%0 Journal Article %~ PubMed %A Vlemmix, F %A Warendorf, Jk %A Rosman, An %A Kok, M %A Mol, Bwj %A Morris, Jm %A Nassar, N %T Decision aids to improve informed decision-making in pregnancy care: a systematic review. %B BJOG %D 2013 %C United Kingdom %I Wiley-Blackwell Publishing Ltd. %V 120 %N 3 %P 257-266 %@ 1471-0528 %X %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Sedgley, Jocelyn %A Rickard, Kristen %A Morris, Jonathan %T A survey of women and health providers about information regarding the timing of driving a car after experiencing a caesarean section. %B The Australian & New Zealand Journal of Obstetrics & Gynaecology %D 2012 %C Australia %I Wiley-Blackwell Publishing Asia %V 52 %N 4 %P 361-365 %@ 1479-828X %X BACKGROUND: In NSW, around 30% of women experience a caesarean section. Anecdotally, few receive consistent information regarding driving after a caesarean delivery. AIMS: The aims were to determine the information provided to women following caesarean section and by whom it was given, and compare this with women''s actual driving behaviour. METHOD: Prior to hospital discharge, 101 consenting women completed a survey of five questions documenting the information they received about when to commence driving. They were telephoned 6-8 weeks postpartum and asked when they drove and whether they experienced any problems. Following this, a staff survey was conducted to establish what information was given to women. Insurance companies and government departments were contacted for relevant polices about when women can drive postcaesarean. RESULTS: 100 women completed both surveys (99% of recruits); 65% were advised to wait for 6 weeks or longer before driving. However, 72% of women reported they had driven by 6 weeks, and 35% by 3 weeks. In our sample, women reported minimal discomfort and rarely discontinued driving. Returned staff surveys (n = 138) revealed inconsistent advice ranging from no advice to 8 weeks of driving abstinence. Other recommendations included following insurance company guidelines (of which there were none specific to postcaesarean) (34%), ''listen to your body and be able to perform an emergency stop'' (27%). CONCLUSION: Women receive conflicting advice, and current recommendations are not reflected in women''s behaviour. Women are driving earlier than advised with minimal reported complications. %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Schneuer, Francisco J %A Nassar, Natasha %A Tasevski, Vitomir %A Morris, Jonathan M %A Roberts, Christine L %T Association and Predictive Accuracy of High TSH Serum Levels in First Trimester and Adverse Pregnancy Outcomes. %B Journal of Clinical Endocrinology and Metabolism %D 2012 %C United States %I The Endocrine Society %V 97 %N 9 %P 3115-3122 %@ 1945-7197 %X Context:High serum levels of TSH have been associated with adverse pregnancy outcomes by some studies, and not by others.Objective:The aim of the study was to assess the association between high levels of TSH in the first trimester of pregnancy and adverse pregnancy outcomes; and to examine the predictive accuracy as a screening test.Setting and Participants:Serum levels of TSH were measured in a cohort of 2801 women with a singleton pregnancy attending first trimester Down syndrome screening. Information on maternal and infant outcomes was obtained through record linkage to population-based birth and hospital data. Association between high TSH (>95th and >97.5th centiles) multiple of the median levels, and risk of adverse pregnancy outcomes was evaluated using multivariable logistic regression, and the predictive accuracy of models was assessed.Main Outcomes:Rates of infants being small for gestational age (SGA), preterm birth, preeclampsia, miscarriage, and stillbirth were investigated.Results:High TSH multiple of the median levels were associated with SGA (<10th centile) [adjusted odds ratio (aOR), 1.71; 95% confidence interval (CI), 0.99-2.94]; preterm birth at less than 37 wk gestation (aOR, 2.59; 95% CI, 1.21-5.53); miscarriage (aOR, 3.66; 95% CI, 1.59-8.44); and a composite measure of any study outcome (aOR, 2.10; 95% CI, 1.23-3.59). The area under the receiver operator characteristic curves were 0.69 (95% CI, 0.65-0.73) for SGA; 0.56 (95% CI, 0.51-0.61) for preterm birth; 0.70 (95% CI, 0.61-0.79) for miscarriage; and 0.63 (95% CI, 0.60-0.65) for any adverse pregnancy outcome.Conclusions:High TSH serum levels during the first trimester of pregnancy were associated with adverse pregnancy outcomes; however, the predictive accuracy was poor. Screening for high TSH levels in the first trimester would be of no benefit to identify women at risk. %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Hirst, Jane E %A Tran, Thach S %A Do, My An T %A Morris, Jonathan M %A Jeffery, Heather E %T Consequences of gestational diabetes in an urban hospital in viet nam: a prospective cohort study. %B PLoS Medicine %D 2012 %C United States %I Public Library of Science %V 9 %N 7 %P e1001272 %@ 1549-1676 %X Gestational diabetes mellitus (GDM) is increasing and is a risk for type 2 diabetes. Evidence supporting screening comes mostly from high-income countries. We aimed to determine prevalence and outcomes in urban Viet Nam. We compared the proposed International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criterion, requiring one positive value on the 75-g glucose tolerance test, to the 2010 American Diabetes Association (ADA) criterion, requiring two positive values. %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Ford, Jane B %A Algert, Charles S %A Morris, Jonathan M %A Roberts, Christine L %T Decreasing length of maternal hospital stay is not associated with increased readmission rates. %B Australian and New Zealand Journal of Public Health %D 2012 %C Australia %I Wiley-Blackwell Publishing Asia %V 36 %N 5 %P 430-434 %@ 1326-0200 %X %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Falster, Michael O %A Roberts, Christine L %A Ford, Jane %A Morris, Jonathan %A Kinnear, Ann %A Nicholl, Michael %T Development of a maternity hospital classification for use in perinatal research. %B New South Wales Public Health Bulletin %D 2012 %C Australia %I CSIRO Publishing %V 23 %N 1-2 %P 12-16 %@ 1034-7674 %X We aimed to develop a maternity hospital classification, using stable and easily available criteria, that would have wide application in maternity services research and allow comparison across state, national and international jurisdictions. A classification with 13 obstetric groupings (12 hospital groups and home births) was based on neonatal care capability, urban and rural location, annual average number of births and public/private hospital status. In a case study of early elective birth we demonstrate that neonatal morbidity differs according to the maternity hospital classification, and also that the 13 groups can be collapsed in ways that are pragmatic from a clinical and policy decision-making perspective, and are manageable for analysis. %Z FOR Codes: 111402 111799 %0 Journal Article %~ PubMed %A Schneuer, F J %A Nassar, N %A Khambalia, A Z %A Tasevski, V %A Ashton, A W %A Morris, J M %A Roberts, C L %T First trimester screening of maternal placental protein 13 for predicting preeclampsia and small for gestational age: In-house study and systematic review. %B Placenta %D 2012 %C United Kingdom %I Elsevier Ltd %V 33 %N 9 %P 735-740 %@ 0143-4004 %X OBJECTIVE: To describe normative levels of PP13 in first trimester of pregnancy and determine the accuracy of PP13 in predicting preeclampsia and small for gestational age (SGA) infants. METHODS: We measured PP13 in archived first trimester serum samples from an unselected maternal cohort of 2989 women. Associations of PP13 levels and diagnostic accuracy in predicting adverse pregnancy outcomes were assessed using multivariate logistic regression models. Due to inadequate number of cases we then conducted a systematic review and subsequent meta-analysis of predictive accuracy. Structured searches including all languages were completed in electronic databases and supplemented by cross-checking reference