus was brought to bear on febrile convulsions in Australian children particularly in relation to influenza vaccination. Febrile convulsions are relatively common in infants and can lead to hospital admission and severe outcomes. We aimed to examine the relationships between the population incidence of febrile convulsions and influenza and respiratory syncytial virus (RSV) seasonal epidemics in children less than six years of age in Sydney Australia using routinely collected syndromic surveillance data and to assess the feasibility of using this data to predict increases in population rates of febrile convulsions. Methods Using two readily available sources of routinely collected administrative data; the NSW Emergency Department (ED) patient management database (1 January 2003 - 30 April 2010) and the Ambulance NSW dispatch database (1 July 2006 - 30 April 2010), we used semi-parametric generalized additive models (GAM) to determine the association between the population incidence rate of ED presentations and urgent ambulance dispatches for 'convulsions', and the population incidence rate of ED presentations for 'influenza-like illness' (ILI) and 'bronchiolitis' - proxy measures of influenza and RSV circulation, respectively. Results During the study period, when the weekly all-age population incidence of ED presentations for ILI increased by 1/100,000, the 0 to 6 year-old population incidence of ED presentations for convulsions increased by 6.7/100,000 (P < 0.0001) and that of ambulance calls for convulsions increased by 3.2/100,000 (P < 0.0001). The increase in convulsions occurred one week earlier relative to the ED increase in ILI. The relationship was weaker during the epidemic of pandemic (H1N1) 2009 influenza virus. When the 0 to 3 year-old population incidence of ED presentations for bronchiolitis increased by 1/100,000, the 0 to 6 year-old population incidence of ED presentations for convulsions increased by 0.01/100,000 (P < 0.01). We did not find a meaningful and statistically significant association between bronchiolitis and ambulance calls for convulsions. Conclusions Influenza seasonal epidemics are associated with a substantial and statistically significant increase in the population incidence of hospital attendances and ambulance dispatches for reported febrile convulsions in young children. Monitoring syndromic ED and ambulance data facilitates rapid surveillance of reported febrile convulsions at a population level.
- Published
- 2011
- Full Text
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32. Automated data extraction from general practice records in an Australian setting: Trends in influenza-like illness in sentinel general practices and emergency departments
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Puech Michele, Staff Michael, Liljeqvist Gösta TH, Blom Hans, and Torvaldsen Siranda
- Subjects
Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Influenza intelligence in New South Wales (NSW), Australia is derived mainly from emergency department (ED) presentations and hospital and intensive care admissions, which represent only a portion of influenza-like illness (ILI) in the population. A substantial amount of the remaining data lies hidden in general practice (GP) records. Previous attempts in Australia to gather ILI data from GPs have given them extra work. We explored the possibility of applying automated data extraction from GP records in sentinel surveillance in an Australian setting. The two research questions asked in designing the study were: Can syndromic ILI data be extracted automatically from routine GP data? How do ILI trends in sentinel general practice compare with ILI trends in EDs? Methods We adapted a software program already capable of automated data extraction to identify records of patients with ILI in routine electronic GP records in two of the most commonly used commercial programs. This tool was applied in sentinel sites to gather retrospective data for May-October 2007-2009 and in real-time for the same interval in 2010. The data were compared with that provided by the Public Health Real-time Emergency Department Surveillance System (PHREDSS) and with ED data for the same periods. Results The GP surveillance tool identified seasonal trends in ILI both retrospectively and in near real-time. The curve of seasonal ILI was more responsive and less volatile than that of PHREDSS on a local area level. The number of weekly ILI presentations ranged from 8 to 128 at GP sites and from 0 to 18 in EDs in non-pandemic years. Conclusion Automated data extraction from routine GP records offers a means to gather data without introducing any additional work for the practitioner. Adding this method to current surveillance programs will enhance their ability to monitor ILI and to detect early warning signals of new ILI events.
- Published
- 2011
- Full Text
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33. Short-term outcomes of community-based adolescent weight management: The Loozit® Study
- Author
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Kohn Michael R, Shah Smita, Hill Andrew J, Lee Anthea, Steinbeck Katharine S, O'Connor Janice, Nguyen Binh, Shrewsbury Vanessa A, Torvaldsen Siranda, and Baur Louise A
- Subjects
Pediatrics ,RJ1-570 - Abstract
Abstract Background The Loozit® Study is a randomised controlled trial investigating extended support in a 24 month community-based weight management program for overweight to moderately obese, but otherwise healthy, 13 to 16 year olds. Methods This pre-post study examines the two month outcomes of the initial Loozit® group intervention received by both study arms. Adolescents (n = 151; 48% male) and their parents separately attended seven weekly group sessions focused on lifestyle modification. At baseline and two months, adolescents' anthropometry, blood pressure, and fasted blood sample were assessed. Primary outcomes were two month changes in body mass index (BMI) z-score and waist-to-height-ratio (WHtR). Secondary outcomes included changes in metabolic profile, self-reported dietary intake/patterns, physical and sedentary activities, psychological characteristics and social status. Changes in outcome measures were assessed using paired samples t-tests for continuous variables or McNemar's test for dichotomous categorical variables. Results Of the 151 adolescents who enrolled, 130 (86%) completed the two month program. Among these 130 adolescents (47% male), there was a statistically significant (P < 0.01) reduction in mean [95% CI] BMI (0.27 kg/m2 [0.41, 0.13]), BMI z-score (0.05 [0.06, 0.03]), WHtR (0.02 [0.03, 0.01]), total cholesterol (0.14 mmol/L [0.24, 0.05]) and low-density lipoprotein cholesterol (0.12 mmol/L [0.21, 0.04]). There were improvements in all psychological measures, the majority of the dietary intake measures, and some physical activities (P < 0.05). Time spent watching TV and participating in non-screen sedentary activities decreased (P < 0.05). Conclusions The Loozit® program may be a promising option for stabilizing overweight and improving various metabolic factors, psychological functioning and lifestyle behaviors in overweight adolescents in a community setting. Trial registration Australian New Zealand Clinical Trials Registry ACTRNO12606000175572
- Published
- 2011
- Full Text
