Objective To assess the impact of publicly reporting a statewide fetal growth restriction (FGR) performance indicator. Design Retrospective cohort study from 2000 to 2017. Setting All maternity services in Victoria, Australia. Population A total of 1 231 415 singleton births at ≥32 weeks of gestation. Methods We performed an interrupted time‐series analysis to assess the impact of publicly reporting an FGR performance indicator on the rate of detection for severe cases of small for gestational age (SGA). Rates of perinatal mortality and morbidity and obstetric intervention were assessed for severe SGA pregnancies and pregnancies delivered for suspected SGA. Main outcome measures Gestation at delivery, obstetric management and perinatal outcome. Results The public reporting of a statewide FGR performance indicator was associated with a steeper reduction per quarter in the percentage of severe SGA undelivered by 40 weeks of gestation, from 0.13 to 0.51% (P = 0.001), and a decrease in the stillbirth rate by 3.3 per 1000 births among those babies (P = 0.01). Of babies delivered for suspected SGA, the percentage with birthweights ≥ 10th centile increased from 41.4% (n = 307) in 2000 to 53.3% (n = 1597) in 2017 (P < 0.001). Admissions to a neonatal intensive care unit for babies delivered for suspected SGA but with a birthweight ≥ 10th centile increased from 0.8 to 2.0% (P < 0.001). Conclusions The public reporting of an FGR performance indicator has been associated with the improved detection of severe SGA and a decrease in the rate of stillbirth among those babies, but with an increase in the rate of iatrogenic birth for babies with normal growth. Tweetable abstract The public reporting of hospital performance is associated with a reduction in stillbirth, but also with unintended interventions.

delivery worldwide, and the significant morbidity and mortality that can occur with abnormal implantation or placentation following a cesarean delivery, attention to optimizing operative techniques to minimize these risks would seem to be important. Although limited data are available, in 1 previous study, a cesarean delivery performed after labor was associated with a lower risk of accreta in the next pregnancy (Am J Perinatol 2020;37:633-637), and there are likely characteristics of the uterine closure and scar that contribute to risk.It has been hypothesized that different closure techniques might be associated with difference in risk of CSP and abnormal placentation, but the jury is still out (J Obstet Gynaecol 2021;1-8). It does seem that further data would be helpful in guiding management of the first cesarean to decrease the risk in subsequent pregnancies. This would seem like an important area of investigation that could make a substantial difference in the morbidity and mortality of these subsequent pregnancies.-MEN)

Objective: To assess pregnancy outcomes following first trimester combined screening for preterm preeclampsia in Australia. Methods:We compared pregnancy outcomes of women with singleton pregnancies who underwent first trimester combined preeclampsia screening with the Fetal Medicine Foundation algorithm between 2014 and 2017 in Melbourne and Sydney, Australia, with those from women who received standard care. The primary outcomes were preterm preeclampsia and screening performance. Effect estimates were presented as risk ratios with 95% confidence intervals.Results: A total of 29 618 women underwent combined screening and 301 566 women received standard care. Women who had combined screening were less likely to have preeclampsia, preterm birth, small neonates, and low Apgar scores than the general population. Women with high-risk results (≥1 in 100) were more likely to develop preterm preeclampsia (2.1% vs. 0.7%, risk ratio [RR] 3.04, 95% CI 2.46-3.77), while low-risk women (risk <1 in 100) had lower rates of preterm preeclampsia (0.2% vs. 0.7%, RR 0.26, 95% CI 0.19-0.35) and other pregnancy complications. Screening detected 65.2% (95% CI 56.4-73.2%) of all preterm preeclampsia cases, with improved performance after adjustment for treatment effect.Conclusions: First trimester screening for preeclampsia in clinical practice identified a population at high risk of adverse pregnancy outcomes and low-risk women who may be suitable for less intensive antenatal care.