lists of relevant publications. Characteristics, data extraction and quality assessment of studies was conducted by independent assessors. RESULTS: Overall, 2678 women were included in the in-house study with 71 (2.7%) preeclampsia cases, 5 (0.2%) early-onset preeclampsia (???34 weeks) cases; and 191 (7.1%) and 41 (1.5%) infants SGA<10th and <3rd centile. Median (IQR) normative level of PP13 in unaffected pregnancies was 53.5 (37.7-71.8) pg/ml. The area under the receiver operating characteristic curve (AUC) for multivariate models was 0.72 (95%CI 0.66-0.78) for preeclampsia; 0.82 (95%CI 0.63-0.99) for early-onset preeclampsia; 0.73 (95%CI 0.69-0.77) for SGA<10th centile; and 0.83 (95%CI 0.78-0.88) for SGA<3rd centile. Eight studies were included in the systematic review, normative levels of PP13 were assessed in four studies but these were variable; and meta-analysis was performed on seven studies. Sensitivity rates of PP13 based on 5% fixed false positive rates were 24%, 45% and 26% for preeclampsia, for early-onset preeclampsia and SGA, respectively. There was no evidence of between-study heterogeneity. CONCLUSIONS: First trimester PP13, in combination with maternal characteristics and other serum biomarkers was inadequate for screening purposes and predicting women at risk. %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Lee, Yy %A Roberts, Cl %A Dobbins, T %A Stavrou, E %A Black, K %A Morris, J %A Young, J %T Incidence and outcomes of pregnancy-associated cancer in Australia, 1994-2008: a population-based linkage study. %B BJOG %D 2012 %C United Kingdom %I Wiley-Blackwell Publishing Ltd. %V 119 %N 13 %P 1572-1582 %@ 1471-0528 %X Please cite this paper as: Lee Y, Roberts C, Dobbins T, Stavrou E, Black K, Morris J, Young J. Incidence and outcomes of pregnancy-associated cancer in Australia, 1994-2008: a population-based linkage study. BJOG 2012; DOI: 10.1111/j.1471-0528.2012.03475.x. Objective??? To determine trends in pregnancy-associated cancer and associations between maternal cancer and pregnancy outcomes. Design??? Population-based cohort study. Setting??? New South Wales, Australia, 1994-2008. Population??? A total of 781???907 women and their 1???309???501 maternities. Methods??? Cancer and maternal information were obtained from linked cancer registry, birth and hospital records for the entire population. Generalised estimating equations with a logit link were used to examine associations between cancer risk factors and pregnancy outcomes. Main outcome measures??? Incidence of pregnancy-associated cancer (diagnosis during pregnancy or within 12???months of delivery), maternal morbidities, preterm birth, and small- and large-for-gestational-age (LGA). Results??? A total of 1798 new cancer diagnoses were identified, including 499 during pregnancy and 1299 postpartum. From 1994 to 2007, the crude incidence rate of pregnancy-associated cancer increased from 112.3 to 191.5 per 100???000 maternities (P???/=35 years (aRR 1.2; 95% CI 0.9-1.6). Second pregnancy factors included birth defects (aRR 2.5; 95% CI 1.4-4.2), placenta praevia (aRR 2.5; 95% CI 1.5-4.1) and a female infant (aRR 1.2; 95% CI 1.0-1.5). Conclusions The increased recurrence risk of breech presentations suggests that women with a history of breech delivery should be closely monitored in the latter stages of pregnancy. %Z FOR Codes: 111402 111706 %0 Journal Article %~ PubMed %A Algert, Charles S %A Roberts, Christine L %A Shand, Antonia W %A Morris, Jonathan M %A Ford, Jane B %T Seasonal variation in pregnancy hypertension is correlated with sunlight intensity. %B American journal of obstetrics and gynecology %D 2010 %C United States %I Mosby, Inc. %V 203 %N 3 %P 215.e1-5 %@ 0002-9378 %X To examine seasonality of pregnancy hypertension rates, and whether they related to sunlight levels around conception. %Z FOR Codes: 104 %0 Journal Article %~ PubMed %A Lain, Samantha J %A Roberts, Christine L %A Raynes-Greenow, Camille H %A Morris, Jonathan %T The impact of the baby bonus on maternity services in New South Wales. %B The Australian & New Zealand Journal of Obstetrics & Gynaecology %D 2010 %C Australia %I Wiley-Blackwell Publishing Asia %V 50 %N 1 %P 25-29 %@ 1479-828X %X BACKGROUND: In 2004, the Federal Government introduced the baby bonus, a one-off payment upon the birth of a child. AIMS: To assess the impact of an increase in the number of births on maternity services in New South Wales following the introduction of the baby bonus payment in July 2004. METHODS: A population-based study, using NSW birth records, of 965 635 deliveries from 1998 to 2008 was carried out. The difference between the predicted number of births in 2005-2008, estimated from trends in births from 1998 to 2004, and the observed number of births in NSW hospitals in 2005-2008 were calculated. We also estimated the increase in cost to the health system of births in 2008 compared with previous years. RESULTS: Compared with trends prior to the introduction of the baby bonus, there were an estimated 11 283 extra singleton births per year in NSW hospitals by 2008. There were significant increases in the number of deliveries performed in tertiary, urban and rural public hospitals; however, the number of deliveries in private hospitals remained stable. Compared with predicted estimates, in 2008, there were over 8700 more vaginal deliveries, over 1000 more preterm births and over 45 000 extra infant hospital days each year. Compared with 2004, in 2008, the estimated cost of births in NSW hospitals increased by $60 million. CONCLUSIONS: The increase in births following the introduction of the baby bonus has significantly impacted maternity services in NSW. %Z FOR Codes: 1117 1114 %0 Journal Article %~ PubMed %A Chan, Patricia Y L %A Morris, Jonathan M %A Leslie, Garth I %A Kelly, Patrick J %A Gallery, Eileen D M %T The long-term effects of prematurity and intrauterine growth restriction on cardiovascular, renal, and metabolic function. %B International Journal of Pediatrics %D 2010 %C United States %I Hindawi Publishing Corporation %V 2010 %N %P 280402 %@ 1687-9740 %X Objective. To determine relative influences of intrauterine growth restriction (IUGR) and preterm birth on risks of cardiovascular, renal, or metabolic dysfunction in adolescent children. Study Design. Retrospective cohort study. 71 periadolescent children were classified into four groups: premature small for gestational age (SGA), premature appropriate for gestational age (AGA), term SGA, and term AGA. Outcome Measures. Systolic blood pressure (SBP), augmentation index (Al), glomerular filtration rate (GFR) following protein load; plasma glucose and serum insulin levels. Results. SGA had higher SBP (average 4.6???mmHg) and lower GFR following protein load (average 28.5???mL/min/1.73???m(2)) than AGA. There was no effect of prematurity on SBP (P = .4) or GFR (P = .9). Both prematurity and SGA were associated with higher AI (average 9.7%) and higher serum insulin levels 2???hr after glucose load (average 15.5???mIU/L) than all other groups. Conclusion. IUGR is a more significant risk factor than preterm birth for later systolic hypertension and renal dysfunction. Among children born preterm, those who are also SGA are at increased risk of arterial stiffness and metabolic dysfunction. %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Hirst, Jane E %A Jeffery, Heather E %A Morris, Jonathan %A Foster, Kirsty %A Elliott, Elizabeth J %T Application of evidence-based teaching in maternal and child health in remote Vietnam. %B International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics %D 2009 %C Ireland %I Elsevier Ireland Ltd %V 104 %N 2 %P 152-5 %@ 0020-7292 %X To develop, implement, and evaluate an evidence-based multidisciplinary teaching program to improve maternal and infant health in remote Vietnam. %Z FOR Codes: 130209 %0 Journal Article %~ PubMed %A Hadfield, Ruth M %A Lain, Samantha J %A Simpson, Judy M %A Ford, Jane B %A Raynes-Greenow, Camille H %A Morris, Jonathan M %A Roberts, Christine L %T Are babies getting bigger? An analysis of birthweight trends in New South Wales, 