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Professor Elizabeth Sullivan

Biography

Professor of Public Health

Qualifications
(MD (UNSW), MBBS (USYD), MPH (USYD), MMed (Sexual Health) (USYD), FAFPHM, Cert Sexual and Reproductive Health, Cert Executive and Management Development)

Professor Sullivan is an internationally esteemed public health physician with over 24 years' experience as a medical epidemiologist, specialising in the fields of perinatal, maternal, sexual and reproductive health.

Professor Sullivan was recently appointed to the NHMRC for the triennium 2015-2018. She is a member of the Obstetrics Clinical Committee of the Medicare Benefits Schedule (MBS) Review Taskforce, Research Australia University Roundtable. Professor Sullivan is also the Chair of the UTS SAT for the Science in Australia Gender Equity (SAGE) National Pilot of Athena SWAN in Australia; she is committed to the advancement of gender equality in academia, by addressing unequal gender representation and empowering women across academic disciplines.

Professor Sullivan has a strong commitment to social justice and is nationally and internationally recognised for her innovative program of population health and health services research that focuses on vulnerable reproductive populations, specifically Aboriginal women, mental health, substance use (drug and alcohol), severe rare illness in pregnancy, pregnancy in prison and infertility. She has increasingly focused on health inequality among mothers and the immediate and longer term health impact on their infants.

Professor Sullivan has had a successful track record of research development and management, with more than $20 million in research and contract funding as a chief investigator, several national and international collaborations, over 170 peer review publications and AIHW and WHO reports and has successfully supervised and mentored many high degree students.

Prior to her appointment at UTS appointment in May 2014, she was Professor of Perinatal and Reproductive Health and Director at the Australian Institute of Health and Welfare (AIHW) National Perinatal Epidemiology and Statistics Unit, UNSW Medicine, University of New South Wales (2002-2014), and Head of Research at Family Planning NSW (2012-2014).

Image of Elizabeth Sullivan
Assistant DVC (Research)/ Professor of Public Health, Deputy Vice-Chancellor (Research)
Director, CHSP - Health Services and Practice
Core Member, CHSP - Health Services and Practice
Member, WHO Collaborating Centre for Nursing, Midwifery and Health Development (WHO or WHOCC)
FAFPHM, MBBS (USYD), MPH (USYD), MMed(Sexual Health) (USYD), MD (UNSW)
Fellow, Australasian Faculty of Public Health Medicine
Member, Perinatal Society of Australia and New Zealand
Member, European Society for Human Reproduction and Embryology
 
Phone
+61 2 9514 4833

Research Interests

  • social justice
  • population health and health services with a focus on vulnerable reproductive populations (Aboriginal women; pregnant women with mental health and or substance use (drug and alcohol), severe rare illness in pregnancy; pregnancy in prison; and infertility)
  • health inequality among mothers and impact on infants
  • severe maternal morbidity and mortality
  • justice health
  • sexual and reproductive health
  • use of population data to inform policy and practice particularly in the areas of pregnancy and fertility treatment including assisted reproductive technology

Current NHMRC research
Professor Sullivan is chief investigator on the following projects:

  • Recidivism, health and social functioning following release to the community of NSW prisoners with problematic drug use, an evaluation of the Connections Program
    NHMRC Project Grant APP1109009
    Sullivan EA, Sherwood J , Zador D, Wang Y, Chang S. (2016-2018)
  • Aboriginal and non-Aboriginal women perpetrators of violence: a trial of a prison-based intervention (Beyond Violence)
    NHMRC Project Grant APP1108115
    Butler T, Kubiak S, Schofield PW, Wilson M, Jones J, Kariminia A, Sullivan EA, Dean K. (2016-2020)
  • Centre for Research Excellence in the evaluation, management and health care needs of Polycystic Ovary Syndrome and related health implications
    NHMRC Centres of Research Excellence APP1078444
    Teede H, Norman R, Hart R, Handelsman D, Davies M, Sullivan E, McNeil J, Moran L, Rodgers R, Patton G. (2014-2018)
  • Sexual and Reproductive Health and Behaviours of Young Offenders (14–18 years) in New South Wales and Queensland
    NHMRC Project Grant APP1043693
    Butler A, Ward J, Sullivan EA, Donovan B. Amin J, Yap L, Nathan S. (2013-2016)
  • A national population-based study of rheumatic heart disease in pregnancy
    NHMRC Project Grant APP1024206
    Sullivan EA, Jackson Pulver L, Walsh W, McLintock C, Carapetis J, Peek M, Kruske S. (2012-2016).
  • The Australian Perinatal Mental Health Reforms: using population data to evaluate their impact on service utilisation and related cost-effectiveness
    NHMRC Partnership Project APP1028554
    Austin MP, Sullivan EA, Highet N, Morgan V, Mihalopoulos C, Croft M. (2012-2016)
  • Social and Cultural Resilience and Emotional wellbeing of Aboriginal Mothers in prison (SCREAM)
    NHMRC Project Grant APP630653
    Sullivan EA, Sherwood J, Jones J, Baldry E, Butler T, Giles M, Levy M. (2010-2015)

Australasian maternity outcomes surveillance system (AMOSS)
In 2009 Professor Sullivan established AMOSS at the UNSW. AMOSS is a system that supports research on the incidence, management and outcomes of rare conditions resulting in severe maternal and perinatal morbidity and mortality with associated studies investigating the patient experience and unmet needs. AMOSS studies to date include H1N1 in pregnancy with admission to intensive care, amniotic fluid embolism, extreme morbid obesity, placenta accreta, peripartum hysterectomy, antenatal pulmonary embolism, gestational breast cancer, vasa praevia and massive obstetric haemorrhage requiring rapid blood transfusion.

Can supervise: Yes
Category 1, all supervisory roles.

Chapters

Wang, Y.A. & Sullivan, E.A. 2011, 'How to report IVF success rates' in How to Improve your ART Success Rates An Evidence-Based Review of Adjuncts to IVF, Cambridge University Press.
Units are striving to improve their success rates, and many treatments are being advocated as 'yet another breakthrough'. The purpose of this book is to help clinicians to evaluate each of these new treatments.

Conferences

Dawson, A., Turkmani, S., Varol, N., Sullivan, E. & Homer, C. 2015, 'Midwives' experiences of caring for women with female genital mutilation: Insights and ways forward for practice in Australia', Super Midwives - Making a Difference, Australian College of Midwives, 19th Biennial Conference, Gold Coast, Australia.
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Journal articles

