Pregnancy outcomes in primigravid women aged 35 years and over in South Australia, 1986-1988.

The South Australian perinatal data collection for 1986-1988 was used to compare the characteristics and outcomes of singleton pregnancies in 515 primigravid women aged 35 years and over with those in 4175 younger primigravid women aged 20-29 years. Notable differences observed were a higher prevalence of medical, obstetric and labour complications and assisted deliveries in the older group. Breech presentations were almost twice as common in the older women, as were caesarean sections. Only 27% achieved a spontaneous vaginal delivery. The mean duration of hospital stay for the older women was longer for both vaginal and caesarean deliveries. However, although their babies were more likely to be premature or of low birthweight, the perinatal mortality rate was not significantly increased and the great majority of older primigravid women managed by modern obstetric methods can expect a good pregnancy outcome.

Surveillance and sentinel systems.

The research committee of the RACGP has urged authorities in each State to introduce sentinel practice schemes in order to provide information on selected conditions not normally notifiable to public health agencies. To date not all States have taken up the request. In this article the history and role of such schemes are examined. Special attention is paid to the sentinel system that has operated in South Australia since 1983.

Pregnancy and perinatal factors associated with persistently low Apgar scores: an analysis of the birth records of infants born in South Australia.

This study included all newborns with Apgar scores below seven at one minute after birth who were born in 1986 and whose births were notified to the South Australian Perinatal Statistics Collection. Univariate comparisons were made of the demographic, obstetric and pregnancy outcome characteristics of the 301 newborns whose Apgar scores remained below seven at five minutes and the 3165 whose scores recovered to seven or more. The results provide a general risk profile of the 301 newborn infants who perform poorly at birth, as indicated by a low Apgar score at both one and five minutes. Adverse risk factors identified in this study were similar to those for intellectual disability (mental retardation) and cerebral palsy in South Australia. It is suggested that persisting low Apgar scores, when combined with the other risk factors demonstrated in this and previous studies, would provide more reliable prognostic information than would Apgar scores alone. The study also shows that the majority of infants with low Apgar scores at one minute scored seven or better at five minutes. This demonstrates, that although a low one minute Apgar score has value in identifying newborns in need of immediate attention, it must be supplemented by the five minute score's stronger association with perinatal morbidity.

Pregnancy and birth risk factors for intellectual disability in South Australia.

It is generally accepted that developmental handicaps can often be minimized through early detection and intervention. For this reason, it is normal practice in many hospitals to follow-up and screen infants who present at birth with established risk factors. Clinical judgement will always be important when selecting children for follow-up. However, as hospital data systems improve, automated systems could be developed for listing children potentially "at risk". Where initial clinical decisions not to follow-up individual children prove to be at odds with this automated output, the individual child could be re-assessed clinically. This process could increase the level of quality control. An initial risk-factor model for intellectual disability has been developed, based on the South Australian Perinatal Statistics Collection, for use in this context.

Caesarean section in South Australia, 1986.

A profile of Caesarean section in South Australia was obtained by analysing the 19,800 births in the perinatal statistics collection in 1986. The Caesarean confinement rate was 19.0%, of which 9.0% were elective sections and 9.9% emergency sections. The rates were highest in large metropolitan hospitals. Elective rates were highest in metropolitan private hospitals, among older women, among those with a previous perinatal death or where a fetal malpresentation occurred. Emergency sections were more common in primigravidas, non-Caucasian women, those with a poor pregnancy history, few antenatal visits and a medical or obstetric complication of pregnancy. The obstetric complications most commonly encountered with Caesarean sections were fetopelvic disproportion, fetal distress, malposition or malpresentation, pregnancy hypertension and uterine inertia. Neonates born by emergency section were more likely to be premature, or low birth-weight and to manifest depression of vital signs compared with vaginal births. They also required more intensive resuscitation and neonatal care, and neonatal death occurred more frequently. Morbidity was much lower in neonates born by elective than emergency section.

A South Australian study of pregnancy and birth risk factors associated with cerebral palsy.

Using the Perinatal Statistics Collection compiled by the Pregnancy Outcome Unit of the South Australian Health Commission, a profile of statistically significant risk factors for cerebral palsy has been established for a South Australian population. Logistic regression analysis revealed that these factors included threatened miscarriage, ante-partum haemorrhage, maternal age of under 20 years, shortened gestational age, low birthweight, low Apgar score at 5 minutes, foetal distress, delay in establishing spontaneous regular respiration, presence of a congenital abnormality and prolonged hospital stay. In addition, pregnancy hypertension, reduced number of antenatal visits, breech presentation, resuscitation of the neonate by intubation and intermittent positive pressure ventilation, and the need for specialised nursery care were found to be significant in univariate analyses. These data point to the risk factors which may help identify infants who require closer monitoring for early signs of cerebral palsy.

Obstetric profiles of immigrant women from non-English speaking countries in South Australia, 1981-1983.