1990-2005. %B The Medical Journal of Australia %D 2009 %C Australia %I Australasian Medical Publishing Company Pty. Ltd %V 190 %N 6 %P 312-315 %@ 1326-5377 %X OBJECTIVE: To determine whether the proportion of babies born large for gestational age (LGA) in New South Wales has increased, and to identify possible reasons for any increase. DESIGN AND SETTING: Population-based study using data obtained from the NSW Midwives Data Collection, a legislated surveillance system of all births in NSW. PARTICIPANTS: All 1 273 924 live-born singletons delivered at term (> or = 37 complete weeks'' gestation) in NSW from 1990 to 2005. MAIN OUTCOME MEASURES: LGA, defined as > 90th centile for sex and gestational age using 1991-1994 Australian centile charts; maternal factors associated with LGA were assessed using logistic regression. RESULTS: The proportion of babies born LGA increased from 9.2% to 10.8% (18% increase) for male infants and from 9.1% to 11.0% (21% increase) for female infants. The mean birthweight increased by 23 g for boys and 25 g for girls over the study period. Increasing maternal age, higher rates of gestational diabetes and a decline in smoking contributed significantly to these increases, but did not fully explain them. CONCLUSIONS: There is an increasing trend in the proportion of babies born LGA, which is only partly attributable to decreasing maternal smoking, increasing maternal age and increasing gestational diabetes. %Z FOR Codes: 111402 111706 %0 Journal Article %~ PubMed %A Hyland, Catherine A %A Gardener, Glenn J %A Davies, Helen %A Ahvenainen, Minna %A Flower, Robert L %A Irwin, Darryl %A Morris, Jonathan M %A Ward, Christopher M %A Hyett, Jonathan A %T Evaluation of non-invasive prenatal RHD genotyping of the fetus. %B The Medical Journal of Australia %D 2009 %C Australia %I Australasian Medical Publishing Company Pty. Ltd. %V 191 %N 1 %P 21-25 %@ 0025-729X %X OBJECTIVE: To evaluate a non-invasive molecular test using free circulating fetal DNA in maternal plasma to predict the fetal RHD type. DESIGN: A prospective cohort study. PARTICIPANTS AND SETTING: Venous blood samples were collected from 140 Rhesus (Rh) D-negative women booked for antenatal care in two tertiary maternity hospitals in Sydney and Brisbane between November 2006 and April 2008. Cell-free DNA, including free maternal and fetal DNA, was extracted from maternal plasma in the tertiary Australian Red Cross Blood Service laboratory, and three exon regions of the RHD gene were amplified. MAIN OUTCOME MEASURES: Comparison of the predicted fetal RHD status and the infant''s RhD serotype. Secondary analysis involved using SRY and RASSF1A assays as internal controls to confirm the presence of fetal DNA in RHD-negative samples. RESULTS: Of 140 samples tested, results for RHD status were assigned for 135, and all 135 predictions were correct. A result was not assigned in five cases: three did not meet strict threshold criteria for classification, and two were due to RHD variants. Fetal SRY status was correctly predicted in 137 of 140 cases. In 16 samples typed both RHD- and SRY-negative, a positive RASSF1A result verified the presence of fetal DNA. CONCLUSIONS: Non-invasive testing of multiple exons provides a robust method of assessing fetal RHD status, and provides a safer alternative to amniocentesis for the management of RhD-negative pregnant women who are isoimmunised. %Z FOR Codes: 111401 %0 Journal Article %~ PubMed %A Hadfield, Ruth M %A Lain, Samantha J %A Raynes-Greenow, Camille H %A Morris, Jonathan M %A Roberts, Christine L %T Is there an association between endometriosis and the risk of pre-eclampsia? A population based study. %B Human reproduction (Oxford, England) %D 2009 %C United Kingdom %I Oxford University Press %V 24 %N 0 %P 2348-52 %@ 0268-1161 %X An association between endometriosis and reduced risk of pre-eclampsia has recently been reported. Longitudinally-linked electronic hospital records are a valuable resource for investigating such findings in a large, population-based sample. Our aim was to determine whether women with a history of endometriosis were at modified risk for pregnancy hypertension or pre-eclampsia. %Z FOR Codes: 111402 111706 %0 Journal Article %~ PubMed %A Roberts, Christine L %A Bell, Jane C %A Ford, Jane B %A Morris, Jonathan M %T Monitoring the quality of maternity care: how well are labour and delivery events reported in population health data? %B Paediatric and Perinatal Epidemiology %D 2009 %C United Kingdom %I Wiley-Blackwell Publishing Ltd. %V 23 %N 2 %P 144-152 %@ 1365-3016 %X Administrative or population health data sets (PHDS), such as birth and hospital discharge data, are used increasingly to evaluate maternity care. Use of PHDS requires reliable identification of diagnoses and procedures. The aim of this study was to determine the accuracy and reliability of the reporting of diagnoses and procedures related to childbirth in both individual and linked, birth and ICD10-coded hospital discharge data. Data from a population-based validation study of 1200 women provided the ''gold standard'' for labour and delivery events and were compared with the hospital discharge and birth databases. Reporting characteristics (sensitivity, specificity, positive and negative predictive values) were determined for: induction, augmentation and obstruction of labour, modes of delivery (including failed instrumental delivery), episiotomy, perineal tears and repairs, and manual removal of the placenta. Differences in reporting by mode of delivery were also examined. Of the 1184 records available for review, 25% had labour induced, 25% had labour augmented and, of those who laboured, 17% had obstructed labour reported. Fourteen per cent had an elective/planned caesarean section (CS) including 2% that went into labour prior to the planned date, and 11% had an emergency, unplanned CS including 2% who had no labour. With the exception of augmentation and obstruction of labour, failed instrumental delivery and manual removal, there were high levels of accuracy for reporting of diagnoses and procedures during labour and delivery. There were no significant differences in reporting by mode of delivery. The findings suggest that PHDS-reported induction of labour, mode of delivery, and 3rd and 4th degree tears and repairs can be reliably used to evaluate maternity care. Consistency in reporting in birth and hospital discharge data from different countries and over time suggests the findings are likely to be generalisable to high-income countries. %Z FOR Codes: 111706 %0 Journal Article %~ PubMed %A Algert, C S %A McElduff, A %A Morris, J M %A Roberts, C L %T Perinatal risk factors for early onset of Type 1 diabetes in a 2000-2005 birth cohort. %B Diabetic Medicine %D 2009 %C United Kingdom %I Wiley-Blackwell %V 26 %N 12 %P 1193-1197 %@ 1464-5491 %X Aims To examine perinatal risk factors for the onset of Type 1 diabetes before 6 years of age, in a 2000-2005 Australian birth cohort. Methods Data from longitudinally linked delivery and hospital admission records (until June 2007) were analysed. Diabetes in mothers and children was identified from International Classification of Diseases 10 diagnosis codes in the hospital records. Results There were 272 children admitted to hospital with a first diagnosis of diabetes out of 502 040 live births. Incidence for the infants born in 2000 was 16.0 per 100 000 person-years. Maternal Type 1 diabetes was a significant risk factor [crude relative risk (RR) 6.33], but maternal Type 2 diabetes and gestational diabetes were not significantly associated with diabetes in the child. Late preterm birth (34-36 weeks) (RR 1.64) and caesarean section (RR 1.30) increased the risk of a diabetes admission. Size-for-gestational-age was significantly associated with onset of diabetes (small-for-gestational age RR 0.48), but neither birth weight categories nor birth weight as a continuous variable were associated with risk of diabetes. Increasing maternal age was associated with an increased risk of diabetes in the child (RR 1.13 for each additional 5 years of age). Conclusions