Souza, J., Betran, A., Dumont, A., de Mucio, B., Gibbs Pickens, C., Deneux-Tharaux, C., Ortiz-Panozo, E., Sullivan, E., Ota, E., Togoobaatar, G., Carroli, G., Knight, H., Zhang, J., Cecatti, J., Vogel, J., Jayaratne, K., Leal, M., Gissler, M., Morisaki, N., Lack, N., Oladapo, O., Tunalp, O., Lumbiganon, P., Mori, R., Quintana, S., Costa Passos, A., Marcolin, A., Zongo, A., Blondel, B., Hernández, B., Hogue, C., Prunet, C., Landman, C., Ochir, C., Cuesta, C., Pileggi-Castro, C., Walker, D., Alves, D., Abalos, E., Moises, E., Vieira, E., Duarte, G., Perdona, G., Gurol-Urganci, I., Takahiko, K., Moscovici, L., Campodonico, L., Oliveira-Ciabati, L., Laopaiboon, M., Danansuriya, M., Nakamura-Pereira, M., Costa, M., Torloni, M., Kramer, M., Borges, P., Olkhanud, P., Pérez-Cuevas, R., Agampodi, S., Mittal, S., Serruya, S., Bataglia, V., Li, Z., Temmerman, M. & Gülmezoglu, A. 2016, 'A global reference for caesarean section rates (C-Model): A multicountry cross-sectional study', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 123, no. 3, pp. 427-436.
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© 2015 RCOG. Objective: To generate a global reference for caesarean section (CS) rates at health facilities. Design: Cross-sectional study. Setting: Health facilities from 43 countries. Population/Sample: Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10 045 875 women giving birth from 43 countries for model testing. Methods: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. Main outcome measures: Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. Results: According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/). Conclusions: This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS.
Wang, Y.A., Chughtai, A.A., Farquhar, C.M., Pollock, W., Lui, K. & Sullivan, E.A. 2016, 'Increased incidence of gestational hypertension and preeclampsia after assisted reproductive technology treatment.', Fertility and sterility, vol. 105, no. 4, pp. 920-926.e2.
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To determine the association between assisted reproductive technology (ART) treatment and the rate of combined gestational hypertension (GH), preeclampsia (PE).Retrospective population study.Not applicable.A total of 596,520 mothers (3.6% ART mothers) who gave birth between 2007 and 2011.Not applicable.Comparison of the rate of GH/PE for ART and non-ART mothers, with odds ratio (OR), adjusted odds ratio (AOR), and 95% confidence interval (CI) used to assess the association between ART and GH/PE.The overall rate of GH/PE was 4.3%, with 6.4% for ART mothers and 4.3% for non-ART mothers. The rate of GH/PE was higher for mothers of twins than singletons (12.4% vs. 5.7% for ART mothers; 8.6% vs. 4.2% for non-ART mothers). The ART mothers had a 17% increased odds of GH/PE compared with the non-ART mothers (AOR 1.17; 95% CI, 1.10-1.24). After stratification by plurality, the difference in GH/PE rates between ART and non-ART mothers was not statistically significant, with AOR 1.05 (95% CI, 0.98-1.12) for mothers of singletons and AOR 1.10 (95% CI, 0.94-1.30) for mothers of twins.The changes in AOR after stratification indicated that multiple pregnancies after ART are the single most likely explanation for the increased rate of GH/PE among ART mothers. The lower rate of GH/PE among mothers of singletons compared with mothers of twins suggests that a policy to minimize multiple pregnancies after ART may reduce the excess risk of GH/PE due to ART treatment.
Anazodo, A., Gerstl, B., Sullivan, E., Ledger, W., Orme, L., Stern, K., Viney, R.C., Gillam, L., Jetti, M., Mclachlan, R., Jayasinghe, Y., Cohn, R., Wakefield, C., Dean, R., Agresta, F., Vu, J., Daly, E., Chan, D., Chapman, M., Kemertzis, M., Wand, H. & Gilbert, L. 2016, 'A Study Protocol for the Australasian Oncofertility Registry: Monitoring referral patterns and the uptake, quality and complications of fertility preservation strategies in Australia and New Zealand', Journal of Adolescent and Young Adult Oncology.
Wang, A.Y., Dill, S.K., Bowman, M. & Sullivan, E.A. 2016, 'Gestational surrogacy in Australia 2004-2011: treatment, pregnancy and birth outcomes.', The Australian & New Zealand journal of obstetrics & gynaecology, vol. 56, no. 3, pp. 255-259.
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Information on gestational surrogacy arrangement and outcomes is limited in Australia.This national population study investigates the epidemiology of gestational surrogacy arrangement in Australia: treatment procedures, pregnancy and birth outcomes.A retrospective study was conducted of 169 intended parents cycles and 388 gestational carrier cycles in Australia in 2004-2011. Demographics were compared between intended parents and gestational carrier cycles. Pregnancy and birth outcomes were compared by number of embryos transferred.Over half (54%) intended parents cycles were in women aged <35 years compared to 38% of gestational carrier cycles. About 77% of intended parents cycles were of nulliparous women compared to 29% of gestational carrier cycles. Of the 360 embryo transfer cycles, 91% had cryopreserved embryos transferred and 69% were single-embryo transfer (SET) cycles. The rates of clinical pregnancy and live delivery were 26% and 19%, respectively. There were no differences in rates of clinical pregnancy and live delivery between SET cycles (27% and 19%) and double-embryo transfer (DET) cycles (25% and 19%). Five of 22 deliveries following DET were twin deliveries compared to none of 48 deliveries following SET. There were 73 liveborn babies following gestational surrogacy treatment, including 9 liveborn twins. Of these, 22% (16) were preterm and 14% (10) were low birthweight. Preterm birth was 13% for liveborn babies following SET, lower than the 31% or liveborn babies following DET.To avoid adverse outcomes for both carriers and babies, SET should be advocated in all gestational surrogacy arrangements.
Anazodo, A.C., Gerstl, B., Stern, C.J., McLachlan, R.I., Agresta, F., Jayasinghe, Y., Cohn, R.J., Wakefield, C.E., Chapman, M., Ledger, W. & Sullivan, E.A. 2016, 'Utilizing the Experience of Consumers in Consultation to Develop the Australasian Oncofertility Consortium Charter.', Journal of adolescent and young adult oncology.
In Australia and New Zealand, there has not been a national systematic development of oncofertility services for cancer patients of reproductive age although many cancer and fertility centers have independently developed services. A number of barriers exist to the development of these services, including a lack of clear referral pathways, a lack of communication between clinicians and patients about fertility preservation, differences in the knowledge base of clinicians about the risk of cancer treatment causing infertility and fertility preservation options, a lack of national health insurance funding covering all aspects of fertility preservation, and storage costs and cultural, religious, and ethical barriers. The development of strategies to overcome these barriers is a high priority for oncofertility care to ensure that equitable access to the best standard of care is available for all patients.The FUTuRE Fertility Research Group led a collaborative consultation process with the Australasian Oncofertility Consumer group and oncofertility specialists to explore consumers' experiences of oncofertility care. Consumers participated in qualitative focus group meetings to define and develop a model of consumer driven or informed "gold standard oncofertility care" with the aim of putting together a Charter that specifically described this.The finalized Australasian Oncofertility Consortium Charter documents eight key elements of gold standard oncofertility care that will be used to monitor the implementation of oncofertility services nationally, to ensure that these key elements are incorporated into standard practice over time.
Hilder, L., Walker, J.R., Levy, M.H. & Sullivan, E.A. 2016, 'Preparing linked population data for research: cohort study of prisoner perinatal health outcomes.', BMC medical research methodology, vol. 16, no. 1, p. 72.
A study of pregnancy outcomes related to pregnancy in prison in New South Wales, Australia, designed a two stage linkage to add maternal history of incarceration and serious mental health morbidity, neonatal hospital admission and infant congenital anomaly diagnosis to birth data. Linkage was performed by a dedicated state-wide data linkage authority. This paper describes use of the linked data to determine pregnancy prison exposure pregnancy for a representative population of mothers.Researchers assessed the quality of linked records; resolved multiple-matched identities; transformed event-based incarceration records into person-based prisoner records and birth records into maternity records. Inconsistent or incomplete records were censored. Interrogation of the temporal relationships of all incarceration periods from the prisoner record with pregnancies from birth records identified prisoner maternities. Interrogation of maternities for each mother distinguished prisoner mothers who were incarcerated during pregnancy, from prisoner control mothers with pregnancies wholly in the community and a subset of prisoner mothers with maternities both types of maternity. Standard descriptive statistics are used to provide population prevalence of exposures and compare data quality across study populations stratified by mental health morbidity.Women incarcerated between 1998 and 2006 accounted for less than 1&nbsp;% of the 404,000 women who gave birth in NSW between 2000 and 2006, while women with serious mental health morbidity accounted for 7&nbsp;% overall and 68&nbsp;% of prisoners. Rates of false positive linkage were within the predicted limits set by the linkage authority for non-prisoners, but were tenfold higher among prisoners (RR 9.9; 95%CI 8.2, 11.9) and twice as high for women with serious mental health morbidity (RR 2.2; 95%CI 1.9, 2.6). This case series of 597 maternities for 558 prisoners pregnant while in prison (of whom 128 gave birth in prison); and 2,031 contemporane...
Ataman, L.M., Rodrigues, J.K., Marinho, R.M., Caetano, J.P., Chehin, M.B., Alves da Motta, E.L., Serafini, P., Suzuki, N., Furui, T., Takae, S., Sugishita, Y., Morishige, K.I., Almeida-Santos, T., Melo, C., Buzaglo, K., Irwin, K., Wallace, W.H., Anderson, R.A., Mitchell, R.T., Telfer, E.E., Adiga, S.K., Anazodo, A., Stern, C., Sullivan, E., Jayasinghe, Y., Orme, L., Cohn, R., McLachlan, R., Deans, R., Agresta, F., Gerstl, B., Ledger, W.L., Robker, R.L., de Meneses E Silva, J.M., Silva, L.H., Lunardi, F.O., Lee, J.R., Suh, C.S., De Vos, M., Van Moer, E., Stoop, D., Vloeberghs, V., Smitz, J., Tournaye, H., Wildt, L., Winkler-Crepaz, K., Andersen, C.Y., Smith, B.M., Smith, K. & Woodruff, T.K. 2016, 'Creating a Global Community of Practice for Oncofertility.', Journal of global oncology, vol. 2, no. 2, pp. 83-96.
Fertility preservation in the cancer setting, known as oncofertility, is a field that requires cross-disciplinary interaction between physicians, basic scientists, clinical researchers, ethicists, lawyers, educators, and religious leaders. Funded by the National Institutes of Health, the Oncofertility Consortium (OC) was formed to be a scientifically grounded, transparent, and altruistic resource, both intellectual and monetary, for building this new field of practice capable of addressing the unique needs of young patients with cancer. The OC has expanded its attention to include other nonmalignant conditions that can threaten fertility, and the work of the OC now extends around the globe, involving partners who together have created a community of shared effort, resources, and practices. The OC creates materials that are translated, disseminated, and amended by all participants in the field, and local programs of excellence have developed worldwide to accelerate the pace and improve the quality of oncofertility research and practice. Here we review the global oncofertility programs and the capacity building activities that strengthen these research and clinical programs, ultimately improving patient care.
Donnolley, N., Butler-Henderson, K., Chapman, M. & Sullivan, E. 2016, 'The development of a classification system for maternity models of care.', The HIM journal.
A lack of standard terminology or means to identify and define models of maternity care in Australia has prevented accurate evaluations of outcomes for mothers and babies in different models of maternity care.As part of the Commonwealth-funded National Maternity Data Development Project, a classification system was developed utilising a data set specification that defines characteristics of models of maternity care.The Maternity Care Classification System or MaCCS was developed using a participatory action research design that built upon the published and grey literature.The study identified the characteristics that differentiate models of care and classifies models into eleven different Major Model Categories.The MaCCS will enable individual health services, local health districts (networks), jurisdictional and national health authorities to make better informed decisions for planning, policy development and delivery of maternity services in Australia.
Lindquist, A., Noor, N., Sullivan, E. & Knight, M. 2015, 'The impact of socioeconomic position on severe maternal morbidity outcomes among women in Australia: a national case-control study.', BJOG : an international journal of obstetrics and gynaecology, vol. 122, no. 12, pp. 1601-1609.
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Studies in other developed countries have suggested that socioeconomic position may be a risk factor for poorer pregnancy outcomes. This analysis aimed to explore the independent impact of socioeconomic position on selected severe maternal morbidities among women in Australia.A case-control study using data on severe maternal morbidities associated with direct maternal death collected through the Australasian Maternity Outcomes Surveillance System.Australia.623 cases, 820 controls.Logistic regression analysis to investigate differences in outcomes among different socioeconomic groups, classified by Socio-Economic Indexes for Areas (SEIFA) quintile.Severe maternal morbidity (amniotic fluid embolism, placenta accreta, peripartum hysterectomy, eclampsia or pulmonary embolism).SEIFA quintile was statistically significantly associated with maternal morbidity, with cases being twice as likely as controls to reside in the most disadvantaged areas (adjusted OR 2.00, 95%CI 1.29-3.10). Maternal age [adjusted odds ratio (aOR) 2.20 for women aged 35 or over compared with women aged 25-29, 95%CI 1.64-3.15] and previous pregnancy complications (aOR 1.30, 95%CI 1.21-1.87) were significantly associated with morbidity. A parity of 1 or 2 was protective (aOR 0.58, 95%CI 0.43-0.79), whereas previous caesarean delivery was associated with maternal morbidity (aOR 2.20 for women with one caesarean delivery, 95%CI 1.44-2.85, compared with women with no caesareans).The risk of severe maternal morbidity among women in Australia is significantly increased by social disadvantage. This study suggests that future efforts in improving maternity care provision and maternal outcomes in Australia should include socioeconomic position as an independent risk factor for adverse outcome.
Reid, S., Bajuk, B., Lui, K., Sullivan, E.A. & NSW and ACT Neonatal Intensive Care Units Audit Group 2015, 'Comparing CRIB-II and SNAPPE-II as mortality predictors for very preterm infants', Journal of Paediatrics and Child Health, vol. 51, no. 5, pp. 524-528.
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Aims: This article compares the severity of illness scoring systems clinical risk index for babies (CRIB)-II and score for neonatal acute physiology with perinatal extension (SNAPPE)-II for discriminatory ability and goodness of fit in the same cohort of babies of less than 32 weeks gestation and aims to provide validation in the Australian population. Methods: CRIB-II and SNAPPE-II scores were collected on the same cohort of preterm infants born within a 2-year period, 2003 and 2004. The discriminatory ability of each score was assessed by the area under the receiver operator characteristic curve, and goodness of fit was assessed by the Hosmer-Lemeshow (HL) test. The outcome measure was in-hospital mortality. A multivariate logistic regression model was tested for perinatal variables that might add to the risk of in-hospital mortality. Results: Data for both scores were available for 1607 infants. Both scores had good discriminatory ability (CRIB-II area under the curve 0.913, standard error (SE) 0.014; SNAPPE-II area under the curve 0.907, SE 0.012) and adequate goodness of fit (HL 2=11.384, 8 degrees of freedom, P=0.183 for CRIB-II; HL 2=4.319, 7 degrees of freedom, P=0.742 for SNAPPE-II). The multivariate model did not reveal other significant variables. Conclusions: Both severity of illness scores are ascertained during the first 12h of life and perform similarly. Both can facilitate risk-adjusted comparisons of mortality and quality of care after the first post-natal 12h. CRIB-II scores have the advantage of being simpler to collect and calculate.
Ishihara, O., Adamson, G.D., Dyer, S., de Mouzon, J., Nygren, K.G., Sullivan, E.A., Zegers-Hochschild, F. & Mansour, R. 2015, 'International Committee for Monitoring Assisted Reproductive Technologies: World Report on Assisted Reproductive Technologies, 2007', Fertility and Sterility.
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Objective: To analyze information on assisted reproductive technology (ART) performed worldwide, and trends in outcomes over successive years. Design: Cross-sectional survey on access, efficiency, and safety of ART procedures performed in 55 countries during2007. Setting: Not applicable. Patient(s): Infertile women and men undergoing ART globally. Intervention(s): Collection and analysis of international ART data. Main Outcome Measure(s): Number of cycles performed, by country and region, including pregnancies, single and multiple birth rates, and perinatal mortality. Result(s): Overall, >1,251,881 procedures with ART were reported, and resulted in 229,442 reported babies born. The availability of ART varied by country, from 12 to 4,140 treatments per million population. Of all aspiration cycles, 65.2% (400,617 of 614,540) were intracytoplasmic sperm injection. The overall delivery rate per fresh aspiration was 20.3%, and for frozen-embryo transfer (FET), 18.4%, with a cumulative delivery rate of 25.8%. With wide regional variations, single-embryo transfer represented 23.4% of fresh transfers, and the proportion of deliveries with twins and triplets from fresh transfers was 22.3% and 1.2%, respectively. The perinatal mortality rate was 19.9 per 1,000 births for fresh invitro fertilization using intracytoplasmic sperm injection, and 9.6 per 1,000 for FET. The proportion of women aged 40years increased to 19.8% from 15.5% in2006. Conclusion(s): The international trend toward &#60;3 transferred embryos continued, as did the wider uptake of FET. This was achieved without compromising delivery rates. The application of ART for women aged >40years was a major component of ART services in some regions and countries.
Dawson, A.J., Turkmani, S., Varol, N., Nanayakkara, S., Sullivan, E. & Homer, C.S. 2015, 'Midwives' experiences of caring for women with female genital mutilation: Insights and ways forward for practice in Australia.', Women and Birth, vol. 28, no. 3, pp. 207-214.
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Female genital mutilation (FGM) has serious health consequences, including adverse obstetric outcomes and significant physical, sexual and psychosocial complications for girls and women. Migration to Australia of women with FGM from high-prevalence countries requires relevant expertise to provide women and girls with FGM with specialised health care. Midwives, as the primary providers of women during pregnancy and childbirth, are critical to the provision of this high quality care.To provide insight into midwives' views of, and experiences working with, women affected by FGM.A descriptive qualitative study was undertaken using focus group discussions with midwives from four purposively selected antenatal clinics and birthing units in three hospitals in urban New South Wales. The transcripts were analysed thematically.Midwives demonstrated knowledge and recalled skills in caring for women with FGM. However, many lacked confidence in these areas. Participants expressed fear and a lack of experience caring for women with FGM. Midwives described practice issues, including the development of rapport with women, working with interpreters, misunderstandings about the culture of women, inexperience with associated clinical procedures and a lack of knowledge about FGM types and data collection.Midwives require education, training and supportive supervision to improve their skills and confidence when caring for women with FGM. Community outreach through improved antenatal and postnatal home visitation can improve the continuity of care provided to women with FGM.
Ishihara, O., Adamson, G.D., Dyer, S., de Mouzon, J., Nygren, K.G., Sullivan, E.A., Zegers-Hochschild, F. & Mansour, R. 2015, 'International committee for monitoring assisted reproductive technologies: world report on assisted reproductive technologies, 2007.', Fertility and sterility, vol. 103, no. 2, pp. 402-13.e11.
OBJECTIVE: To analyze information on assisted reproductive technology (ART) performed worldwide, and trends in outcomes over successive years. DESIGN: Cross-sectional survey on access, efficiency, and safety of ART procedures performed in 55 countries during 2007. SETTING: Not applicable. PATIENT(S): Infertile women and men undergoing ART globally. INTERVENTION(S): Collection and analysis of international ART data. MAIN OUTCOME MEASURE(S): Number of cycles performed, by country and region, including pregnancies, single and multiple birth rates, and perinatal mortality. RESULT(S): Overall, >1,251,881 procedures with ART were reported, and resulted in 229,442 reported babies born. The availability of ART varied by country, from 12 to 4,140 treatments per million population. Of all aspiration cycles, 65.2% (400,617 of 614,540) were intracytoplasmic sperm injection. The overall delivery rate per fresh aspiration was 20.3%, and for frozen-embryo transfer (FET), 18.4%, with a cumulative delivery rate of 25.8%. With wide regional variations, single-embryo transfer represented 23.4% of fresh transfers, and the proportion of deliveries with twins and triplets from fresh transfers was 22.3% and 1.2%, respectively. The perinatal mortality rate was 19.9 per 1,000 births for fresh in vitro fertilization using intracytoplasmic sperm injection, and 9.6 per 1,000 for FET. The proportion of women aged 40 years increased to 19.8% from 15.5% in 2006. CONCLUSION(S): The international trend toward <3 transferred embryos continued, as did the wider uptake of FET. This was achieved without compromising delivery rates. The application of ART for women aged >40 years was a major component of ART services in some regions and countries.
Li, Z., Sullivan, E.A., Chapman, M., Farquhar, C. & Wang, Y.A. 2015, 'Risk of ectopic pregnancy lowest with transfer of single frozen blastocyst.', Human reproduction (Oxford, England), vol. 30, no. 9, pp. 2048-2054.
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What type of transferred embryo is associated with a lower rate of ectopic pregnancy?The lowest risk of ectopic pregnancy was associated with the transfer of blastocyst, frozen and single embryo compared with cleavage stage, fresh and multiple embryos.Ectopic pregnancy is a recognized complication following assisted reproductive technology (ART) treatment. It has been estimated that the rate of ectopic pregnancy is doubled in pregnancies following ART treatment compared with spontaneous pregnancies. However, it was not clear whether the excess rate of ectopic pregnancy following ART treatment is related to the underlying demographic factors of women undergoing ART treatment, the number of embryos transferred or the developmental stage of the embryo.A population-based cohort study of pregnancies following autologous treatment cycles between January 2009 and December 2011 were obtained from the Australian and New Zealand Assisted Reproduction Technology Database (ANZARD). The ANZARD collects ART treatment information and clinical outcomes annually from all fertility centres in Australia and New Zealand.Between 2009 and 2011, a total of 44 102 pregnancies were included in the analysis. The rate of ectopic pregnancy was compared by demographic and ART treatment factors. Generalized linear regression of Poisson distribution was used to estimate the likelihood of ectopic pregnancy. Odds ratios, adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated.The overall rate of ectopic pregnancy was 1.4% for women following ART treatment in Australia and New Zealand. Pregnancies following single embryo transfers had 1.2% ectopic pregnancies, significantly lower than double embryo transfers (1.8%) (P < 0.01). The highest ectopic pregnancy rate was 1.9% for pregnancies from transfers of fresh cleavage embryo, followed by transfers of frozen cleavage embryo (1.7%), transfers of fresh blastocyst (1.3%), and transfers of frozen blastocyst (0.8%). Compared with f...
Li, Z., Umstad, M.P., Hilder, L., Xu, F. & Sullivan, E.A. 2015, 'Australian national birthweight percentiles by sex and gestational age for twins, 2001-2010.', BMC pediatrics, vol. 15, p. 148.
Birthweight remains one of the strongest predictors of perinatal mortality and disability. Birthweight percentiles form a reference that allows the detection of neonates at higher risk of neonatal and postneonatal morbidity. The aim of the study is to present updated national birthweight percentiles by gestational age for male and female twins born in Australia.Population data were extracted from the Australian National Perinatal Data Collection for twins born in Australia between 2001 and 2010. A total of 43,833 women gave birth to 87,666 twins in Australia which were included in the study analysis. Implausible birthweights were excluded using Tukey's methodology based on the interquartile range. Univariate analysis was used to examine the birthweight percentiles for liveborn twins born between 20 and 42 weeks gestation.Birthweight percentiles by gestational age were calculated for 85,925 live births (43,153 males and 42,706 females). Of these infants, 53.6% were born preterm (birth before 37 completed weeks of gestation) while 50.2% were low birthweight (<2500 g) and 8.7% were very low birthweight (<1500 g). The mean birthweight decreased from 2462 g in 2001 to 2440 g in 2010 for male twins, compared with 2485 g in 1991-94. For female twins, the mean birthweight decreased from 2375 g in 2001 to 2338 g in 2010, compared with 2382 g in 1991-94.The birthweight percentiles provide clinicians and researchers with up-to-date population norms of birthweight percentiles for twins in Australia.
Sullivan, E.A., Dickinson, J.E., Vaughan, G.A., Peek, M.J., Ellwood, D., Homer, C.S.E., Knight, M., McLintock, C., Wang, A., Pollock, W., Pulver, L.J., Li, Z., Javid, N., Denney-Wilson, E. & Callaway, L. 2015, 'Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study', BMC Pregnancy and Childbirth, vol. 15, pp. 322-322.
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McDonnell, N., Knight, M., Peek, M.J., Ellwood, D., Homer, C.S., McLintock, C., Vaughan, G., Pollock, W., Li, Z., Javid, N. & Sullivan, E. 2015, 'Amniotic fluid embolism: an Australian-New Zealand population-based study.', BMC Pregnancy and Childbirth, vol. 15, pp. 352-352.
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Amniotic fluid embolism (AFE) is a major cause of direct maternal mortality in Australia and New Zealand. There has been no national population study of AFE in either country. The aim of this study was to estimate the incidence of amniotic fluid embolism in Australia and New Zealand and to describe risk factors, management, and perinatal outcomes.A population-based descriptive study using the Australasian Maternity Outcomes Surveillance System (AMOSS) carried out in 263 eligible sites (>50 births per year) covering an estimated 96&nbsp;% of women giving birth in Australia and all 24 New Zealand maternity units (100&nbsp;% of women giving birth in hospitals) between January 1 2010-December 31 2011. A case of AFE was defined either as a clinical diagnosis (acute hypotension or cardiac arrest, acute hypoxia and coagulopathy in the absence of any other potential explanation for the symptoms and signs observed) or as a post mortem diagnosis (presence of fetal squames/debris in the pulmonary circulation).Thirty-three cases of AFE were reported from an estimated cohort of 613,731women giving birth, with an estimated incidence of 5.4 cases per 100000 women giving birth (95&nbsp;% CI 3.5 to 7.2 per 100000). Two (6&nbsp;%) events occurred at home whilst 46&nbsp;% (n=15) occurred in the birth suite and 46&nbsp;% (n=15) in the operating theatre (location not reported in one case). Fourteen women (42&nbsp;%) underwent either an induction or augmentation of labour and 22 (67&nbsp;%) underwent a caesarean section. Eight women (24&nbsp;%) conceived using assisted reproduction technology. Thirteen (42&nbsp;%) women required cardiopulmonary resuscitation, 18&nbsp;% (n=6) had a hysterectomy and 85&nbsp;% (n=28) received a transfusion of blood or blood products. Twenty (61&nbsp;%) were admitted to an Intensive Care Unit (ICU), eight (24&nbsp;%) were admitted to a High Dependency Unit (HDU) and seven (21&nbsp;%) were transferred to another hospital for further management. Five woman died (case fatality rate 15&nbsp;%) giving an estimated maternal morta...
Dawson, A., Turkmani, S., Varol, N., Sullivan, E. & Homer, C.S.E. 2015, 'Midwives' experiences of caring for women with female genital mutilation: Insights and ways forward for practice in Australia', WOMEN AND BIRTH, vol. 28, no. 1, pp. S30-S30.
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Chambers, G., Hoang, V., Sullivan, E., Chapman, M., Ishihara, O., Zegers-hochschild, F., Nygren, K. & Adamson, G. 2014, 'The Impact Of Consumer Affordability On Access To Assisted Reproductive Technologies And Embryo Transfer Practices: An International Analysis', Fertility And Sterility, vol. 101, no. 1, pp. 191-0.
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Objective: To systematically quantify the impact of consumer cost on assisted reproduction technology (ART) utilization and numbers of embryos transferred. Design: Ordinary least squared (OLS) regression models were constructed to measure the independent impact of ART affordability-measured as consumer cost relative to average disposable income-on ART utilization and embryo transfer practices. Setting: Not applicable. Patient(s): Women undergoing ART treatment. Intervention(s): None. Main Outcome Measure(s): OLS regression coefficient for ART affordability, which estimates the independent effect of consumer cost relative to income on utilization and number of embryos transferred. Result(s): ART affordability was independently and positively associated with ART utilization with a mean OLS coefficient of 0.032. This indicates that, on average, a decrease in the cost of a cycle of 1 percentage point of disposable income predicts a 3.2% increase in utilization. ART affordability was independently and negatively associated with the number of embryos transferred, indicating that a decrease in the cost of a cycle of 10 percentage points of disposable income predicts a 5.1% increase in single-embryo transfer cycles. Conclusion(s): The relative cost that consumers pay for ART treatment predicts the level of access and number of embryos transferred. Policies that affect ART funding should be informed by these findings to ensure equitable access to treatment and clinically responsible embryo transfer practices. (Fertil Steril (R) 2014; 101: 191-8. (C) 2014 by American Society for Reproductive Medicine.)