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34. Assisting informed decision making for labour analgesia: a randomised controlled trial of a decision aid for labour analgesia versus a pamphlet
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Torvaldsen Siranda, Nassar Natasha, Raynes-Greenow Camille H, Trevena Lyndal, and Roberts Christine L
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Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background Most women use some method of pain relief during labour. There is extensive research evidence available of pharmacological pain relief during labour; however this evidence is not readily available to pregnant women. Decision aids are tools that present evidence based information and allow preference elicitation. Methods We developed a labour analgesia decision aid. Using a RCT design women either received a decision aid or a pamphlet. Eligible women were primiparous, ≥ 37 weeks, planning a vaginal birth of a single infant and had sufficient English to complete the trial materials. We used a combination of affective (anxiety, satisfaction and participation in decision-making) and behavioural outcomes (intention and analgesia use) to assess the impact of the decision aid, which were assessed before labour. Results 596 women were randomised (395 decision aid group, 201 pamphlet group). There were significant differences in knowledge scores between the decision aid group and the pamphlet group (mean difference 8.6, 95% CI 3.70, 13.40). There were no differences between decisional conflict scores (mean difference -0.99 (95% CI -3.07, 1.07), or anxiety (mean difference 0.3, 95% CI -2.15, 1.50). The decision aid group were significantly more likely to consider their care providers opinion (RR 1.28 95%CI 0.64, 0.95). There were no differences in analgesia use and poor follow through between antenatal analgesia intentions and use. Conclusions This decision aid improves women's labour analgesia knowledge without increasing anxiety. Significantly, the decision aid group were more informed of labour analgesia options, and considered the opinion of their care providers more often when making their analgesia decisions, thus improving informed decision making. Trial Registration Trial registration no: ISRCTN52287533
- Published
- 2010
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35. A randomised controlled trial of a community-based healthy lifestyle program for overweight and obese adolescents: the Loozit® study protocol
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Shah Smita, Kohn Michael R, Hill Andrew J, Lee Anthea, Stevenson Kate, Steinbeck Katharine S, O'Connor Janice, Shrewsbury Vanessa A, Torvaldsen Siranda, and Baur Louise A
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background There is a need to develop sustainable and clinically effective weight management interventions that are suitable for delivery in community settings where the vast majority of overweight and obese adolescents should be treated. This study aims to evaluate the effect of additional therapeutic contact as an adjunct to the Loozit® group program – a community-based, lifestyle intervention for overweight and lower grade obesity in adolescents. The additional therapeutic contact is provided via telephone coaching and either mobile phone Short Message Service or electronic mail, or both. Methods and design The study design is a two-arm randomised controlled trial that aims to recruit 168 overweight and obese 13–16 year olds (Body Mass Index z-score 1.0 to 2.5) in Sydney, Australia. Adolescents with secondary causes of obesity or significant medical illness are excluded. Participants are recruited via schools, media coverage, health professionals and several community organisations. Study arm one receives the Loozit® group weight management program (G). Study arm two receives the same Loozit® group weight management program plus additional therapeutic contact (G+ATC). The 'G' intervention consists of two phases. Phase 1 involves seven weekly group sessions held separately for adolescents and their parents. This is followed by phase 2 that involves a further seven group sessions held regularly, for adolescents only, until two years follow-up. Additional therapeutic contact is provided to adolescents in the 'G+ATC' study arm approximately once per fortnight during phase 2 only. Outcome measurements are assessed at 2, 12 and 24 months post-baseline and include: BMI z-score, waist z-score, metabolic profile indicators, physical activity, sedentary behaviour, eating patterns, and psychosocial well-being. Discussion The Loozit® study is the first randomised controlled trial of a community-based adolescent weight management intervention to incorporate additional therapeutic contact via a combination of telephone coaching, mobile phone Short Message Service, and electronic mail. If shown to be successful, the Loozit® group weight management program with additional therapeutic contact has the potential to be readily translatable to a range of health care settings. Trial registration The protocol for this study is registered with the Australian Clinical Trials Registry (ACTRNO12606000175572).
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- 2009
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36. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study
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Simpson Judy M, Roberts Christine L, Torvaldsen Siranda, Thompson Jane F, and Ellwood David A
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Pediatrics ,RJ1-570 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Anecdotal reports suggest that the addition of fentanyl (an opioid) to epidural analgesia for women during childbirth results in difficulty establishing breastfeeding. The aim of this paper is to determine any association between epidural analgesia and 1) breastfeeding in the first week postpartum and 2) breastfeeding cessation during the first 24 weeks postpartum. Methods A prospective cohort study of 1280 women aged ≥ 16 years, who gave birth to a single live infant in the Australian Capital Territory in 1997 was conducted. Women completed questionnaires at weeks 1, 8, 16 and 24 postpartum. Breastfeeding information was collected in each of the four surveys and women were categorised as either fully breastfeeding, partially breastfeeding or not breastfeeding at all. Women who had stopped breastfeeding since the previous survey were asked when they stopped. Results In the first week postpartum, 93% of women were either fully or partially breastfeeding their baby and 60% were continuing to breastfeed at 24 weeks. Intrapartum analgesia and type of birth were associated with partial breastfeeding and breastfeeding difficulties in the first postpartum week (p < 0.0001). Analgesia, maternal age and education were associated with breastfeeding cessation in the first 24 weeks (p < 0.0001), with women who had epidurals being more likely to stop breastfeeding than women who used non-pharmacological methods of pain relief (adjusted hazard ratio 2.02, 95% CI 1.53, 2.67). Conclusion Women in this cohort who had epidurals were less likely to fully breastfeed their infant in the few days after birth and more likely to stop breastfeeding in the first 24 weeks. Although this relationship may not be causal, it is important that women at higher risk of breastfeeding cessation are provided with adequate breastfeeding assistance and support.