This study identified risk factors associated with onset of Type 1 diabetes before 6 years of age, in a recent birth cohort. Size-for-gestational-age had a consistent association with risk of early onset of Type 1 diabetes, small size being protective. Size-for-gestational-age measures should be preferred to birth weight thresholds when assessing risk of diabetes. %Z FOR Codes: 111402 111706 110306 %0 Journal Article %~ PubMed %A Roberts, Christine L %A Ford, Jane B %A Thompson, Jane F %A Morris, Jonathan M %T Population rates of haemorrhage and transfusions among obstetric patients in NSW: a short communication. %B The Australian and New Zealand Journal of Obstetrics and Gynecology %D 2009 %C Australia %I Wiley-Blackwell Publishing Asia %V 49 %N 3 %P 296-298 %@ 1479-828X %X We estimated the population rates of obstetric haemorrhage and transfusion among women giving birth, utilising data collected in a review of the delivery admissions of 1200 randomly selected women in New South Wales in 2002. The estimated population obstetric haemorrhage rate was 13.1% (11.4% post-partum haemorrhage (PPH), 2.2% antepartum haemorrhage) and the transfusion rate was 1.06% (0.9% vaginal births, 1.6% of caesarean sections). When variations in definitions and denominators were accounted for, the difference in PPH rates among vaginal births (13.1%) and caesarean sections (6.3%) disappeared, suggesting PPH is under-ascertained for women delivered by caesarean section. %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Lain, Samantha J %A Algert, Charles S %A Tasevski, Vitomir %A Morris, Jonathan M %A Roberts, Christine L %T Record linkage to obtain birth outcomes for the evaluation of screening biomarkers in pregnancy: a feasibility study. %B BMC Medical Research Methodology %D 2009 %C United Kingdom %I BioMed Central Ltd. %V 9 %N 0 %P 48 %@ 1471-2288 %X BACKGROUND: Linking population health data to pathology data is a new approach for the evaluation of predictive tests that is potentially more efficient, feasible and efficacious than current methods. Studies evaluating the use of first trimester maternal serum levels as predictors of complications in pregnancy have mostly relied on resource intensive methods such as prospective data collection or retrospective chart review. The aim of this pilot study is to demonstrate that record-linkage between a pathology database and routinely collected population health data sets provides follow-up on patient outcomes that is as effective as more traditional and resource-intensive methods. As a specific example, we evaluate maternal serum levels of PAPP-A and free beta-hCG as predictors of adverse pregnancy outcomes, and compare our results with those of prospective studies. METHODS: Maternal serum levels of PAPP-A and free beta-hCG for 1882 women randomly selected from a pathology database in New South Wales (NSW) were linked to routinely collected birth and hospital databases. Crude relative risks were calculated to investigate the association between low levels (multiples of the median < or = 5th percentile) of PAPP-A or free beta-hCG and the outcomes of preterm delivery (<37 weeks), small for gestational age (<10th percentile), fetal loss and stillbirth. RESULTS: Using only full name, sex and date of birth for record linkage, pregnancy outcomes were available for 1681 (89.3%) of women included in the study. Low levels of PAPP-A had a stronger association with adverse pregnancy outcomes than a low level of free beta-hCG which is consistent with results in published studies. The relative risk of having a preterm birth with a low maternal serum PAPP-A level was 3.44 (95% CI 1.96-6.10) and a low free beta-hCG level was 1.31 (95% CI 0.55-6.16). CONCLUSION: This study provides data to support the use of record linkage for outcome ascertainment in studies evaluating predictive tests. Linkage proportions are likely to increase if more personal identifiers are available. This method of follow-up is a cost-efficient technique and can now be applied to a larger cohort of women. %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Lain, Samantha J %A Ford, Jane B %A Raynes-Greenow, Camille H %A Hadfield, Ruth M %A Simpson, Judy M %A Morris, Jonathan M %A Roberts, Christine L %T The impact of the Baby Bonus payment in New South Wales: who is having "one for the country"? %B The Medical Journal of Australia %D 2009 %C Australia %I Australasian Medical Publishing Company Pty. Ltd %V 190 %N 5 %P 238-241 %@ 1326-5377 %X OBJECTIVE: To assess the change in birth rates, both overall and in age, parity, socioeconomic and geographical subgroups of the population, after the introduction of the Baby Bonus payment in Australia on 1 July 2004. DESIGN AND SETTING: Population-based study using New South Wales birth records and Australian Bureau of Statistics population estimates for the period 1 January 1997 - 31 December 2006. PARTICIPANTS: All 853 606 women aged 15-44 years with a pregnancy resulting in a birth at > or = 20 weeks'' gestation or a baby > or = 400 g birthweight. MAIN OUTCOME MEASURE: Change in birth rate in 2005 and 2006 compared with the trend in birth rates before the introduction of the Baby Bonus. RESULTS: The crude annual birth rate showed a downward trend from 1997 to 2004; after 2004 this trend reversed with a sharp increase in 2005 and a further increase in 2006. All age-specific birth rates increased after 2004, with the greatest increase in birth rate, relative to the trend before the Baby Bonus, being seen in teenagers. Rates of first births were not significantly affected by the bonus; however, rates of third or subsequent births increased across all age, socioeconomic and geographical subgroups. CONCLUSIONS: In the first 2 years after the introduction of the Baby Bonus, birth rates increased, especially among women having a third or subsequent birth. This could represent an increase in family size and/or a change in the timing of births. %Z FOR Codes: 111402 111706 %0 Journal Article %~ PubMed %A Roberts, Christine L %A Ford, Jane B %A Algert, Charles S %A Bell, Jane C %A Simpson, Judy M %A Morris, Jonathan M %T Trends in adverse maternal outcomes during childbirth: a population-based study of severe maternal morbidity. %B BMC Pregnancy and Childbirth %D 2009 %C United Kingdom %I BioMed Central Ltd. %V 9 %N %P 7 %@ 1471-2393 %X BACKGROUND: Maternal mortality is too rare in high income countries to be used as a marker of the quality of maternity care. Consequently severe maternal morbidity has been suggested as a better indicator. Using the maternal morbidity outcome indicator (MMOI) developed and validated for use in routinely collected population health data, we aimed to determine trends in severe adverse maternal outcomes during the birth admission and in particular to examine the contribution of postpartum haemorrhage (PPH). METHODS: We applied the MMOI to the linked birth-hospital discharge records for all women who gave birth in New South Wales, Australia from 1999 to 2004 and determined rates of severe adverse maternal outcomes. We used frequency distributions and contingency table analyses to examine the association between adverse outcomes and maternal, pregnancy and birth characteristics, among all women and among only those with PPH. Using logistic regression, we modelled the effects of these characteristics on adverse maternal outcomes. The impact of adverse outcomes on duration of hospital admission was also examined. RESULTS: Of 500,603 women with linked birth and hospital records, 6242 (12.5 per 1,000) suffered an adverse outcome, including 22 who died. The rate of adverse maternal outcomes increased from 11.5 in 1999 to 13.8 per 1000 deliveries in 2004, an annual increase of 3.8% (95%CI 2.3-5.3%). This increase occurred almost entirely among women with a PPH. Changes in pregnancy and birth factors during the study period did not account for increases in adverse outcomes either overall, or among the subgroup of women with PPH. Among women with severe adverse outcomes there was a 12% decrease in hospital days over the study period, whereas women