GM, C., E, L., VP, H., M, H., C, B. & Sullivan, E. 2014, 'Hospital utilization, costs and mortality rates during the first 5 years of life: a population study of ART and non-ART singletons', Human Reproduction, vol. 29, no. 3, pp. 601-610.
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Abstract STUDY QUESTION: Do singletons conceived following assisted reproduction technologies (ARTs) have significantly different hospital utilization, and therefore costs, compared with non-ART children during the first 5 years of life? SUMMARY ANSWER: ART singletons have longer hospital birth-admissions and a small increased risk of re-admission during the first 5 years of life resulting in higher costs of hospital care.
Walker, J.R., Hilder, L., Levy, M.H. & Sullivan, E. 2014, 'Pregnancy, prison and perinatal outcomes in New South Wales, Australia: a retrospective cohort study using linked health data', BMC Pregnancy Childbirth, vol. Epub.
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Bonello, M.R., Xu, F., Li, Z., Burns, L., Austin, M.-.P. & Sullivan, E.A. 2014, 'Mental and behavioral disorders due to substance abuse and perinatal outcomes: a study based on linked population data in New South Wales, Australia', International Journal of Environmental Research and Public Health, vol. 11, no. 5, pp. 4991-5005.
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Background: The effects of mental and behavioral disorders (MBD) due to substance use during peri-conception and pregnancy on perinatal outcomes are unclear. The adverse perinatal outcomes of primiparous mothers admitted to hospital with MBD due to substance use before and/or during pregnancy were investigated. Method: This study linked birth and hospital records in NSW, Australia. Subjects included primiparous mothers admitted to hospital for MBD due to use of alcohol, opioids or cannabinoids during peri-conception and pregnancy. Results: There were 304 primiparous mothers admitted to hospital for MBD due to alcohol use (MBDA), 306 for MBD due to opioids use (MBDO) and 497 for MBD due to cannabinoids (MBDC) between the 12 months peri-conception and the end of pregnancy. Primiparous mothers admitted to hospital for MBDA during pregnancy or during both peri-conception and pregnancy were significantly more likely to give birth to a baby of low birthweight (AOR = 4.03, 95%CI: 1.97-8.24 for pregnancy; AOR = 9.21, 95%CI: 3.76-22.57 both periods); preterm birth (AOR = 3.26, 95% CI: 1.52-6.97 for pregnancy; AOR = 4.06, 95%CI: 1.50-11.01 both periods) and admission to SCN or NICU (AOR = 2.42, 95%CI: 1.31-4.49 for pregnancy; AOR = 4.03, 95%CI: 1.72-9.44 both periods). Primiparous mothers admitted to hospital for MBDO, MBDC or a combined diagnosis were almost three times as likely to give birth to preterm babies compared to mothers without hospital admissions for psychiatric or substance use disorders. Babies whose mothers were admitted to hospital with MBDO before and/or during pregnancy were six times more likely to be admitted to SCN or NICU (AOR = 6.29, 95%CI: 4.62-8.57). Conclusion: Consumption of alcohol, opioids or cannabinoids during peri-conception or pregnancy significantly increased the risk of adverse perinatal outcomes. &copy; 2014 by the authors; licensee MDPI, Basel, Switzerland.
Li, Z., Wang, Y., W, L. & Sullivan, E. 2014, 'Birthweight percentiles by gestational age for births following assisted reproductive technology in Australia and New Zealand, 2002-2010', Human Reproduction, vol. 29, no. 8, pp. 1787-1800.
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Study question: What is the standard of birthweight for gestational age for babies following assisted reproductive technology (ART) treatment? Summary answer: Birthweight for gestational age percentile charts were developed for singleton births following ART treatment using population-based data.
Xu, F., Li, Z., Binns, C., Bonello, M., Austin, M.-.P. & Sullivan, E. 2014, 'Does infant feeding method impact on maternal mental health?', Breastfeeding Medicine, vol. 9, pp. 215-221.
Javid, N., Sullivan, E., Halliday, L.E., Duncombe, G. & Homer, C.S. 2014, '"Wrapping myself in cotton wool": Australian women's experience of being diagnosed with vasa praevia', BMC Pregnancy and Childbirth, vol. 14, pp. 318-318.
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This is the first study to describe women's experience of being diagnosed with or suspected to have VP. The findings from this research reveal the dilemmas these women face even if their baby is ultimately born healthy. Their need for clear and consistent information, sensitive care, support and continuity is evident. Clinicians can use these findings in developing information, counselling and models of care for these women.
Laws, P.J., Xu, F., Welsh, A., Tracy, S.K. & Sullivan, E.A. 2014, 'Maternal Morbidity of Women Receiving Birth Center Care in New South Wales: A Matched-Pair Analysis Using Linked Health Data', Birth, vol. 41, pp. 268-275.
Mansour, R., Ishihara, O., GD, A., S, D., dM, J., KG, N., Sullivan, E. & F, Z. 2014, 'International Committee for Monitoring Assisted Reproductive Technologies (ICMART) world report: assisted reproductive technology 2006', Human Reproduction, vol. 29, no. 7, pp. 1536-1551.
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STUDY QUESTION What are the access, effectiveness and safety of assisted reproductive technology (ART) worldwide in 2006? SUMMARY ANSWER ART access, effectiveness and safety vary markedly among countries. Overall, there was an increase in the use of ICSI, single embryo transfer (SET) and frozen embryo transfer (FET). There was a decline in the multiple delivery rate (DR) and preterm birth rate.
Li, Z., Wang, Y.A., Ledger, W., Edgar, D.H. & Sullivan, E.A. 2014, 'Clinical outcomes following cryopreservation of blastocysts by vitrification or slow freezing: a population-based cohort study.', Human reproduction (Oxford, England), vol. 29, no. 12, pp. 2794-2801.
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STUDY QUESTION: What are the clinical efficacy and perinatal outcomes following transfer of vitrified blastocysts compared with transfer of fresh or of slow frozen blastocysts? SUMMARY ANSWER: Compared with slow frozen blastocysts, vitrified blastocysts resulted in significantly higher clinical pregnancy and live delivery rates with similar perinatal outcomes at population level. WHAT IS KNOWN ALREADY: Although vitrification has been reported to be associated with significantly increased post-thaw survival rates compared with slow freezing, there has been a lack of general consensus over which method of cryopreservation (vitrification versus slow freezing) is most appropriate for blastocysts. STUDY DESIGN, SIZE, DURATION: A population-based cohort of autologous fresh and initiated thaw cycles (a cycle where embryos were thawed with intention to transfer) performed between January 2009 and December 2011 in Australia and New Zealand was evaluated retrospectively. A total of 46 890 fresh blastocyst transfer cycles, 12 852 initiated slow frozen blastocyst thaw cycles and 20 887 initiated vitrified blastocyst warming cycles were included in the data analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS: Pairwise comparisons were made between the vitrified blastocyst group and slow frozen or fresh blastocyst group. A Chi-square test was used for categorical variables and t-test was used for continuous variables. Cox regression was used to examine the pregnancy outcomes (clinical pregnancy rate, miscarriage rate and live delivery rate) and perinatal outcomes (preterm delivery, low birthweight births, small for gestational age (SGA) births, large for gestational age (LGA) births and perinatal mortality) following transfer of fresh, slow frozen and vitrified blastocysts. MAIN RESULTS AND THE ROLE OF CHANCE: The 46 890 fresh blastocyst transfers, 11 644 slow frozen blastocyst transfers and 19 978 vitrified blastocyst transfers resulted in 16 845, 2766 and 6537 clinical pregna...
Ory, S.J., Devroey, P., Banker, M., Brinsden, P., Buster, J., Fiadjoe, M., Horton, M., Nygren, K., Pai, H., Le Roux, P. & Sullivan, E. 2014, 'International Federation of Fertility Societies Surveillance 2013: preface and conclusions.', Fertility and sterility, vol. 101, no. 6, pp. 1582-1583.
Surveillance is a triennial worldwide compendium of national rules and regulations for assisted reproductive technology. It was last published in 2010.
Chambers, G.M., Hoang, V.P., Lee, E., Hansen, M., Sullivan, E.A., Bower, C. & Chapman, M. 2014, 'Hospital costs of multiple-birth and singleton-birth children during the first 5 years of life and the role of assisted reproductive technology.', JAMA pediatrics, vol. 168, no. 11, pp. 1045-1053.
IMPORTANCE: The unprecedented increase in multiple births during the past 3 decades is a major public health concern and parallels the uptake of medically assisted conception. The economic implications of such births are not well understood. OBJECTIVES: To conduct a comprehensive economic and health services assessment of the frequency, duration, and cost of hospital admissions during the first 5 years of life for singleton, twin, and higher-order multiple (HOM) children and to examine the contribution of assisted reproductive technology (ART) to the incidence and cost of multiple births. DESIGN, SETTING, AND PARTICIPANTS: A retrospective population cohort study using individually linked birth, hospital, and death records among 233,850 infants born in Western Australia between October 1993 and September 2003, and followed up to September 2008. EXPOSURES: Multiple-gestation delivery and ART conception. MAIN OUTCOMES AND MEASURES: Odds of stillbirth, prematurity and low birth weight, frequency and length of hospital admissions, the mean costs by plurality, and the independent effect of prematurity on childhood costs. RESULTS: Of 226,624 singleton, 6941 twin, and 285 HOM infants, 1.0% of singletons, 15.4% of twins, and 34.7% of HOM children were conceived following ART. Compared with singletons, twins and HOMs were 3.4 and 9.6 times, respectively, more likely to be stillborn and were 6.4 and 36.7 times, respectively, more likely to die during the neonatal period. Twins and HOMs were 18.7 and 525.1 times, respectively, more likely to be preterm, and 3.6 and 2.8 times, respectively, more likely to be small for gestational age. The mean hospital costs of a singleton, twin, and HOM child to age 5 years were $2730, $8993, and $24,411 (in 2009-2010 US dollars), respectively, with cost differences concentrated in the neonatal period and during the first year of life. Almost 15% of inpatient costs for multiple births could have been avoided if ART twins and HOMs had been bo...
Xu, F., Sullivan, E.A., Li, Z., Burns, L., Austin, M.-.P. & Slade, T. 2014, 'The increased trend in mothers' hospital admissions for psychiatric disorders in the first year after birth between 2001 and 2010 in New South Wales, Australia', BMC women's health, vol. 14, pp. 119-119.
Xu, X.K., Wang, Y.A., Li, Z., Lui, K. & Sullivan, E.A. 2014, 'Risk factors associated with preterm birth among singletons following assisted reproductive technology in Australia 2007–2009–a population-based retrospective study', BMC Pregnancy and Childbirth, vol. 14, no. 1, pp. 152-170.
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Background: Preterm birth, a leading cause of neonatal death, is more common in multiple births and thus there has being an increasing call for reducing multiple births in ART. However, few studies have compared risk factors for preterm births amongst ART and non-ART singleton birth mothers. Methods: A population-based study of 393,450 mothers, including 12,105 (3.1%) ART mothers, with singleton gestations born between 2007 and 2009 in 5 of the 8 jurisdictions in Australia. Univariable and multivariable logistic regression models were conducted to evaluate sociodemographic, medical and pregnancy factors associated with preterm births in contrasting ART and non-ART mothers. Results: Ten percent of singleton births to ART mothers were preterm compared to 6.8% for non-ART mothers (P < 0.01). Compared with non-ART mothers, ART mothers were older (mean 34.0 vs 29.7 yr respectively), less socio-economically disadvantaged (12.4% in the lowest quintile vs 20.7%), less likely to be smokers (3.8% vs 19.4%), more likely to be first time mothers (primiparous 62.4% vs 40.5%), had more preexisting hypertension and complications during pregnancy. Irrespective of the mode of conception, preexisting medical and pregnancy complications of hypertension, diabetes and antepartum hemorrhages were consistently associated with preterm birth. In contrast, socio-demographic variables, namely young and old maternal age (<25 and >34), socioeconomic disadvantage (most disadvantaged quintile Odds Ratio (OR) 0.95, 95% Confidence Interval (CI): 0.77-1.17), smoking (OR 1.12, 95%CI: 0.79-1.61) and priminarity (OR 1.19, 95%CI: 1.05-1.35, AOR not significant) shown to be associated with elevated risk of preterm birth for non-ART mothers were not demonstrated for ART mothers, even after adjusting for potential confounders. Nonetheless, in multivariable analysis, the association between ART and the elevated risk for singleton preterm birth persisted after controlling for all included confounding medi...
Xu, F., Austin, M.-.P., Reilly, N., Hilder, L. & Sullivan, E.A. 2014, 'Length of stay for mental and behavioural disorders postpartum in primiparous mothers: a cohort study', International journal of environmental research and public health, vol. 11, pp. 3540-3552.
Zegers-Hochschild, F., Mansour, R., Ishihara, O., Adamson, G.D., de Mouzon, J., Nygren, K.G. & Sullivan, E.A. 2014, 'International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2005.', Fertility and sterility, vol. 101, no. 2, pp. 366-378.
OBJECTIVE: To analyze information on assisted reproductive technology (ART) performed worldwide and trends in outcomes over successive years. DESIGN: Cross-sectional survey on access, effectiveness, and safety of ART procedures performed in 53 countries during 2005. SETTING: A total of 2,973 clinics from national and regional ART registries. PATIENT(S): Infertile women and men undergoing ART globally. INTERVENTION(S): Collection and analysis of international ART data. MAIN OUTCOME MEASURE(S): Number of cycles performed by country and region, including pregnancies, single and multiple birth rates, and perinatal mortality. RESULT(S): Overall, 1,052,363 ART procedures resulted in an estimated 237,315 babies born. The availability of ART varied by country from 15 to 3,982 cycles per million of population. Of all initiated fresh cycles, 62.9% were intracytoplasmic sperm injection. The overall delivery rate per fresh aspiration was 19.6% and for frozen embryo transfer 17.4%, with a cumulative delivery rate of 23.9%. With wide regional variations, single embryo transfer represented 17.5% of cycles, and the proportion of deliveries with twins and triplets from fresh transfers was 23.6% and 1.5%, respectively. CONCLUSION(S): Systematic collection and dissemination of international ART data allows patients, health professionals, and policy makers to examine and compare the impact of reproductive strategies or lack of them as markers of reproductive health.
Xu, F., LI, Z., Binns, C., Bonello, M., Austin, M.-.P. & Sullivan, E.A. 2014, 'Breastfeeding and mother's mental illness', Breastfeeding Medicine, vol. 9, no. 4, pp. 1-7.
Halliday, L.E., Peek, M.J., Ellwood, D.A., Homer, C.S., Knight, M., McLintock, C., Jackson-Pulver, L. & Sullivan, E. 2013, 'The Australasian Maternity Outcomes Surveillance System: An evaluation of stakeholder engagement, usefulness, simplicity, acceptability, data quality and stability', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 53, no. 2, pp. 152-157.
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Background: The Australasian Maternity Outcomes Surveillance System (AMOSS) conducts active, prospective surveillance of severe maternal conditions in Australia and New Zealand (ANZ). AMOSS captures greater than 96% of all births, and utilises an online, active case-based negative reporting system.
Li, Z., Chen, M., Guy, R., Wand, H., Oats, J. & Sullivan, E. 2013, 'Chlamydia Screening In Pregnancy In Australia: Integration Of National Guidelines Into Clinical Practice And Policy', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 53, no. 4, pp. 338-346.
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Background Chlamydia trachomatis is the most common reportable infection in Australia. Since 2006, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) have recommended chlamydia screening in pregnant women aged <25years. Aims To assess clinical uptake and policy integration of the 2006 RANZCOG recommendation on chlamydia testing in pregnant women aged <25years. Methods A mixed method approach was used involving a literature review, a survey of obstetricians and gynaecologists, and survey of hospital managers from April 2010 to May 2010. Results Of the 1644 participating RANZCOG Fellows, Trainees, and Diplomates, 21.2% reported universal screening for pregnant women <25years (25% of primary care clinicians, 23% of those working in the public hospital sector, 16% of those working in both public and private hospitals, and 13% of those in private hospitals or private practice). There was a strong association between members who agreed with the guideline and offering universal screening to pregnant women aged <25years (adjusted odds ratio=17.1, 95% CI: 6.0-49.2, P<0.01). Of the 143 participating hospital managers who completed the hospital policy questionnaire; 20% reported that their hospital had a formal screening guideline. There were two national and four state/local policy documents recommending chlamydia screening in pregnancy. Conclusions This study shows low uptake of chlamydia screening of young pregnant women by RANZCOG Fellows, Trainees, and Diplomates involved in antenatal care and highlights the need for national clinical leadership regarding screening for chlamydia among pregnant women aged <25years.
Xu, F., Bonello, M., Burns, L., Austin, M.-.P., Li, Z. & Sullivan, E. 2013, 'Hospital Admissions for Alcohol Use Disorders Before, During, and After Pregnancy: A Study Based on Linked Population Data in New South Wales, Australia', Alcoholism: Clinical and Experimental Research, vol. 37, pp. 1706-1712.
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Umstad, M., Hale, L., Wang, Y. & Sullivan, E. 2013, 'Multiple Deliveries: The Reduced Impact Of In Vitro Fertilisation In Australia', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 53, no. 2, pp. 158-164.
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Background The number of twins born in Australia steadily increased from 2420 sets in 1983 to 4458 sets in 2010. At one stage, almost 25% of all twin deliveries in Australia were a consequence of assisted reproductive technologies. Aims To determine the influence of a policy of single embryo transfer (SET) on the rate of multiple deliveries in Australia. Methods We used population data to compare the prevalence of twin and higher order multiple births in women giving birth in Australia before and after the implementation of the RTAC COP 2001 and 2005 revisions for ART units. Results There was a steady fall in the twin delivery rate for assisted reproductive technologies from 210.4 per 1000 deliveries in 2001 to 84.3 per 1000 deliveries in 2009. In 2009, assisted reproductive technologies accounted for approximately 16% of all twin births from 3% of all conceptions, substantially less than the 24.5% in 2002. Conclusions The decline in multiple births is multifactorial. However, the fall in the proportion of ART multiple births has paralleled adoption of a voluntary policy of SET within a setting of largely public funding of ART.
Sullivan, E., Wang, Y., Norman, R., Chambers, G., Chughtai, A. & Farquhar, C. 2013, 'Perinatal Mortality Following Assisted Reproductive Technology Treatment In Australia And New Zealand, A Public Health Approach For International Reporting Of Perinatal Mortality', BMC Pregnancy And Childbirth, vol. 13, no. NA, pp. 0-0.
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Chambers, G., Wang, Y., Chapman, M., Hoang, V., Sullivan, E., Abdalla, H. & Ledger, W. 2013, 'What Can We Learn From A Decade Of Promoting Safe Embryo Transfer Practices? A Comparative Analysis Of Policies And Outcomes In The Uk And Australia, 2001-2010', Human Reproduction, vol. 28, no. 6, pp. 1679-1686.
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Wang, Y.A., Nikravan, R., Smith, H.C. & Sullivan, E.A. 2013, 'Higher prevalence of gestational diabetes mellitus following assisted reproduction technology treatment.', Human reproduction (Oxford, England), vol. 28, no. 9, pp. 2554-2561.
STUDY QUESTION: Do mothers following assisted reproduction technology (ART) treatment have increased likelihood of gestational diabetes mellitus (GDM) compared with non-ART mothers after controlling for maternal factors and plurality? SUMMARY ANSWER: ART mothers had 28% increased likelihood of GDM compared with non-ART mothers. WHAT IS KNOWN ALREADY: Advanced maternal age and multiple pregnancies are independently associated with increased likelihood of GDM. Given the average age of mothers having ART treatment is higher than non-ART mothers and the higher multiple pregnancy rate following ART treatment, ART treatment might be expected to be associated with increased risk of GDM. STUDY DESIGN, SIZE, DURATION: A population retrospective cohort study of 400 392 mothers who gave birth in Australia between 2007 and 2009, using the Australian National Perinatal Data Collection from five states (Australian Capital Territory, Queensland, Tasmania, Victoria and Western Australia) where a code for ART treatment is available. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study included 13 732 ART mothers and 386 660 non-ART mothers. The prevalence of GDM was compared between ART and non-ART mothers. Logistic regressions were used to assess the association between ART treatment and GDM. Odds ratio (OR), adjusted OR (AOR) and 95% confidence interval (CI) were calculated. MAIN RESULTS AND THE ROLE OF CHANCE: A larger proportion of ART mothers were aged 40 years compared with non-ART counterpart (11.7 versus 3.4%, P < 0.01). The prevalence of GDM was 7.6% for ART mothers and 5.0% for non-ART mothers (P < 0.01). Mothers who had twins had higher prevalence of GDM than those who gave births to singletons (8.8 versus 7.5%, P = 0.06 for ART mothers; and 7.3 versus 5.0%, P < 0.01 for non-ART mothers). Overall, ART mothers had a 28% increased likelihood of GDM compared with non-ART mothers (AOR 1.28, 95% CI 1.20-1.37). Of mothers who had singletons, ART mothers had higher odds of GD...
Sullivan, E.A., Zegers-Hochschild, F., Mansour, R., Ishihara, O., de Mouzon, J., Nygren, K.G. & Adamson, G.D. 2013, 'International Committee for Monitoring Assisted Reproductive Technologies (ICMART) world report: assisted reproductive technology 2004.', Human reproduction (Oxford, England), vol. 28, no. 5, pp. 1375-1390.
STUDY QUESTION: Have changes in assisted reproductive technology (ART) practice and outcomes occurred globally between 2003 and 2004? SUMMARY ANSWER: Globally, ART practice has changed with an increasing prevalence of the use of ICSI rather than conventional IVF. In 2004, a small but increasing number of countries are incorporating single embryo transfer. There remain unacceptably high rates of three or more embryo transfers in select countries resulting in multiple births and adverse perinatal outcomes. WHAT IS KNOWN ALREADY: World data on the availability, effectiveness and safety of ART have been published since 1989. The number of embryos transferred is a major determinant of the iatrogenic increase in multiple pregnancies and is highly correlated with the likelihood of multiple birth and excess perinatal morbidity and mortality. STUDY DESIGN, SIZE, DURATION: Cross-sectional survey of countries and regions undertaking surveillance of ART procedures started in 2004 and their corresponding outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS: Of total, 2184 clinics from 52 reporting countries and regions. Number of ART clinics, types of cycles and procedures, pregnancy, delivery and multiple birth rates and perinatal outcomes. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 954 743 initiated cycles resulted in an estimated 237 809 babies born. This was a 2.3% increase in the number of reported cycles from 2003. The availability of ART varied by country and ranged from 14 to 3844 treatment cycles per million population. Over one-third (37.2%) of ART clinics performed <100 cycles per year with only 19.9% performing 500 cycles per year. Of all cycles, 60.6% were ICSI. Frozen embryo transfers (FETs) represented 31% of the initiated cycles. The overall delivery rate per fresh aspiration for IVF and ICSI was 20.2% compared with 16.6% per FET. The average number of embryos transferred was 2.35. Single (16.3%) and double embryo transfers accounted for 73.2% of cycles....
Vaughan, G., Pollock, W., Peek, M., Knight, M., Ellwood, D., Homer, C.S., Pulver, L.J., McLintock, C., Ho, M.T. & Sullivan, E. 2012, 'Ethical issues: The multi-centre low-risk ethics/governance review process and AMOSS', The Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 52, no. 2, pp. 195-203.
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The Australasian Maternity Outcomes Surveillance System (AMOSS) conducts surveillance and research of rare and serious conditions in pregnancy. This multi-centre population health study is considered low risk with minimal ethical impact. Objective: To describe the ethics/governance review pathway undertaken by AMOSS. Method: Prospective, descriptive study during 2009- 2011 of the governance/ethical review processes required to gain approval for Australian and New Zealand (ANZ) maternity units with more than 50 births per year (n = 303) to participate in AMOSS. Results: Review processes ranged from a single application for 24 NZ sites, a single application for eligible hospitals in two Australian states, full Health Research Ethics Committee (HREC) applications for individual hospitals, through simple letters of support. As of September 2011, 46 full/expedited ethics applications, 131 site governance applications and 136 letters of support requests were made over 33 months, involving an estimated 3261 hours by AMOSS staff/investigators, and an associated resource burden by participating sites, to obtain approval to receive nonidentifiable data from 291 hospitals. Conclusion: The AMOSS research system provides an important resource to enhance knowledge of conditions that cause rare and serious maternal morbidity. Yet the highly variable ethical approval processes required to implement this study have been excessively repetitive and burdensome. This process jeopardises timely, efficient research project implementation, without corresponding benefits to research participants. The resource burden to establish research governance for AMOSS confirms the urgent need for the Harmonisation of Multi- centre Ethical Review (HoMER) to further streamline ethics/governance review processes for multi- centre research.
Knight, M., Berg, C., Brocklehurst, P., Kramer, M., Lewis, G., Oats, J., Roberts, C., Spong, C., Sullivan, E., Van Roosmalen, J. & Zwart, J. 2012, 'Amniotic Fluid Embolism Incidence, Risk Factors And Outcomes: A Review And Recommendations', BMC Pregnancy And Childbirth, vol. 12, no. NA, pp. 0-0.
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Background: Amniotic fluid embolism (AFE) is a rare but severe complication of pregnancy. A recent systematic review highlighted apparent differences in the incidence, with studies estimating the incidence of AFE to be more than three times higher in North America than Europe. The aim of this study was to examine population-based regional or national data from five high-resource countries in order to investigate incidence, risk factors and outcomes of AFE and to investigate whether any variation identified could be ascribed to methodological differences between the studies. Methods: We reviewed available data sources on the incidence of AFE in Australia, Canada, the Netherlands, the United Kingdom and the USA. Where information was available, the risk factors and outcomes of AFE were examined. Results: The reported incidence of AFE ranged from 1.9 cases per 100 000 maternities (UK) to 6.1 per 100 000 maternities (Australia). There was a clear distinction between rates estimated using different methodologies. The lowest estimated incidence rates were obtained through validated case identification (range 1.9-2.5 cases per 100 000 maternities); rates obtained from retrospective analysis of population discharge databases were significantly higher (range 5.5-6.1 per 100 000 admissions with delivery diagnosis). Older maternal age and induction of labour were consistently associated with AFE. Conclusions: Recommendation 1: Comparisons of AFE incidence estimates should be restricted to studies using similar methodology. The recommended approaches would be either population-based database studies using additional criteria to exclude false positive cases, or tailored data collection using existing specific population-based systems. Recommendation 2: Comparisons of AFE incidence between and within countries would be facilitated by development of an agreed case definition and an agreed set of criteria to minimise inclusion of false positive cases for database studies. Recomm...
Dobbins, T., Sullivan, E., Roberts, C. & Simpson, J. 2012, 'Australian National Birthweight Percentiles By Sex And Gestational Age, 1998-2007', Medical Journal Of Australia, vol. 197, no. 5, pp. 291-294.
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Objective: To present updated national birthweight percentiles by gestational age for male and female singleton infants born in Australia. Design and setting: Cross-sectional population-based study of 2.53 million singleton live births in Australia between 1998 and 2007. Main outcome measures: Birthweight percentiles by gestational age and sex. Results: Between 1998 and 2007, women in Australia gave birth to 2 539 237 live singleton infants. Of these, 2 537 627 had a gestational age between 20 and 44 weeks, and sex and birthweight data were available. Birthweight percentiles are presented by sex and gestational age for a total of 2 528 641 births, after excluding 8986 infants with outlying birthweights. Since the publication of the previous Australian birthweight percentiles in 1999, median birthweight for term babies has increased between 0 and 25 g for boys and between 5 g and 45 g for girls. Conclusions: There has been only a small increase in birthweight percentiles for babies of both sexes and most gestational ages since 1991-1994. These national percentiles provide a current Australian reference for clinicians and researchers assessing weight at birth.
Xu, F., Hilder, L., Austin, M.-.P. & Sullivan, E.A. 2012, 'Data preparation techniques for a perinatal psychiatric study based on linked data', BMC medical research methodology, vol. 12, pp. 71-71.
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Wang, Y., Farquhar, C. & Sullivan, E. 2012, 'Donor Age Is A Major Determinant Of Success Of Oocyte Donation/recipient Programme', Human Reproduction, vol. 27, no. 1, pp. 118-125.
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BACKGROUND: In recent years, particularly in developed countries, women have tended to delay childbirth until over 40 years of age. Our study aims to identify whether the donor"s age or recipient"s age influences the pregnancy and live birth rate following oocyte recipient cycles. METHODS: A population study included 3889 fresh oocyte recipient cycles. Pregnancy and live delivery rates were compared in recipient age groups (<35, 35-39, 40-44 and >= 45 years) and donor age groups (<30, 30-34, 35-39 and >= 40 years). RESULTS: The highest live birth rate was of cycles in donors aged 30-34 years (25.0%), it decreased (P < 0.05) to 24.1% in donors aged <30 years, 20.7% in donors aged 35-39 years and 11.5% in donors aged >= 40 years. The multivariate analysis showed no significant differences in the success by recipient"s age. Compared with cycles in donors aged 30-34 years, cycles in donors aged 35-39 years had 14 and 18% less chance to achieve a pregnancy [adjusted rate ratio (ARR) 0.86, 95% confidence interval (CI) 0.75-0.98] and a live delivery (ARR 0.82, 95% CI 0.71-0.96), while cycles in donors aged 40 years or older had 42 and 54% less chance to achieve a pregnancy (ARR 0.58, 95% CI 0.41-0.84) and a live delivery (ARR 0.46, 95% CI 0.29-0.73). CONCLUSIONS: Older recipients with younger donors did not have a poorer pregnancy outcome compared with younger recipients with younger donors. Choosing a donor aged <35 years would increase the chance of pregnancy and live delivery for older recipients.