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- 2006
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37. A randomised controlled trial of a community-based healthy lifestyle program for overweight and obese adolescents: the Loozit study protocol.
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Shrewsbury VA, O'Connor J, Steinbeck KS, Stevenson K, Lee A, Hill AJ, Kohn MR, Shah S, Torvaldsen S, Baur LA, Shrewsbury, Vanessa A, O'Connor, Janice, Steinbeck, Katharine S, Stevenson, Kate, Lee, Anthea, Hill, Andrew J, Kohn, Michael R, Shah, Smita, Torvaldsen, Siranda, and Baur, Louise A
- Abstract
Background: There is a need to develop sustainable and clinically effective weight management interventions that are suitable for delivery in community settings where the vast majority of overweight and obese adolescents should be treated. This study aims to evaluate the effect of additional therapeutic contact as an adjunct to the Loozit group program -- a community-based, lifestyle intervention for overweight and lower grade obesity in adolescents. The additional therapeutic contact is provided via telephone coaching and either mobile phone Short Message Service or electronic mail, or both.Methods and Design: The study design is a two-arm randomised controlled trial that aims to recruit 168 overweight and obese 13-16 year olds (Body Mass Index z-score 1.0 to 2.5) in Sydney, Australia. Adolescents with secondary causes of obesity or significant medical illness are excluded. Participants are recruited via schools, media coverage, health professionals and several community organisations. Study arm one receives the Loozit group weight management program (G). Study arm two receives the same Loozit group weight management program plus additional therapeutic contact (G+ATC). The 'G' intervention consists of two phases. Phase 1 involves seven weekly group sessions held separately for adolescents and their parents. This is followed by phase 2 that involves a further seven group sessions held regularly, for adolescents only, until two years follow-up. Additional therapeutic contact is provided to adolescents in the 'G+ATC' study arm approximately once per fortnight during phase 2 only. Outcome measurements are assessed at 2, 12 and 24 months post-baseline and include: BMI z-score, waist z-score, metabolic profile indicators, physical activity, sedentary behaviour, eating patterns, and psychosocial well-being.Discussion: The Loozit study is the first randomised controlled trial of a community-based adolescent weight management intervention to incorporate additional therapeutic contact via a combination of telephone coaching, mobile phone Short Message Service, and electronic mail. If shown to be successful, the Loozit group weight management program with additional therapeutic contact has the potential to be readily translatable to a range of health care settings.Trial Registration: The protocol for this study is registered with the Australian Clinical Trials Registry (ACTRNO12606000175572). [ABSTRACT FROM AUTHOR]- Published
- 2009
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38. Trends in early gestation stillbirths and neonatal deaths in New South Wales, Australia 2002-2019.
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Parry M, Torvaldsen S, Nippita TA, Bowen J, Morris JM, and Ibiebele I
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- Infant, Newborn, Female, Humans, Pregnancy, Infant, New South Wales epidemiology, Cohort Studies, Infant Mortality, Gestational Age, Australia, Stillbirth epidemiology, Perinatal Death
- Abstract
Background: Little research has focused on understanding trends in early gestation (20-27 weeks) stillbirths and neonatal deaths., Aims: To examine trends in early gestation stillbirths and neonatal deaths in New South Wales (NSW), Australia., Materials and Methods: Population-based cohort study of all births ≥20 weeks gestation among female NSW residents during 2002 to 2019, induced pregnancy terminations excluded. Stillbirth rates by gestational age and birth year were calculated per 1000 fetuses-at-risk (FAR). Neonatal death rates by gestational age and birth year were calculated per 1000 live births. Linear regression was used to examine trends in stillbirth and neonatal death rates among all, singleton and twin births., Results: Declining trends in early gestation stillbirth and neonatal death rates were found. Stillbirth rates decreased from 1.9 and 0.9/1000 FAR in 2002 to 1.6 and 0.7 in 2019 for 20-23 and 24-27 week groups, respectively. Neonatal rates decreased from 940 and 315/1000 live births in 2002 to 925 and 189 in 2019 for the 20-23 and 24-27 week groups, respectively. Among singleton births, declining trends in stillbirth and neonatal death rates across all age groups were observed, except for 37-38 week stillbirths. No trends in twin stillbirth rates were found across gestational age groups, although a decreasing trend was observed for 20-23 week twin neonatal deaths., Conclusions: Trends in early gestation stillbirth and neonatal deaths have declined in recent decades in NSW but further efforts are needed to reduce both early and late gestation stillbirth rates among twin births., (© 2023 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)
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- 2023
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39. Maternal Mortality in a Rural District of Pakistan and Contributing Factors.
