Development of a maternity hospital classification for use in perinatal research

Falster, Michael O.; Roberts, Christine L.; Ford, Jane B.; Morris, Jonathan M.; Kinnear, Ann; Nicholl, Michael C.

doi:10.1071/nb11026

Cited by 13 publications

(15 citation statements)

References 9 publications

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“…Two area-based variables, socio-economic status using the index of education and occupation based on 2011 census data [ 27 ] by postcode of residence and the rate of overweight/obesity based on local health district and year [ 28 ] were assigned to each individual record and used as explanatory variables. Hospital factors included birth volume, hospital status (private; public with primary obstetric training; public with secondary obstetric training (large district and rural hospitals that host obstetric registrars); and other (non-training public hospitals)), level of perinatal care (NICU, CPAP, other) and hospital location (urban/rural) [ 29 ]. Hospital rates of obstetric transfusions; instrumental birth (forceps and vacuum assisted); caesarean sections performed under general anaesthetic and births where regional analgesia was used (as indicators of anaesthetic services) were also considered.…”

Section: Methodsmentioning

confidence: 99%

Variation in hospital caesarean section rates for women with at least one previous caesarean section: a population based cohort study

Schemann

Patterson

Nippita

et al. 2015

BMC Pregnancy Childbirth

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BackgroundInternationally, repeat caesarean sections make the largest contribution to overall caesarean section rates and inter-hospital variation has been reported. The aim of this study was to determine if casemix and hospital factors explain variation in hospital rates of repeat caesarean sections and whether these rates are associated with maternal and neonatal morbidity.MethodsThis population-based record linkage study utilised data from New South Wales, Australia between 2007 and 2011. The study population included maternities with any previous caesarean section(s) and were singleton, cephalic and ≥37 weeks’ gestation (Robson Group 5). Multilevel regression models were used to examine variation in hospital rates of ‘planned repeat caesarean section’ and, among women who planned a vaginal birth, ‘intrapartum caesarean section’. We assessed associations between risk-adjusted hospital rates of planned and intrapartum caesarean sections and rates of casemix adjusted maternal and neonatal morbidity, postpartum haemorrhage and Apgar score <7 at five minutes.ResultsOf 61894 maternities with a previous caesarean section in 81 hospitals, 82.1 % resulted in a caesarean section (72.7 % planned and 9.4 % unplanned intrapartum caesareans) and 17.9 % in vaginal birth. Observed hospital rates of planned caesarean sections ranged from 50.7 % to 98.4 %. Overall 49.0 % of between-hospital variation in planned repeat caesarean section rates was explained by patient (17.3 %) and hospital factors (31.7 %). Increased odds of planned caesarean section were associated with private hospital status and lower hospital propensity for vaginal birth after caesarean. There were no associations between hospital rates of planned repeat caesarean section and adjusted morbidity rates. Among women who intended a vaginal birth, the observed rates of intrapartum caesarean section ranged from 12.9 % to 71.9 %. In total, 27.5 % of between-hospital variation in rates of intrapartum caesarean section was explained by patient (19.5 %) and hospital factors (8.0 %). The adjusted morbidity rates differed among hospital intrapartum caesarean section rates, but were influenced by a few hospitals with outlying morbidity rates.ConclusionsAmong women with at least one previous caesarean section, less than half of the variation in hospital caesarean section rates was explained by differences in hospital’s patient characteristics and practices. Strategies aimed at modifying caesarean section rates for these women should not affect morbidity rates.

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Section: Methodsmentioning

confidence: 99%

Variation in hospital caesarean section rates for women with at least one previous caesarean section: a population based cohort study

Schemann

Patterson

Nippita

et al. 2015

BMC Pregnancy Childbirth

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“…25 The hospital data were used to obtain information on the history of PPH (in any previous pregnancy), index pregnancy complications not already excluded (antepartum hemorrhage and placental abruption) and insurance status. Hospitals were grouped based on their available resources, geographic area and annual birth volume.…”

Section: Key Messagementioning

confidence: 99%

“…Hospitals were grouped based on their available resources, geographic area and annual birth volume. 25 The hospital data were used to obtain information on the history of PPH (in any previous pregnancy), index pregnancy complications not already excluded (antepartum hemorrhage and placental abruption) and insurance status. Information on pregnancy hypertension and gestational diabetes were obtained from either birth or hospital data according to the reliability of the sources as determined by validation studies.…”

Section: Key Messagementioning

confidence: 99%

Blood transfusion following intended vaginal birth after cesarean vs elective repeat cesarean section in women with a prior primary cesarean: A population‐based record linkage study