Xu, F., Sullivan, E.A., Madden, R.C., Black, D. & Pulver, L.R.J. 2012, 'Improvement of maternal Aboriginality in NSW birth data', BMC medical research methodology, vol. 12, pp. 8-8.
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Xu, F., Austin, M.-.P., Reilly, N., Hilder, L. & Sullivan, E.A. 2012, 'Major depressive disorder in the perinatal period: using data linkage to inform perinatal mental health policy', Archives of women's mental health, vol. 15, pp. 333-341.
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Sullivan, E., Wang, Y., Hayward, I., Chambers, G., Illingworth, P., Mcbain, J. & Norman, R. 2012, 'Single Embryo Transfer Reduces The Risk Of Perinatal Mortality, A Population Study', Human Reproduction, vol. 27, no. 12, pp. 3609-3615.
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Liu, B., Guthridge, S., Li, S., Markey, P., Krause, V., Mcintyre, P., Sullivan, E., Ward, J., Wood, N. & Kaldor, J. 2012, 'The End Of The Australia Antigen? An Ecological Study Of The Impact Of Universal Newborn Hepatitis B Vaccination Two Decades On', Vaccine, vol. 30, no. 50, pp. 7309-7314.
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Background: A universal newborn hepatitis B (HBV) vaccination program was introduced in the Northern Territory of Australia in 1990, followed by a school-based catch-up program. We evaluated the prevalence of hepatitis B infection in birthing women up to 20 years after vaccination and compared this to women born before the programs commenced. Methods: A cohort of birthing mothers was defined from Northern Territory public hospital birth records between 2005 and 2010 and linked to laboratory confirmed notifications of chronic HBV, based principally on a record of hepatitis B surface antigen detection. Prevalence of HBV was compared between women born before or after implementation of the newborn and catch-up vaccination programs. Findings: Among 10797 birthing mothers, 138 (1.3%) linked to a chronic HBV record. HBV prevalence was substantially higher in Aboriginal women compared to non-Indigenous women (2.4% versus 0.04%; p < 0.001). Among 5678 Aboriginal women, those eligible for catch-up and newborn HBV vaccination programs had a significantly lower HBV prevalence than older women born prior to the programs: HBV prevalence respectively 2.2% versus 3.5%, (OR 0.61, 95%CI 0.43-0.88) and 0.8% versus 3.5% (OR 0.21, 95%Cl 0.11-0.43). This represents a risk reduction of respectively 40% and 80% compared to unvaccinated women. Interpretation: The progressively greater reduction in the prevalence of chronic HBV in adult Aboriginal women co-inciding with eligibility for catch-up and newborn vaccination programs is consistent with a significant impact from both programs. The use of data derived from antenatal screening to track ongoing vaccine impact is applicable to a range of settings globally.
Austin, M., Reilly, N. & Sullivan, E. 2012, 'The Need To Evaluate Public Health Reforms: Australian Perinatal Mental Health Initiatives', Australian And New Zealand Journal Of Public Health, vol. 36, no. 3, pp. 208-211.
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Objective: To describe the Australian perinatal mental health reforms and explore ways of improving surveillance of maternal mental health morbidity and mortality in this context. Approaches: We reviewed the Australian perinatal (defined as conception to one year postpartum) mental health reforms, in association with an appraisal of the population health methods that could be used for their evaluation. Conclusion: Despite the increasing focus of public health reforms on maternal mental health in the perinatal period, there is currently no national data available to evaluate these reforms or to provide an evidence base for improved health outcomes. National data development and linkage of relevant datasets would go a long way towards enabling such an endeavour. Implications: Inclusion of key mental health items in the Perinatal National Minimum Dataset and use of data linkage techniques will allow for monitoring of trends in maternal mental health morbidity and mortality in response to the Australian reforms. Once this is implemented, cost-benefit analyses can be undertaken.
Xu, F., Sullivan, E.A., Black, D.A., Pulver, L.R.J. & Madden, R.C. 2012, 'Under-reporting of birth registrations in New South Wales, Australia', BMC pregnancy and childbirth, vol. 12, pp. 147-147.
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Homer, C.S., Biggs, J.B., Vaughan, G. & Sullivan, E. 2011, 'Mapping Maternity Services In Australia: Location, Classification And Services', Australian Health Review, vol. 35, no. 2, pp. 222-229.
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Abstract Objective. To describe maternity services available to Australian women and, in particular, the location, classification of services and support services available. Design. A descriptive study was conducted using an online survey that was emailed to eligible hospitals. Inclusion criteria for the study included public and private maternity units with greater than 50 births per year. In total, 278 maternity units were identified. Units were asked to classify their level of acuity (Levels 26). Results. A total of 150 (53%) maternity units responded. Those who responded were reasonably similar to those who did not respond, and were representative of Australian maternity units. Almost three-quarters of respondents were from public maternity units and almost 70% defined themselves as being in a rural or remote location. Maternity units with higher birth rates were more likely to classify themselves as providing higher acuity services, that is, Levels 5 and 6. Private maternity units were more likely to have higher acuity classifications. Interventions such as induction of labour, either using an artificial rupture of membranes (ARM) and oxytocin infusion or with prostaglandins, were common across most units. Although electronic fetal monitoring (EFM) was also widely available, access to fetal scalp pH monitoring was low. Conclusion. Maternity service provision varies across the country and is defined predominately by location and annual birth rate.
Chambers, G., Illingworth, P. & Sullivan, E. 2011, 'Assisted Reproductive Technology: Public Funding And The Voluntary Shift To Single Embryo Transfer In Australia', Medical Journal Of Australia, vol. 195, no. 10, pp. 594-598.
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Objectives: To calculate cost savings to the Australian federal and state governments from the reduction in twin and triplet birth rates for infants conceived by assisted reproductive technology (ART) since 2002, and to determine the number of ART treatment programs theoretically funded by means of these savings. Design and setting: Costing model using data from the Australia and New Zealand Assisted Reproduction Database, the National Perinatal Data Collection and Medicare Australia on ART treatment cycles undertaken in Australia between 2002 and 2008. Main outcome measures: Annual savings in maternal and infant inpatient birth-admission costs resulting from the reduction in ART multiple birth rate; theoretical number of ART treatment programs funded and infants born by means of these savings. Results: The reduction in the ART multiple birth rate from 18.8% in 2002 to 8.6% in 2008 resulted in estimated savings to government of $47.6 million in birth-admission costs alone. Theoretically, these savings funded 7042 ART treatment programs comprising one fresh plus one frozen embryo transfer cycle, equating to the birth of 2841 babies. Fifty-five per cent of the increased use of ART services since 2002 has been theoretically funded by the reduction in multiple birth infants. Conclusions: Against a backdrop of supportive public funding of ART in Australia, a voluntary shift to single embryo transfer by fertility clinicians and ART patients has resulted in substantial savings in hospital costs. Much of the growth in ART use has been theoretically cross-subsidised by the move to safer embryo transfer practices.
Laws, P., Lim, C., Tracy, S., Dahlen, H. & Sullivan, E. 2011, 'Changes To Booking, Transfer Criteria And Procedures In Birth Centres In Australia From 1997-2007: A National Survey', Journal Of Clinical Nursing, vol. 20, no. 19-20, pp. 2812-2821.
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Aims. This study aimed to describe booking and transfer criteria and procedures available in birth centres in Australia in 2007 and to compare results with those of a previous national birth centre study undertaken in 1997. Background. Approximately 2% of women who give birth in Australia each year do so in a birth centre. A national study on birth centre procedures was conducted in 1997. There have been changes in the management of women in birth centres during the past 10 years and this may be due in part to changes in booking and transfer criteria. Design. Survey. Methods. Questionnaires were sent to 23 birth centres. Questions included: types of procedures, equipment and pain relief available and exclusion criteria for booking and transfer. Of the birth centres, 19 satisfied the inclusion criteria and 16 completed surveys. Results. Changes were noted in booking and transfer criteria and procedures for birth centres between 1997-2007. These included a decline in birth centres accepting postterm pregnancies, vaginal births after caesarean section and women who are obese. There were also reductions in the use of artificial rupture of membranes for augmentation of labour, forceps and opioids. Use of natural therapies was widespread in 2007. Increases in birth centres managing induction of labour and electronic fetal monitoring were also noted. Conclusions. The changes observed in birth centre practice reflect overall changes in maternity care in Australia from 1997-2007. Relevance to clinical practice. Findings of the study suggest that factors such as increasing obesity and limited admission for vaginal births after caesarean section may lead to proportionately more women being unable to access birth centres as their preferred place of birth.
Nair, P., Davies, A., Beca, J., Bellomo, R., Ellwood, D., Forrest, P., Jackson, A., Pye, R., Seppelt, I., Sullivan, E. & Webb, S. 2011, 'Extracorporeal Membrane Oxygenation For Severe Ards In Pregnant And Postpartum Women During The 2009 H1n1 Pandemic', Intensive Care Medicine, vol. 37, no. 4, pp. 648-654.
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Purpose: To describe the technical challenges, efficacy, complications and maternal and infant outcomes associated with extracorporeal membrane oxygenation (ECMO) for severe adult respiratory distress syndrome (ARDS) in pregnant or postpartum patients during the 2009 H1N1 pandemic. Methods: Twelve critically ill pregnant and postpartum women were included in this retrospective observational study on the application of ECMO for the treatment of severe ARDS refractory to standard treatment. The study was conducted at seven tertiary hospitals in Australia and New Zealand. Results: Of the 12 patients treated with ECMO, 7 (58%) were pregnant and 5 (42%) were postpartum. Their median (interquartile range [IQR]) age was 29 (26-33) years, 6 (50%) were obese. Two patients were initially treated with veno-arterial (VA) ECMO. All others received veno-venous (VV) ECMO with one or two drainage cannulae. ECMO circuit-related complications were rare, circuit change was needed in only two cases and there was no sudden circuit failure. On the other hand, bleeding was common, leading to relatively large volumes of packed red blood cell transfusion (median [ IQR] volume transfused was 3,499 [1,451-4,874] ml) and was the main cause of death (three cases). Eight (66%) patients survived to discharge and seven were ambulant, with normal oxygen saturations. The survival rate of infants whose mothers received ECMO was 71% and surviving infants were discharged home with no sequelae. Conclusions: The use of ECMO for severe ARDS in pregnant and postpartum women was associated with a 66% survival rate. The most common cause of death was bleeding. Infants delivered of mothers who had received ECMO had a 71% survival rate and, like their mothers, had no permanent sequelae at hospital discharge.
Nygren, K., Sullivan, E., Zegers-hochschild, F., Mansour, R., Ishihara, O., Adamson, G. & De Mouzon, J. 2011, 'International Committee For Monitoring Assisted Reproductive Technology (icmart) World Report: Assisted Reproductive Technology 2003', Fertility And Sterility, vol. 95, no. 7, pp. 2209-0.
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Objective: To analyze information on assisted reproductive technologies (ART) performed globally. Design: Data on access, efficacy, and safety of ART were collected for the year 2003 from 54 countries. Setting: National and regional ART registries globally. Patient(s): Patients undergoing ART globally. Intervention(s): Collection and analysis of international ART registry data. Main Outcome Measure(s): Number of cycles performed in reporting countries and regions globally for different ART procedures with resulting pregnancy, live birth and multiple birth rates. Result(s): A total of 433,427 initiated cycles reported in this registry resulted in 173,424 babies born. This corresponded to a delivery rate per aspiration of 22.4% for in vitro fertilization (IVF), 23.3% for intracytoplasmic sperm injection (ICSI), and a delivery rate per transfer of 17.1% for frozen embryo transfer. Although there is wide variation among countries and regions, the overall proportion of deliveries with twins and triplets from IVF and ICSI was 24.8% and 2.0%, respectively. There were wide variations in access, and compared with the previous report (year 2002), there was a 3.9% increase in the number of reported cycles and a minor increase in the delivery rate per aspiration. There was also a marginal decline in the mean number of embryos transfered and in the rate of multiple births. Conclusion(s): ART access, efficacy, and safety varies greatly globally. Collection and analysis of data over time will benefit ART patients, providers, and policy makers. (Fertil Steril (R) 2011;95:2209-22. (C)2011 by American Society for Reproductive Medicine.)
Wang, Y., Costello, M., Chapman, M., Black, D. & Sullivan, E. 2011, 'Transfers Of Fresh Blastocysts And Blastocysts Cultured From Thawed Cleavage Embryos Are Associated With Fewer Miscarriages', Reproductive BioMedicine Online, vol. 23, no. 6, pp. 777-788.
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The literature shows an inconsistent relationship between miscarriage and assisted reproduction treatment factors. This study assessed the association between miscarriage and transfer of fresh or thawed embryos at cleavage/blastocyst stages. A population study included 52,874 pregnancies following autologous cycles. The miscarriage rate was compared by groups of transferred embryos (fresh cleavage embryo, fresh blastocyst, thawed cleavage embryo, blastocyst from thawed cleavage embryo, thawed blastocyst), IVF/intracytoplasmic sperm injection procedures, number of embryos transferred and woman"s demographics. The overall miscarriage rate was 18.7%. Women aged 35-39 years and >= 40 years had a 51% and 177% increased hazard of miscarriage, respectively, compared with women <35 years. Women with history of miscarriage had 1.22 times hazard of miscarriage compared with those without previous miscarriage. Singleton pregnancies following fresh double-embryo transfer had 1.43 times higher rate of miscarriage than fresh single-embryo transfer. Fresh blastocyst transfer was associated with 8% less hazard of miscarriage than fresh cleavage-embryo transfer. Compared with pregnancies following thawed cleavage-embryo transfers, thawed blastocyst transfers were at 14% higher hazard of miscarriage. This study suggests that a practice model that includes transferring blastocysts and freezing cleavage embryos in fresh cycles would result in better outcomes.
Li, Z., Page, A., Martin, G. & Taylor, R. 2011, 'Attributable risk of psychiatric and socio-economic factors for suicide from individual-level, population-based studies: A systematic review', SOCIAL SCIENCE & MEDICINE, vol. 72, no. 4, pp. 608-616.
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Knight, M., Pierce, M., Seppelt, I., Kurinczuk, J.J., Spark, P., Brocklehurst, P., McLintock, C. & Sullivan, E. 2011, 'Authors' reply', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 118, no. 9, pp. 1140-1141.
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Knight, M., Pierce, M., Seppelt, I., Kurinczuk, J.J., Spark, P., Brocklehurst, P., McLintock, C. & Sullivan, E. 2011, 'Critical illness with AH1N1v influenza in pregnancy: a comparison of two population-based cohorts.', BJOG : an international journal of obstetrics and gynaecology, vol. 118, no. 2, pp. 232-239.
OBJECTIVE: To compare admissions to intensive care units (ICUs) with confirmed AH1N1v influenza in pregnancy in Australia, New Zealand and the UK. DESIGN: National cohort studies. SETTING: ICUs in Australia, New Zealand and the UK. POPULATION: Fifty-nine women admitted to ICUs in Australia and New Zealand in June-August 2009, and 57 women admitted to ICUs in the UK in September 2009-January 2010. METHODS: Comparison of cohort data. MAIN OUTCOME MEASURES: Incidence of ICU admission, comparison of characteristics and outcomes. RESULTS: There was a significantly higher ICU admission risk in Australia and New Zealand than in the UK (risk ratio 2.59, 95% CI 1.75-3.85). Indigenous women from Australia and women with Maori/Pacific Island backgrounds from New Zealand had the highest admission risk (29.7 admissions per 10 000 maternities, 95% CI 17.9-46.3). Women admitted in Australia and New Zealand were significantly more likely to have a pre-existing medical condition (51% versus 21%, P = 0.001), but were less likely to receive antiviral treatment (80% versus 93%, P = 0.038) than women admitted in the UK. Women admitted in the UK had a longer length of hospital stay (median 21 days, range 3-128 days) than women admitted in Australia and New Zealand (median 12 days, range 3-66 days), but there were no other differences in maternal or pregnancy outcomes. CONCLUSIONS: The difference in admission risk may reflect a second phase effect from successful clinical and public health interventions, as well as differences in population characteristics between the countries. The overall severity of the AH1N1v influenza infection in pregnancy is evident, and emphasises the importance of an ongoing immunisation programme in pregnant women in both northern and southern hemispheres.
Sullivan, E., Ellwood, D., Peek, M., Knight, M., Jackson Pulver, L.R., Homer, C.S., Elliott, E., McLintock, C., Thompson, J., Zurynski, Y., Ho, T., McDonnell, N. & Pollock, W. 2010, 'Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study', British Medical Journal, vol. 340:c1279, no. NA, pp. 1-6.
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Objective To describe the epidemiology of 2009 A/H1N1 influenza in critically ill pregnant women. Design Population based cohort study. Setting All intensive care units in Australia and New Zealand. Participants All women with 2009 H1N1 influenza who were pregnant or recently post partum and admitted to an intensive care unit in Australia or New Zealand between 1 June and 31 August 2009. Main outcome measures Maternal and neonatal mortality and morbidity.
Wang, Y., Chapman, M., Costello, M. & Sullivan, E. 2010, 'Better Perinatal Outcomes Following Transfer Of Fresh Blastocysts And Blastocysts Cultured From Thawed Cleavage Embryos: A Population-based Study', Human Reproduction, vol. 25, no. 6, pp. 1536-1542.
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Background: Fresh embryo transfer results in higher live birth rates, while thawed embryo transfer appears to result in healthier babies. This study aims to investigate the association between the transfer of fresh or thawed embryos at the cleavage or blastocyst stage and the perinatal outcomes. Methods: This analysis is a retrospective population-based study of 150 376 autologous embryo transfer cycles in Australia during 2002-2006. The rates of pregnancy, live delivery and "healthy baby" delivery (a single baby born live at term, weighing >= 2500 g, surviving for at least 28 days post birth and not having congenital anomalies) were compared after transfer of fresh cleavage embryos, fresh blastocysts, thawed cleavage embryos, blastocysts from thawed cleavage embryos and thawed blastocysts. Results: The live delivery rate was significantly higher for transfer of fresh blastocysts (27.9%) than for blastocysts cultured from thawed cleavage embryos (22.0%), fresh cleavage embryos (21.7%), thawed blastocysts (16.3%) and thawed cleavage embryos (15.2%). Compared with the transfer of fresh blastocysts, the likelihood of a "healthy baby" was significantly lower for blastocysts from thawed cleavage embryos [adjusted odds ratios (AOR) 0.73, 95% confidence intervals (CI) 0.65-0.82], fresh cleavage embryos (AOR 0.67, 95% CI 0.64-0.69), thawed blastocysts (AOR 0.57, 95% CI 0.53-0.62) and thawed cleavage embryos (AOR 0.53, 95% CI 0.51-0.56). Of thaw cycles, transfers of thawed blastocysts (AOR 0.79, 95% CI 0.70-0.89) and thawed cleavage embryos (AOR 0.71, 95% CI 0.63-0.79) had significantly lower odds of "healthy baby" than transfer of blastocysts from thawed cleavage embryos. Conclusions: These data suggest that an optimum practice model to maximize the outcomes of the birth of a "healthy baby" is the transfer of blastocysts and the freezing of cleavage embryos in fresh cycles and subsequent transfer of blastocysts cultured from these thawed cleavage embryos.
Chambers, G., Sullivan, E., Shanahan, M., Ho, M., Priester, K. & Chapman, M. 2010, 'Is In Vitro Fertilisation More Effective Than Stimulated Intrauterine Insemination As A First-line Therapy For Subfertility? A Cohort Analysis', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 50, no. 3, pp. 280-288.
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Objective: To compare a strategy of two cycles of intrauterine insemination with controlled ovarian hyperstimulation (IUI/COH) vs one in vitro fertilisation (IVF) treatment programme (one fresh plus associated frozen embryo cycles) in couples presenting with unexplained, mild male or mild female subfertility. Methods: A retrospective cohort design was used and analysed according to intention-to-treat principles. A total of 272 couples underwent an intended course of two cycles of IUI/COH and 176 couples underwent one IVF treatment programme. Results: The cumulative live birth rate (CLBR) per couple for the IUI/COH group was 27.6% compared to 39.2% for the IVF group (P = 0.01). The mean time to pregnancy was 69 days in the IUI/COH group compared to 44 days in the IVF group (P = 0.02). The IVF programme was costlier, with an incremental cost-effectiveness ratio for an additional live birth in the range of $39 637-$46 325. The multiple delivery rate was 13.3% in the IUI/COH group compared to 10.1% in the IVF group (P = 0.55). One set of triplets and one set of quadruplets followed IUI/COH treatment. Conclusions: One IVF treatment programme was more effective, but costlier than an intended course of two cycles of IUI/COH. With consistently higher success rates, shorter times to pregnancy and a trend to less higher order multiple pregnancies, this study supports the view that IVF is now potentially safer and more clinically effective than IUI/COH as a first-line therapy for subfertility.
Laws, P., Tracy, S. & Sullivan, E. 2010, 'Perinatal Outcomes Of Women Intending To Give Birth In Birth Centers In Australia', Birth-issues In Perinatal Care, vol. 37, no. 1, pp. 28-36.
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Background: A recent Australian study showed perinatal mortality was lower among women who gave birth in a birth center than in a comparable low-risk group of women who gave birth in a hospital. The current study used the same large population database to investigate whether perinatal outcomes were improved for women intending to give birth in a birth center at the onset of labor, regardless of the actual place of birth. Methods: Data were obtained from the National Perinatal Data Collection (NPDC) in Australia. The study included 822,955 mothers who gave birth during the 5-year period, 2001 to 2005, and their 836,919 babies. Of these, 22,222 women (2.7%) intended to give birth in a birth center at the onset of labor. Maternal and perinatal factors and outcomes were compared according to the intended place of birth. Data were not available on congenital anomalies, or cause, or timing of death. Results: Women intending to give birth in a birth center at the onset of labor had lower rates of intervention and of adverse perinatal outcomes compared with women intending to give birth in a hospital, including less preterm birth and low birthweight. No statistically significant difference was found in perinatal mortality for term babies of mothers intending to give birth in a birth center compared with term babies of low-risk women intending to give birth in a hospital (1.3 per 1,000 births [99% CI = 0.66, 1.95] vs 1.7 per 1,000 births [99% CI = 1.50, 1.80], respectively). Conclusions: Term babies of women who intended to give birth in a birth center were less likely to be admitted to a neonatal intensive care unit or special care nursery, and no significant difference was found in other perinatal outcomes compared with term babies of low-risk women who intended to give birth in a hospital labor ward. Birth center care remains a viable option for eligible women giving birth at term. (BIRTH 37:1 March 2010).
Sullivan, E., Chapman, M., Wang, Y. & Adamson, G. 2010, 'Population-based Study Of Cesarean Section After In Vitro Fertilization In Australia', Birth-issues In Perinatal Care, vol. 37, no. 3, pp. 184-191.
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Background: Decisions about method of birth should be evidence based. In Australia, the rising rate of cesarean section has not been limited to births after spontaneous conception. This study aimed to investigate cesarean section among women giving birth after in vitro fertilization (IVF). Methods: Retrospective population-based study was conducted using national registry, data on IVF treatment. The study included 17,019 women who underwent IVF treatment during 2003 to 2005 and a national comparison population of women who gave birth in Australia. The outcome measure was cesarean section. Results: Crude rate of cesarean section was 50.1 percent versus 28.9 percent for all other births. Single embryo transfer was associated with the lowest (40.7%) rate of cesarean section. Donor status and twin gestation were associated with significantly higher rates of cesarean section (autologous, 49.0% vs donor, 74.9%; AOR: 2.20, 95% CI: 1.80, 2.69) and (singleton, 45.0% vs twin gestations, 75.7%; AOR: 3.81, 95% CI: 3.46, 4.20). The gestation-specific rate (60.1%) of cesarean section peaked at 38 weeks for singleton term pregnancies. Compared with other women, cesarean section rates for assisted reproductive technology term singletons (27.8% vs 43.8%, OR: 2.02 [95% Cl: 1.95-2.10]) and twins (62.0% vs 75.7%, OR: 1.92 [95% Cl: 1.74-2.111) were significantly higher. Conclusions: Rates for cesarean section appear to be disproportionatel) high in term singleton births after assisted reproductive technology. Vaginal birth should be supported and the indications for cesarean section evidence based. (BIRTH 37:3 September 2010)
Abeywardana, S., Bower, C., Halliday, J., Chan, A. & Sullivan, E. 2010, 'Prevalence Of Neural Tube Defects In Australia Prior To Mandatory Fortification Of Bread-making Flour With Folic Acid', Australian And New Zealand Journal Of Public Health, vol. 34, no. 4, pp. 351-355.
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Objective: To establish baseline prevalence of neural tube defects (NTDs) prior to mandatory folic acid fortification in Australia. Method: Retrospective population based study. Data from the Australian Congenital Anomalies Monitoring System, for 1998-2005 were used to calculate birth prevalence including live/stillbirths of at least 20 weeks gestation or 400 g birthweight. Total prevalence and trends of NTD including terminations of pregnancy (TOPs) before 20 weeks were established using data from South Australia, Victoria and Western Australia because of the incomplete ascertainment in other states. Results: The birth prevalence of NTDs from 1998-2005, was 5/10,000 births. The total prevalence including TOPs was 13/10,000 births. A 26% declining trend in total prevalence was seen from 1992-2005, but the main decline occurred prior to 1998. Women who were Indigenous, socially disadvantaged, young, living in remote areas and had multiple gestations were more likely to give birth to babies with NTDs. Conclusion: The prevalence of NTD has been stable since 1998. Reporting of the birth prevalence alone underestimates the actual prevalence of NTD. Implications: From a public health perspective, future monitoring of NTD following implementation of fortification of bread-making flour with folic acid should include a mixed methods approach; reporting birth prevalence on national data and total prevalence on tri-state data.
Wang, Y., Kovacs, G. & Sullivan, E. 2010, 'Transfer Of A Selected Single Blastocyst Optimizes The Chance Of A Healthy Term Baby: A Retrospective Population Based Study In Australia 2004-2007', Human Reproduction, vol. 25, no. 8, pp. 1996-2005.
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The practice of single embryo transfer (SET) is highly accepted by clinicians in Australia. This study investigates whether the SET of blastocysts results in optimal perinatal outcomes. This retrospective population-based study included 34 035 single or double embryo transfer cycles in women who had their first fresh autologous treatment in Australia during 2004-2007. Pregnancy, live delivery and "healthy baby" (live born term singleton of >= 2500 g birthweight and survived for at least 28 days without a notified/reported congenital anomaly) rates per transfer cycle were compared in four groups: selective single embryo transfer (SSET), unselective single embryo transfer (USSET), selective double embryo transfer (SDET) and unselective double embryo transfer (USDET). Live delivery and "healthy baby" rates per transfer following SSET were further compared by number of embryos available. The analysis was stratified by woman"s age and stage of embryo development. The highest rates of live delivery and "healthy baby" per transfer cycle (46.2 and 38.0%) were achieved with transfer of a single blastocyst in women aged younger than 35 years. In women aged younger than 40 years, SSET had a significantly higher rate of "healthy baby" per transfer cycle than did SDET regardless of stage of embryo development. In woman aged younger than 35 years who had SSET, there was no significant difference in live delivery and "healthy baby" rates per transfer cycle whether two, three, four or five embryos were available. For all of these women, SSET of a cleavage embryo had significantly lower rates of live delivery and "healthy baby" per transfer cycle compared with SSET of a blastocyst where only two blastocysts were available. Consultation with the patient with respect to the advantage of extended culture and selective single blastocyst transfer will result in better success rates following assisted reproductive technology treatment in Australia.