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Anwar J, Torvaldsen S, Morrell S, and Taylor R
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- Pregnancy, Child, Humans, Female, Maternal Mortality, Prospective Studies, Pakistan epidemiology, Rural Population, Maternal Death, Sepsis, Maternal Health Services
- Abstract
Introduction: Pakistan is among the ten countries that account for 60% of global maternal mortality. Lack of accurate data on maternal mortality and a complex interrelation of access and quality of healthcare services, healthcare delivery system, and socio-economic and demographic factors contribute significantly to inadequate progress in reducing maternal mortality., Material and Methods: A population-based prospective cohort study was conducted in a rural district of Pakistan using data obtained from an enhanced surveillance system. A total of 7572 pregnancies and their outcomes were recorded by 273 Lady Health Workers and 73 Community Health Workers over 2016-2017. Logistic regression was used to calculate the unadjusted and adjusted odds ratios (OR) for maternal mortality for each risk factor. Population Attributable Fraction (PAF) was derived from the ORs and risk factor prevalence., Results: The study recorded 18 maternal deaths. The maternal mortality rate was estimated at 238/100,000 pregnancies (95% CI 141-376), and the maternal mortality ratio was 247/100,000 live births (95% CI 147-391). Half of the maternal deaths (9) were from obstetric hemorrhage, and 28% (5) from puerperal sepsis. Postpartum hemorrhage was associated with a 17-fold higher risk of maternal mortality (PAF = 40%) and puerperal sepsis with a 12-fold higher mortality risk (PAF = 29%) compared to women without these conditions. Women delivered by unskilled birth attendants had a three-fold (PAF = 21%), and women having prolonged labour had a fourfold risk of maternal mortality compared to those with these conditions. Women with leg swelling (47%) and pre-eclampsia (26%) are at seven times the risk of maternal mortality compared to those without these conditions. Mortality in women delivered by unskilled birth attendants was three times higher than with skilled attendants., Conclusion: The study, among a few large-scale prospective cohort studies conducted at the community level in a rural district of Pakistan, provides a better understanding of the risk factors determining maternal mortality in Pakistan. Poverty emerged as a significant risk factor for maternal mortality in the study area and contributes to the underutilization of health facilities and skilled birth attendants. Incorporating poverty reduction strategies across all sectors, including health, is urgently required to address higher maternal mortality in Pakistan. A paradigm shift is required in Maternal and Child health related programs and interventions to include poverty estimation and measuring mortality through linking mortality surveillance with the Civil Registration and Vital Statistics system. Accelerated efforts to expand the coverage and completeness of mortality data with risk factors to address inequalities in access and utilization of health services., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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40. Interventional radiology in obstetric patients: A population-based record linkage study of use and outcomes.
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Baldwin HJ, Randall DA, Maher R, West SP, Torvaldsen S, Morris JM, and Patterson JA
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- Humans, Pregnancy, Female, Cesarean Section methods, Radiology, Interventional, Australia, Parturition, Hysterectomy methods, Retrospective Studies, Postpartum Hemorrhage epidemiology, Placenta Accreta diagnostic imaging, Placenta Accreta surgery
- Abstract
Introduction: Interventional radiology (IR) is a technique for controlling hemorrhage and preserving fertility for women with serious obstetric conditions such as placenta accreta spectrum (PAS) or postpartum hemorrhage. This study examined maternal, pregnancy and hospital characteristics and outcomes for women receiving IR in pregnancy and postpartum., Material and Methods: A population-based record linkage study was conducted, including all women who gave birth in hospital in New South Wales or the major tertiary hospital in the neighboring Australian Capital Territory, Australia, between 2003 and 2019. Data were obtained from birth and hospital records. Characteristics and outcomes of women who underwent IR in pregnancy or postpartum are described. Outcomes following IR were compared in a high-risk cohort of women: those with PAS who had a planned cesarean with hysterectomy. Women were grouped by those who did and those who did did not have IR and were matched using propensity score and other factors., Results: We identified IR in 236 pregnancies of 1 584 708 (15.0 per 100 000), including 208 in the delivery and 26 in a postpartum admission. Two-thirds of women receiving IR in the birth admission received a transfusion of red cells or blood products, 28% underwent hysterectomy and 12.5% were readmitted within 6 weeks. Other complications included: severe maternal morbidity (29.8%), genitourinary tract trauma/repair (17.3%) and deep vein thrombosis/pulmonary embolism (4.3%). Outcomes for women with PAS who underwent planned cesarean with hysterectomy were similar for those who did and did not receive IR, with a small reduction in transfusion requirement for those who received IR., Conclusions: Interventional radiology is infrequently used in pregnant women. In our study it was performed at a limited number of hospitals, largely tertiary centers, with the level of adverse outcomes reflecting use in a high-risk population. For women with PAS undergoing planned cesarean with hysterectomy, most outcomes were similar for those receiving IR and those not receiving IR, but IR may reduce bleeding., (© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)
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- 2023
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41. Pregnancy outcomes in women with endometriosis and/or ART use: a population-based cohort study.
