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BackgroundIn Australia, approximately 0.1% of births occur to women 45 years or older and this rate has been increasing in recent years. There are however, few population based studies examining perinatal outcomes among this age group. The aim of this study was to determine the maternal and perinatal outcomes of pregnancies in women aged 45 years or older compared to women aged 30–34 years.MethodsData on births at 20 or more weeks’ gestation were obtained from the Victorian Perinatal Data Collection for the years 2005 and 2006. We examined selected maternal and perinatal outcomes for women of very advanced maternal age (VAMA) aged 45 years or older (n = 217) and compared them to women aged 30–34 years (n = 48,909). Data were summarised using numbers and percentages. Categorical data were analysed by Chi-square tests and Fisher’s exact test. Comparisons are presented using unadjusted odds ratios, 95 percent confidence intervals (CIs) and p-values.ResultsWomen aged 45 years and older had higher odds of gestational diabetes (OR 2.05; 95% CI 1.3–3.3); antepartum haemorrhage (OR 1.89; 95% CI 1.01–3.5), and placenta praevia (OR 4.88; 95% CI 2.4–9.5). The older age-group also had higher odds of preterm birth between 32–36 weeks (OR 2.61; 95% CI 1.8–3.8); low birth-weight (<2,500 gr) (OR 2.22; 95% CI 1.5–3.3) and small for gestational age (OR 1.53; 95% CI 1.0–2.3). Stratified analysis revealed that VAMA was most strongly associated with caesarean section in primiparous women (OR 8.24; 95% CI 4.5, 15.4) and those using ART (OR 5.75; 95% CI 2.5, 13.3), but the relationship persisted regardless of parity, ART use and plurality. Low birthweight was associated with VAMA only in first births (OR 3.90; 95% CI 2.3, 6.6), while preterm birth was more common in older women for both first (OR 3.13; 95% CI 1.8, 5.3) and subsequent (OR 2.08; 95% CI 1.2, 3.5) births, and for those having singleton births (OR 2.11; 95% CI 1.3, 3.4), and those who did not use ART (OR 2.10; 95% CI 1.3, 3.4). Preterm birth was very common in multiple births and following ART use, regardless of maternal age.ConclusionsThis study demonstrates that women aged 45 years and older, in Victoria, Australia, have higher rates of pregnancy and perinatal complications, compared to women aged 30–34 years.

Objective: To highlight the importance of sampling and data collection processes in qualitative interview studies, and to discuss the contribution of these processes to determining the strength of the evidence generated and thereby to decisions for public health practice and policy.Approach: This discussion is informed by a hierarchy-of-evidence-for-practice model. Pu bl i c h e a l t h r e s e a r c h u s i n g qualitative methods produces studies that can range from an exploratory study with modest implications for practice to well-developed, generalisable studies. The contribution that a study can make to public health practice and policy rests on several core features of sound qualitative research. In common with other empirical studies, qualitative research starts by justifying the research problem by reference to the literature. Qualitative research then defines a theoretical framework for the study, identifying the theoretical concepts that are relevant and will be employed in the study.1 The next step is to collect data according to a sampling plan, following which there is the analysis of data and reporting of research findings.2 In this paper, our focus is on sampling and data collection.There are inconsistencies and gaps in the literature regarding appropriate appraisal of qualitative research. 3 We propose that sampling and data collection are critical to determining the quality of a study. We use the underlying model of a hierarchy of evidencefor-practice 3 to discuss the role of sampling and data collection in determining the strength of the evidence for decisions made in practice or policy settings. This has particular relevance as a guide for researchers seeking publication and reviewers of submitted articles, given recent concerns about the quality of qualitative papers being submitted for publication. 4 One of the biggest problems noted was the lack of information provided about sampling, providing little opportunity Methods Article

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