Guy, R.J., Kong, F., Goller, J., Franklin, N., Bergeri, I., Dimech, W., Reilly, N., Sullivan, E., Ward, J., Kaldor, J.M., Hellard, M. & Donovan, B. 2010, 'A new national Chlamydia Sentinel Surveillance System in Australia: evaluation of the first stage of implementation.', Communicable diseases intelligence quarterly report, vol. 34, no. 3, pp. 319-328.
The Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) was established with funding from the Department of Health and Ageing to trial the monitoring of the uptake and outcome of chlamydia testing in Australia. ACCESS involved 6 separate networks; 5 clinical networks involving sexual health services, family planning clinics, general practices, antenatal clinics, Aboriginal community controlled health services, and 1 laboratory network. The program ran from May 2007 to September 2010. An evaluation of ACCESS was undertaken in early 2010, 2 years after the program was funded. At the time of the evaluation, 76 of the 91 participating sites were contributing data. The jurisdictional distribution of the 76 sites generally matched the jurisdictional distribution of the Australian population. In 2008, the chlamydia testing rates in persons aged 16-29 years attending the 26 general practices was 4.2% in males and 7.0% in females. At the 25 sexual health services, the chlamydia testing rates in heterosexuals aged less than 25 years in 2008 was 77% in males and 74% in females. Between 2004 and 2008, the chlamydia positivity rate increased significantly in heterosexual females aged less than 25 years attending the sexual health services, from 11.5% to 14.1% (P < 0.01). Data completeness was above 85% for all core variables except Aboriginal and/or Torres Strait Islander status and country of birth, which ranged from 68%-100%, and 74%-100%, respectively, per network. There were delays in establishment of the system due to recruitment of 91 sites, multiple ethics applications and establishment of automated extraction programs in 10 different database systems, to transform clinic records into a common, pre-defined surveillance format. ACCESS has considerable potential as a mechanism toward supporting a better understanding of long-term trends in chlamydia notifications and to support policy and program delivery.
Farquhar, C.M., Wang, Y.A. & Sullivan, E.A. 2010, 'A comparative analysis of assisted reproductive technology cycles in Australia and New Zealand 2004-2007.', Human reproduction (Oxford, England), vol. 25, no. 9, pp. 2281-2289.
BACKGROUND: There are different funding arrangements for fertility treatments between New Zealand (NZ) and Australia. In NZ, there are two options for patients accessing treatment: either meeting specified criteria for age, no smoking and BMI for publicly funding or funding their own treatment. This differs from Australia, which has no explicit eligibility criteria restricting access to fertility treatment. An analysis of assisted reproductive technology (ART) in Australia and NZ was undertaken to consider the impact of these different funding approaches. METHODS: Data were extracted from the Australian and New Zealand Assisted Reproduction Database between 2004 and 2007. A total of 116 111 autologous fresh cycles were included. RESULTS: In Australia, more cycles were in women aged 40 years or older compared with those in NZ (23.5 versus 16.0%, P < 0.01). Single embryo transfer was more common in NZ than that in Australia, in women < 35 years of age (75.1 versus 59.6%, P < 0.01). In women <35 years, the crude rates of clinical pregnancy (37.5 versus 31.2%, P < 0.01) and live delivery (31.6 versus 26%, P < 0.01) following fresh ART cycles were significantly higher in NZ than that in Australia. These differences in outcomes persisted in older age groups. CONCLUSIONS: The purpose of the criteria used in NZ to access public funding for fertility treatments is to optimize pregnancy outcomes. This approach has resulted in a healthier population of women undergoing treatment and may explain the improved pregnancy outcomes seen in NZ couples who undergo fertility treatments.
Knight, M. & Sullivan, E.A. 2010, 'Variation in caesarean delivery rates.', BMJ (Clinical research ed.), vol. 341, p. c5255.
Dean, J.H., Chapman, M.G. & Sullivan, E.A. 2010, 'The effect on human sex ratio at birth by assisted reproductive technology (ART) procedures--an assessment of babies born following single embryo transfers, Australia and New Zealand, 2002-2006.', BJOG : an international journal of obstetrics and gynaecology, vol. 117, no. 13, pp. 1628-1634.
OBJECTIVE: To assess the effect on the human sex ratio at birth by assisted reproductive technology (ART) procedures. DESIGN: Retrospective population-based study. SETTING: Fertility clinics in Australia and New Zealand. POPULATION: The study included 13,368 babies by 13,165 women who had a single embryo transfer (SET) between 2002 and 2006. METHODS: Logistic regression was used to model the effect on the sex ratio at birth of ART characteristics [in vitro fertilisation (IVF) or intracytoplasmic sperm insemination (ICSI) SET, cleavage-stage or blastocyst SET, and fresh or thawed SET] and biological characteristics (woman's and partner's age and cause of infertility). MAIN OUTCOME MEASURES: Proportion of male births. RESULTS: The crude sex ratio at birth was 51.3%. Individual ART procedures had a significant effect on the sex ratio at birth. More males were born following IVF SET (53.0%) than ICSI SET (50.0%), and following blastocyst SET (54.1%) than cleavage-stage SET (49.9%). For a specific ART regimen, IVF blastocyst SET produced more males (56.1%) and ICSI cleavage-stage SET produced fewer males (48.7%). CONCLUSIONS: The change in the sex ratio at birth of SET babies is associated with the ART regimen. The mechanism of these effects remains unclear. Fertility clinics and patients should be aware of the bias in the sex ratio at birth when using ART procedures.
De Mouzon, J., Lancaster, P., Nygren, K.G., Sullivan, E., Zegers-Hochschild, F., Mansour, R., Ishihara, O. & Adamson, D. 2010, 'Erratum: World collaborative report on assisted reproductive technology, 2002 (Human Reproduction (2009) 24 (2310-2320) DOI: 10.1093/humrep/dep098)', Human Reproduction, vol. 25, no. 5, p. 1345.
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Homer, C.S., Clements, V.J., McDonnell, N., Peek, M. & Sullivan, E. 2009, 'Maternal mortality: What can we learn from stories of postpartum haemorrhage?', Women and Birth, vol. 22, no. 3, pp. 97-104.
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Death from pregnancy is rare in developed countries such as Australia but is still common in third world and developing countries. The investigation of each maternal death yields valuable information and lessons that all health care providers involved with the care of women can learn from. The aim of these investigations is to prevent future maternal morbidity and mortality. Obstetric haemorrhage remains a leading cause of maternal death internationally. It is the most common cause of death in developing countries. In Australia and the United Kingdom, obstetric haemorrhage is ranked as the 4th and 3rd most common cause of direct maternal death respectively. In a number of cases there are readily identifiable factors associated with the care that the women received that may have contributed to their death. It is from these identifiable factors that both midwives and doctors can learn to help prevent similar episodes from occurring.
Laws, P., Lim, C., Tracy, S.K. & Sullivan, E. 2009, 'Characteristics and practices of birth centres in Australia', Australian and NZ Journal of Obstetrics and Gynaec..., vol. 49, no. 3, pp. 290-295.
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Background: Around 2% of women who give birth in Australia each year give birth in a birth centre. There is currently no standard definition of a birth centre in Australia. Aims: This study aimed to locate all birth centres nationally, describe their characteristics and procedures, and develop a definition. Methods: Surveys were sent to 23 birth centres. Questions included: types of procedures, equipment and pain relief available, staffing, funding, philosophies, physical characteristics and transfer procedures. Of the birth centres, 19 satisfied the inclusion criteria and 16 completed surveys. Results: Three constructs of a birth centre were identified. A 'commitment to normality of pregnancy and birth' was most commonly reported as the most important philosophy (44%). The predominant model of care was group practice/caseload midwifery (63%). Thirteen birth centres were located within/attached to a hospital, two were on a hospital campus and one was freestanding. The distance to the nearest labour ward ranged from 2 m to 15 km. Reported intrapartum transfer rates ranged from 7% to 29%. Thirteen centres had a special care nursery or neonatal intensive care unit onsite, or both. Eight centres undertook artificial rupture of membranes for induction of labour, while two administered oxytocin or prostaglandins. All centres offered nitrous oxide and local anaesthetic. Twelve centres had systemic opioids available and one offered pudendal analgesia. Fetal monitoring was used in all birth centres. Only three centres conducted instrumental deliveries, while 15 performed episiotomies. Conclusion: Birth centres vary in their philosophies, characteristics and service delivery.
Robson, S., Laws, P. & Sullivan, E. 2009, 'Adverse Outcomes Of Labour In Public And Private Hospitals In Australia: A Population-based Descriptive Study', Medical Journal Of Australia, vol. 190, no. 9, pp. 474-477.
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Objective: To compare the rate of serious adverse perinatal outcomes of term labour between private and public maternity hospitals in Australia. Design, setting and participants: A population-based study of 789240 term singleton births in public and private hospitals in 2001-2004, using data from the National Perinatal Data Collection. Main outcome measures: Third- and fourth-degree perineal injury, requirement for high level of neonatal resuscitation, Apgar score < 7 at 5 minutes, admission to neonatal intensive care unit or special care nursery, and perinatal death. Results: 31.4% of the term singleton births occurred in private hospitals. After adjusting for maternal age, Indigenous status, parity, smoking status, diabetes, hypertension, remoteness of usual residence, and method of birth, the rates of all adverse outcomes studied were higher for public hospital births. For women, the adjusted odds ratio (AOR) for third- or fourth-degree perineal injury was 2.28 (95% Cl, 2.16-2.40). For babies, the odds of a high level of resuscitation (AOR, 2.37; 95% Cl, 2.17-2.59), low Apgar score (AOR, 1.75; 95% Cl, 1.65-1.84), intensive care requirement (AOR, 1.48; 95% Cl, 1.45-1.51) and perinatal death (AOR, 2.02; 95% Cl, 1.78-2.29) were all higher in public hospitals. Conclusion: For women delivering a single baby at term in Australia, the prevalence of adverse perinatal outcomes is higher in public hospitals than in private hospitals.
Laws, P., Lim, C., Tracy, S. & Sullivan, E. 2009, 'Characteristics And Practices Of Birth Centres In Australia', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 49, no. 3, pp. 290-295.
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Background: Around 2% of women who give birth in Australia each year give birth in a birth centre. There is currently no standard definition of a birth centre in Australia. Aims: This study aimed to locate all birth centres nationally, describe their characteristics and procedures, and develop a definition. Methods: Surveys were sent to 23 birth centres. Questions included: types of procedures, equipment and pain relief available, staffing, funding, philosophies, physical characteristics and transfer procedures. Of the birth centres, 19 satisfied the inclusion criteria and 16 completed surveys. Results: Three constructs of a birth centre were identified. A "commitment to normality of pregnancy and birth" was most commonly reported as the most important philosophy (44%). The predominant model of care was group practice/caseload midwifery (63%). Thirteen birth centres were located within/attached to a hospital, two were on a hospital campus and one was freestanding. The distance to the nearest labour ward ranged from 2 m to 15 km. Reported intrapartum transfer rates ranged from 7% to 29%. Thirteen centres had a special care nursery or neonatal intensive care unit onsite, or both. Eight centres undertook artificial rupture of membranes for induction of labour, while two administered oxytocin or prostaglandins. All centres offered nitrous oxide and local anaesthetic. Twelve centres had systemic opioids available and one offered pudendal analgesia. Fetal monitoring was used in all birth centres. Only three centres conducted instrumental deliveries, while 15 performed episiotomies. Conclusion: Birth centres vary in their philosophies, characteristics and service delivery.
Lim, J., Sullivan, E. & Kennedy, D. 2009, 'Mothersafe: Review Of Three Years Of Counselling By An Australian Teratology Information Service', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 49, no. 2, pp. 168-172.
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MotherSafe was established in January 2000 at the Royal Hospital for Women as Australia"s first "purpose-built" Teratogen Information Service and since then has received over 75 000 calls regarding exposures during pregnancy and lactation. To describe the patterns of use of MotherSafe over a three-year period. Retrospective descriptive epidemiological study using data from the database established at MotherSafe. Records from all the calls logged at MotherSafe between January 2005 and December 2007 were analysed to determine total number of calls, demographic characteristics of callers, including age, caller category and postcode, reason for call, source of referral and type of exposure. A total of 47 138 calls were recorded to the MotherSafe service from January 2005 to December 2007. The majority of calls were regarding exposures in pregnancy (55%) and breast-feeding (38%). Average age of patients was 32.3 years. Of the calls made, 81.9% (38 485 of 46 968) were by consumers (the pregnant or lactating woman herself or a relative). The most common primary exposure categories were: over-the-counter medications (11.3%), psychotropic medication (9.0%), herbal or vitamin products (8.2%), antibiotics (7.0%), gastrointestinal medications (6.8%) and topical products (6.6%). Forty per cent of callers enquired about multiple exposures. The utilisation of MotherSafe by consumers and general practitioners continues to increase, reflecting the strong demand for a teratogen counselling service that provides high-quality, evidence-based information on exposures during pregnancy and lactation.
Wang, Y., Sullivan, E., Healy, D. & Black, D. 2009, 'Perinatal Outcomes After Assisted Reproductive Technology Treatment In Australia And New Zealand: Single Versus Double Embryo Transfer', Medical Journal Of Australia, vol. 190, no. 5, pp. 234-237.
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Objective: To compare the perinatal outcomes of babies conceived by single embryo transfer (SET) with those conceived by double embryo transfer (DET). Design, setting and participants: A retrospective population-based study of embryo transfer cycles in Australia and New Zealand between 2002 and 2006, using data from the Australia and New Zealand Assisted Reproduction Database. Main outcome measures: Proportion of SET procedures; comparison of SET and DET procedures with respect to multiple births, low birthweight (LBW), preterm birth and fetal death. Results: The proportion of SET procedures has increased from 28.4% in 2002 to 32.0% in 2003, 40.5% in 2004, 48.2% in 2005 and 56.9% in 2006. The multiple birth rate for all babies conceived by SET (4.0%) was 10 times lower than for those conceived by DET (39.1%) (P < 0.01). The average birthweight for all liveborn babies conceived by SET (3290 g) was higher than for those conceived by DET (2934 9) (P < 0.01). The preterm birth rate of all DET-conceived babies (30.3%) was higher than for SET-conceived babies (12.3%) (adjusted odds ratio [AOR], 3.19 [95% Cl, 3.01-3.38]). All babies conceived by DET were more likely to be stillborn than those conceived by SET (AOR, 1.49 [95% Cl, 1.21-1.82]). Singletons conceived by DET were more likely to be born preterm than singletons conceived by SET (AOR, 1.13 [95% Cl, 1.05-1.22]). Liveborn singletons conceived by DET were 15% more likely to have LBW than liveborn singletons conceived by SET (AOR, 1.15 [95% Cl, 1.05-1.26]). There was no significant difference in fetal death rate between DET- and SET-conceived singletons. Conclusion: The increase in proportion of SET procedures has resulted in a lower rate of multiple births and in better perinatal outcomes in Australian and New Zealand assisted reproduction programs.
Sullivan, E., Moran, K. & Chapman, M. 2009, 'Term Breech Singletons And Caesarean Section: A Population Study, Australia 1991-2005', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 49, no. 5, pp. 456-460.
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Objective: To describe the method of birth of term breech singletons in Australia. Design, setting and participants: A retrospective population-based study of women who gave birth to term breech singletons in Australia between 1 January 1991 and 31 December 2005 using data from the National Perinatal Data Collection. Main outcome measures: Caesarean section, vaginal breech birth. Results: Method of birth changed for term breech singletons from 1991 (vaginal breech birth 23.1% versus caesarean (no labour 55.6%, labour 21.2%)) to 2005 (vaginal breech birth 3.7% versus caesarean (no labour 76.6%, labour 19.7%)). Overall, the population attributable risk percentage of term breech singletons for all caesarean sections declined from 10.2% in 1991 to 6.9% in 2005. Conclusion: Planned caesarean section is the standard method of birth for term breech singletons in Australia. Active measures including external cephalic version should be supported to reduce the rate of caesarean section where clinically indicated. Retention of a skilled clinical workforce is essential in the provision of the latter and to assist the minority of women having vaginal breech births. Breech presentation is not a major factor in the overall rise in caesarean section experienced by Australia since 1996.
Chambers, G., Sullivan, E., Ishihara, O., Chapman, M. & Adamson, G. 2009, 'The Economic Impact Of Assisted Reproductive Technology: A Review Of Selected Developed Countries', Fertility And Sterility, vol. 91, no. 6, pp. 2281-2294.
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Objective: To compare regulatory and economic aspects of assisted reproductive technologies (ART) in developed countries. Design: Comparative policy and economic analysis. Patient(s): Couples undergoing ART treatment in the United States, Canada, United Kingdom, Scandinavia, Japan, and Australia. Outcome Measure(s): Description of regulatory and financing arrangements, cycle costs, cost-effectiveness ratios, total expenditure, utilization, and price elasticity. Result(s): Regulation and financing of ART share few general characteristics in developed countries. The cost of treatment reflects the costliness of the underlying healthcare system rather than the regulatory or funding environment. The cost (in 2006 United States dollars) of a standard IVF cycle ranged from $12,513 in the United States to $3,956 in Japan. The cost per live birth was highest in the United States and United Kingdom ($41,132 and $40,364, respectively) and lowest in Scandinavia and Japan ($24,485 and $24,329, respectively). The cost of an lVF cycle after government subsidization ranged front 50% of annual disposable income in the United States to 6% in Australia. The cost of ART treatment did not exceed 0.25% of total healthcare expenditure in any country. Australia and Scandinavia were the only country/region to reach levels of utilization approximating demand, with North America meeting only 24% of estimated demand. Demand displayed variable price elasticity. Conclusion(s): Assisted reproductive technology is expensive from a patient perspective but not from a societal perspective. Only countries with funding arrangements that minimize out-of-pocket expenses met expected demand. Funding mechanisms should maximize efficiency and equity of access while minimizing the potential harm from multiple births. (Fertil Steril (R) 2009;91:2281-94. (C) 2009 by American Society for Reproductive Medicine.)
de Mouzon, J., Lancaster, P., Nygren, K.G., Sullivan, E., Zegers-Hochschild, F., Mansour, R., Ishihara, O. & Adamson, D. 2009, 'World collaborative report on Assisted Reproductive Technology, 2002.', Human reproduction (Oxford, England), vol. 24, no. 9, pp. 2310-2320.
The International Committee for Monitoring Assisted Reproductive Technology's (ICMART) Eighth World Report analyzes assisted reproductive technology (ART) practice and results for the year 2002 from 53 countries by type of ART, women's age, number of embryos transferred and multiple births. Over 601,243 initiated cycles resulted in a delivery rate (DR) per aspiration of 22.4% for conventional IVF, 21.2% for ICSI and a DR per transfer of 15.3% for frozen embryo transfer. For conventional IVF and ICSI, there was an overall twin rate of 25.7% per delivery and a triplet rate of 2.5%. The number of babies born worldwide through ART in 2002 was estimated to range between 219,000 and 246,000. There were wide variations in availability, DRs and multiple birth rates across the countries. Compared with the previous report (year 2000), there was a large increase in the number of cycles and a slight increase in the DR. There was a marginal decline in the mean number of embryos transferred and in the multiple DRs.
Zegers-Hochschild, F., Adamson, G.D., de Mouzon, J., Ishihara, O., Mansour, R., Nygren, K., Sullivan, E. & van der Poel, S. 2009, 'The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009.', Human reproduction (Oxford, England), vol. 24, no. 11, pp. 2683-2687.
BACKGROUND: Many definitions used in medically assisted reproduction (MAR) vary in different settings, making it difficult to standardize and compare procedures in different countries and regions. With the expansion of infertility interventions worldwide, including lower resource settings, the importance and value of a common nomenclature is critical. The objective is to develop an internationally accepted and continually updated set of definitions, which would be utilized to standardize and harmonize international data collection, and to assist in monitoring the availability, efficacy, and safety of assisted reproductive technology (ART) being practiced worldwide. METHOD: Seventy-two clinicians, basic scientists, epidemiologists and social scientists gathered together at the WHO headquarters in Geneva, Switzerland in December, 2008. Several months in advance, three working groups were established which were responsible for terminology in three specific areas: clinical conditions and procedures, laboratory procedures and outcome measures. Each group reviewed the existing ICMART glossary, made recommendations for revisions and introduced new terms to be considered for glossary expansion. RESULTS: A consensus was reached on 87 terms, expanding the original glossary by 34 terms, which included definitions for numerous clinical and laboratory procedures. Special emphasis was placed in describing outcome measures such as cumulative delivery rates and other markers of safety and efficacy in ART. CONCLUSIONS: Standardized terminology should assist in analysis of worldwide trends in MAR interventions and in the comparison of ART outcomes across countries and regions. This glossary will contribute to a more standardized communication among professionals responsible for ART practice, as well as those responsible for national, regional and international registries.
Zegers-Hochschild, F., Adamson, G.D., de Mouzon, J., Ishihara, O., Mansour, R., Nygren, K., Sullivan, E. & Vanderpoel, S. 2009, 'International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009.', Fertility and sterility, vol. 92, no. 5, pp. 1520-1524.
OBJECTIVE: Many definitions used in medically assisted reproduction (MAR) vary in different settings, making it difficult to standardize and compare procedures in different countries and regions. With the expansion of infertility interventions worldwide, including lower resource settings, the importance and value of a common nomenclature is critical. The objective is to develop an internationally accepted and continually updated set of definitions, which would be utilized to standardize and harmonize international data collection, and to assist in monitoring the availability, efficacy, and safety of assisted reproductive technology (ART) being practiced worldwide. METHOD: Seventy-two clinicians, basic scientists, epidemiologists and social scientists gathered together at the World Health Organization headquarters in Geneva, Switzerland, in December 2008. Several months before, three working groups were established as responsible for terminology in three specific areas: clinical conditions and procedures, laboratory procedures, and outcome measures. Each group reviewed the existing International Committee for Monitoring Assisted Reproductive Technology glossary, made recommendations for revisions and introduced new terms to be considered for glossary expansion. RESULT(S): A consensus was reached on 87 terms, expanding the original glossary by 34 terms, which included definitions for numerous clinical and laboratory procedures. Special emphasis was placed in describing outcome measures, such as cumulative delivery rates and other markers of safety and efficacy in ART. CONCLUSION(S): Standardized terminology should assist in analysis of worldwide trends in MAR interventions and in the comparison of ART outcomes across countries and regions. This glossary will contribute to a more standardized communication among professionals responsible for ART practice, as well as those responsible for national, regional, and international registries.
Robson, S.J., Laws, P. & Sullivan, E.A. 2009, 'Adverse outcomes of labour in public and private hospitals in Australia: Reply', Medical Journal of Australia, vol. 190, no. 9, p. 519.
Pollock, W., Sullivan, E., Nelson, S. & King, J. 2008, 'Authors' reply', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 48, no. 3, pp. 356-357.
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Cliffe, S., Black, D., Bryant, J. & Sullivan, E. 2008, 'Maternal deaths in New South Wales, Australia: a data linkage project.', The Australian & New Zealand journal of obstetrics & gynaecology, vol. 48, no. 3, pp. 255-260.
BACKGROUND: The magnitude of maternal mortality is underestimated as deaths occurring beyond the traditional 42-day time period after the pregnancy ending ('late death') have not been reported routinely in Australia. AIMS: The aims of this study were to undertake a data linkage study to improve the ascertainment of maternal deaths and to determine the number of deaths occurring 43-365 days after the pregnancy ended ('late maternal death'). METHODS: Data from the New South Wales Midwives Data Collection were linked with the Australian Institute of Health and Welfare National Death Index. Australian identified pregnancy-related deaths were then coded as direct, indirect and incidental to the pregnancy. RESULTS: During the period 1994-2001, 173 maternal deaths were identified. Of these, 97 were classified as occurring up to 42 days of the pregnancy ending, 15 (15.5%) of which were previously unknown to the maternal mortality committee. In addition, 76 deaths were classified as occurring between 43 and 365 days after the pregnancy ended. The majority (70 of 76) of these late deaths were only identified through the linkage study. Most (73 of 76) of these deaths were classified as indirect maternal deaths with the most common causes of deaths suicide (n= 23), cardiac disorders (n= 16) or accident/violence (n= 16). CONCLUSIONS: The ascertainment of maternal and late maternal mortality was enhanced through data linkage of birth and mortality data. Data linkage is a viable method for monitoring late maternal deaths.
Sullivan, E., Wang, Y., Chapman, M. & Chambers, G. 2008, 'Success rates and cost of a live birth following fresh assisted reproduction treatment in women aged 45 years and older, Australia 2002-2004.', Human reproduction (Oxford, England), vol. 23, no. 7, pp. 1639-1643.
BACKGROUND: The aim of this study was to calculate assisted reproductive technology (ART) success rates for fresh autologous and donor cycles in women aged > or = 45 and the resultant cost per live birth. METHODS: We performed a retrospective population-based study of 2339 ART cycles conducted in Australia, 2002-2004 to women aged > or = 45 years. The cost-outcome study was performed on fresh autologous treatment cycles. RESULTS: There were 1101 fresh autologous cycles initiated in women aged > or = 45, with a pregnancy rate of 1.9 per 100 initiated cycles. There were 21 women who achieved a clinical pregnancy with 15 (71%) ending in early pregnancy loss and 6 in live singleton births. The live birth rate following fresh autologous initiated cycles was 0.5% [95% confidence interval (CI): 0.1-1.0%]. Fresh donor recipients had an higher live birth rate of 19.1% (95% CI: 15.1-23.2) (odds ratio 43.2; 95% CI: 18.6-100.3) compared with women having fresh autologous cycles. The average cost of a live birth following fresh autologous cycles was 753,107 euros. CONCLUSIONS: The success rate of fresh autologous treatment for women aged > or = 45 years was < 1%. The very high cost of a live birth reflects a treatment failure rate of > 99%. The ART profession should counsel patients of the reality of the technology before the patients consent to treatment.
Wang, Y.A., Healy, D., Black, D. & Sullivan, E.A. 2008, 'Age-specific success rate for women undertaking their first assisted reproduction technology treatment using their own oocytes in Australia, 2002-2005.', Human reproduction (Oxford, England), vol. 23, no. 7, pp. 1633-1638.
BACKGROUND: Woman's age is an independent factor determining the success of assisted reproductive technology treatment. This study presents the age-specific success rate of first autologous fresh treatment in Australia during 2002-2005. METHODS: This is a retrospective population-based study of 36,412 initiated first autologous fresh cycles conducted in Australian clinics during 2002-2005. Pregnancy and live delivery rates per initiated cycle were determined for each age. RESULTS: The overall live delivery rate per initiated cycle was 20.4% with the highest success rate in women aged between 22 and 36 years. Male factor only infertility had a higher live delivery rate (22.0%) than female factor only infertility (19.2%). Advancing woman's age was associated with a decline in success rate. For women > or = 30 years, each additional 1 year in age was associated with an 11% (99% CI: 10-12%) reduction in the chance of achieving pregnancy and a 13% (99% CI: 12-14%) reduction in the chance of a live delivery. If women aged 35 years or older would have had their first autologous fresh treatment 1 year earlier, 15% extra live deliveries would be expected. CONCLUSIONS: This study suggested that women aged 35 years or older should be encouraged to seek early fertility assessment and treatment where clinically indicated.
Cliffe, S.J., Tabrizi, S. & Sullivan, E.A. 2008, 'Chlamydia in the Pacific region, the silent epidemic.', Sexually transmitted diseases, vol. 35, no. 9, pp. 801-806.