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Ibiebele I, Nippita T, Baber R, and Torvaldsen S
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- Birth Weight, Cohort Studies, Female, Humans, Infant, Newborn, Placenta, Pregnancy, Pregnancy Outcome epidemiology, Retrospective Studies, Uterine Hemorrhage epidemiology, Uterine Hemorrhage etiology, Endometriosis complications, Endometriosis epidemiology, Placenta Previa epidemiology, Premature Birth epidemiology, Premature Birth etiology
- Abstract
Study Question: What is the association between endometriosis and adverse pregnancy outcomes with ART use and non-use?, Summary Answer: Endometriosis and ART use are both associated with increased risk of preterm birth, antepartum haemorrhage, placenta praevia and planned birth (caesarean delivery or induction of labour)., What Is Known Already: There are contradictory findings on the association between endometriosis and adverse pregnancy outcomes, and many large studies have not considered the effect of ART use., Study Design, Size, Duration: Population-based cohort study of 578 221 eligible pregnancies during 2006-2015, comparing pregnancy outcomes across four groups (No endo/no ART, No endo/ART, Endo/no ART and Endo/ART)., Participants/materials, Setting, Methods: All female residents of New South Wales, Australia aged 15-45 years and their index singleton pregnancy of at least 20 weeks gestation or 400 g birthweight. Linked hospital, pregnancy/birth and mortality data were used. Modified Poisson regression with robust error variances was used to estimate adjusted risk ratios (aRRs) and 99% CIs, adjusting for sociodemographic and pregnancy factors., Main Results and the Role of Chance: Compared to women without endometriosis who had pregnancies without ART use, there was increased risk of preterm birth (<37 weeks) in all groups [No endo/ART (aRR 1.85, 99% CI 1.46-2.34), Endo/no ART (aRR 1.24, 99% CI 1.06-1.44), Endo/ART (aRR 1.93, 99% CI 1.11-3.35)] and antepartum haemorrhage [No endo/ART (aRR 1.99, 99% CI 1.39-2.85), Endo/no ART (aRR 1.31, 99% CI 1.03-1.67), Endo/ART (aRR 2.69, 99% CI 1.30-5.56)] among pregnancies affected by endometriosis or ART use, separately and together. There was increased risk of placenta praevia [No endo/ART (aRR 2.26, 99% CI 1.42-3.60), Endo/no ART (aRR 1.66, 99% CI 1.18-2.33)] and planned birth [No endo/ART (aRR 1.08, 99% CI 1.03-1.14), Endo/no ART (aRR 1.11, 99% CI 1.07-1.14)] among pregnancies with endometriosis or ART use, separately. There was increased risk of placental abruption [No endo/ART (aRR 2.36, 99% CI 1.12-4.98)], maternal morbidity [No endo/ART (aRR 1.67, 99% CI 1.07-2.62)] and low birthweight (<2500 g) [No endo/ART (aRR 1.45, 99% CI 1.09-1.93)] among pregnancies with ART use without endometriosis. There was decreased risk of having a large-for-gestational age infant [Endo/no ART (aRR 0.83, 99% CI 0.73-0.94)] among pregnancies with endometriosis without ART use., Limitations, Reasons for Caution: Endometriosis is often under-diagnosed and women with a history of hospital diagnosis of endometriosis may represent those with more symptomatic or severe disease. If the effects of endometriosis on pregnancy are greater for those with more severe disease, our results may over-estimate the effect of endometriosis on adverse pregnancy outcomes at a population level. We were unable to assess the effect of endometriosis stage or typology on the study outcomes., Wider Implications of the Findings: These results suggest that women with endometriosis including those who used ART to achieve pregnancy are a higher-risk obstetric group requiring appropriate surveillance and management during their pregnancy., Study Funding/competing Interest(s): This study was supported by the Prevention Research Support Program, funded by the New South Wales Ministry of Health. The funder had no role in the design, data collection and analysis, interpretation of results, manuscript preparation or the decision to submit the manuscript for publication. The authors have no conflicts of interest., Trial Registration Number: N/A., (© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.)
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- 2022
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42. Alternatives to low birthweight as a population-level indicator of infant and child health.
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Hennessy D, Torvaldsen S, Bentley JP, Bowen JR, Moore HA, and Roberts CL
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- Birth Weight, Child, Cohort Studies, Humans, Infant, Infant, Newborn, Infant, Premature, Child Health, Premature Birth epidemiology
- Abstract
Background: Low birthweight (<2500 g) is often used as a population-level indicator of maternal-child health, as it is easy to measure and correlates with poorer infant health outcomes. However, it conflates preterm birth and intrauterine growth restriction, which have different causal pathways and require different approaches to prevention. Small for gestational age (SGA) (a proxy for growth restriction) and preterm birth may be more informative measures. We evaluated low birthweight as a population-level indicator., Methods: We conducted a population-based cohort study of singleton live births in New South Wales (NSW), Australia, using linked data from 1994-2006 birth, hospital, death and educational records, with follow-up until 2014. Outcomes of babies born of low birthweight, preterm and SGA were compared with well-grown term infants (i.e. not low birthweight or SGA). Overlap between groups and temporal trends were also examined., Results: Of 1 093 765 singleton live births, 47 946 (4.4%) infants were low birthweight and had poorer outcomes than well-grown term infants (2.7% vs. 0.1% infant mortality; 13% vs. 6% below national minimum numeracy standard). SGA and preterm infants also had poorer outcomes (0.5%, 2.3% infant mortality respectively; 10%, 11% below numeracy standard) but 80% of SGA and 47% of preterm infants were not low birthweight. For all outcomes, low birthweight identified a smaller proportion of infants with poor outcomes than preterm birth and than either SGA or low birthweight at term. The proportion of low-birthweight births remained constant over time, while the proportion of births that were preterm increased and proportion of SGA decreased., Conclusions: Low birthweight, SGA and preterm infants are all at higher risk of poorer outcomes but low birthweight inadequately captures, and masks trends in, both preterm births and births that are SGA. Reporting preterm births and an indicator of growth restriction at term will identify vulnerable groups better than using the measure of low birthweight., Competing Interests: None declared.
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- 2022
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43. Benefits of not smoking during pregnancy for non-Aboriginal women and their babies in New South Wales, Australia: a record linkage study.
