Risk factors of stillbirths in Victoria (Australia): A case-control study.

Stillbirth is one of the most adverse pregnancy outcomes. The rate of stillbirth in high income countries has remained stagnant in recent decades. This study aimed to determine the incidence and risk factors of stillbirths specific to hospital-based deliveries in a secondary level hospital in Melbourne, Australia, over a 5-year period. We conducted a case-control study from January 2007 to December 2011. Univariate and multivariate analyses were conducted in STATA 12.1. The 5-year cumulative incidence of still-birth was 5.3 per 1000 total births (95% CI 4.3, 6.5). Univariate analysis revealed that higher body-mass index, smoking during pregnancy, haemoglobin level (≥14.5 g/dl), previous stillbirth, primiparity, marital status, previous caesarean section and reduced foetal movement in the 2 weeks prior to delivery were associated with increased risk of stillbirth. However, after adjustment for confounders in a multiple-regression model, only previous caesarean section (p = 0.006), unmarried (p = 0.004), high haemoglobin level (p = 0.007) and reduced foetal movement in the 2 weeks prior to delivery (p < 0.001) remained significantly associated with increased risk of stillbirth. The characteristics of our study population was similar to the population of state-wide survey in 2009, however, the incidence in our study was slightly lower. We concluded that previous caesarean section, pregnancy while being unmarried, higher haemoglobin level and reduced foetal movement in the 2 weeks before delivery were significant predictors of stillbirth. The identified risk factors were similar to other studies and the obstetric practice at the hospital or the demographics of the study population did not add to additional risk.

Increased endometrial vascularity and intraoperative haemorrhage among women undergoing surgical evacuation for retained product of conception.

The aim of this study was to ascertain the incidence of "increased endometrial vascularity" recorded in the ultrasound scan reports, in the context of RPOC and correlate this finding with the incidence of life threatening intra-operative bleeding. Ultrasound scan reports sometimes mention the presence of increased endometrial / sub-endometrial vascularity in the context of retained products of conception or secondary post partum haemorrhage. This raises the possibility of serious intra-operative haemorrhage in the minds of the junior doctors because of the possibility of arterio-venous malformation. This retrospective case series was designed to find the incidences of increased endometrial vascularity and severe intra-operative haemorrhage in the patients with RPOC in the south eastern part of Melbourne population. The study found that the incidence of increased endometrial vascularity was 7.57% and none of these patients suffered severe intra-operative haemorrhage. A literature survey revealed that there were few studies on this topic.

Is the caesarean section rate a performance indicator of an obstetric unit?

The indications of caesarean section are increasing. The need to respect maternal desire in the decision making has been supported by law and ethics. Some of the other contributors to the increasing caesarean section rate are breech with failed external cephalic version, decreasing rate of trial of scar, increasing induction rate and electronic fetal heart rate monitoring and changing demography. Despite the adverse effects of caesarean section, the incidence of severe morbidity and mortality is low. The strategies put forward to reduce the caesarean section rate (CSR) have not been effective and in no country or province, the CSR has come down. CSR should not be looked at in isolation or as high or low. It is the product of changing obstetric practice and societal norms and demographics. CSR not reflect the performance of a maternity unit.