Dr Wang is Associate Professor of Perinatal Epidemiology and Biostatistics. He has extensive experience in epidemiological study design, database development and management, data linkage and advanced statistical analysis in the fields of reproduction, pregnancy, neonate and child health, particularly in assisted reproductive technology (ART), and resulting pregnancy and birth outcomes. He has an international reputation in population-based ART research and management of the Australian and New Zealand Assisted Reproduction Database.
A/Prof Wang completed his medical training at Fudan University (Shanghai China) in 1993. He worked as a medical/quarantine doctor in China before moving to Australia in 2002. He started his research career in 2004 by completing a major project for his Master of Public Health at the University of New South Wales (UNSW). In 2005 he published his first international journal article in Fertility & Sterility. In 2011, he submitted his PhD thesis with 6 journal articles published: four in Human Reproduction, one in Medical Journal of Australia and one in Reproductive BioMedicine Online.
In addition to completing both Master and PhD degrees, since 2005 A/Prof Wang published extensively in the fields of reproduction, pregnancy, neonate, and child health, with more than 70 peer-reviewed journal articles, book chapter and technical reports. He was granted several domestic and international research grants from the: NHMRC, Fertility Society of Australia, Royal Hospital for Women Foundation, the Victorian Assisted Reproductive Treatment Authority and Health Futures Development Grants of UTS Faculty of Health. He has received a number of awards including the: NHMRC Public Health Postgraduate Scholarship, NHMRC Travelling Award, UNSW Postgraduate Research Student Support Scheme and the Dean’s Rising Star Award of Faculty of Medicine UNSW.
2007 - Fertility Society of Australia
2012 - American Society for Reproductive Medicine
2013 - European Society of Human Reproduction and Embryology
- Dean’s Rising Star Award (2012) Medicine, The University of New South Wales
- Postgraduate Research Student Support Scheme (2009) The University of New South Wales
- School of Public Health & Community Medicine Travel Scholarship (2008) The University of New South Wales
- NHMRC Traveling Award (2006) Australian Government National Health and Medical Research Council, Australia
- NHMRC Public Health Postgraduate Scholarship (2005) Australian Government National Health and Medical Research Council, Australia
- Outstanding Graduate Prize (1993) Shanghai Tertiary Education Bureau, China
Can supervise: YES
- Obstetrics and gynaecology
- Public health and health services
Epidemiology and Statistics
Hogan, RG, Wang, AY, Li, Z, Hammarberg, K, Johnson, L, Mol, BW & Sullivan, EA 2019, 'Oocyte donor age has a significant impact on oocyte recipients' cumulative live-birth rate: a population-based cohort study', Fertility and Sterility.View/Download from: UTS OPUS or Publisher's site
© 2019 Objective: To study the impact of the donor's and recipient's age on the cumulative live-birth rate (CLBR) in oocyte donation cycles. Design: A population-based retrospective cohort study. Setting: Not applicable. Patient(s): All women using donated oocytes (n = 1,490) in Victoria, Australia, between 2009 and 2015. Intervention(s): None. Main Outcome Measure(s): The association between the donor's and recipient's age and CLBR modeled by multivariate Cox proportional hazard regression with the covariates of male partner's age, recipient parity, and cause of infertility adjusted for, and donor age grouped as <30, 30–34, 35–37, 38–40, and ≥41 years, and recipient age as <35, 35–37, 38–40, 41–42, 43–44, and ≥45 years. Result(s): The mean age of the oocyte donors was 33.7 years (range: 21 to 45 years) with 49% aged 35 years and over. The mean age of the oocyte recipients was 41.4 years (range: 19 to 53 years) with 25.4% aged ≥45 years. There was a statistically significant relationship between the donor's age and the CLBR. The CLBR for recipients with donors aged <30 years and 30–34 years was 44.7% and 43.3%, respectively. This decreased to 33.6% in donors aged 35–37 years, 22.6% in donors aged 38–40 years, and 5.1% in donors aged ≥41 years. Compared with recipients with donors aged <30 years, the recipients with donors aged 38–40 years had 40% less chance of achieving a live birth (adjusted hazard ratio 0.60; 95% CI, 0.43–0.86) and recipients with donors aged ≥41 years had 86% less chance of achieving a live birth (adjusted hazard ratio 0.14; 95% CI, 0.04–0.44). The multivariate analysis showed no statistically significant effect of the recipient's age on CLBR. Conclusion(s): We have demonstrated that the age of the oocyte donor is critical to the CLBR and is independent of the recipient woman's age. Recipients using oocytes from donors aged ≥35 years had a statistically significantly lower CLBR when compared with recipients using oocytes from donors aged <35 ...