with no severe adverse outcome occupied 23% fewer hospital days in 2004 than in 1999. CONCLUSION: Severe adverse maternal outcomes associated with childbirth have increased in Australia and the increase was entirely among women who experienced a PPH. Reducing or stabilising PPH rates would halt the increase in adverse maternal outcomes. %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Mealing, N M %A Roberts, C L %A Ford, J B %A Simpson, J M %A Morris, J M %T Trends in induction of labour, 1998-2007: a population-based study. %B The Australian and New Zealand Journal of Obstetrics and Gynecology %D 2009 %C Australia %I Wiley-Blackwell Publishing Asia %V 49 %N 6 %P 599-605 %@ 1479-828X %X BACKGROUND: Increasing rates of induction have been reported in the UK, the USA, Canada and Australia since the early 1990s; however, there is a lack of population-based studies on trends and pharmacological management of induction of labour. AIMS: To determine population trends in induction of labour and predictors of failed induction (in caesarean section, specifically for failure to progress with cervix dilation < or =3 cm). METHODS: Trends in induction were determined for women in NSW who laboured at > or = 32 weeks from 1998 to 2007 (N = 739 904). To determine the predictors of failed induction, 92 359 deliveries of live singletons for whom linked birth and hospital data were available (2001-2005) were examined using logistic regression analysis. RESULTS: The rate of induction increased over the decade from 25.3 to 29.1%; however, among those induced with prostaglandin alone, it decreased from 33.5 to 23.8%. Oxytocin alone was the most commonly used labour induction agent overall (51%) and in most population subgroups. The predictors of failed induction in both nullipara and multipara included increasing maternal age, pre-term and post-term birth and the use of prostaglandin or mechanical methods of induction (neither oxytocin nor prostaglandin). CONCLUSIONS: The pharmacological agents used for induction of labour have changed over the past decade. An important area for future research is to investigate how the dosage of oxytocin and prostaglandin affects pregnancy outcomes. %Z FOR Codes: 111706 111402 %0 Journal Article %~ PubMed %A Algert, Charles S %A Morris, Jonathan M %A Bowen, Jennifer R %A Giles, Warwick %A Roberts, Christine L %T Twin deliveries and place of birth in NSW 2001-2005. %B The Australian and New Zealand Journal of Obstetrics and Gynecology %D 2009 %C Australia %I Wiley-Blackwell Publishing Asia %V 49 %N 5 %P 461-466 %@ 1479-828X %X BACKGROUND: Twin pregnancies have an elevated risk of adverse outcomes, particularly preterm twins. AIMS: Describe the distribution of twin deliveries by hospital level, the associated perinatal and maternal morbidity, and determine predictors of perinatal morbidity and urgent transfer to a neonatal intensive care unit. METHODS: Longitudinally linked New South Wales delivery and hospital records for the years 2001-2005 were used to identify perinatal and maternal morbidity/mortality in twin pregnancies. Regression analysis was used to examine predictive factors, including birth hospital volume. RESULTS: At < or = 32 weeks, 88.1% of twins were delivered in tertiary referral hospitals. By 34-35 weeks, only 39.7% of twins were delivered in tertiary units. Gestational age was the primary predictor of perinatal morbidity/mortality. Perinatal morbidity/mortality and maternal morbidity were lowest for deliveries at 38 weeks. There was no evidence that planned caesarean section at < or = 38 weeks was protective against perinatal morbidity/mortality. There was an increased risk of perinatal morbidity/mortality (odds ratio (OR) = 2.22) for twins delivered at 33-35 weeks gestation at hospitals with < 500 deliveries per annum, and an increased risk of urgent neonatal transfer (OR = 2.06). Twin pairs for whom there was a > or = 20% discordance in birthweight had an increased risk of morbidity/mortality at 36-38 weeks (OR = 1.79). CONCLUSIONS: Both infant and maternal morbidity increase from 39 weeks gestation. Delivery of twins before 36 weeks at smaller hospitals (< 500 deliveries per annum) should be avoided. A twin pregnancy where there is a > or = 20% difference in estimated fetal weights should be considered for referral to a tertiary obstetric unit. %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Barrett, Helen Lorraine %A Morris, Jonathan %A McElduff, Aidan %T Watchful waiting: a management protocol for maternal glycaemia in the peripartum period. %B The Australian and New Zealand Journal of Obstetrics and Gynecology %D 2009 %C Australia %I Wiley-Blackwell Publishing Asia %V 49 %N 2 %P 162-167 %@ 1479-828X %X BACKGROUND: It is accepted that tight glycaemic control is necessary during labour in women with pregestational or gestational diabetes mellitus (GDM). Although policies vary, routine use of intravenous glucose and insulin remains a standard practice in some institutions. We present a retrospective review of a more conservative approach. Briefly, regardless of planned delivery method, maternal blood sugar level (BSL) is monitored during delivery and only if outside 4-7 mmol/L is action taken. We report the results of an audit of this practice. METHODS: A retrospective (August 2001-July 2004) review of 137 singleton, term deliveries of women with diabetes (23 pregestational, 114 GDM). Predetermined outcomes reported were BSL achieved prior to delivery, first neonatal BSL and/or admission to neonatal intensive care unit (NICU) for hypoglycaemia. RESULTS: With our management practice, most women had a BSL between 4 and 8 mmol/L prior to delivery (17 (74%) diabetes mellitus (DM), 37 (93%) diet-controlled GDM, 55 (89%) insulin-requiring GDM). Neonatal hypoglycaemia (< 2.6 mmol/L) was common (n = 30 (22%)). However, most neonatal hypoglycaemia occurred in infants born to mothers with BSL 4-8 mmol/L (n = 26 (87%)). Neonatal hypoglycaemia requiring NICU admission (n = 13) was predominantly in infants born to mothers with BSL < 8mmol/L prior to delivery (n = 10 (77%)). Three of eight maternal BSLs > 8 mmol/L occurred prior to emergency caesarean section in women with pregestational diabetes. CONCLUSION: These results suggest that our current practice, particularly in women with GDM, may offer an alternative to more aggressive regimes. %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Algert, Charles S %A Bowen, Jennifer R %A Hadfield, Ruth M %A Olive, Emily C %A Morris, Jonathan M %A Roberts, Christine L %T Birth at hospitals with co-located paediatric units for infants with correctable birth defects. %B Australian and New Zealand Journal of Obstetrics and Gynaecology %D 2008 %C Australia %I Blackwell Publishing Asia %V 48 %N 3 %P 273-279 %@ 1479-828X %X OBJECTIVES: To determine the percentage of liveborn infants with selected antenatally identifiable and correctable birth defects who were delivered at hospitals with co-located paediatric surgical units (co-located hospitals). Additionally, to determine the survival rates for these infants. PATIENTS AND METHODS: Data were from linked New South Wales hospital discharge records from 2001 to 2004. Livebirths with one of the selected defects were included if they underwent an appropriate surgical repair, or died during the first year of life. Infants with multiple lethal birth defects were excluded. Deliveries at co-located hospitals were identified, but no data on antenatal diagnosis were available. RESULTS: The study identified 287 eligible livebirths with the selected defects. The highest rates of delivery at co-located hospitals were for gastroschisis (88%), exomphalos (71%), spina bifida (63%) and diaphragmatic hernia (61%), and the lowest for transposition of the great arteries (43%) and oesophageal atresia (40%). Mothers resident outside of metropolitan areas, where the co-located hospitals are located, had a similar rate of delivery at co-located hospitals as metropolitan women. For the non-metropolitan mothers of infants with a birth defect, this represented a 30-fold increase over the baseline