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Patterson JA, Cashmore A, Ioannides S, Milat AJ, Nippita TA, Morris JM, and Torvaldsen S
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- Australia, Cohort Studies, Female, Humans, Infant, Infant, Newborn, New South Wales epidemiology, Parturition, Pregnancy, Premature Birth epidemiology
- Abstract
Background: Smoking rates among pregnant women in New South Wales (NSW) have plateaued at 8-9%. To inform relevant smoking reduction efforts, we aimed to quantify the benefits of not smoking during pregnancy for non-Aboriginal NSW mothers and their babies. The benefits of not smoking during pregnancy for NSW Aboriginal mothers have previously been described. These data are important inputs in modelling health and economic impacts of smoking cessation interventions., Methods: This population-based cohort study used linked-data from routinely collected data sets. Not smoking during pregnancy was the exposure of interest among all NSW non-Aboriginal women who became mothers of singleton babies in 2012-2016. Unadjusted and adjusted relative risks (aRR) were used to examine associations between not smoking during pregnancy and adverse outcomes including severe morbidity, inter-hospital transfer, perinatal death, preterm birth and small-for-gestational age. Population attributable fractions (PAFs) were calculated to quantify adverse perinatal outcomes avoided in the population if all mothers were non-smokers., Results: Compared with babies born to mothers who smoked during pregnancy, babies born to non-smoking mothers had a lower risk of all adverse perinatal outcomes including perinatal death (aRR = 0.68, 95%CI 0.61-0.76), preterm birth (aRR = 0.58, 95%CI 0.56-0.61) and small-for-gestational age (aRR = 0.48, 95%CI 0.47-0.50). PAFs(%) were 3.9% for perinatal death, 5.6% for preterm birth and 7.3% for small-for-gestational-age. Compared with women who smoked during pregnancy (n = 36,518), those who did not smoke (n = 413,072) had a lower risk of suffering severe maternal morbidity (aRR = 0.87, 95%CI 0.81-0.93) and being transferred to another hospital (aRR = 0.92, 95%CI 0.86-0.99)., Conclusions: Mothers who reported not smoking during pregnancy had a small reduction in their risk of morbidity and of being transferred to another hospital whilst their babies had substantially reduced risks of all adverse perinatal outcomes. Results have implications for clinician training, clinical care standards, and performance management., Competing Interests: Conflicts of interest: The authors have no conflicts of interest to declare.
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- 2021
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44. Place of birth and outcomes associated with large volume transfusion: an observational study.
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Patterson J, Randall D, Isbister J, Peek M, Nippita T, and Torvaldsen S
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- Adult, Female, Humans, Morbidity, New South Wales epidemiology, Pregnancy, Risk Factors, Routinely Collected Health Data, Blood Transfusion, Hospitalization statistics & numerical data, Hospitals, Public, Parturition blood, Postpartum Hemorrhage epidemiology, Postpartum Hemorrhage therapy
- Abstract
Background: Guidelines recommend that women at high risk of postpartum haemorrhage deliver at facilities able to handle heavy bleeding. However postpartum haemorrhage is often unexpected. This study aims to compare outcomes and health service use related to transfusion of ≥4 units of red blood cells between women delivering in tertiary and lower level hospitals., Methods: The study population was women giving birth in public hospitals in New South Wales, Australia, between July 2006 and December 2010. Data were obtained from linked hospital, birth and blood bank databases. The exposure of interest was transfusion of four or more units of red cells during admission for delivery. Outcomes included maternal morbidity, length of stay, neonatal morbidity and need for other blood products or transfer to higher care. Multivariable regression models were developed to predict need of transfusion of ≥4 units of red cells using variables known early in pregnancy and those known by the birth admission., Results: Data were available for 231,603 births, of which 4309 involved a blood transfusion, with 1011 (0.4%) receiving 4 or more units. Women giving birth in lower level and/or smaller hospitals were more likely to receive ≥4 units of red cells. Women receiving ≥4 units in tertiary settings were more likely to receive other blood products and have longer hospital stays, but morbidity, readmission and hysterectomy rates were similar. Although 46% of women had no identifiable risk factors early in pregnancy, 20% of transfusions of ≥4 units occurred within this group. By the birth admission 70% of women had at least one risk factor for requiring ≥4 units of red cells., Conclusions: Overall outcomes for women receiving ≥4 units of red cells were comparable between tertiary and non-tertiary facilities. This is important given the inability of known risk factors to predict many instances of postpartum haemorrhage., (© 2021. The Author(s).)
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- 2021
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45. Comparison of costs related to infant hospitalisations for spontaneous, induced and Caesarean births: population-based cohort study.
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Owen KB, Ibiebele I, Simpson JM, Morton RL, Morris JM, and Torvaldsen S
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- Cohort Studies, Female, Gestational Age, Hospitalization, Humans, Infant, New South Wales, Pregnancy, Cesarean Section, Labor, Induced
- Abstract
Objective This study examined hospitalisations and associated in-patient costs for babies during the first year of life following spontaneous labour, compared with labour induction or prelabour Caesarean section, at each gestational age. Methods Birth data for singleton liveborn babies from 33 weeks gestation in New South Wales from 2005 to 2014 were linked to hospital and death data. Generalised linear models were used to examine the association between the type of labour and the length of hospitalisations and hospital costs. Results From 2005 to 2014, 598640 women gave birth to 1187451 liveborn singleton babies. The mean total length of hospitalisations and costs of hospitalisations for babies in the first year of life decreased significantly as week of gestational age increased to 39 weeks, then plateaued. Overall, the total length of hospitalisations and hospital costs were significantly (P<0.001) lower for babies born after spontaneous labour (5.6 days and A$8405 respectively) than for babies born following labour induction (6.1 days and A$9452 respectively) or prelabour Caesarean section (8.2 days and A$12320 respectively). Conclusions Babies born following spontaneous labour spend less time in hospital and have lower hospital costs than those born following labour induction or prelabour Caesarean section. Hospitalisations and costs decrease with each week of gestational age until 39 weeks. What is known about the topic? It is known that induction of labour and prelabour Caesarean sections are increasing, and this increase has changed the distribution of gestational age towards birth at earlier ages. It is also known that babies born before 39 weeks of gestation are at increased risk of mortality and morbidity. What does this paper add? This study shows that babies born following spontaneous labour spend the least amount of time in hospital and subsequently have the lowest hospital costs at each week of gestation compared with babies born following labour induction or prelabour Caesarean section. This study also shows a small but significant economic advantage of labour induction compared with prelabour Caesarean delivery. This study quantifies the mean time babies spend in hospital in their first year of life, by week of gestational age and mode of birth. What are the implications for practitioners? The findings from this study can assist clinicians in judicious decision making when balancing the risks and benefits of early planned births. Clinicians can use the results of this study to inform women who are intending to have a planned birth of risks they may not have anticipated, such as the increased risk of rehospitalisation. The finding that hospitalisations and costs continue to decline until 39 weeks gestation can be used to reinforce the importance of continuing the pregnancy beyond 37 weeks if safe to do so, even though 37 weeks is considered term.