Li, Z, Wang, AY, Bowman, M, Hammarberg, K, Farquhar, C, Johnson, L, Safi, N & Sullivan, EA 2019, 'Cumulative live birth rates following a 'freeze-all' strategy: a population-based study.', Human reproduction open, vol. 2019, no. 2, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
STUDY QUESTION:What is the cumulative live birth rate following a 'freeze-all' strategy compared with a 'fresh-transfer' strategy? SUMMARY ANSWER:The 'freeze-all' strategy resulted in a similar cumulative live birth rate as the 'fresh-transfer' strategy among high responders (>15 oocytes retrieved) but did not benefit normal (10-15 oocytes) and suboptimal responders (<10 oocytes). WHAT IS KNOWN ALREADY:Frozen-thawed embryo transfer is associated with a decreased risk of adverse obstetric and perinatal outcomes compared with fresh embryo transfer. It is unclear whether the 'freeze-all' strategy should be offered to all women undergoing ART treatment. STUDY DESIGN SIZE DURATION:A population-based retrospective cohort study using data collected by the Victorian Assisted Reproductive Treatment Authority. This study included 14 331 women undergoing their first stimulated ART cycle with at least one oocyte fertilised between 1 July 2009 and 30 June 2014 in Victoria, Australia. Demographic characteristics, type of ART procedures and resulting pregnancy and birth outcomes were recorded for the stimulated cycle and associated thaw cycles until 30 June 2016, or until a live birth was achieved, or until all embryos from the stimulated cycle had been used. PARTICIPANTS/MATERIALS SETTING METHODS:Women were grouped by whether they had undergone the 'freeze-all' strategy (n = 1028) where all embryos were cryopreserved for future transfer, or the 'fresh-transfer' strategy (n = 13 303) where selected embryo(s) were transferred in the stimulated cycle, and remaining embryo(s) were cryopreserved for future use. A discrete-time survival model was used to evaluate the cumulative live birth rate following 'freeze-all' and 'fresh-transfer' strategy. MAIN RESULTS AND THE ROLE OF CHANCE:A total of 1028 women undergoing 'freeze-all' strategy and 13 303 women undergoing 'fresh-transfer' strategy had 1788 and 22 334 embryo transfer cycles resulting in 452 and 5126 live births, respectively....
Liu, Z-Y, Zhao, J-J, Gao, L-L & Wang, AY 2019, 'Glucose screening within six months postpartum among Chinese mothers with a history of gestational diabetes mellitus: a prospective cohort study.', BMC pregnancy and childbirth, vol. 19, no. 1.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Gestational diabetes mellitus (GDM) is a risk factor for diabetes mellitus. The 75-g, 2-h oral glucose tolerance test is recommended for mothers with a history of GDM to screen for diabetes in the postnatal period. The aim of this study was to investigate the rate of glucose screening within 6 months postpartum among Chinese mothers with a history of GDM, and to identify its predictors. METHODS:A prospective cohort study was conducted in a regional teaching hospital in Guangzhou, China, between July 2016 and June 2017. The participants were Chinese mothers (n = 237) who were diagnosed with GDM, were aged 18 years or older with no serious physical or mental disease and had not been diagnosed with type 1 or type 2 diabetes prior to their pregnancy. The revised Chinese version of the Champion's Health Belief Model Scale and social-demographic and perinatal characteristics factors were collected and used to predict postpartum glucose screening (yes or no). Adjust odds ratio (AOR) and 95% confidence interval (95% CI) were calculated. RESULTS:The mean age of the 237 mothers was 32.70 years (range from 22 to 44). Almost half of the mothers (45.6%) were college graduates or higher. Chinese mothers reported a high level of perceived benefits, self-efficacy, and health motivation towards postpartum glucose screening, with a mean score above 3.5. Chinese mothers were more likely to undertake postpartum glucose screening if they were a first-time mother [AOR 2.618 (95% CI: 1.398-4.901)], had a high perceived susceptibility score [AOR 2.173 (95% CI: 1.076-4.389)], a high perceived seriousness score [AOR 1.988 (95%CI: 1.020-3.875)] and high perceived benefits score [AOR 2.978 (95%CI: 1.540-5.759)]. CONCLUSION:The results of this study will lead to better identification of mothers with a history of GDM who may not screen for postpartum glucose abnormality. Health care professionals should be cognizant of issues that may affect postpartum glucose screening among mothe...