delivery rate of 1.8%. Post-surgery survival rates were 87% or higher. Overall survival rates were > or = 86% except for infants with a diaphragmatic hernia. CONCLUSIONS: Delivery rates at co-located hospitals were high for mothers of infants with these correctable birth defects. Regionalised health care appears to work well for these pregnancies, as women living outside metropolitan areas had a similar rate of delivery at co-located hospitals to that of urban women. %Z FOR Codes: 111706 111402 111401 %0 Journal Article %~ PubMed %A Lain, Samantha J %A Roberts, Christine L %A Hadfield, Ruth M %A Bell, Jane C %A Morris, Jonathan M %T How accurate is the reporting of obstetric haemorrhage in hospital discharge data? A validation study. %B The Australian & New Zealand Journal of Obstetrics & Gynaecology %D 2008 %C Australia %I Wiley-Blackwell Publishing %V 48 %N 5 %P 481-484 %@ 1479-828X %X Background: Routinely collected datasets are frequently used for population-based research but their accuracy needs to be assured. Aim: This study aims to assess the accuracy of hospital discharge data in identifying obstetric haemorrhage diagnoses and procedures, and estimate their population incidence. Methods: The medical records of 1200 randomly selected women were reviewed and compared with obstetric haemorrhage diagnoses and procedures in the hospital discharge data. Sensitivity, specificity, and positive and negative predictive values were calculated using the medical records as the ''gold standard''. Estimates of population incidence were calculated and weighted by the sampling probabilities. Results: Estimated population incidence for any antepartum haemorrhage was 1.8 per 100, and post partum haemorrhage was 7.2 per 100 women. Obstetric haemorrhage diagnosis and procedure codes tended to be underreported, with sensitivities ranging from 28.3% to 100%. All codes had specificities of 98.9% or greater. The identification of obstetric haemorrhage differed between levels of severity. Conclusion: The results indicate that population health datasets can be a reliable information source; however, these datasets could be improved with more complete documentation in medical records. %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Algert, Charles S %A Morris, Jonathan M %A Simpson, Judy M %A Ford, Jane B %A Roberts, Christine L %T Labor before a primary cesarean delivery: reduced risk of uterine rupture in a subsequent trial of labor for vaginal birth after cesarean. %B Obstetrics and Gynecology %D 2008 %C United States %I Lippincott Williams and Wilkins %V 112 %N 5 %P 1061-1066 %@ 0029-7844 %X OBJECTIVE: To estimate the effect of the onset of labor before a primary cesarean delivery on the risk of uterine rupture if vaginal birth after cesarean (VBAC) is attempted in the next pregnancy. METHODS: Longitudinally linked birth records were used to follow women from a primary cesarean delivery to a trial of labor at term for their next birth. The effects of characteristics of both the trial of labor and primary cesarean deliveries on the risk of uterine rupture were examined. RESULTS: Of 10,160 women who had a trial of labor, 39 (0.38%) had a uterine rupture. Women who were induced or augmented for their trial of labor had a greater relative risk (RR) of uterine rupture (crude RR 4.24, 95% confidence interval [CI] 2.23-8.07). Women whose primary cesarean delivery was planned or followed induction of labor also had an increased risk of uterine rupture (crude RR 2.61, 95% CI 1.24-5.49), and this risk remained after adjustment for other factors. Women with a history of either spontaneous labor or vaginal birth had one uterine rupture for every 460 deliveries; women without this history who required induction or augmentation to proceed with a VBAC attempt had one uterine rupture for every 95 deliveries. CONCLUSION: Labor before the primary cesarean delivery can decrease the risk of uterine rupture in a subsequent trial of labor. A history of primary cesarean delivery preceded by spontaneous labor is favorable for VBAC. LEVEL OF EVIDENCE: II. %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Roberts, Christine %A Cameron, Carolyn %A Bell, Jane %A Algert, Charles %A Morris, Jonathan %T Measuring Maternal Morbidity in Routinely Collected Health Data: Development and Validation of a Maternal Morbidity Outcome Indicator. %B Medical Care %D 2008 %C United States %I Lippincott Williams and Wilkins %V 46 %N 8 %P 786-794 %@ 0025-7079 %X BACKGROUND:: As maternal deaths become rare in many countries, severe maternal morbidity has been suggested as a better indicator of quality of care. OBJECTIVE:: To develop and validate an indicator for measuring major maternal morbidity in routinely collected population health datasets (PHDS). METHODS:: First, diagnoses and procedures that might indicate major maternal morbidity were compiled and used to sample possible cases in PHDS; second, a validation study of indicated cases was undertaken by review of birth admission medical records using a nested case-control study approach with 400 possible cases and 800 controls; finally "true" morbidity from the validation study was used to define a maternal morbidity outcome indicator (MMOI) with a high positive predictive value (PPV). Sensitivity, specificity, PPV, negative predictive value (NPV), and exact 95% confidence intervals (95% CI) were weighted by the sampling probabilities. RESULTS:: There were 1184 records available for review. Of 393 possible cases only 188 were confirmed as suffering major morbidity (weighted PPV 47.3%, sensitivity 72.9%) and of the 791 initial noncases, 787 were confirmed as noncases (weighted NPV 99.5%, specificity 98.5%). Revision of the initial indicator with exclusion of noncontributing International Classification of Disease (ICD) codes provided a MMOI with population-weighted rate of 1.5%, PPV 94.6% (95% CI: 72.3-99.9), sensitivity 78.4% (95% CI: 55.2-93.1), specificity 99.9% (95% CI: 99.5-99.9), and 99.5% agreement with "true" morbidity (kappa 0.86). CONCLUSIONS:: PHDS can be used reliably to identify women who suffer a major adverse outcome during the birth admission and have potential for monitoring the quality of obstetric care in a uniform and cost-effective way. %Z FOR Codes: 111402 111706 %0 Journal Article %~ PubMed %A Roberts, Christine L %A Ford, Jane B %A Kelman, Chris W %A Morris, Jonathan M %T Monitoring severe maternal morbidity in Australia. %B The Australian & New Zealand journal of obstetrics & gynaecology %D 2008 %C Australia %I Wiley-Blackwell Publishing Asia %V 48 %N 3 %P 355-355 %@ 1479-828X %X %Z FOR Codes: 111402 111706 %0 Journal Article %~ PubMed %A Roberts, Christine L %A Algert, Charles S %A Ford, Jane B %A Morris, Jonathan M %T Reporting of routinely collected data by public and private hospitals. %B The Australian & New Zealand Journal of Obstetrics & Gynaecology %D 2008 %C Australia %I Wiley-Blackwell Publishing Asia %V 48 %N 5 %P 521-522 %@ 1479-828X %X %Z FOR Codes: 111706 111402 %0 Journal Article %~ PubMed %A Roberts, Christine L %A Bell, Jane C %A Ford, Jane B %A Hadfield, Ruth M %A Algert, Charles S %A Morris, Jonathan M %T The accuracy of reporting of the hypertensive disorders of pregnancy in population health data. %B Hypertension in pregnancy : official journal of the International Society for the Study of Hypertension in Pregnancy %D 2008 %C United States %I Informa Healthcare %V 27 %N 3 %P 285-297 %@ 1525-6065 %X OBJECTIVE: To assess the accuracy of hypertensive disorders of pregnancy reporting in birth and hospital discharge data compared with data abstracted from medical records. METHODS: Data from a validation study of 1200 women provided the ''gold standard'' for hypertension status. The validation data were linked to both hospital discharge and birth databases. Hypertension could be reported in one, both, or neither database. RESULTS: Of the 1184 records available for review, 8.3% of women had pregnancy-related hypertension and 1.3% had chronic hypertension. Reporting sensitivities ranged from 23% to 99% and specificities from 96% to 100%. Using broad rather