BACKGROUND: Second generation surveillance of HIV infection and sexually transmitted infections (STIs) among pregnant women in 6 Pacific Island Countries and Territories were undertaken to improve knowledge and to make recommendations on future prevention and management of STIs. METHODS: Cross-sectional studies, using standardized questionnaire, laboratory tests, and protocols were undertaken in Fiji, Kiribati, Samoa, Solomon Islands, Tonga, and Vanuatu between 2004 and 2005. For each country, between 200 and 350 pregnant women aged 15 to 44 years were consecutively recruited from antenatal clinics located in the main hospital of the major urban centre of each Pacific Island Countries and Territories. Consenting participants were interviewed about their socio-demographic characteristics and their sexual behavior, and were tested for HIV, chlamydia, syphilis (Treponema pallidum antibody seroactivity), and gonorrhoea. RESULTS: Amongst the 1618 pregnant women studied, the most prevalent STI was chlamydia with 26.1% of women under 25 and 11.9% of women aged 25 years and over being positive. Highest infection was detected in single teenage women with 38.1% positive for chlamydia. The overall prevalence of gonorrhoea and syphilis was 1.7% and 3.4%, respectively. No case of HIV was detected. Chlamydia infection was independently associated with younger age, being nulliparous, single status, multiple lifetime sexual partners, and commercial sex activity. CONCLUSION: In a population of young women, chlamydia infection was endemic. Regional leadership is needed to implement strategies to prevent the spread of chlamydia and to implement HIV and STI prevention and management.
Pollock, W., Sullivan, E., Nelson, S. & King, J. 2008, 'Capacity to monitor severe maternal morbidity in Australia.', The Australian & New Zealand journal of obstetrics & gynaecology, vol. 48, no. 1, pp. 17-25.
Maternal mortality has traditionally been the key element in the monitoring of maternal health and adequacy of obstetric services in Australia and around the world. In developed countries, the ability of maternal mortality to serve this purpose is reduced because of the rarity of maternal mortality, reflected in very low maternal mortality ratios. Internationally, there has been increasing interest in severe maternal morbidity as an indicator to monitor maternal health and maternity services. The aim of this paper is to critically examine the capacity to measure and monitor maternal morbidity in Australia. There is a paucity of reliable maternal morbidity data in Australia; Australia is lagging behind peer countries that are endeavouring to monitor severe maternal morbidity. Dedicated efforts and adequate resources are needed in order to monitor severe maternal morbidity in Australia.
Tracy, S.K., Tracy, M.B. & Sullivan, E. 2008, 'Admission of term infants to neonatal intensive care: A population-based study', Obstetrical and Gynecological Survey, vol. 63, no. 4, pp. 217-218.
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Tracy, S.K., Sullivan, E.A. & Tracy, M.B. 2008, 'Reply: Admitting term infants to neonatal intensive care units in Australia', Birth, vol. 35, no. 3, pp. 259-260.
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Tracy, S.K., Dahlen, H., Tracy, M.B., Laws, P. & Sullivan, E. 2008, 'Reply', Birth, vol. 35, no. 1, p. 86.
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Chan, D.L. & Sullivan, E.A. 2008, 'Teenage smoking in pregnancy and birthweight: a population study, 2001-2004.', The Medical journal of Australia, vol. 188, no. 7, pp. 392-396.
OBJECTIVE: To determine the association between smoking in pregnant teenagers and baby birthweight. DESIGN, SETTING AND PARTICIPANTS: A retrospective population-based study of women aged < 20 years who gave birth to liveborn singletons in Australia between January 2001 and December 2004. Data were drawn from the National Perinatal Data Collection. MAIN OUTCOME MEASURES: Maternal smoking, birthweight, low birthweight (LBW). RESULTS: The prevalence of LBW in babies born to teenage smokers was 9.9%, compared with 6.0% in babies born to teenage non-smokers (odds ratio [OR], 1.72 [95% CI, 1.57-1.90]). On average, babies born to teenage smokers were 179.8 g lower in birthweight than babies born to teenage non-smokers (95% CI, 165.5 -194.1 g; t = 24.6, P < 0.001). Smoking, Indigenous status, Socio-Economic Indexes for Areas category and parity were independently associated with LBW (all ORs > 1.3; P < 0.001) after adjusting for maternal age group. Teenagers smoking > 10 cigarettes a day had babies with lower birthweight that those who smoked < or = 10 cigarettes a day, demonstrating a dose-response relationship. The babies of teenage smokers who stopped smoking before 20 weeks' gestation had birthweights similar to those of babies born to teenage non-smokers. One in 15 teenage smokers stopped smoking during pregnancy. CONCLUSION: Babies whose mothers smoked during pregnancy were more likely to have LBW than babies whose mothers did not smoke. Mothers who continue to smoke in the second half of pregnancy increase their baby's risk of LBW. There is significant scope to improve the quitting rate, and health professionals need to target smoking cessation at all contacts with pregnant women who continue to smoke.
Austin, M.P., Priest, S.R. & Sullivan, E.A. 2008, 'Antenatal psychosocial assessment for reducing perinatal mental health morbidity.', The Cochrane database of systematic reviews, no. 4, p. CD005124.
BACKGROUND: Mental health conditions arising in the perinatal period, including depression, have the potential to impact negatively on not only the woman but also her partner, infant, and family. The capacity for routine, universal antenatal psychosocial assessment, and thus the potential for reduction of morbidity, is very significant. OBJECTIVES: To evaluate the impact of antenatal psychosocial assessment on perinatal mental health morbidity. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, the Cochrane Depression, Anxiety and Neurosis Group's Trials Register (CCDAN TR-Studies), HSRProj in the National Library of Medicine (USA), and the Current Controlled Trials website: http://www.controlled trials.com/ and the UK National Research Register (last searched March 2008). SELECTION CRITERIA: Randomised and quasi-randomised controlled trials. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed trials for eligibility; they also extracted data from included trials and assessed the trials for potential bias. MAIN RESULTS: Two trials met criteria for an RCT of antenatal psychosocial assessment. One trial examined the impact of an antenatal tool (ALPHA) on clinician awareness of psychosocial risk, and the capacity of the antenatal ALPHA to predict women with elevated postnatal Edinburgh Depression Scale (EDS) scores, finding a trend towards increased clinician awareness of 'high level' psychosocial risk where the ALPHA intervention had been used (relative risk (RR) 4.61 95% confidence interval (CI) 0.99 to 21.39). No differences between groups were seen for numbers of women with antenatal EDS scores, a score of greater than 9 being identified by ALPHA as of concern for depression (RR 0.69 95% CI 0.35 to 1.38); 139 providers. The other trial reported no differences in EPS scores greater than 12 at 16 weeks postpartum between the intervention (communication about the EDS scores with the woman and her ...
Austin, M.P., Priest, S.R. & Sullivan, E.A. 2008, 'Antenatal psychosocial assessment for reducing perinatal mental health morbidity', Cochrane Database of Systematic Reviews, no. 4.
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Background: Mental health conditions arising in the perinatal period, including depression, have the potential to impact negatively on not only the woman but also her partner, infant, and family. The capacity for routine, universal antenatal psychosocial assessment, and thus the potential for reduction of morbidity, is very significant. Objectives: To evaluate the impact of antenatal psychosocial assessment on perinatal mental health morbidity. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, the Cochrane Depression, Anxiety and Neurosis Group's Trials Register (CCDANTR-Studies), HSRProj in the National Library of Medicine (USA), and the Current Controlled Trials website: http://www.controlledtrials.com/ and the UK National Research Register (last searched March 2008). Selection criteria: Randomised and quasi-randomised controlled trials. Data collection and analysis: At least two review authors independently assessed trials for eligibility; they also extracted data from included trials and assessed the trials for potential bias. Main results: Two trialsmet criteria for an RCT of antenatal psychosocial assessment. One trial examined the impact of an antenatal tool (ALPHA) on clinician awareness of psychosocial risk, and the capacity of the antenatal ALPHA to predict women with elevated postnatal Edinburgh Depression Scale (EDS) scores, finding a trend towards increased clinician awareness of 'high level' psychosocial risk where the ALPHA intervention had been used (relative risk (RR) 4.61 95% confidence interval (CI) 0.99 to 21.39). No differences between groups were seen for numbers of women with antenatal EDS scores, a score of greater than 9 being identified by ALPHA as of concern for depression (RR 0.69 95% CI 0.35 to 1.38); 139 providers. The other trial reported no differences in EPS scores greater than 12 at 16 weeks postpartum between the intervention (communication about the EDS scores with the woman and her hea...
Tracy, S.K., Dahlen, H., Caplice, S.L., Laws, P., Wang, Y., Tracy, M.B. & Sullivan, E. 2007, 'Birth centers in Australia: A national population-based study of perinatal mortality associated with giving birth in a birth centre', Birth: issues in perinatal care, vol. 34, no. 3, pp. 194-201.
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BACKGROUND: Perinatal mortality is a rare outcome among babies born at term in developed countries after normal uncomplicated pregnancies; consequently, the numbers involved in large databases of routinely collected statistics provide a meaningful evaluation of these uncommon events. The National Perinatal Data Collection records the place of birth and information on the outcomes of pregnancy and childbirth for all women who give birth each year in Australia. Our objective was to describe the perinatal mortality associated with giving birth in "alongside hospital" birth centers in Australia during 1999 to 2002 using nationally collected data. METHODS: This population-based study included all 1,001,249 women who gave birth in Australia during 1999 to 2002. Of these women, 21,800 (2.18%) gave birth in a birth center. Selected perinatal outcomes (including stillbirths and neonatal deaths) were described for the 4-year study period separately for first-time mothers and for women having a second or subsequent birth. A further comparison was made between deaths of low-risk term babies born in hospitals compared with deaths of term babies born in birth centers. RESULTS: The total perinatal death rate attributed to birth centers was significantly lower than that attributed to hospitals (1.51/1,000 vs 10.03/1,000). The perinatal mortality rate among term births to primiparas in birth centers compared with term births among low-risk primiparas in hospitals was 1.4 versus 1.9 per 1,000; the perinatal mortality rate among term births to multiparas in birth centers compared with term births among low-risk multiparas in hospitals was 0.6 versus 1.6 per 1,000. CONCLUSIONS: This study using Australian national data showed that the overall rate of perinatal mortality was lower in alongside hospital birth centers than in hospitals irrespective of the mother's parity.
Tracy, S.K., Tracy, M.B. & Sullivan, E. 2007, 'Admission Of Term Infants To Neonatal Intensive Care: A Population-based Study', Birth-issues In Perinatal Care, vol. 34, no. 4, pp. 301-307.
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Background: Neonatal intensive care and special care nurseries provide a level of care that is both high in cost and low in volume. The aim of our study was to determine the rate of admission of term babies to neonatal intensive care in association with
Bryant, J., Porter, M., Tracy, S. & Sullivan, E. 2007, 'Caesarean Birth: Consumption, Safety, Order, And Good Mothering', Social Science & Medicine, vol. 65, no. 6, pp. 1192-1201.
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This article draws on qualitative data to explore the beliefs through which decisions about caesarean birth are made and to consider how these might contribute to the increasing rate of caesarean birth. A total of 36 interviews were conducted in Australia, including 12 hospital-based midwives, 6 obstetricians, and 18 women who had experienced caesarean birth within the 2 years prior to the research interview. Data reveal a belief derived from the pervasive discourse of neo-liberalism that women are self-governing autonomous subjects in their birth experience, with entitlement to the consumption of birthing information and services, as guided by obstetricians. Feeding into this belief are coexisting discourses that serve to organise "free choice" in terms of safe/unsafe, order/disorder, life/death; and with ontological meanings, by structuring women"s mothering identities as good/bad. The neo-liberal obligation to manage risk and pursue success for both mothers and babies means that women (and others) are obliged to choose what is set up as the most obvious and sensible option: safe, ordered caesareans. The structuring of discourses in this way shows how caesareans can be positioned as a preferential means of birth. (C) 2007 Elsevier Ltd. All rights reserved.
Haddow, L., Sullivan, E., Taylor, J., Abel, M., Cunningham, A., Tabrizi, S. & Mindel, A. 2007, 'Herpes Simplex Virus Type 2 (hsv-2) Infection In Women Attending An Antenatal Clinic In The South Pacific Island Nation Of Vanuatu', Sexually Transmitted Diseases, vol. 34, no. 5, pp. 258-261.
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The objective of this study was to estimate the prevalence and correlates of herpes simplex virus type 2 infection in women in an antenatal clinic in the South Pacific island nation of Vanuatu. Study Design: A prevalence survey of sexually transmitted infections of pregnant women attending an antenatal clinic at Vila Central Hospital was conducted in 1999-2000. Serum samples were tested for HSV-1 and HSV-2 antibodies by enzyme-linked immunosorbent assay. Results for other sexually transmitted infections and demographic and obstetric variables were analyzed for their association with HSV-2 serostatus. Results: HSV-2 serum antibody results were obtained on 535 women and HSV-1 results on 134. The seroprevalence of HSV-2 was 30% and HSV-1 was 100%. On multivariate analysis, the independent predictors of HSV-2 infection were age, marital status, and trichomoniasis. Conclusions: HSV-2 was common in this sample of sexually active women in Vanuatu. This is the first study of HSV in Vanuatu and one of very few studies in the Pacific region.
Graham, S., Pulver, L., Wang, Y., Kelly, P., Laws, P., Grayson, N. & Sullivan, E. 2007, 'The Urban-remote Divide For Indigenous Perinatal Outcomes', Medical Journal Of Australia, vol. 186, no. 10, pp. 509-512.
Objective: To determine whether remoteness category of residence of Indigenous women affects the perinatal outcomes of their newborn infants. Design and participants: A population-based study of 35 240 mothers identified as Indigenous and their 35658 babies included in the National Perinatal Data Collection in 2001-2004. Main outcome measures: Australian Standard Geographical Classification remoteness category, birthweight, Apgar score at 5 minutes, stillbirth, gestational age and a constructed measure of perinatal outcomes of babies called "healthy baby" (live birth, singleton, 37-41 completed weeks" gestation, 2500-4499 g birthweight, and an Apgar score at 5 minutes >= 7). Results: The proportion of healthy babies in remote, regional and city areas was 74.9%, 77.7% and 77.6%, respectively. After adjusting for age, parity, smoking and diabetes or hypertension, babies born to mothers in remote areas were less likely to satisfy the study criteria of being a healthy baby (adjusted odds ratio [AOR], 0.87; 95% CI, 0.81-0.93) compared with those born in cities. Babies born to mothers living in remote areas had higher odds of being of low birthweight (AOR, 1.09; 95% CI, 1.01-1.19) and being born with an Apgar score < 7 at 5 minutes (AOR, 1.63; 95% CI, 1.39-1.92). Conclusions: Only three in four babies born to Indigenous mothers fell into the "healthy baby" category, and those born in more remote areas were particularly disadvantaged. These findings demonstrate the continuing need for urgent and concerted action to address the persistent perinatal inequity in the Indigenous population.
Tracy, S.K., Tracy, M.B., Dean, J., Laws, P. & Sullivan, E. 2007, 'Spontaneous preterm birth of liveborn infants in women at low risk in Australia over 10 years: a population-based study.', BJOG : an international journal of obstetrics and gynaecology, vol. 114, no. 6, pp. 731-735.
OBJECTIVES: To describe a 10-year trend in preterm birth. DESIGN: Population-based study. SETTING: Australia. POPULATION: All women who gave birth during 1994-03. METHODS: The proportion of spontaneous preterm births (greater than or equal to 22 weeks of gestation and less than 37 completed weeks of gestation) was calculated by dividing the number of women who had a live spontaneous preterm birth (excluding elective caesarean section and induction of labour) by the total number of women who had a live birth after spontaneous onset of labour (excluding elective caesarean section and induction of labour). This method was repeated for the selected population of women at low risk. MAIN OUTCOME MEASURE: Preterm birth rates among the overall population of women; preterm birth among all women with a spontaneous onset of labour; and preterm birth in a selected population of women who were either primiparous or multiparous, non-Indigenous; aged 20-40 years and who gave birth to a live singleton baby after the spontaneous onset of labour. RESULTS: Over the 10-year study period, the proportion of all women having a live preterm birth in Australia increased by 12.1% (from 5.9% in 1994 to 6.6% in 2003). Among women with a spontaneous onset of labour, there was an increase of 18.3% (from 5.7 to 6.7%). Among the selected population of low-risk women after the spontaneous onset of labour, the rate increased by 10.7% (from 5.6 to 6.2%) among first time mothers and by 19.2% (4.4-5.2%) among selected multiparous women. CONCLUSIONS: Over the 10-year period of 1994-03, the rate of spontaneous preterm birth among low-risk women having a live singleton birth has risen in Australia.
Tracy, S.K., Sullivan, E., Wang, Y.A., Black, D. & Tracy, M. 2007, 'Birth outcomes associated with interventions in labour amongst low risk women: a population-based study.', Women and birth : journal of the Australian College of Midwives, vol. 20, no. 2, pp. 41-48.
INTRODUCTION: Despite concern over high rates of operative birth in many countries, particularly amongst low risk healthy women, the obstetric antecedents of operative birth are poorly described. We aimed to determine the association between interventions introduced during labour with interventions in the birth process amongst women of low medical risk. METHODS: We undertook a population-based descriptive study of all low risk women amongst the 753,895 women who gave birth in Australia during 2000-2002. Adjusted odds ratios (AOR) were calculated using multinomial logistic regression to describe the association between mode of birth and each of four labour intervention subgroups separately for primiparous and multiparous women. RESULTS: We observed increased rates of operative birth in association with each of the interventions offered during the labour process. For first time mothers the association was particularly strong. CONCLUSIONS: This study underlines the need for better clinical evidence of the effects of epidurals and pharmacological agents introduced in labour. At a population level it demonstrates the magnitude of the fall in rates of unassisted vaginal birth in association with a cascade of interventions in labour and interventions at birth particularly amongst women with no identified risk markers and having their first baby. This information may be useful for women wanting to explore other methods of influencing the course of labour and the management of pain in labour, especially in their endeavour to achieve a normal vaginal birth.
Austin, M.P., Kildea, S. & Sullivan, E. 2007, 'Maternal mortality and psychiatric morbidity in the perinatal period: challenges and opportunities for prevention in the Australian setting.', The Medical journal of Australia, vol. 186, no. 7, pp. 364-367.
Maternal mortality associated with psychiatric illness in the perinatal period (pregnancy to the end of the first year postpartum) has until recently been under-reported in Australia due to limitations in the scope of the data collection and methods of detection. The recent United Kingdom report Why mothers die 2000-2002 identified psychiatric illness as the leading cause of maternal death in the UK. Findings from the last three reports on maternal deaths in Australia (covering the period 1994-2002) suggest that maternal psychiatric illness is one of the leading causes of maternal death, with the majority of suicides occurring by violent means. Such findings strengthen the case for routine perinatal psychosocial screening programs, with clear referral guidelines and assertive perinatal treatment of significant maternal psychiatric morbidity. Data linkage studies are needed to measure the full extent of maternal mortality associated with psychiatric illness in Australia.
Chambers, G.M., Chapman, M.G., Grayson, N., Shanahan, M. & Sullivan, E.A. 2007, 'Babies born after ART treatment cost more than non-ART babies: a cost analysis of inpatient birth-admission costs of singleton and multiple gestation pregnancies.', Human reproduction (Oxford, England), vol. 22, no. 12, pp. 3108-3115.
BACKGROUND: Currently, about one-third of infants born after assisted reproductive technology (ART) worldwide are twins or triplets. This study compared the inpatient birth-admission costs of singleton and multiple gestation ART deliveries to non-ART deliveries. METHODS: A cohort of 5005 mothers and 5886 infants conceived following ART treatment were compared to 245 249 mothers and 248 539 infants in the general population. Birth-admission costs were calculated using Australian Refined Diagnosis Related Groups and weighted national average costs (2003-2004 euro). RESULTS: ART infants were 4.4 times more likely to be low birthweight (LBW) compared with non-ART infants, translating into 89% higher birth-admission costs (euro2,832 and euro1,502, respectively). ART singletons were also more likely to be LBW compared with non-ART singletons, translating into 31% higher birth-admission costs (euro1,849 and euro1,415, respectively). After combining infant and maternal admission costs, the average cost of an ART singleton delivery was euro4,818 compared with euro13 890 for ART twins and euro54 294 for ART higher order multiples. Findings were not sensitive to changes in casemix. CONCLUSIONS: The poorer neonatal outcomes of ART singletons compared with non-ART singletons are significant enough to impact healthcare resource consumption. The high costs associated with ART multiple births add to the overwhelming clinical and economic evidence in support of single embryo transfer.
Hansen, M., Sullivan, E., Jequier, A.M., Burton, P., Junk, S., Yovich, J. & Bower, C. 2007, 'Practitioner reporting of birth defects in children born following assisted reproductive technology: Does it still have a role in surveillance of birth defects?', Human reproduction (Oxford, England), vol. 22, no. 2, pp. 516-520.
BACKGROUND: National assisted reproductive technology (ART) data collections that rely on practitioners' reports of birth defects have consistently reported lower proportions of children with birth defects than record linkage studies that link ART infants to birth and malformation registers. METHODS: We compared the birth defect data reported to the national Australian Assisted Conception Data Collection (ACDC) by practitioners at three Western Australian ART clinics with the birth defect data identified on the Western Australian Birth Defects Registry (WABDR) through record linkage of all the pregnancies conceived at these clinics to the WABDR. Cases are reported to the WABDR by multiple statutory and voluntary sources. RESULTS: We found that the national ACDC significantly underestimated the prevalence of birth defects in WA-born ART infants. Less than one-third of ART children identified with a major birth defect on the WABDR were reported to the ACDC. CONCLUSIONS: Although national ART data collections provide valuable information on pregnancy rates and short-term pregnancy outcomes such as multiple birth and birth weight, we strongly recommend that birth defect information used for patient counselling is preferentially drawn from large studies that have used record linkage to high-quality birth defect registers.
Zegers-hochschild, F., Nygren, K., Adamson, G., De Mouzon, J., Lancaster, P., Mansour, R. & Sullivan, E. 2006, 'The Icmart Glossary On Art Terminology', Human Reproduction, vol. 21, no. 8, pp. 1968-1970.
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The International Committee Monitoring Assisted Reproductive Technologies (ICMART) is an independent, international non-profit organization that has taken a leading role in the development, collection and dissemination of worldwide data on ART. Information on availability, efficacy and safety is provided to health professionals, health authorities and the public. The glossary facilitates dissemination of ART data through a set of agreed definitions as seen in the most recent World Report on ART. It provides a conceptual framework for further international terminology and data development of ART.
Zegers-hochschild, F., Nygren, K., Adamson, G., De Mouzon, J., Lancaster, P., Mansour, R. & Sullivan, E. 2006, 'The International Committee Monitoring Assisted Reproductive Technologies (icmart) Glossary On Art Terminology', Fertility And Sterility, vol. 86, no. 1, pp. 16-19.
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The International Committee Monitoring Assisted Reproductive Technologies (ICMART) is an independent international nonprofit organization that has taken a leading role in the development collection, and dissemination of worldwide data on assisted reproductive technology CART. Information on availability, efficacy, and safety is provided health professionals, health authorities and the public. The glossary facilitates dissemination of ART data through a set -of agreed-upon definitions, as seen in the most recent World Report on ART. It provides a conceptual framework for further international terminology and data development of ART.
Tracy, S.K., Sullivan, E., Dahlen, H., Black, D., Wang, Y.A. & Tracy, M.B. 2006, 'Does size matter? A population-based study of birth in lower volume maternity hospitals for low risk women.', BJOG : an international journal of obstetrics and gynaecology, vol. 113, no. 1, pp. 86-96.
OBJECTIVE: To study the association between volume of hospital births per annum and birth outcome for low risk women. DESIGN: Population-based study using the National Perinatal Data Collection (NPDC). SETTING: Australia. PARTICIPANTS: Of 750,491 women who gave birth during 1999-2001, there were 331,147 (47.14%) medically 'low risk' including 132,696 (40.07%) primiparae and 198,451 (59.93%) multiparae. METHODS: The frequency of each birth and infant outcome was described according to the size of the hospital where birth took place. We investigated whether unit size (defined by volume) was an independent risk factor for each outcome factor using public hospitals with greater than 2000 births per annum as a reference point. MAIN OUTCOME MEASURES: Rates of intervention at birth and neonatal mortality for low risk women in relation to hospitals with <100, 100-500, 501-1000, 1001-2000 and >2001 births per annum. RESULTS: Neonatal death was less likely in hospitals with less than 2000 births per annum regardless of parity. For multiparous low risk women in hospitals of 100 and 500 births per annum compared with hospitals of >2000 births per annum the adjusted odds of neonatal mortality [adjusted odds ratio (AOR) 0.36; 99% confidence interval (CI) 0.14-0.93]. For low risk primiparous women in hospitals with less than 100 births per annum, there were lower rates of induction of labour (AOR 0.62; 99% CI 0.54-0.73); intrathecal analgesia/anaesthesia (AOR 0.34; 99% CI 0.28-0.42); instrumental birth (AOR 0.80; 99% CI 0.69-0.93); caesarean section after labour (AOR 0.59; 99% CI 0.49-0.72) and admission to a neonatal unit (AOR 0.15; 99% CI 0.10-0.22) and for low risk multiparous women in hospitals with less than 100 births per annum: induction (AOR 0.69; 99% CI 0.62-0.76); intrathecal analgesia/anaesthesia (AOR 0.32; 99% CI 0.29-0.36); instrumental birth (AOR 0.52; 99% CI 0.41-0.67); caesarean section after labour (AOR 0.41; 99% CI 0.33-0.52); and admission to a neonatal unit...
Sullivan, E. 2006, 'Prevalence and perinatal outcomes of multiple gestation: Introduction to theme', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 46, no. SUPPL. 1, pp. S3-S7.
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Tracy, S.K., Dahlen, H., Tracy, M.B. & Sullivan, E. 2006, 'Does size matter? A population based study of birth in lower volume maternity hospitals for low risk women [4]', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 113, no. 5, pp. 617-618.
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Adamson, G.D., de Mouzon, J., Lancaster, P., Nygren, K.G., Sullivan, E. & Zegers-Hochschild, F. 2006, 'World collaborative report on in vitro fertilization, 2000.', Fertility and sterility, vol. 85, no. 6, pp. 1586-1622.
The International Committee for Monitoring Assisted Reproductive Technology's 7th World Report for the year 2000 analyzes wide variations in live and multiple birth rates from 49 countries and six regions by type of assisted reproductive technology, age, number of embryos transferred, and multiple births. More than 460,157 procedures resulted in delivery rate per aspiration for conventional in vitro fertilization (IVF) of 18.6%; for intracytoplasmic sperm injection (ICSI), 20.4%; for egg donation, 32.3% per transfer; and for frozen ET, 12.0% per transfer. Conventional IVF and ICSI twin rates were 26.9% and 26.2%, respectively, and triplet rates were 2.8% and 2.9%, respectively, for an estimated total of approximately 197,000 to 220,000 babies worldwide.
Chambers, G.M., Ho, M.T. & Sullivan, E.A. 2006, 'Assisted reproductive technology treatment costs of a live birth: an age-stratified cost-outcome study of treatment in Australia.', The Medical journal of Australia, vol. 184, no. 4, pp. 155-158.
OBJECTIVES: To calculate the cost of assisted reproductive technology (ART) treatment cycles and resultant live-birth events. DESIGN: Cost-outcome study based on a decision analysis model of significant clinical and economic outcomes of ART. SETTING AND PARTICIPANTS: All non-donor ART treatments initiated in Australia in 2002. Treatment cycles, maternal age and birth outcome data were obtained from the Australian and New Zealand Assisted Reproduction Database. Direct health care costs were obtained from fertility centres, and included government, private insurer and patient costs. MAIN OUTCOME MEASURES: Average health care cost of non-donor, fresh and frozen embryo ART treatment cycles. Average and age-specific costs per live-birth event following ART treatment. RESULTS: Average health care cost per non-donor ART live-birth event was 32,903 US dollars (range, 24,809 US dollars for women < 30 years to 97,884 US dollars for women > or = 40 years). The cost per live birth for women aged > or = 42 years was 182,794 US dollars. The average treatment cost of a fresh cycle was 6,940 US dollars, compared with 1,937 US dollars for a frozen embryo transfer cycle. CONCLUSIONS: Debate regarding funding for ART services has been hindered by a lack of economic studies of ART treatments and outcomes in Australia. This is the most comprehensive costing study of ART services to date in terms of resources consumed during ART treatment. It confirms that ART treatment is less cost-effective in older women. Alongside economic considerations of ART, community values, ethical judgements and clinical factors should influence policy decision-making.
