Preventing early births in a regional tertiary maternity unit: Evaluating preterm and early term birth rates before and after implementation of the Preterm Birth Prevention Initiative in the Australian Capital Territory.

BACKGROUND: A multifaceted preterm birth (PTB) prevention initiative was launched in the Australian Capital Territory (ACT) in 2019. The aim of this initiative was to safely lower the rate of early births across the ACT and the surrounding areas in New South Wales. Modelled on the Western Australian PTB Prevention Initiative, the program included new clinical guidelines and a new PTB prevention clinic at the main tertiary hospital. AIM: To evaluate the initiative and its effects on preterm and early term birth rates at the main tertiary hospital after 16 months of implementation. MATERIALS AND METHODS: A before and after intervention study was conducted. Rates of preterm and early term birth before (previous five years) and after 16 months of implementation of the ACT PTB Prevention Initiative were evaluated. RESULTS: At the main tertiary hospital in The Canberra Hospital, the rate of PTB was significantly reduced by 10% after 16 months of implementation of the initiative. Rates of PTB were lower than any of the preceding five years and resulted in 45 averted or delayed PTBs. The number of planned early term births with no medical indication was significantly reduced by 34.5% and resulted in 77 averted or delayed early term births. CONCLUSIONS: The multifaceted PTB Prevention Initiative safely lowered the rates of early birth in the ACT context. These results highlight the importance of prioritising early birth prevention, education, research and expanding the initiative nationwide.

Improving vaccination of pregnant women against seasonal influenza through use of a mandatory field in the obstetric electronic medical record.

BACKGROUND: The aim of the present study was to determine whether using a mandatory data field in an electronic health record would increase compliance with the recommendation to vaccinate pregnant women against influenza. METHODS: Two cohorts of women who delivered at the Centenary Hospital for Women and Children between 1-31 July 2015 and 1-31 July 2017 were compared for compliance with the national public health recommendation to vaccinate all pregnant women against influenza. The single change between audit periods was programming the electronic health record to include a mandatory field preventing clinicians from closing patient files unless they selected an answer to the question asking whether influenza vaccination had been performed. Data were audited and compliance rates were compared. RESULTS: A total of 275 and 299 women delivered in the two audit periods. There were no significant differences in maternal or neonatal characteristics between the two cohorts except for maternal age, which was younger in the second period (33.3 versus 31.5 years; P = 0.001). Vaccination rates doubled between audit periods (35.0% versus 79.8%, P < 0.0001). CONCLUSION: Introducing a mandatory data field into an electronic health record system may increase compliance with public health interventions, such as influenza vaccination in pregnant women.

Of pregnancies complicated by small for gestational age babies at term, what proportions have placental findings with implications for future pregnancies or neonatal outcomes?

Background: Small for gestational age (SGA) is a term to define any baby born with birth weight <10th centile. SGA can be associated with a number of placental pathology findings, which may influence maternal outcomes, neonatal neurodevelopment, and future pregnancies.Aims: To identify the proportion of term pregnancies complicated by SGA with placental findings that may have implications for future pregnancies or neonatal outcomes.Method: A retrospective review between 2011 and 2015 of babies and placentas born at term with SGA histopathological findings were categorized as to whether they had a high recurrence rate and where the long-term neurodevelopmental outcome may affect the neonate.Results: Six hundred and ninety-eight babies were identified as SGA. Only 335 (47.8%) placentas were sent for histopathological assessment. Of these, 60 (17.9%) had histopathological findings associated with high recurrence rates and 68 (20.2%) had findings associated with potential adverse neonatal outcomes.Conclusions: Of those placentas sent for examination between 17.9% and 20.2% had findings associated with either high recurrence rates or findings that may benefit from neonatal follow-up. Under 50% of pregnancies complicated by SGA at term had a placental examination, resulting in a significant number of potential important clinical consequences being missed.

Small interface changes have dramatic impacts: how mandatory fields in electronic medical records increased pertussis vaccination rates in Australian obstetric patients.

INTRODUCTION: Electronic health records have been widely introduced into clinical practice. The aim of this study was to determine whether a small interface change could improve compliance with a key quality indicator, namely antenatal pertussis vaccination. METHODS: Audits were performed between 1-31 July 2015 and 1-31 July 2017 of all deliveries at the Centenary Hospital for Women and Children to determine compliance with antenatal pertussis vaccination. The single difference between time points was changing the interface so the antenatal pertussis vaccination field became compulsory. RESULTS: 275 and 299 women delivered in the audit periods. Vaccination rates almost doubled (52.7% vs 91.4%, p<0.0001). CONCLUSION: Small interface changes increase compliance. Interface change could be considered for key quality outcomes in patient care.