than specific categories of hypertension and more than one source to identify hypertension improved case ascertainment. Women with severe preeclampsia or adverse outcomes were more likely to have their pregnancy-related hypertension reported. When the hypertension reporting was discordant on the birth and hospital discharge data, the hospital data were more accurate. CONCLUSIONS: Pregnancy-related hypertension is reported with a reasonable level of accuracy, but chronic hypertension is markedly under-ascertained, even when cases were identified from more than one source. Milder forms of hypertension are more likely to go unreported. Studies utilizing population health data may overestimate the proportion of more severe forms of disease and any risk these conditions contribute to other outcomes. %Z FOR Codes: 111706 %0 Journal Article %~ PubMed %A Hadfield, Ruth M %A Lain, Samantha J %A Cameron, Carolyn A %A Bell, Jane C %A Morris, Jonathan M %A Roberts, Christine L %T The prevalence of maternal medical conditions during pregnancy and a validation of their reporting in hospital discharge data. %B The Australian & New Zealand journal of obstetrics & gynaecology %D 2008 %C Australia %I Wiley-Blackwell Publishing Asia %V 48 %N 1 %P 78-82 %@ 1479-828X %X Population health datasets are a valuable resource for studying maternal and obstetric health outcomes. However, their validity has not been thoroughly examined. We compared medical records from a random selection of New South Wales (NSW) women who gave birth in a NSW hospital in 2002 with coded hospital discharge records. We estimated the population prevalence of maternal medical conditions during pregnancy and found a tendency towards underreporting although specificities were high, indicating that false positives were uncommon. %Z FOR Codes: 111706 111402 111404 %0 Journal Article %~ PubMed %A McElduff, Aidan %A Morris, Jonathan %T Thyroid function tests and thyroid autoantibodies in an unselected population of women undergoing first trimester screening for aneuploidy. %B The Australian & New Zealand journal of obstetrics & gynaecology %D 2008 %C Australia %I Wiley-Blackwell Publishing Asia %V 48 %N 5 %P 478-480 %@ 0004-8666 %X Context: Thyroid dysfunction in early pregnancy is associated with a number of adverse outcomes. Furthermore, the presence of thyroid autoantibodies has been associated with an increased risk of miscarriage. Objective: To determine the prevalence of thyroid autoantibodies and their effect on thyroid function tests in an unselected population of women in early pregnancy. Design and setting: Cross-sectional study of samples that were collected for aneuploidy screening between 10 and 14 weeks gestation in Northern Sydney Area Health Service. Thyroid function tests (free T3, free T4 and thyroid-stimulating hormone) and thyroid autoantibodies to thyroperoxidase and thyroglobulin were measured. Patients and methods: Thyroid function tests were performed on a random sample of 257 blood samples. Results: The presence of thyroid autoantibodies was common (18.3%) and was associated with subtle changes in thyroid function consistent with impaired thyroidal reserve. Conclusions: The prevalence of antithyroid Abs in an unselected pregnant population in the late first trimester was about 18%. %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Roberts, Christine L %A Lain, Samantha J %A Morris, Jonathan M %T Variation in adherence to recommendations for management of the third stage of labor. %B International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics %D 2008 %C Ireland %I Elsevier Ireland Ltd %V 103 %N 2 %P 172-3 %@ 0020-7292 %X %Z FOR Codes: 111402 %0 Journal Article %~ PubMed %A Seeho, S K M %A Park, J H %A Rowe, J %A Morris, J M %A Gallery, E D M %T Villous explant culture using early gestation tissue from ongoing pregnancies with known normal outcomes: the effect of oxygen on trophoblast outgrowth and migration. %B Human Reproduction %D 2008 %C United Kingdom %I Oxford University Press %V 23 %N 5 %P 1170-1179 %@ 0268-1161 %X BACKGROUND: Early placental and embryo development occur in a physiologically low oxygen environment, with a rise in oxygen tension within the placenta towards the end of the first trimester. Oxygen is implicated in the regulation of trophoblast differentiation and invasion. This study examined the effects of oxygen tension on extravillous trophoblast outgrowth and migration from normal pregnancies free of significant pathology. METHODS: Early gestation villous tissue (11-14 weeks gestation), obtained by chorionic villus sampling, was cultured in 3 or 20% oxygen. Maternal and fetal outcomes were ascertained for all samples. The frequency and amount of trophoblast outgrowth and migration from villi were measured for up to 192 h. RESULTS: Significantly fewer explants produced outgrowths in 3% compared with 20% oxygen. The number of sites of trophoblast outgrowth and the extent of migration were also significantly less in 3% compared with 20% oxygen. In vitro hypoxia/reoxygenation further reduced trophoblast growth compared with 3% oxygen alone. HLA-G expression in extravillous trophoblasts was not affected by oxygen tension, with HLA-G positive extravillous trophoblasts being universally Ki67 negative. CONCLUSION: Human placental villi and extravillous trophoblasts in the late first trimester of pregnancy are sensitive to oxygen tension, with low oxygen inhibiting extravillous trophoblast outgrowth and migration. %Z FOR Codes: 111499 %0 Journal Article %~ PubMed %A Rawlinson, W D %A Hall, B %A Jones, C A %A Jeffery, H E %A Arbuckle, S M %A Graf, N %A Howard, J %A Morris, J M %T Viruses and other infections in stillbirth: what is the evidence and what should we be doing? %B Pathology %D 2008 %C 655 Avenue Of The Americas, New York, Ny, 10010 %I Elsevier Science Inc %V 40 %N 2 %P 149-160 %@ 0031-3025 %X In Australia, as in other developed countries, approximately 40-50% of stillbirths are of unknown aetiology. Emerging evidence suggests stillbirths are often multifactorial. The absence of a known cause leads to uncertainty regarding the risk of recurrence, which can cause extreme anguish for parents that may manifest as guilt, anger or bewilderment. Further, clinical endeavours to prevent recurrences in future pregnancies are impaired by lack of a defined aetiology. Therefore, efforts to provide an aetiological diagnosis of stillbirth impact upon all aspects of care of the mother, and inform many parts of clinical decision making. Despite the magnitude of the problem, that is 7 stillbirths per 1000 births in Australia, diagnostic efforts to discover viral aetiologies are often minimal. Viruses and other difficult to culture organisms have been postulated as the aetiology of a number of obstetric and paediatric conditions of unknown cause, including stillbirth. Reasons forwarded for testing stillbirth cases for infectious agents are non-medical factors, including addressing all parents'' need for diagnostic closure, identifying infectious agents as a sporadic cause of stillbirth to reassure parents and clinicians regarding risk for future pregnancies, and to reduce unnecessary testing. It is clear that viral agents including rubella, human cytomegalovirus (CMV), parvovirus B19, herpes simplex virus (HSV), lymphocytic choriomeningitis virus (LCMV), and varicella zoster virus (VZV) may cause intrauterine deaths. Evidence for many other agents is that minimal or asymptomatic infections also occur, so improved markers of adverse outcomes are needed. The role of other viruses and difficult-to-culture organisms in stillbirth is uncertain, and needs more research. However, testing stillborn babies for some viral agents remains a useful adjunct to histopathological and other examinations at autopsy. Modern molecular techniques such as multiplex PCR, allow searches for multiple agents. Now that such testing is available, it is important to assess the clinical usefulness of such testing. %Z FOR Codes: 111402 111404 111401 %0 Journal Article %~ PubMed %A Campbell, S %A Park, J H %A Rowe, J %A Seeho, S K M %A