Sullivan, E, Ward, S, Zeki, R, Wayland, S, Sherwood, J, Wang, A, Worner, F, Kendall, S, Brown, J & Chang, S 2019, 'Recidivism, health and social functioning following release to the community of NSW prisoners with problematic drug use: study protocol of the population-based retrospective cohort study on the evaluation of the Connections Program.', BMJ open, vol. 9, no. 7, pp. e030546-e030546.View/Download from: UTS OPUS or Publisher's site
INTRODUCTION:The rising rate of incarceration in Australia, driven by high reoffending, is a major public health problem. Problematic drug use is associated with increasing rates of reoffending and return to custody of individuals. Throughcare provides support to individuals during imprisonment through to post-release, improving both the transition to community and health outcomes post-incarceration. The aim of this study is to evaluate the Connections Programme (CP) that utilises a throughcare approach for release planning of people in prison with a history of problematic drug use. The study protocol is described. METHODS AND ANALYSIS:Population-based retrospective cohort study. The study will use record linkage of the Connections dataset with 10 other New South Wales (NSW) population datasets on offending, health service utilisation, opioid substitution therapy, pregnancy, birth and mortality. The study includes all patients who were eligible to participate in the CP between January 2008 and December 2015 stratified by patients who were offered CP and eligible patients who were not offered the programme (non-CP (NCP)). Propensity-score matching will be used to appropriately adjust for the observable differences between CP and NCP. The differences between two groups will be examined using appropriate univariate and multivariate analyses. A generalised estimating equation approach, which can deal with repeat outcomes for individuals will be used to examine recidivism, mortality and other health outcomes, including perinatal and infant outcomes. Survival analysis techniques will be used to examine the effect of the CP by sex and Indigenous status on the 'time-to' health-related outcomes after adjusting for potential confounders. ETHICS AND DISSEMINATION:Ethical approval was received from the NSW Population and Health Services Research Ethics Committee, the Justice Health and Forensic Mental Health Network Human Research Ethics Committee, the Aboriginal Health and ...
Zeki, R, Li, Z, Wang, AY, Homer, CSE, Oats, JJN, Marshall, D & Sullivan, EA 2019, 'Obstetric anal sphincter injuries among women with gestational diabetes and women without gestational diabetes: A NSW population-based cohort study', Australian and New Zealand Journal of Obstetrics and Gynaecology.View/Download from: Publisher's site
© 2019 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Background: Obstetric anal sphincter injuries (OASIs) are associated with maternal morbidity; however, it is uncertain whether gestational diabetes (GDM) is an independent risk factor when considering birthweight mode of birth and episiotomy. Aims: To compare rates of OASIs between women with GDM and women without GDM by mode of birth and birthweight. To investigate the association between episiotomy, mode of birth and the risk of OASIs. Methods: A population-based cohort study of women who gave birth vaginally in NSW, from 2007 to 2013. Rates of OASIs were compared between women with and without GDM, stratified by mode of birth, birthweight and a multi-categorical variable of mode of birth and episiotomy. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated by multivariable logistic regression. Results: The rate of OASIs was 3.6% (95% CI: 2.6–2.7) vs 2.6% (95% CI: 3.4–2.8; P < 0.001) among women with and without GDM, respectively. Women with GDM and a macrosomic baby (birthweight ≥ 4000 g) had a higher risk of OASIs with forceps (aOR 1.76, 95% CI: 1.08–2.86, P = 0.02) or vacuum (aOR 1.89, 95% CI: 1.17–3.04, P = 0.01), compared with those without GDM. For primiparous women with GDM and all women without GDM, an episiotomy with forceps was associated with lower odds of OASIs than forceps only (primiparous GDM, forceps-episiotomy aOR 2.49, 95% CI: 2.00–3.11, forceps aOR 5.30, 95% CI: 3.72–7.54), (primiparous without GDM, forceps-episiotomy aOR 2.71, 95% CI: 2.55–2.89, forceps aOR 5.95, 95% CI: 5.41–6.55) and (multiparous without GDM, forceps-episiotomy aOR 3.75, 95% CI: 3.12–4.50, forceps aOR 6.20, 95% CI: 4.96–7.74). Conclusion: Women with GDM and a macrosomic baby should be counselled about the increased risk of OASIs with both vacuum and forceps. With forceps birth, this risk can be partially mitigated by performing a concomitant episiotomy.