Obstetric profiles of non-English speaking immigrant women in South Australia are presented to assist in planning for health services. They were derived from perinatal data routinely collected by midwives and neonatal nurses. The characteristics of 5,675 immigrant women were compared with those of a random sample of approximately 5% of Australian-born women who delivered babies in 1981-1983 in South Australia. This study demonstrates that immigrant women tended to be urban dwellers and to deliver their babies in large metropolitan hospitals. They were less often from unemployed families but more often from those of low occupational status. They were older, with fewer teenagers and single women among them. They were of higher parity, and tended to commence antenatal care later. They had lower incidences of pregnancy hypertension and induced labour, but were more likely to have anaemia, antepartum haemorrhage and a Caesarean section. There were also important differences between the 7 largest immigrant groups. For example, the very high Caesarean section rate (36%) in Filipino women is of concern. Also, the mean birth-weight of babies of Vietnamese women was 263g lower than that of babies of Australian-born women. Support services need to be logistically located and address the findings of this study in a culturally acceptable way.

Induced abortion trends in South Australia, 1970-84.

Following legislative amendments extending the grounds for abortion in South Australia the abortion rate rose from 6.0/1000 in 1970, to 9.9/1000 in 1971, to 13.2/1000 in 1984. However, rates differ widely by marital status among young women, the age pattern varies markedly for different marital status groups, and trends over time differ for different age/marital status groups. Collection of detailed age and marital status data on every live birth and abortion is recommended in order to provide the most informative analysis of abortion trends.

Clinical aspects of induced abortion in South Australia from 1970-1984.

Clinical changes, and their implication, in medically induced abortion within South Australia from 1970-1984 were assessed by analysis of legally required reports provided by operating practitioners. In the past 15 years vacuum aspiration has largely replaced dilatation and curettage for early abortions, and intrauterine chemical methods have greatly decreased the use of hysterotomy for late abortions. A marked improvement in gestational pattern has also occurred, and recorded complication rates have been halved for all gestational ages. Sterilization rates at the time of abortions increased with increasing age and with increasing gravidity, but the total rates, adjusted for age and gravidity of patients, have changed little in the past 15 years.

PIP: Changes in the clinical aspects and epidemiology of induced abortions in South Australia in the period 1970-84 were assessed through the analysis of data from reports legally required from operating practitioners. The number of legal abortions in South Australia increased from 1434 in 1970 (5.9/1000 women 15-44 years old) to 4081 in 1980 (14.0/1000) and has remained stable since this time. A marked improvement in gestational age at abortion has occurred over time; the proportion of abortions performed at 12 weeks' gestation or under increased from 76.8% in 1970-74 to 80.1% in 1975-79 to 92.3% in 1980-84. In the past 15 years, vacuum aspiration has largely replaced dilatation and curettage for early abortion, and intrauterine chemical methods have greatly decreased the use of hysterotomy for late abortion. In 1970-74, 44% of 1st-trimester and 36% of mid-trimester abortions were performed by dilatation and curettage, and hysterotomy was used for 22% of early mid-trimester abortions and 35% of abortions beyond 15 weeks' gestation. In contrast, in 1984, 95% of 1st-trimester and 78% of early mid-trimester abortions are performed by vacuum aspiration, intrauterine chemical methods are used for 76% of abortions beyond 15 weeks' gestation, and hysterotomy is used for only 3% of late abortions. Between 1970 and 1984, complications of abortion decreased from 3.1% to 1.1% for gestations up to 8 weeks, from 5.2% to 1.7% for 9-12 weeks' gestation, and from 11.5% to 4.1% for longer gestations. Sterilization rates at the time of abortion have remained relatively constant over time when adjusted for age and gravidity. In 1980-84, the sterilization rates for primigravidae and those with more than 4 previous pregnancies were 0.2% and 16.3%, respectively, for 20-24-year olds and 28.2% and 46.0%, respectively, for women over 34 years of age.

Aboriginal pregnancies and births in South Australia, 1981-1982.

Information on 555 Aboriginal births which occurred during 1981 and 1982 was forwarded by midwives to the South Australian perinatal statistics unit. Corresponding information was also supplied for all other births in the state. This information showed that Aboriginal women appear to have a higher fertility rate than do other women, particularly in the teenage years. Aboriginal mothers are very young and have a high parity. They appear to receive little antenatal care and there is a greater tendency for their pregnancies to be complicated by medical conditions, such as anaemia, urinary tract infections, cardiac disorders and diabetes. Post-partum haemorrhages and retained placentas are relatively common, as are genital tract infections after delivery. Aboriginal babies are characterized by low birthweights, low Apgar scores, and prematurity. There is an indication that Aboriginal babies may have a high perinatal mortality rate in the country areas of South Australia. It is intended that this information be used as a baseline for evaluating trends in the health status of Aborigines.