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- 2021
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46. Validation of anaemia, haemorrhage and blood disorder reporting in hospital data in New South Wales, Australia.
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Baldwin HJ, Nippita TA, Torvaldsen S, McGee TM, Rickard K, and Patterson JA
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- Australia, Female, Hospitals, Humans, New South Wales epidemiology, Pregnancy, Reproducibility of Results, Anemia diagnosis, Anemia epidemiology, Postpartum Hemorrhage diagnosis, Postpartum Hemorrhage epidemiology
- Abstract
Objective: Hospital data are a useful resource for studying pregnancy complications, including bleeding-related conditions, however, the reliability of these data is unclear. This study aims to examine reliability of reporting of bleeding-related conditions, including anaemia, obstetric haemorrhage and blood disorders, and procedures, such as blood transfusion and hysterectomy, in coded hospital records compared with obstetric data from two large tertiary hospitals in New South Wales., Results: There were 36,051 births between 2011 and 2015 included in the analysis. Anaemia and blood disorders were poorly reported in the hospital data, with sensitivity ranging from 2.5% to 24.8% (positive predictive value (PPV) 12.0-82.6%). Reporting of postpartum haemorrhage, transfusion and hysterectomy showed high sensitivity (82.8-96.0%, PPV 78.0-89.6%) while moderate consistency with the obstetric data was observed for other types of obstetric haemorrhage (sensitivity: 41.9-65.1%, PPV: 50.0-56.8%) and placental complications (sensitivity: 68.2-81.3%, PPV: 20.3-72.3%). Our findings suggest that hospital data may be a reliable source of information on postpartum haemorrhage, transfusion and hysterectomy. However, they highlight the need for caution for studies of anaemia and blood disorders, given high rates of uncoded and 'false' cases, and suggest that other sources of data should be sought where possible.
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- 2021
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47. Pregnancy outcomes for women with a history of stroke: A population-based record linkage study.
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Austin K, Seeho S, Ibiebele I, Ford J, Morris J, and Torvaldsen S
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- Adolescent, Adult, Australia epidemiology, Cesarean Section, Female, Humans, Infant, Infant, Newborn, New South Wales epidemiology, Pregnancy, Young Adult, Pregnancy Outcome epidemiology, Stroke epidemiology
- Abstract
Background: Little is known about the pregnancy outcomes of women who have had a stroke prior to a first pregnancy., Aim: To identify a cohort of primiparous women giving birth to a single baby and compare the pregnancy outcomes of those with a pre-pregnancy stroke hospitalisation record to those without a stroke hospitalisation record., Materials and Methods: Record linkage study of all primiparous women aged 15-44 years with singleton pregnancies birthing in New South Wales, Australia from 2003 to 2015. Stroke was identified from 2001 to 2015 hospital data using International Classification of Diseases tenth Edition - Australian Modification codes I60-64. Women whose first hospital record of stroke was during pregnancy or <42 days after birth were excluded. Outcomes included diabetes or hypertension during pregnancy, mode of delivery, haemorrhage, severe maternal morbidity (validated composite outcome indicator), gestational age at birth, Apgar score (1 min < 7), and small-for-gestational age., Results: Of 487 767 women with a first pregnancy, 124 (2.5/10 000) had a hospital record which included a pre-pregnancy stroke diagnosis. Women with a stroke history were more likely to have an early-term delivery (37-38 weeks; relative risk (RR) 1.49, 95% CI 1.17-1.90) and a pre-labour caesarean (RR 2.83, 95% CI 2.20-3.63). There were no significant differences in other maternal or neonatal outcomes., Conclusion: This is the largest reported study of pregnancy and birth outcomes for women with a history of stroke. With the exception of pre-labour caesarean, there were no differences in pregnancy outcomes for women with a history of stroke compared with women with no history of stroke., (© 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)
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- 2021
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48. Reporting of gestational diabetes and other maternal medical conditions: validation of routinely collected hospital data from New South Wales, Australia.
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Baldwin HJ, Nippita TA, Rickard K, Torvaldsen S, McGee TM, and Patterson JA
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- Australia, Female, Hospitals, Humans, New South Wales epidemiology, Pregnancy, Reproducibility of Results, United States, Diabetes, Gestational diagnosis, Hypertension, Pregnancy-Induced diagnosis
- Abstract
Introduction: Hospital datasets are a valuable resource for examining prevalence and outcomes of medical conditions during pregnancy. To enable effective research and health planning, it is important to determine whether variables are reliably captured., Objective: To examine the reliability of reporting of gestational and pre-existing diabetes, hypertension, thyroid conditions, and morbid obesity in coded hospital records that inform the population-level New South Wales Admitted Patient Data Collection., Methods: Coded hospital admission data from two large tertiary hospitals in New South Wales, from 2011 to 2015, were compared with obstetric data, collected by midwives at outpatient pregnancy booking and in hospital after birth, as the reference standard. Records were deterministically linked and sensitivity, specificity, positive predictive values and negative predictive values for the conditions of interest were obtained., Results: There were 36,051 births included in the analysis. Sensitivity was high for gestational diabetes (83.6%, 95% CI 82.4-84.7%), pre-existing diabetes (88.2%, 95% CI 84.1-91.6%), and gestational hypertension (80.1%, 95% CI 78.2-81.9%), moderate for chronic hypertension (53.5%, 95% CI 47.8-59.1%), and low for thyroid conditions (12.9%, 95% CI 11.7-14.2%) and morbid obesity (9.8%, 95% CI 7.6-12.4%). Specificity was high for all conditions (≥97.8%, 95% CI 97.7-98.0) and positive predictive value ranged from 53.2% for chronic hypertension (95% CI 47.5-58.8%) to 92.7% for gestational diabetes (95% CI 91.8-93.5%)., Conclusion: Our findings suggest that coded hospital data are a reliable source of information for gestational and pre-existing diabetes and gestational hypertension. Chronic hypertension is less consistently reported, which may be remedied by grouping hypertension types. Data on thyroid conditions and morbid obesity should be used with caution, and if possible, other sources of data for those conditions should be sought., Competing Interests: Statement of conflicts of interest: None declared.