Chenoweth, L, Stein-Parbury, J, Lapkin, S, Wang, A, Liu, Z & Williams, A 2019, 'Effects of person-centered care at the organisational-level for people with dementia. A systematic review.', PloS one, vol. 14, no. 2.View/Download from: UTS OPUS or Publisher's site
The aim of the systematic review was to determine the effectiveness of organizational-level person-centered care for people living with dementia in relation to their quality of life, mood, neuropsychiatric symptoms and function. ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialised Register databases, were searched up to June 2018 using the terms dementia OR cognitive impairment OR Alzheimer AND non-pharmacological AND personhood OR person-centered care. Reviewed studies included randomized controlled trials (RCTs), cluster-randomized trials (CRTs) and quasi-experimental studies that compared outcomes of person-centered care and usual (non-person-centered) care, for people with a diagnosis of dementia. The search yielded 12 eligible studies with a total of 2599 people living with dementia in long-term care homes, 600 receiving hospital care and 293 living in extra-care community housing. Random-effects models were used to pool adjusted risk ratios and standard mean differences from all studies; the findings were assessed followed the PRISMA guidelines and GRADE criteria. Statistical heterogeneity was assessed using the I2 method and Chi2 P value; studies with low statistical heterogeneity were analyzed using a random-effects model with restricted maximum likelihood estimation in R. Analyses of pre/post data within 12 months identified: a significant effect for quality of life (standardized mean difference (SMD) 0.16 and 95% CI 0.03 to 0.28; studies = 6; I2 = 22%); non-significant effects for neuropsychiatric symptoms (SMD 0.06, 95% CI -0.08 to 0.19; studies = 4; I2 = 0%) and well-being (SMD 0.15, 95% CI -0.15 to 0.45; studies = 4; I2 = 77%); and no effects for agitation (SMD -0.05 (95% CI -0.17 to -0.07; studies 5; I2 = 0%) and depression (SMD -0.06 and 95% CI -0.27 to 0.15, studies = 5; I2 = 53%). The evidence from this review recommends implementation of person-centered care at the organizational-level to support the quality of life of people...
Chughtai, AA, Wang, AY, Hilder, L, Li, Z, Lui, K, Farquhar, C & Sullivan, EA 2018, 'Gestational age-specific perinatal mortality rates for assisted reproductive technology (ART) and other births.', Human Reproduction, vol. 33, no. 2, pp. 320-327.View/Download from: UTS OPUS or Publisher's site
Is perinatal mortality rate higher among births born following assisted reproductive technology (ART) compared to non-ART births?Overall perinatal mortality rates in ART births was higher compared to non-ART births, but gestational age-specific perinatal mortality rate of ART births was lower for very preterm and moderate to late preterm births.Births born following ART are reported to have higher risk of adverse perinatal outcomes compared to non-ART births.This population-based retrospective cohort study included 407 368 babies (391 952 non-ART and 15 416 ART)-393 491 singletons and 10 877 twins or high order multiples.All births (≥20 weeks of gestation and/or ≥400 g of birthweight) in five states and territories in Australia during the period 2007-2009 were included in the study, using National Perinatal Data Collection (NPDC). Primary outcome measures were rates of stillbirth, neonatal and perinatal deaths. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to estimate the likelihood of perinatal death.Rates of multiple birth and low birthweight were significantly higher in ART group compared to the non-ART group (P < 0.01). Overall perinatal mortality rate was significantly higher for ART births (16.5 per 1000 births, 95% CI 14.5-18.6), compared to non-ART births (11.3 per 1000 births, 95% CI 11.0-11.6) (AOR 1.45, 95% CI 1.26-1.68). However, gestational age-specific perinatal mortality rate of ART births (including both singletons and multiples) was lower for very preterm (<32 weeks' gestation) and moderate to late preterm births (32-36 weeks' gestation) (AOR 0.61, 95% CI 0.53-0.70 and AOR 0.61, 95% CI 0.53-0.70, respectively) compared to non-ART births. Congenital abnormality and spontaneous preterm were the most common causes of neonatal deaths in both ART and non-ART group.Due to different cut-off limit for perinatal period in Australia, the results of this study should be interpreted with cautions for other countries. Australian definit...