Wang, Y.A., Sullivan, E.A., Black, D., Dean, J., Bryant, J. & Chapman, M. 2005, 'Preterm birth and low birth weight after assisted reproductive technology-related pregnancy in Australia between 1996 and 2000.', Fertility and sterility, vol. 83, no. 6, pp. 1650-1658.
OBJECTIVE: To describe patterns of preterm birth and low birth weight (LBW) for infants born after assisted reproductive technology (ART) and determine whether these were associated with maternal or treatment characteristics. DESIGN: Retrospective cohort study of national population data of infants conceived through ART. SETTING: Australian birth records from 1996 to 2000. PATIENT(S): Eighteen thousand, four hundred twenty-nine liveborn and stillborn infants conceived through ART. INTERVENTION(S): In vitro fertilization, intracytoplasmic sperm injection, and gamete intrafallopian transfer. MAIN OUTCOME MEASURE(S): Preterm birth and LBW. RESULT(S): Preterm birth and LBW were more common among singletons and twins conceived with IVF and born to nulliparous mothers. Preterm birth and LBW were, respectively, 1.3 times and 1.5 times more likely to occur among singletons conceived by transfer of fresh embryos, compared with transfer of frozen embryos. Preterm birth and LBW was more common among couples who had female-factor infertility compared with male-factor infertility. CONCLUSION(S): The transfer of fresh embryos and female-factor infertility were independently associated with preterm birth and LBW for both singletons and twins after ART.
Henry, A., Birch, M.R., Sullivan, E.A., Katz, S. & Wang, Y.A. 2005, 'Primary postpartum haemorrhage in an Australian tertiary hospital: a case-control study.', The Australian & New Zealand journal of obstetrics & gynaecology, vol. 45, no. 3, pp. 233-236.
The present study aimed to determine the incidence of primary postpartum haemorrhage (PPH) after vaginal birth at an Australian tertiary hospital, and to investigate risk factors for primary PPH at this hospital. A case-control study of women delivering vaginally at a tertiary hospital from February to June 2003 was performed. Demographic, antenatal, intrapartum, treatment and outcome data were abstracted from patient records. The study population comprised 125 cases and 125 controls, with a primary PPH rate of 12.1 per 100 vaginal births. Risk factors on multivariate analysis were past history of PPH, second stage labour > 60 min, forceps delivery, and incomplete placenta/ragged membranes.
Sullivan, E.A., Koro, S., Tabrizi, S., Kaldor, J., Poumerol, G., Chen, S., O'Leary, M. & Garland, S.M. 2004, 'Prevalence of sexually transmitted diseases and human immunodeficiency virus among women attending prenatal services in Apia, Samoa.', International journal of STD & AIDS, vol. 15, no. 2, pp. 116-119.
There is no routine prenatal screening for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) in pregnancy in Samoa. Testing for chlamydial infection is not available. To gather information on pregnant women, a prevalence survey was conducted in Apia, Samoa, utilizing two prenatal hospital clinics. Pregnant (n=427) women were tested for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis using polymerase chain reaction (PCR), and for syphilis (n=441) by rapid plasmid reagin (RPR) and HIV (n=441) by enzyme-linked immunosorbent assay (ELISA). Results were: chlamydia 30.9% (132); trichomoniasis 20.8%; gonorrhoea 3.3%; syphilis 0.5%; and HIV 0%. Overall 42.7% had at least 1 STD. Young women aged <25 years were three times more likely to have a STD than older women (odds ratio=3.0, 95% confidence intervals 2.0, 4.5). The lack of inexpensive, reliable field diagnostics remain a barrier to sustainable STD control programmes for pregnant women living in developing countries.
Ford, J.B., Henry, R.L. & Sullivan, E.A. 2004, 'Comparison of selected reasons for hospitalization of children among children's/tertiary hospitals, Australia, 1996-97 and 1997-98.', Journal of paediatrics and child health, vol. 40, no. 7, pp. 374-379.
OBJECTIVES: To describe the major characteristics of admissions to children's/tertiary hospitals (compared to other hospitals) and to compare characteristics of local and non-local admissions to specialist children's hospitals. METHODS: A cross-sectional analysis of a routinely collected data set of hospitalizations in Australia in 1996-97 and 1997-98. RESULTS: Hospital-specific proportions of asthma and bronchitis, tonsillectomy and/or adenoidectomy and gastroenteritis varied considerably. Multivariate analysis comparing the characteristics of admitted patients by locality showed that non-local admissions of patients with asthma and bronchitis and gastroenteritis to selected children's hospitals were significantly more likely to be Indigenous children and/or children who had been transferred from another hospital. Non-local admissions of tonsillectomy and/or adenoidectomy patients to selected hospitals were significantly more likely to be public patients. CONCLUSIONS: Differences in the characteristics of admitted patients to children's hospitals by locality raise issues about equality of access and availability of appropriate services for these children and their families.
Sullivan, E.A., Ford, J.B., Chambers, G. & Slaytor, E.K. 2004, 'Maternal mortality in Australia, 1973-1996.', The Australian & New Zealand journal of obstetrics & gynaecology, vol. 44, no. 5, pp. 452-377.
AIMS: Maternal mortality has declined dramatically over the past 30 years in developed countries. This retrospective study aims to provide an epidemiological overview of maternal deaths in Australia between 1973 and 1996. METHODS: Data were abstracted from national maternal mortality data collection and triennial reports for the period 1973-1996 for women who died from pregnancy-related causes while pregnant or within 42 days of a pregnancy being delivered or terminated. Deaths were restricted to those classified as direct or indirect maternal deaths. Maternal mortality age-specific mortality ratios were calculated. The leading causes of death were examined. RESULTS: Of the 584 deaths, 363 were direct and 221 indirect. The leading causes of direct death were pulmonary embolism (18.4%) and hypertensive disorders (16.3%). Cardiovascular disease accounted for 41% of indirect deaths. The maternal mortality ratio declined from 12.7 deaths per 100,000 confinements in 1973-1975 to 6.2 in 1991-1993, and was 10.0 for the entire 24-year period. For women aged 40-44 years the ratio declined from 165.1 to 14.2 between 1973 and 1996. The ratio for Indigenous mothers was three times higher than for non-Indigenous mothers, being 34.8 in the most recent triennium 1994-1996. CONCLUSIONS: Although maternal deaths are rare in Australia, apparent health inequality persists with Indigenous mothers continuing to have a higher risk of maternal death. While mortality in traditionally higher risk women aged > 40 years has declined, women with morbid cardiovascular disease continue to be over-represented in the deaths. The comparatively high rate of deaths from pulmonary embolism needs to be addressed.
King, J.F., Slaytor, E.K. & Sullivan, E.A. 2004, 'Maternal deaths in Australia, 1997-1999.', The Medical journal of Australia, vol. 181, no. 8, pp. 413-414.
Many maternal deaths in Australia are still preventable.
Sullivan, E.A., Abel, M., Tabrizi, S., Garland, S.M., Grice, A., Poumerol, G., Taleo, H., Chen, S., Kaun, K., O'Leary, M. & Kaldor, J. 2003, 'Prevalence of sexually transmitted infections among antenatal women in Vanuatu, 1999-2000.', Sexually transmitted diseases, vol. 30, no. 4, pp. 362-366.
BACKGROUND: The epidemiology of sexually transmitted infections (STIs) and HIV in Vanuatu is poorly defined. GOAL: The goal was to determine the prevalence of laboratory-confirmed gonorrhea, chlamydia, trichomoniasis, syphilis seroreactivity, and HIV among pregnant women in Vila, Vanuatu. STUDY DESIGN: A cross-sectional survey of 547 pregnant women attending a first-visit antenatal hospital clinic in Vila. Laboratory testing included polymerase chain reaction on tampons for chlamydia, gonorrhea, and trichomoniasis; testing of sera for syphilis with rapid plasmid reagin; and enzyme-linked immunosorbent assay for HIV. RESULTS: The prevalence of trichomoniasis was 27.5% (150); of chlamydia, 21.5% (117); of gonorrhea, 5.9% (32); and of syphilis, 13 (2.4%). No HIV cases were detected; 214 women (40%) had > or =1 STI. Young age and single marital status were both significantly associated with infection (P < 0.001). CONCLUSION: Chlamydial infection and trichomoniasis are hyperendemic among pregnant women in Vila. Young, single women are at greatest risk for infection.
Sullivan, E.A., Willcock, S., Ardzejewska, K. & Slaytor, E.K. 2002, 'A pre-employment programme for overseas-trained doctors entering the Australian workforce, 1997-99.', Medical education, vol. 36, no. 7, pp. 614-621.
OBJECTIVES: Overseas-trained doctors (OTDs) have limited access and formal interaction with the Australian health care system prior to joining the Australian medical workforce. A pre-employment programme was designed to familiarize OTDs with the Australian health care system. METHOD: All OTDs who had passed their Australian Medical Council (AMC) exams and were applying for a pre-registration year in New South Wales were invited to participate in the voluntary, free programme. A 4-week full-time programme was developed consisting of core group teaching and a hospital attachment. The curriculum included communication, health and workplace skills; and sessions on culture shock and the role of junior doctors. A pilot programme was run in 1997. The programme was repeated in 1998 and 1999. The OTDs' confidence regarding the general duties of internship, and attitudes towards hospital workplace skills were examined. RESULTS: The 66 OTDs reported greater understanding of staff and communication issues and familiarization with the hospital environment. They reported a more realistic understanding of the role of a junior doctor, the need for separation of workplace and personal responsibilities and knowledge of pathways for future professional development. The course structure, with a focus on hospital attachments, establishment of a peer network, and workplace familiarization facilitated entry into the hospital workforce. CONCLUSION: The pre-employment programme enabled the OTDs to have a more equitable entry into the public hospital system, resulting in a more integrated, confident and functional workforce.
Walters, W.A., Ford, J.B., Sullivan, E.A. & King, J.F. 2002, 'Maternal deaths in Australia.', The Medical journal of Australia, vol. 176, no. 9, pp. 413-414.
Marks, G.B., Bai, J., Simpson, S.E., Stewart, G.J. & Sullivan, E.A. 2001, 'The incidence of tuberculosis in a cohort of South-East Asian refugees arriving in Australia 1984-94.', Respirology (Carlton, Vic.), vol. 6, no. 1, pp. 71-74.
We have used record linkage analysis to describe the incidence of tuberculosis in a cohort of 24 652 predominantly south-east Asian refugees who arrived in Sydney, Australia during the period 1984 to 1994. Cases that had been registered with the State Department of Health were confirmed by examination of case records. After an average follow-up interval of 10.3 years there were 189 cases of tuberculosis, equivalent to an average incidence rate of 74.9 cases per 100 000 person-years. The highest incidence rate was in 40-49 year olds and 47% of cases were in women. One hundred and twenty seven cases (67%) were pulmonary and, of these, 64 (50%) were direct smear positive. The incidence of tuberculosis in this cohort is similar to that observed among Vietnamese migrants to Australia and the USA and substantially higher than the incidence among people born in Australia. It is important to maintain awareness of the diagnosis of tuberculosis, especially in countries such as Australia, where the incidence in the general population is low but where there are large populations of migrants and refugees in whom a higher incidence is expected.
Marks, G.B., Bai, J., Stewart, G.J., Simpson, S.E. & Sullivan, E.A. 2001, 'Effectiveness of postmigration screening in controlling tuberculosis among refugees: a historical cohort study, 1984-1998.', American journal of public health, vol. 91, no. 11, pp. 1797-1799.
OBJECTIVES: This study assessed the effectiveness of postmigration screening for the control of tuberculosis (TB) among refugee migrants. METHODS: We conducted a historical cohort study among 24 610 predominantly Southeast Asian refugees who had arrived in Sydney, Australia, between 1984 and 1994. All had been screened for TB before arrival and had radiologic follow-up for 18 months after arrival. Incident cases of TB were identified by record linkage analysis with confirmatory review of case notes. RESULTS: The crude annual incidence rate over 10-year follow-up was 74.9 per 100 000 person-years. Only 29.6% of the cases were diagnosed as a result of routine follow-up procedures. CONCLUSIONS: Enhanced passive case finding is likely to be more effective than active case finding for the control of TB among refugees.
Marks, G.B., Bai, J., Simpson, S.E., Sullivan, E.A. & Stewart, G.J. 2000, 'Incidence of tuberculosis among a cohort of tuberculin-positive refugees in Australia: reappraising the estimates of risk.', American journal of respiratory and critical care medicine, vol. 162, no. 5, pp. 1851-1854.
Estimates of the lifetime risk of tuberculosis have varied widely and may not be applicable in all current settings. The aim of this study was to measure the incidence of reactivation of latent tuberculosis in a cohort of 15,489 predominantly Southeast Asian refugees aged 12 yr and over who arrived in Sydney, Australia during the period 1984 to 1994 and who had a clear chest X-ray on arrival. Tuberculin skin test (TST) reaction size and the presence of a BCG scar were recorded at entry. Incident cases of tuberculosis, occurring before June 1998, were identified by record linkage analysis with confirmatory review of case notes. There were 122 cases of tuberculosis over an average 10.3 yr of follow-up (crude annual incidence, 76.2/100,000). There was a linear increase in risk with increasing TST reaction size above 10 mm. The risk, and the relation of risk to TST reaction size, were unrelated to BCG scar status. Among those whose initial TST reaction was >/= 15 mm, the annual incidence rate in the first 3 yr was 213 (95% CI, 150 to 300) per 100,000 person-years and in the subsequent 10 yr the rate averaged 122 (95% CI, 90 to 165) per 100,000 person-years. The observed rates are similar to those estimated in the general population of the United States in the 1950s and 1960s. Further data on the prognosis of tuberculosis and the effects of isoniazid preventive therapy in Southeast Asian migrants to Western countries are required to inform policy and practice for the prevention of tuberculosis in this population.
Comino, E., Sullivan, E., Harris, E., Killian, D. & Jiang, C.Y. 2000, 'A community-based health service census: Describing the client base', Australian Journal of Primary Health - Interchange, vol. 6, no. 2, pp. 63-71.
This paper describes the results of a census of newly registered clients attending community-based health services in a large health region on the south western outskirts of Sydney to enumerate the client base of these services and to investigate the reach to population groups. Two questionnaires, one for adults and the other for children were administered to all new clients of community, allied and dental health services. These questionnaires collected enhanced demographic information during a three month period that was compared with the resident population. 10,734 new clients were registered. These included 2,638 adults and 3,047 children who were attending community health services. Older adults were over-represented in the adult client population while adults accompanying children to services were largely aged 20-39 years. The data suggest good reach of services to ethnic minority groups when country of birth was considered (32.3% NESB versus 30.4% in the resident population). When language spoken at home was used those who spoke a language other that English at home were under- represented in these data (31.6%) compared to the resident population (39.7%). Adults attending with a child were more likely to be married and to have stayed at school until at least 17 years. The study was the first attempt in NSW to enumerate the client base of community-based health services and was important in demonstrating to staff the value of adequate systems to monitor the use and reach of services. The data suggest a bias of services to more advantaged groups.
Smith, B., Sullivan, E., Bauman, A., Powell-Davies, G. & Mitchell, J. 1999, 'Lay beliefs about the preventability of major health conditions.', Health education research, vol. 14, no. 3, pp. 315-325.
Beliefs about the extent to which health problems can be prevented reflect an understanding that preventive measures can reduce adverse health events and the level of control individuals perceive that they hold over the factors that affect their health. A population survey of 1659 people conducted in 1995 in south western Sydney, Australia, found that only child drownings, tooth decay, skin cancer, and burns and scalds were considered all or mostly preventable by more than 50% of the sample. The majority of respondents did not believe that heart attacks, cervical cancer, high blood pressure, serious road injury, lung cancer and asthma deaths were all or mostly preventable. Logistic regression analysis showed that people born in an English speaking country, those with more than 10 years of education and men were significantly more likely to recognize a number of key conditions as highly preventable. The findings suggest that, in spite of the range of prevention efforts in Australia to date, these are not matched by strong beliefs within the community that prevention is possible. Communication of the opportunities and methods for prevention needs to be improved, particularly among certain population groups. The findings also indicate a need to examine social and environmental factors which are potentially reducing confidence, and subsequently and adoption of preventive behaviours.
Gosbell, I.B., Sullivan, E.A. & Maidment, C.A. 1999, 'An unexpected result in an evaluation of a serological test to detect syphilis.', Pathology, vol. 31, no. 4, pp. 398-402.
Traditional tests for detection of syphilis are labour intensive and costly. Enzyme immunoassays (EIAs) are readily automated and cost effective if large numbers of tests are performed. Four experiments were devised to evaluate a syphilis EIA test kit where resources are limited: (1) testing antenatal patients; (2) testing refugees; (3) testing a high prevalence population; and (4) testing "problem sera" (containing autoantibodies or antibodies to other infective agents). Forty-one available syphilitic sera from antenatal patients were tested to evaluate sensitivity. Specificity was determined through testing sera determined to be nonreactive with rapid plasma reagin and Treponema pallidum hemagglutination tests, calculating the sample size (456) on the confidence interval (CI) required. Two runs were performed on antenatal sera, giving sensitivities of 32% (95% CI: 20%, 47%) and 37% (95% CI: 24%, 52%) and specificities of 92% (95% CI: 89%, 94%) and 90% (95% CI 87%, 92%), respectively. We present a method to evaluate a serological test where resources are limited. Unexpectedly, the test kit performed poorly as a screening test. New serological tests need to be evaluated in-house prior to adoption.
Gosbell, I.B., Newton, P.J. & Sullivan, E.A. 1999, 'Survey of blood cultures from five community hospitals in south-western Sydney, Australia, 1993-1994.', Australian and New Zealand journal of medicine, vol. 29, no. 5, pp. 684-692.
BACKGROUND: Blood culture results have profound implications for patients. Comprehensive overviews of blood cultures have been uncommon, and focused on tertiary referral hospitals. AIM: To present a review of blood culture results from a laboratory servicing community hospitals in Sydney, Australia. METHODS: Retrospective chart review of patients with positive blood cultures from 1 June 1993 to 31 May 1994. RESULTS: During the survey period there were 107,382 hospital admissions; 12,109 blood culture sets from 9292 patients were processed. Of these 1197 sets were positive, representing 974 febrile episodes in 923 patients. There were 476 episodes of contamination. Of the episodes of true bacteraemia, Escherichia coli was isolated in 139, Staphylococcus aureus in 91 (22 methicillin-resistant), other enterobacteriaceae in 60, and Streptococcus pneumoniae in 5 1. The diagnoses attributable to bacteraemia included intravenous catheter-related sepsis (122 episodes), urinary tract infection (88), bacteraemia from unknown source (79), intra-abdominal and biliary sepsis (91), pneumonia (35), and meningitis (21). Sixty-eight patients died directly due to bacteraemia. Multivariate analysis showed underlying disease (OR 3.97) or shock (OR 28.1) predicted death. Blood cultures confirmed clinical diagnoses in 258 episodes, but made a de novo diagnosis in 205 episodes. CONCLUSIONS: This study describes the clinical and laboratory features of bacteraemias occurring in smaller public hospitals, as distinct from tertiary referral centres. It demonstrated that intravenous catheter-related sepsis was very common in smaller hospitals. The clinical diagnosis was frequently confirmed, and a de novo diagnosis was often established by a positive blood culture. Unfortunately nearly half the positive blood cultures represented contamination.
Bai, J., Marks, G.B., Stewart, G.J., Simpson, S.E. & Sullivan, E.A. 1999, 'Specificity of notification for tuberculosis among screened refugees in NSW.', Australian and New Zealand journal of public health, vol. 23, no. 4, pp. 410-413.
OBJECTIVE: Epidemiological surveillance of tuberculosis (TB) in Australia is dependent on the accuracy of the notification data. We have investigated the specificity of TB notification for the diagnosis of this disease. METHOD: We used data from notifications to the NSW Department of Health to identify members of a cohort of refugees who were screened between 1984 and 1993 and subsequently developed TB during that period. We reviewed notification data and, in most instances, case notes and x-ray films, to independently confirm or refute the diagnosis of TB. RESULTS: Two hundred and fifty members of the cohort were identified in the notification database. After excluding refugees on treatment prior to arrival in Australia, and those who were notified as 'quiescent' and 'atypical' cases, there were 189 cases notified as active TB. There was evidence to support the diagnosis of active TB in 125 cases (66%) and evidence that subjects did not have active disease in 60 cases (32%). We could not determine the status of the remaining four notified cases. CONCLUSION: This study has shown that, in a population of refugees subject to screening, nearly one-third of cases notified as active tuberculosis from the study population were actually not active tuberculosis cases. IMPLICATIONS: The use of the TB notification database may result in overestimation of the incidence of TB in population groups who are subject to active screening.
Sullivan, E.M., Burgess, M.A. & Forrest, J.M. 1999, 'The epidemiology of rubella and congenital rubella in Australia, 1992 to 1997.', Communicable diseases intelligence, vol. 23, no. 8, pp. 209-214.
Selective rubella vaccination of schoolgirls commenced in 1971 and was followed by a significant reduction in congenital rubella. Infant vaccination with MMR was introduced in 1989 to interrupt circulation of the virus in young children, and in 1994/95 the adolescent school based rubella vaccination program was changed to MMR for both boys and girls. This report reviews the epidemiology of rubella and congenital rubella between 1992 and 1997 using reports to the National Notifiable Diseases Surveillance System (NNDSS) and the Australian Paediatric Surveillance Unit (APSU). Notification rates for rubella exceeded 20 per 100,000 in 1992, 1993 and 1995 and declined to 7.2 per 100,000 in 1997. Sixty-one per cent of notifications occurred between September and December and 68% occurred in males. The incidence rate in males aged 15-22 years peaked at 152.6 per 100,000 in 1995 reflecting the lack of immunisation in this cohort. From 1993 to 1997, 19 children were reported with congenital rubella syndrome, representing 1 in 67,000 live births. Of these, 17 had multiple defects (4 died) and 2 had deafness only. There were also 5 infants with congenital rubella infection but no defects. Australia's rate of congenital rubella syndrome exceeded that of the United Kingdom and the United States of America but this may be partly attributable to differences in reporting practices. The impact of changing the second dose of MMR vaccine to 4 years of age in 1998 will require careful monitoring.
Chant, K.G., Sullivan, E.A., Burgess, M.A., Ferson, M.J., Forrest, J.M., Baird, L.M., Tudehope, D.I. & Tilse, M. 1998, 'Varicella-zoster virus infection in Australia.', Australian and New Zealand journal of public health, vol. 22, no. 4, pp. 413-418.
OBJECTIVE: To determine the epidemiology of varicella-zoster virus (VZV) infection in Australia using currently available data sources. DESIGN: Analysis of national death data (23 years), congenital and neonatal cases (one year) and attendances at sentinel general practices (two years); hospital admissions in NSW and SA (six years); serological studies in 1995 involving antenatal clinics in Sydney and Brisbane and child-care centre staff and refugees in Sydney; and case-ascertainment in 1995 in South Western Sydney among public hospital staff, child-care centre staff and the community. RESULTS: In Australia, there have been an average of 3.5 deaths from chickenpox (mostly children) and 11 from herpes zoster (mostly older people) each year since 1980. The crude death rate for chickenpox has declined (p > 0.05). In 1995, there were 14 cases of neonatal and two of congenital varicella. Average annual admission rates for NSW and SA showed 1,200 hospital bed-days used for chickenpox, more than 20% with complications, and more than 7,300 bed days for zoster; annually more than 880 in-patient admissions were complicated by VZV. Most people encounter the virus in their first 15 years, but some remain susceptible into their 20s; 25% of cases and 37% of hospital admissions for chickenpox occur in people > or = 15 years of age. CONCLUSION: VZV infection involves people of all ages. It causes substantial morbidity and mortality, particularly at the extremes of life. The death rate from chickenpox but not zoster has fallen since the introduction of acyclovir in the 1980s. Surveillance of VZV infection must be given priority once vaccines become available, to monitor changes in morbidity and mortality.
Sullivan, E.A., Chey, T. & Nossar, V. 1998, 'Erratum: A population-based survey of immunisation coverage in children aged 2 years and younger in New South Wales (Journal of Paediatrics and Child Health (1998) 34 (342-345))', Journal of Paediatrics and Child Health, vol. 34, no. 6, p. 595.
Sullivan, E.A., Chey, T. & Nossar, V. 1998, 'A population-based survey of immunization coverage in children aged 2 years and younger in New South Wales.', Journal of paediatrics and child health, vol. 34, no. 4, pp. 342-345.
OBJECTIVE: To provide a population-based baseline of immunization rates in children aged 2 years and younger in New South Wales (NSW) in 1992, permitting more accurate evaluation of the efficacy of current programmes. METHODS: A cross-sectional population-based survey of 622 households from areas resident to over 73% of all children aged 4 years and younger in NSW. RESULTS: Of the 322 households with children aged 3-24 months, 212 (66%; confidence interval (CI): 57-75%) were up-to-date with the recommended immunization schedule, 68 (21%; CI: 15-27%) had not commenced any immunization, and 42 (13%; CI: 9-17%) were partially immunised. Ability to read English (odds ratio (OR): 5.43; CI: 2.37-12.44) and receipt of hepatitis B immunization (OR; 2.54; CI: 1.27-5.07%) were highly associated with up-to-date immunization; whilst a history of any illnesses, frequent doctor visits in the past 12 months (OR: 0.47; CI: 0.27-0.85%) and older age (16-24 months) (OR: 0.26; CI: 0.12-0.50%) were less likely to be associated with up-to-date immunization. CONCLUSIONS: In 1992 NSW had low levels of up-to-date immunization. Significantly, one-fifth of NSW families with children aged 3-24 months did not have a record of any immunizations. This could not be explained by delay in commencing immunization. Poor competency in reading English was strongly associated with failure to immunise, suggesting that there had been inadequate targeting of immunization campaigns in non-English-speaking communities.
Stanford, D.G., Georgouras, K.E., Sullivan, E.A. & Greenoak, G.E. 1996, 'Skin phototyping in Asian Australians.', The Australasian journal of dermatology, vol. 37 Suppl 1, pp. S36-S38.
Skin phototype was assessed in 257 Asian Australians by self-reporting questionnaire. Minimal erythema dose, minimal melanogenic dose and minimal immediate pigment darkening dose were measured in a subgroup of 50 subjects. About 15% of Asian Australians in this study report that they have skin type I or II. Phototesting confirms that there is a UV-sensitive group and a wide spectrum of UV-sensitivity in this population. Whether Fitzpatrick's skin typing system adequately identifies this UV-sensitive group needs assessment by a larger study. The relationship between burning tendency and tanning capacity in Asians may differ from Caucasians.
Stanford, D.G., Georgouras, K.E., Sullivan, E.A. & Greenoak, G.E. 1996, 'Skin phototyping in Asian Australians', Australasian Journal of Dermatology, vol. 37, no. SUPPL. 1, pp. S36-S38.
Skin phototype was assessed in 257 Asian Australians by self-reporting questionnaire. Minimal erythema dose, minimal melonogenic dose and minimal immediate pigment darkening dose were measured in a subgroup of 30 subjects. About 15% of Asian Australians in this study report that they have skin type I or II. Phototesting confirms that there is a UV-sensitive group and a wide spectrum of UV-sensitivity in this population. Whether Fitzpatrick's skin typing system adequately identifies this UV-sensitive group needs assessment by a larger study. The relationship between burning tendency and tanning capacity in Asians may differ from Caucasians.
Bek, M.D., Smith, W.T., Levy, M.H., Sullivan, E. & Rubin, G.L. 1992, 'Rabies case in New South Wales, 1990: public health aspects.', The Medical journal of Australia, vol. 156, no. 9, pp. 596-600.
OBJECTIVES: To identify the source of rabies in the recent case in New South Wales, and to determine the need for post-exposure rabies prophylaxis among contacts of the patient. DESIGN: Information was obtained by face-to-face interview of the dead girl's family and face-to-face and telephone interviews using a questionnaire of health care workers. Other information was gathered from overseas and local sources through telephone and facsimile contact. RESULTS: The girl had migrated from Vietnam in 1984 to Hong Kong, and from there in 1986 to Australia. No evidence of contact with a rabid animal in Australia or Hong Kong was found. There had also been no organ donations from the girl. Four health care workers were given post-exposure rabies prophylaxis. CONCLUSIONS: Because of the lack of evidence of animal contact in Australia and the fact that extremely long incubation periods for rabies have been documented, it was considered that the most likely source of the rabies virus was North Vietnam. Genetic studies of the virus also supported a South-East Asian source. Nevertheless the presumed incubation period--at least six years and four months--is one of the longest recorded.