Pont

Austin

Ibiebele

et al. 2018

Acta Obstet Gynecol Scand

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Introduction:There is a lack of evidence around the risk of transfusion following vaginal birth after cesarean (VBAC) compared with elective repeat cesarean section (ERCS); this is important for decision-making about birth options. The aim of this study was to determine transfusion rates and risk of transfusion following intended VBAC and ERCS. Material and methods: Women with a primary cesarean who had a subsequent birth at term (≥37 weeks) in New South Wales between 2000 and 2012, were identified from the New South Wales Perinatal Data Collection. Blood transfusions were identified from linked hospital records. Women deemed ineligible for VBAC were excluded. Modified Poisson regression was used to determine transfusion risk associated with intended VBAC compared with ERCS. Intended mode of birth was classified as: (1) intended VBAC and vaginal birth, (2) intended VBAC and cesarean, (3) intended ERCS and (4) "intention uncertain".Results: A total of 90 439 women were eligible for VBAC. Rates of transfusion were:1.4% for intended VBAC and vaginal birth (n = 17 849); 1.2% for intended VBAC and cesarean (n = 7648); 0.3% for intended ERCS (n = 60 471); and 1.1% for "intention uncertain" (n = 4471). After adjusting for maternal and pregnancy characteristics, risk of transfusion was almost four times higher for women classified as intended VBAC than intended ERCS (adjusted risk ratio = 3.73, 95% confidence interval 2.90-4.78). Conclusions:Following a prior primary cesarean, there was a higher risk of transfusion associated with attempting VBAC compared with ERCS. Though the absolute risk is small, it is important for women considering VBAC to choose birthing facilities with ready access to blood products. K E Y W O R D S blood transfusion, intended mode of birth, postpartum hemorrhage, primary cesarean, vaginal birth after cesarean | 383 PONT eT al.

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“…Otherwise, and for all babies born in 2010, the mother’s 2010 SLA was used. Hospital type is an indicator of the size of a hospital and its location (urban or regional)29 and was assigned using the hospital code recorded in the birth data.…”

Section: Methodsmentioning

confidence: 99%

Benefits of not smoking during pregnancy for Australian Aboriginal and Torres Strait Islander women and their babies: a retrospective cohort study using linked data

et al. 2019

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ObjectivesTo provide evidence for targeted smoking cessation policy, the aim of this study was to compare pregnancy outcomes of Aboriginal mothers who reported not smoking during pregnancy with Aboriginal mothers who reported smoking during pregnancy.DesignPopulation based retrospective cohort study using linked data.SettingNew South Wales, the most populous Australian state.Population18 154 singleton babies born to 13 477 Aboriginal mothers between 2010 and 2014 were identified from routinely collected New South Wales datasets. Aboriginality was determined from birth records and from four linked datasets through an Enhanced Reporting of Aboriginality algorithm.Exposure Not smoking at any time during pregnancy.Main outcome measuresUnadjusted and adjusted relative risks (aRR) and 95% CIs from modified Poisson regression were used to examine associations between not smoking during pregnancy and maternal and perinatal outcomes including severe morbidity, inter-hospital transfer, perinatal death, preterm birth and small-for-gestational age. Population attributable fractions (PAFs) were calculated using adjusted relative risks.ResultsCompared 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=0.58, 95% CI 0.44 to 0.76), preterm birth (aRR=0.58, 95% CI 0.53 to 0.64) and small-for-gestational age (aRR=0.35, 95% CI 0.32 to 0.39). PAFs (%) were 27% for perinatal death, 26% for preterm birth and 48% for small-for-gestational-age. Compared with women who smoked during pregnancy (n=8919), those who did not smoke (n=9235) had a lower risk of being transferred to another hospital (aRR=0.76, 95% CI 0.66 to 0.89).ConclusionsBabies born to women who did not smoke during pregnancy had a lower risk of adverse perinatal outcomes. Rates of adverse outcomes among Aboriginal non-smokers were similar to those among the general population. These results quantify the proportion of adverse perinatal outcomes due to smoking and highlight why effective smoking cessation programme are urgently required for this population.

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Development of a maternity hospital classification for use in perinatal research

Cited by 13 publications

References 9 publications

Variation in hospital caesarean section rates for women with at least one previous caesarean section: a population based cohort study

Variation in hospital caesarean section rates for women with at least one previous caesarean section: a population based cohort study

Blood transfusion following intended vaginal birth after cesarean vs elective repeat cesarean section in women with a prior primary cesarean: A population‐based record linkage study

Benefits of not smoking during pregnancy for Australian Aboriginal and Torres Strait Islander women and their babies: a retrospective cohort study using linked data

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