Li, Z, Wang, AY, Bowman, M, Hammarberg, K, Farquhar, C, Johnson, L, Safi, N & Sullivan, EA 2018, 'ICSI does not increase the cumulative live birth rate in non-male factor infertility.', Human reproduction (Oxford, England), vol. 33, no. 7, pp. 1322-1330.View/Download from: UTS OPUS or Publisher's site
STUDY QUESTION:What is the cumulative live birth rate following ICSI cycles compared with IVF cycles for couples with non-male factor infertility? SUMMARY ANSWER:ICSI resulted in a similar cumulative live birth rate compared with IVF for couples with non-male factor infertility. WHAT IS KNOWN ALREADY:The ICSI procedure was developed for couples with male factor infertility. There has been an increased use of ICSI regardless of the cause of infertility. Cycle-based statistics show that there is no difference in pregnancy rates between ICSI and IVF in couples with non-male factor infertility. However, evidence indicates that ICSI is associated with an increased risk of adverse perinatal outcomes. STUDY DESIGN, SIZE, DURATION:A population-based cohort of 14 693 women, who had their first ever stimulated cycle with fertilization performed for at least one oocyte by either IVF or ICSI between July 2009 and June 2014 in Victoria, Australia was evaluated retrospectively. The pregnancy and birth outcomes following IVF or ICSI were recorded for the first oocyte retrieval (fresh stimulated cycle and associated thaw cycles) until 30 June 2016, or until a live birth was achieved, or until all embryos from the first oocyte retrieval had been used. PARTICIPANTS/MATERIALS, SETTING, METHODS:Demographic, treatment characteristics and resulting outcome data were obtained from the Victorian Assisted Reproductive Treatment Authority. Data items in the VARTA dataset were collected from all fertility clinics in Victoria. Women were grouped by whether they had undergone IVF or ICSI. The primary outcome was the cumulative live birth rate, which was defined as live deliveries (at least one live birth) per woman after the first oocyte retrieval. A discrete-time survival model was used to evaluate the cumulative live birth rate following IVF and ICSI. The adjustment was made for year of treatment in which fertilization occurred, the woman's and male partner's age at first stimulated cycle,...
Wang, AY, Safi, N, Ali, F, Lui, K, Li, Z, Umstad, MP & Sullivan, EA 2018, 'Neonatal outcomes among twins following assisted reproductive technology: an Australian population-based retrospective cohort study.', BMC pregnancy and childbirth, vol. 18, no. 1, pp. 320-320.View/Download from: UTS OPUS or Publisher's site
While their incidence is on the rise, twin pregnancies are associated with risks to the mothers and their babies. This study aims to investigate the likelihood of adverse neonatal outcomes of twins following assisted reproductive technology (ART) compared to non-ART twins.A retrospective population study using the Australian National Perinatal Data Collections (NPDC) which included 19,662 twins of ≥20 weeks gestational age or ≥ 400 g birthweight in Australia. Maternal outcomes and neonatal outcomes (preterm birth, low birth weight, resuscitation and neonatal death) were compared. Generalized Estimating Equations were used to assess the likelihood of any neonatal outcomes, with adjusted odds ratio (AOR) and 95% confidence intervals (CI) presented. Weinberg's differential rule was used to estimate monozygotic twin rate.ART mothers were 3.3 years older than non-ART mothers. The rates of pregnancy-induced hypertension and gestational diabetes were significantly higher for ART mothers than non-ART mothers (12.2% vs. 8.4%, p < 0.01) and (9.7% vs. 7.5%, p < 0.01) respectively. The incidence of monozygotic twins was 2.0% for ART twins and 1.1% for non-ART twins. Compared with non-ART twins, ART twins had higher rates of preterm birth (AOR 1.13, 95% CI: 1.05-1.22), low birth weight (AOR 1.13, 95% CI: 1.05-1.22), and resuscitation (AOR 1.26, 95% CI: 1.17-1.36). Liveborn ART twins had 28% (AOR 1.28, 95% CI 1.09-1.50) increased odds of having any adverse neonatal outcome compared to liveborn non-ART twins, especially for opposite-sex ART twins (AOR 1.42, 95% CI 1.11-1.82).As ART twins had higher rates of adverse outcome, special prenatal care is recommended. Couples accessing ART should be fully informed of the risk of adverse outcome of twin pregnancies.
Wang, AY, Sullivan, EA, Li, Z & Farquhar, C 2018, 'Day 5 versus day 3 embryo biopsy for preimplantation genetic testing for monogenic/single gene defects', Cochrane Database of Systematic Reviews, vol. 2018, no. 12.View/Download from: Publisher's site
© 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the benefits and harms of day 5 embryo biopsy, in comparison to day 3 biopsy, in preimplantation genetic testing for monogenic/single gene defects (PGT-M).