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- 2021
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49. Rates of neonatal morbidity by maternal region of birth and gestational age in New South Wales, Australia 2003-2016.
- Author
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Berman Y, Ibiebele I, Randall D, Torvaldsen S, Nippita TA, Bowen J, Baldwin HJ, Todd SM, Morris JM, Ford JB, and Patterson JA
- Subjects
- Adult, Cohort Studies, Female, Humans, Infant, Newborn, Male, New South Wales epidemiology, New Zealand epidemiology, Pregnancy, Retrospective Studies, Young Adult, Gestational Age, Infant, Newborn, Diseases epidemiology, Racial Groups statistics & numerical data
- Abstract
Introduction: Research suggests that neonatal morbidity differs by maternal region of birth at different gestational ages. This study aimed to determine the overall and gestation-specific risk of neonatal morbidity by maternal region of birth, after adjustment for maternal, infant and birth characteristics, for women giving birth in New South Wales, Australia, from 2003 to 2016., Material and Methods: The study utilized a retrospective cohort study design using linked births, hospital and deaths data. Modified Poisson regression was used to determine risk with 95% confidence intervals (95% CI) of neonatal morbidity by maternal region of birth, overall and at each gestational age, compared with Australian or New Zealand-born women giving birth at 39 weeks., Results: There were 1 074 930 live singleton births ≥32 weeks' gestation that met the study inclusion criteria, and 44 394 of these were classified as morbid, giving a neonatal morbidity rate of 4.13 per 100 live births. The gestational age-specific neonatal morbidity rate declined from 32 weeks' gestation, reaching a minimum at 39 weeks in all maternal regions of birth. The unadjusted neonatal morbidity rate was highest in South Asian-born women at most gestations. Adjusted rates of neonatal morbidity between 32 and 44 weeks were significantly lower for babies born to East (adjusted relative risk [aRR] 0.65, 95% CI 0.62-0.68), South-east (aRR 0.76, 95% CI 0.73-0.79) and West Asian-born (aRR 0.93, 95% CI 0.88-0.98) mothers, and higher for babies of Oceanian-born (aRR 1.11, 95% CI 1.04-1.18) mothers, compared with Australian or New Zealand-born mothers. Babies of African, Oceanian, South Asian and West Asian-born women had a lower adjusted risk of neonatal morbidity than Australian or New Zealand-born women until 37 or 38 weeks' gestation, and thereafter an equal or higher risk in the term and post-term periods., Conclusions: Maternal region of birth is an independent risk factor for neonatal morbidity in New South Wales., (© 2020 Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Published by John Wiley & Sons Ltd.)
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- 2021
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50. A study of pregnancy after endometrial ablation using linked population data.
- Author
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Ibiebele I, Nippita TA, Baber R, and Torvaldsen S
- Subjects
- Abruptio Placentae epidemiology, Adolescent, Adult, Cesarean Section statistics & numerical data, Cohort Studies, Female, Humans, Marital Status statistics & numerical data, Maternal Age, Middle Aged, New South Wales epidemiology, Parity, Placenta Previa epidemiology, Postpartum Hemorrhage epidemiology, Pregnancy, Pregnancy, Multiple statistics & numerical data, Premature Birth epidemiology, Retrospective Studies, Stillbirth epidemiology, Young Adult, Endometrial Ablation Techniques, Menorrhagia surgery
- Abstract
Introduction: Endometrial ablation encapsulates a range of procedures undertaken to destroy the endometrial lining of the uterus as a treatment for heavy menstrual bleeding in women who no longer wish to bear children. Pregnancy following ablation, while unlikely, can occur and may carry higher rates of complications. The aim of this study was to identify factors associated with post-endometrial ablation pregnancy and to describe pregnancy and birth outcomes for post-endometrial ablation pregnancies., Material and Methods: This population-based data linkage study included all female residents of New South Wales, Australia, aged 15-50 years with a hospital admission between July 2001 to June 2014 who birthed between July 2001 and June 2015. Cox proportional hazard regression was used to estimate associations between women's characteristics and post-endometrial ablation pregnancy of at least 20 weeks' gestation. Descriptive statistics were used to characterize pregnancy and birth outcomes., Results: Of 18 559 women with an endometrial ablation, 575 (3.1%) had a post-ablation pregnancy of at least 20 weeks' gestation. Nulliparity (adjusted hazard ratio [aHR] 12.2, 95% confidence interval [CI] 9.1-16.2), older age (35-39 years: aHR 0.39, 95% CI 0.29-0.51; 40-44 years: aHR 0.06, 95% CI 0.04-0.11), marital status (single: aHR 0.67, 95% CI 0.55-0.83; widowed/divorced/separated: aHR 0.58, 95% CI 0.36-0.94) and a diagnosis of heavy menstrual bleeding (aHR 0.09, 95% CI 0.07-0.13) were associated with post-ablation pregnancy. There were high rates of cesarean delivery (43%), preterm birth (13%), twin or higher order pregnancies (9%) and stillbirth (13.3/1000 births) among these post-ablation pregnancies., Conclusions: Nulliparity at the time of endometrial ablation is associated with increased risk of post-ablation pregnancy, highlighting the importance of careful discussion and consideration of treatment options for heavy menstrual bleeding., (© 2020 Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Published by John Wiley & Sons Ltd.)
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- 2021
- Full Text
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