Morris, J M %A Gallery, E D M %T Chorionic Villus Sampling as a Source of Trophoblasts. %B Placenta %D 2007 %C 32 Jamestown Rd, Lon %I W B Saunders Co Ltd %V 28 %N 11-12 %P 1118-22 %@ 0143-4004 %X Unlike trophoblasts obtained from pregnancy termination material, trophoblasts grown from explanted chorionic villus samples (CVS) from 11-14 weeks of gestation potentially enable investigation of pre-eclampsia and other pregnancy disorders as the pregnancy outcome will later be known. CVS surplus to diagnostic needs were cultured as explants on either Matrigel or gelatin and the outgrowing cells characterised. Cell morphology was examined and the cells were stained for cytokeratin-7 and HLA-G. Outgrowing trophoblasts co-stained strongly for HLA-G and cytokeratin-7. While outgrowths on Matrigel grew faster and were 100% positive for cytokeratin-7, they proved to be embedded in the matrix and difficult to passage. Outgrowths on gelatin could be released by trypsinisation and were subcultured and further characterised before and after freezing. These cells should prove a valuable resource for the examination of disorders of pregnancy. %Z FOR Codes: %0 Journal Article %~ PubMed %A Xie, Lijuan %A Galettis, Anoula %A Morris, Jonathan %A Jackson, Christopher %A Twigg, Stephen M %A Gallery, Eileen D M %T Intercellular adhesion molecule-1 (ICAM-1) expression is necessary for monocyte adhesion to the placental bed endothelium and is increased in type 1 diabetic human pregnancy. %B Diabetes/metabolism research and reviews %D 2007 %C United Kingdom %I John Wiley & Sons Ltd. %V 24 %N 0 %P 294-300 %@ 1520-7552 %X That adhesion molecule expression is upregulated in endothelial cells of the placental bed in pregnancies complicated by type 1 diabetes mellitus, and that this is associated with increased adherence of peripheral blood monocytes, which can be reversed by reduction in activity or expression of relevant adhesion molecules. Specific aims were to compare the adherence of monocytes from normal pregnancies to decidual endothelial cells from both normal and diabetic pregnancies, and to examine the involvement of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in regulation of such adhesion. %Z FOR Codes: 111404 111402 111401 %0 Journal Article %~ PubMed %A McCracken, Sharon A %A Hadfield, Katrina %A Rahimi, Zolaikha %A Gallery, Eileen D %A Morris, Jonathan M %T NF-kappaB-regulated suppression of T-bet in T cells represses Th1 immune responses in pregnancy. %B European journal of immunology %D 2007 %C Germany %I Wiley- VCH Verlag GmbH & Co. KGaA %V 37 %N 5 %P 1386-1396 %@ 0014-2980 %X The molecular mechanisms that suppress Th1 immune responses in pregnancy are unknown. We assessed the expression of the Th1 cytokine transcription factor T-bet. We isolated PBMC and T cells from non-pregnant and pregnant women and demonstrated that T-bet is specifically down-regulated in pregnancy under basal and stimulated conditions. Low levels of T-bet protein were detected in the nuclear fraction of unstimulated PBMC from non-pregnant, but not pregnant women. Nuclear levels of T-bet increased in response to PMA/ionomycin in PBMC from non-pregnant, but not pregnant women. T-bet expression was greater in whole cell lysates of stimulated CD3(+) T cells from non-pregnant relative to pregnant women. NF-kappaB is specifically down-regulated in T cells in pregnant women, resulting in suppressed expression of Th1 cytokines IL-2, IFN-gamma and TNF-alpha. In this study, down-regulation of NF-kappaB also resulted in diminished expression of T-bet. PMA induces NF-kappaB translocation, T-bet expression and IL-2, IFN-gamma and TNF-alpha production. Conversely, pre-incubation with SN50, and NF-kappaB oligodeoxyribonucleotide decoys suppressed PMA-induced NF-kappaB translocation and gene transcription, respectively, resulting in diminished T-bet expression and Th1 cytokine production. Therefore, maintenance of the cytokine environment for pregnancy success is mediated via strict regulation of Th1 immune responses, more specifically through control of NF-kappaB and T-bet transcription. %Z FOR Codes: 110702 %0 Journal Article %~ PubMed %A Kwik, M %A Seeho, S K M %A Smith, C %A McElduff, A %A Morris, J M %T Outcomes of pregnancies affected by impaired glucose tolerance. %B Diabetes research and clinical practice %D 2007 %C Ireland %I Elsevier Ireland Ltd %V 77 %N 2 %P 263-268 %@ 0168-8227 %X OBJECTIVE: Gestational diabetes mellitus (GDM) is associated with an increase in both maternal and neonatal morbidity. There remains uncertainty, however, about the diagnostic criteria for GDM. We compared pregnancy outcomes across three groups of women, with the aim of establishing a threshold for diagnosis of GDM at our institution. METHODS: Women with a glucose tolerance test (GTT) were identified on the hospital''s pathology database. Those women with a singleton pregnancy, in whom a GTT had demonstrated a fasting value /=7.8mmol/L and who confined /=5.5mmol/L and/or 2h >/=7.8mmol/L on 75g GTT. %Z FOR Codes: %0 Journal Article %~ PubMed %A Ford, Jane B %A Roberts, Christine L %A Bell, Jane C %A Algert, Charles S %A Morris, Jonathan M %T Postpartum haemorrhage occurrence and recurrence: a population-based study. %B The Medical journal of Australia %D 2007 %C Australia %I Australasian Medical Publishing Company Pty. Ltd. %V 187 %N 7 %P 391-393 %@ 1326-5377 %X OBJECTIVE: To determine the risk of occurrence and recurrence of postpartum haemorrhage (excessive bleeding after childbirth) among women having at least two consecutive pregnancies. DESIGN AND SETTING: Population-based study using longitudinally linked hospital discharge and birth records from New South Wales for the period 1 January 1994 to 31 December 2002. PARTICIPANTS: All 125 295 women having at least a first and second pregnancy resulting in a singleton birth at > 400g or >/= 20 weeks'' gestation in the study period. MAIN OUTCOME MEASURES: Risk of occurrence of postpartum haemorrhage (PPH) in any pregnancy, and of recurrence of PPH in subsequent (second and third) pregnancies. RESULTS: 5.8% of women (7327/125 295) had a PPH in their first pregnancy, and 4.5% (5318/117 968) had a first PPH in their second pregnancy. Among the 23 095 women who had three pregnancies in the study period, 4.4% (908/20 839) had a first PPH in their third pregnancy. The risk of recurrence in a second consecutive pregnancy was 14.8% (1082/7327), and in a third consecutive pregnancy (after two previous PPHs) was 21.7% (43/198); even with an intervening pregnancy with no PPH (ie, PPH in the first and third pregnancies only), the risk for the third pregnancy was 10.2% (111/1085). CONCLUSIONS: These consistently elevated risks of recurrence highlight the need for women with a history of PPH to have active management of the third stage of labour and to give birth in a hospital that has onsite blood cross-match facilities. %Z FOR Codes: 111402 111706 %0 Journal Article %~ PubMed %A Wang, Y %A Tasevski, V %A Wallace, E M %A Gallery, E D %A Morris, J M %T Reduced maternal serum concentrations of angiopoietin-2 in the first trimester precede intrauterine growth restriction associated with placental insufficiency. %B BJOG : an international journal of obstetrics and gynaecology %D 2007 %C United Kingdom %I Blackwell Publishing Ltd %V 114 %N 11 %P 1427-1431 %@ 1470-0328 %X The aim of this study was to investigate whether maternal serum levels of angiopoietin-2 (Ang-2) and pregnancy-associated plasma protein A (PAPP-A) are associated with subsequent intrauterine growth restriction (IUGR). Ang-2 was measured in 29 nonpregnant and 44 pregnant women at 10-13 weeks of gestation. The median concentration of Ang-2 was 26.61 ng/ml in normal pregnant women compared with 1.71 ng/ml in nonpregnant controls (P < 0.01). Women who subsequently developed severe IUGR had lower levels of Ang-2 compared with normal pregnant controls (P < 0.01). PAPP-A levels were similar in all pregnant groups. These findings suggest that Ang-2 should be evaluated for its ability to predict pregnancies that later are affected by IUGR. %Z FOR Codes: 111404 111401