Duffy, JMN, Bhattacharya, S, Curtis, C, Evers, JLH, Farquharson, RG, Franik, S, Khalaf, Y, Legro, RS, Lensen, S, Mol, BW, Niederberger, C, Ng, EHY, Repping, S, Strandell, A, Torrance, HL, Vail, A, van Wely, M, Vuong, NL, Wang, AY, Wang, R, Wilkinson, J, Youssef, MA, Farquhar, CM & COMMIT: Core Outcomes Measures for Infertility Trials 2018, 'A protocol developing, disseminating and implementing a core outcome set for infertility.', Human Reproduction Open, vol. 2018, no. 3.View/Download from: UTS OPUS or Publisher's site
STUDY QUESTIONS:We aim to produce, disseminate and implement a core outcome set for future infertility research. WHAT IS KNOWN ALREADY:Randomized controlled trials (RCTs) evaluating infertility treatments have reported many different outcomes, which are often defined and measured in different ways. Such variation contributes to an inability to compare, contrast and combine results of individual RCTs. The development of a core outcome set will ensure outcomes important to key stakeholders are consistently collected and reported across future infertility research. STUDY DESIGN SIZE DURATION:This is a consensus study using the modified Delphi method. All stakeholders, including healthcare professionals, allied healthcare professionals, researchers and people with lived experience of infertility will be invited to participate. PARTICIPANTS/MATERIALS SETTING METHODS:An international steering group, including people with lived experience of infertility, healthcare professionals, allied healthcare professionals and researchers, has been formed to guide the development of this core outcome set. Potential core outcomes have been identified through a comprehensive literature review of RCTs evaluating treatments for infertility and will be entered into a modified Delphi method. Participants will be asked to score potential core outcomes on a nine-point Likert scale anchored between one (not important) and nine (critical). Repeated reflection and rescoring should promote convergence towards consensus 'core' outcomes. We will establish standardized definitions and recommend high-quality measurement instruments for individual core outcomes. STUDY FUNDING/COMPETING INTERESTS:This project is funded by the Royal Society of New Zealand Catalyst Fund (3712235). BWM reports consultancy fees from Guerbet, Merck, and ObsEva. R.S.L. reports consultancy fees from Abbvie, Bayer, Fractyl and Ogeda and research sponsorship from Ferring. S.B. is the Editor-in-Chief of Human Reproduction Ope...
Thamrin, V, Saugstad, OD, Tarnow-Mordi, W, Wang, YA, Lui, K, Wright, IM, De Waal, K, Travadi, J, Smyth, JP, Craven, P, McMullan, R, Coates, E, Ward, M, Mishra, P, See, KC, Cheah, IGS, Lim, CT, Choo, YM, Kamar, AA, Cheah, FC, Masoud, A & Oei, JL 2018, 'Preterm Infant Outcomes after Randomization to Initial Resuscitation with FiO 2 0.21 or 1.0', Journal of Pediatrics, vol. 201, pp. 55-61.e1.View/Download from: UTS OPUS or Publisher's site
© 2018 Elsevier Inc. Objective: To determine rates of death or neurodevelopmental impairment (NDI) at 2 years corrected age (primary outcome) in children <32 weeks' gestation randomized to initial resuscitation with a fraction of inspired oxygen (FiO 2 ) value of 0.21 or 1.0. Study design: Blinded assessments were conducted at 2-3 years corrected age with the Bayley Scales of Infant and Toddler Development, Third Edition or the Ages and Stages Questionnaire by intention to treat. Results: Of the 290 children enrolled, 40 could not be contacted and 10 failed to attend appointments. Among the 240 children for whom outcomes at age 2 years were available, 1 child had a lethal congenital anomaly, 1 child had consent for follow-up withdrawn, and 23 children died. The primary outcome, which was available in 238 (82%) of those randomized, occurred in 47 of the 117 (40%) children assigned to initial FiO 2 0.21 and in 38 of the 121 (31%) assigned to initial FiO 2 1.0 (OR, 1.47; 95% CI, 0.86-2.5; P =.16). No difference in NDI was found in 215 survivors randomized to FiO 2 0.21 vs 1.0 (OR, 1.26; 95% CI, 0.70-2.28; P =.11). In post hoc exploratory analyses in the whole cohort, children with a 5-minute blood oxygen saturation (SpO 2 ) <80% were more likely to die or to have NDI (OR, 1.85; 95% CI, 1.07-3.2; P =.03). Conclusions: Initial resuscitation of infants <32 weeks' gestation with initial FiO 2 0.21 had no significant effect on death or NDI compared with initial FiO 2 1.0. Further evaluation of optimum initial FiO 2 , including SpO 2 targeting, in a large randomized controlled trial is needed. Trial registration: Australian and New Zealand Clinical Trials Network Registry ACTRN 12610001059055 and the National Malaysian Research Registry NMRR-07-685-957.