Reports

Bonello, M.R., Hilder, L. & Sullivan, E.A. AIHW 2014, Fetal Alcohol Spectrum Disorders: strategies to address information gaps, no. Cat. no. PER 67, Canberra.
Hilder, L., Li, Z., Zeki, R. & Sullivan, E.A. AIHW 2014, Stillbirths in Australia 1991-2009, Perinatal statistics series no. 29, no. Cat. no. PER 63, Canberra.
Johnson, S., Bonello, M.R., Li, Z., Hilder, L. & Sullivan, E. AIHW 2014, Maternal deaths in Australia 2006-2010, Maternal deaths series no. 4, no. Cat. no. PER 61, Canberra.
Li, Z., Zeki, R., Hilder, L. & Sullivan, E.A. AIHW National Perinatal Epidemiology and Statistics Unit 2013, Australia's mothers and babies 2011, Perinatal statistics series no 4, no. Cat. no. PER 59., Canberra.
2.Macaldowie, A., Wang, A., Chambers, G.M. & Sullivan, E.A. University of New South Wales 2013, Assisted reproductive technology in Australia and New Zealand 2011, Sydney: National Perinatal Epidemiology and Statistics Unit.
Macaldowie, A., Wang, Y.A., Chambers, G.M. & Sullivan, E. AIHW 2012, Assisted reproductive technology in Australia and New Zealand 2010, Assisted reproduction technology series, no. Cat. no. PER 55, Canberra.
Li, Z., Zeki, R., Hilder, L. & Sullivan, E. AIHW National Perinatal Epidemiology and Statistics Unit 2012, Australia's mothers and babies 2010, Perinatal statistics series no. 27, no. Cat. no. PER 57, Canberra.
Wang, Y.A., Macaldowie, A., Chambers, G.M. & Sullivan, E.A. AIHW 2011, Assisted Reproductive Technology in Australia and New Zealand 2009, Assisted reproduction technology Series No. 15, no. Cat No. PER 49, Canberra.
Li, Z., McNally, L., Hilder, L. & Sullivan, E. AIHW National Perinatal Epidemiology and Statistics Unit 2011, Australia's mothers and babies 2009, Perinatal statistics series no. 25, no. Cat. no. PER 52, Sydney.
Wang, Y.A., Chambers, G.M. & Sullivan, E.A. AIHW 2010, Assisted Reproductive Technology in Australia and New Zealand 2008, Assisted reproduction technology Series No. 14, no. Cat No. PER 49, Canberra.
Laws, P.J., Li, Z. & Sullivan, E. AIHW 2010, Australia's mothers and babies 2008, Perinatal Statistics Series no. 24, no. Cat. No. PER 50, Canberra.
Wang, Y.A., Chambers, G.M., Dieng, M. & Sullivan, E.A. AIHW National Perinatal Statistics Unit 2009, Assisted Reproductive Technology in Australia and New Zealand 2007, Assisted reproduction technology Series No. 13, no. Cat No. PER 47, Sydney.
Laws, P.J. & Sullivan, E. AIHW National Perinatal Statistics Unit 2009, Australia's mothers and babies 2007, Perinatal Statistics Series no. 23, no. Cat. No. PER 48, Sydney.
Wang, Y.A., Dean, J.H., Badgery-Parker, T. & Sullivan, E. AIHW National Perinatal Statistics Unit 2008, Assisted Reproductive Technology in Australia and New Zealand 2006, Assisted reproduction technology Series No. 12, no. Cat No. PER 43, Sydney.
Laws, P.J., Hilder, L. & Sullivan, E. AIHW National Perinatal Statistics Unit 2008, Australia's mothers and babies 2006, Perinatal Statistics Series no. 22, no. Cat. No. PER 46, Sydney.
Abeywardana, S. & Sullivan, E. AIHW National Perinatal Statistics Unit 2008, Congenital anomalies in Australia 2002-2003, Birth Anomalies series no. 3, no. Cat. no. PER 41, Sydney.
Abeywardana, S., Karim, M., Grayson, N. & Sullivan, E. AIHW National Perinatal Statistics Unit 2007, Congenital anomalies in Australia 1998-2001, Congenital anomalies series no. 2, no. AIHW Cat No. PER37, Sydney.
Leeds, K.L., Gourley, M., Laws, P.J., Zhang, J., Al-Yaman, F. & Sullivan, E. AIHW 2007, Indigenous mothers and their babies, Australia 2001-2004, Perinatal statistics series no. 19, no. AIHW cat n. PER 38, Canberra.
Wang, Y.A., Dean, J.H. & Sullivan, E. AIHW National Perinatal Statistics Unit 2007, Assisted Reproductive Technology in Australia and New Zealand 2005, Assisted reproduction technology Series No. 11, no. Cat No. PER 36, Sydney.
Laws, P.J., Abeywardana, S., Walker, J. & Sullivan, E. AIHW National Perinatal Statistics Unit 2007, Australia's mothers and babies 2005, Perinatal Statistics Series No. 17, no. Cat No PER 40, Sydney.
Sullivan, E. WHO Regional Office for the Western Pacific 2006, Second generation surveillance surveys of HIV, other STIs and risk behaviours in six Pacific Island Countries, Manila, Philippines.
Wang, Y.A., Dean, J.H., Grayson, N. & Sullivan, E.A. AIHW 2006, Assisted reproductive technology in Australia and New Zealand 2004, no. Cat. No. PER 39, Sydney: AIHW Nation Perinatal Statistics Unit.
Sullivan, E. & Wang, Y.A. WHO Regional Office for the Western Pacific 2004, Prevalence surveys of sexually transmitted infections among seafarers and women attending antenatal clinics in Kiribati. 2002-2003, Manila.
Laws, P.J., Grayson, N., Wang, A. & Sullivan, E.A. Canberra: AIHW NPSU 2004, Australia's babies: Their health and wellbeing, no. Bulletin no. 21. AIHW cat. no. AUS 54.
Sullivan, E. WHO Regional Office for the Western Pacific 2000, STI/HIV antenatal clinic STI survey, Apia, Samoa, Manila, Philippines.
Sullivan, E. WHO Regional Office for the Western Pacific 2000, STI/HIV antenatal clinic STI survey, Port Vila, Vanuatu, Manila, Philippines.
Sullivan, E. WHO Regional Office for the Western Pacific 1999, Sexually transmitted infections prevalence study methodology. Guidelines for the implementation of STI prevalence surveys Western Pacific Region, 1999, Manila, Philippines.
Johnson, S., Bonello, M.R., Li, Z., Hilder, L. & Sullivan, E. AIHW Maternal deaths in Australia 2006-2010, Maternal deaths series no. 4, no. Cat. no. PER 61, Canberra.

National Advisory Group and Committee membership and Chair:

  • Council Member, National Health and Medical Research Council for the triennium (2015 - 2018)
  • Chair UTS SAT, Science in Australia Gender Equity (SAGE) National Pilot of Athena SWAN in Australia (2015-current)
  • Member, Research Australia University Roundtable (2014-current)
  • Chair, Family Planning Organisations/Family Planning NSW National Sexual and Reproductive Health Research Forum Steering Committee (2014 - current)
  • Member of the National Health Performance Authority: Healthy Communities Child and maternal health care and outcomes Report Advisory Committee (2014)
  • Member of the National Health Performance Authority: Frequent General Practice Attenders Report Advisory Committee (2014)
  • Member of the Maternal Sentinel Events and PPH Working Group, Australian Commission on Safety and Quality in Health Care, 2013 - 2014
  • Member of the National Core Maternal Indicators Project Expert Advisory Group (2012-2014)
  • Member of the National Maternal and Perinatal Morbidity and Mortality Data Collection Project Advisory Group, 2011 - 2014
  • Chair of the Nomenclature of Models of Care Working Party, 2011 - 2014
  • Member and previous Chair (2011-2014) of the AIHW National Maternal Mortality Advisory Committee
  • Executive Member International Network of Obstetric Survey Systems (2010 - current)
  • Member of the Perinatal Society of Australia and New Zealand (2005-current)
  • Fertility Society of Australia (2005 - current)
  • Australasian representative of the International Committee Monitoring of Assisted Reproductive Technology (2003 - 2015).
  • Member/Chair for national AIHW committees on maternal, perinatal and child health (2002 - 2014).
  • Deputy Chair National of the Perinatal Data Development Committee (2001 - 2014)
  • European Society for Human Reproduction and Embryology.
  • Member, Sax Institute
  • Fellow of the Australasian Faculty of Public Health Medicine (1992)

International consulting and appointments
Professor Sullivan's expertise has been recognized through invited appointments to the World Health Organisation. She has participated as a temporary adviser on multiple occasions for three WHO Geneva projects in the last three years, including representing Australiasia/Oceania in the Technical Consultation Maternal Morbidity Working Group (2012-current). For the most recent meeting she chaired the two day international WHO Maternal Morbidity Working Group and Stakeholder Meeting in October 2014, Istanbul, Turkey. She was the Australasia/Oceania member of the World Health Organisation Working Group on Caesarean Section in 2014. In 2013, she was the Australasian member of the World Health Organisation, Rapid Assessment for Infertility Service Integration (RAISe INTErest) Expert Working Group. Prior to this she has worked extensively in the Pacific for Western Pacific Regional Office of WHO during the period 1998-2006, including leading a seven country project for implementation of second generation HIV surveillance.