Dalinjong, PA, Wang, AY & Homer, CSE 2018, 'Are health facilities well equipped to provide basic quality childbirth services under the free maternal health policy? Findings from rural Northern Ghana', BMC Health Services Research, vol. 18, no. 1.View/Download from: UTS OPUS or Publisher's site
© 2018 The Author(s). Background: Basic inputs and infrastructure including drugs, supplies, equipment, water and electricity are required for the provision of quality care. In the era of the free maternal health policy in Ghana, it is unclear if such basic inputs are readily accessible in health facilities. The study aimed to assess the availability of basic inputs including drugs, supplies, equipment and emergency transport in health facilities. Women and health providers' views on privacy and satisfaction with quality of care were also assessed. Methods: The study used a convergent parallel mixed methods in one rural municipality in Ghana, Kassena-Nankana. A survey among facilities (n = 14) was done. Another survey was carried out among women who gave birth in health facilities only (n = 353). A qualitative component involved focus group discussions (FGDs) with women (n = 10) and in-depth interviews (IDIs) with midwives and nurses (n = 25). Data were analysed using descriptive statistics for the quantitative study, while the qualitative data were recorded, transcribed, read and coded using themes. Results: The survey showed that only two (14%) out of fourteen facilities had clean water, and five (36%) had electricity. Emergency transport for referrals was available in only one (7%) facility. Basic drugs, supplies, equipment and infrastructure especially physical space were inadequate. Rooms used for childbirth in some facilities were small and used for multiple purposes. Eighty-nine percent (n = 314) of women reported lack of privacy during childbirth and this was confirmed in the IDIs. Despite this, 77% of women (n = 272) were very satisfied or satisfied with quality of care for childbirth which was supported in the FGDs. Reasons for women's satisfaction included the availability of midwives to provide childbirth services and to have follow-up homes visits. Some midwives were seen to be patient and empathetic. Providers were not satisfied due to health system...
Dalinjong, PA, Wang, AY & Homer, CSE 2018, 'The implementation of the free maternal health policy in rural Northern Ghana: Synthesised results and lessons learnt', BMC Research Notes, vol. 11, no. 1.View/Download from: UTS OPUS or Publisher's site
© 2018 The Author(s). Objective: A free maternal health policy was implemented under Ghana's National Health Insurance Scheme to promote the use of maternal health services. Under the policy, women are entitled to free services throughout pregnancy and at childbirth. A mixed methods study involving women, providers and insurance managers was carried out in the Kassena-Nankana municipality of Ghana. It explored the affordability, availability, acceptability and quality of services. In this manuscript, we present synthesised results categorised as facilitators and barriers to access as well as lessons learnt (implications). Results: Reasonable waiting times, cleanliness of facilities as well as good interpersonal relationships with providers were the facilitators to access. Barriers included out of pocket payments, lack of, or inadequate supply of drugs and commodities, equipment, water, electricity and emergency transport. Four lessons (implications) were identified. Firstly, out of pocket payments persisted. Secondly, the health system was not strengthened before implementing the free maternal health policy. Thirdly, lower level facilities were poorly resourced. Finally, the lack of essential inputs and infrastructure affected quality of care and therefore, access to care. It is suggested that the Government of Ghana, the Health Insurance Scheme and other stakeholders improve the provision of resources to facilities.
Wang, A, Homer, C & Dalinjong, PA 2018, 'Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in Northern Ghana', PLoS ONE.View/Download from: UTS OPUS or Publisher's site
The free maternal health policy was implemented in Ghana in 2008 under the National Health Insurance Scheme (NHIS). The policy sought to eliminate out of pocket (OOP) payments and enhance the utilisation of maternal health services. It is unclear whether the policy had altered OOP payments for services. The study explored views on costs and actual OOP payments during pregnancy. The source of funding for payments was also explored.
A convergent parallel mixed methods design, involving quantitative and qualitative data collection approaches. The study was set in the Kassena-Nankana municipality, a rural area in Ghana. Women (n = 406) who utilised services during pregnancy were surveyed. Also, 10 focus groups discussions (FGDs) were held with women who used services during pregnancy as well as 28 in-depth interviews (IDIs) with midwives/nurses (n = 25) and insurance managers/directors (n = 3). The survey was analysed using descriptive statistics, focussing on costs from the women's perspective. Qualitative data were audio recorded, transcribed and translated verbatim into English where necessary. The transcripts were read and coded into themes and sub-themes.
The NHIS did not cover all expenses in relation to maternal health services. The overall mean for OOP cost during pregnancy was GH¢17.50 (US$8.60). Both FGDs and IDIs showed that women especially paid for drugs and ultrasound scan services. Sixty-five percent of the women used savings, whilst twenty-two percent sold assets to meet the OOP cost. Some women were unable to afford payments due to poverty and had to forgo treatment. Participants called for payments to be eliminated and for the NHIS to absorb the cost of emergency referrals. All participants admitted the benefits of the policy.
Women needed to make payments despite the policy. Measures should be put in place to eliminate payments to enable all women to receive services and promote universal health coverage.
Zeki, R, Oats, JJN, Wang, AY, Li, Z, Homer, CSE & Sullivan, EA 2018, 'Cesarean section and diabetes during pregnancy: An NSW population study using the Robson classification.', The journal of obstetrics and gynaecology research, vol. 44, no. 5, pp. 890-898.View/Download from: UTS OPUS or Publisher's site
AIM:The aim of this study was to identify the main contributors to cesarean section (CS) among women with and without diabetes during pregnancy using the Robson classification and to compare CS rates within Robson groups. METHODS:A population-based cohort study was conducted of all women who gave birth in New South Wales, Australia, between 2002 and 2012. Women with pregestational diabetes (types 1 and 2) and gestational diabetes mellitus (GDM) were grouped using the Robson classification. Adjusted odd ratios (AOR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression. RESULTS:The total CS rate was 53.6% for women with pregestational diabetes, 36.8% for women with GDM and 28.5% for women without diabetes. Previous CS contributed the most to the total number of CS in all populations. For preterm birth, the contribution to the total was 20.5% for women with pregestational diabetes and 5.7% for women without diabetes. Compared to women without diabetes, for nulliparous with pregestational diabetes, the odds of CS was 1.4 (95% CI, 1.1-1.8) for spontaneous labor and 2.0 (95% CI, 1.7-2.3) for induction of labor. CONCLUSION:A history of CS was the main contributor to the total CS. Reducing primary CS is the first step to lowering the high rate of CS among women with diabetes. Nulliparous women were more likely to have CS if they had pregestational diabetes. This increase was also evident in all multiparous women giving birth. The high rate of preterm births and CS reflects the clinical issues for women with diabetes during pregnancy.
Zeki, R, Wang, AY, Lui, K, Li, Z, Oats, JJN, Homer, CSE & Sullivan, EA 2018, 'Neonatal outcomes of live-born term singletons in vertex presentation born to mothers with diabetes during pregnancy by mode of birth: a New South Wales population-based retrospective cohort study.', BMJ Paediatrics Open, vol. 2, no. 1, pp. e000224-e000224.View/Download from: UTS OPUS or Publisher's site
To investigate the association between the mode of birth and adverse neonatal outcomes of macrosomic (birth weight ≥4000 g) and non-macrosomic (birth weight <4000 g) live-born term singletons in vertex presentation (TSV) born to mothers with diabetes (pre-existing and gestational diabetes mellitus (GDM)).A population-based retrospective cohort study.New South Wales, Australia.All live-born TSV born to mothers with diabetes from 2002 to 2012.Comparison of neonatal outcomes by mode of birth (prelabour caesarean section (CS) and planned vaginal birth resulted in intrapartum CS, non-instrumental or instrumental vaginal birth).Five-minute Apgar score <7, admission to neonatal intensive care unit (NICU) or special care nursery (SCN) and the need for resuscitation.Among the 48 882 TSV born to mothers with diabetes, prelabour CS was associated with a significant increase in the rate of admission to NICU/SCN compared with planned vaginal birth.For TSV born to mothers with pre-existing diabetes, compared with non-instrumental vaginal birth, instrumental vaginal birth was associated with increased odds of the need for resuscitation in macrosomic (adjusted ORs (AOR) 2.6; 95% CI (1.2 to 7.5)) and non-macrosomic TSV (AOR 3.3; 95% CI (2.2 to 5.0)).For TSV born to mothers with GDM, intrapartum CS was associated with increased odds of the need for resuscitation compared with non-instrumental vaginal birth in non-macrosomic TSV (AOR 2.3; 95% CI (2.1 to 2.7)). Instrumental vaginal birth was associated with increased likelihood of requiring resuscitation compared with non-instrumental vaginal birth for both macrosomic (AOR 2.3; 95% CI (1.7 to 3.1)) and non-macrosomic (AOR 2.5; 95% CI (2.2 to 2.9)) TSV.Pregnant women with diabetes, particularly those with suspected fetal macrosomia, need to be aware of the increased likelihood of adverse neonatal outcomes following instrumental vaginal birth and intrapartum CS when planning mode of birth.
Xu, X, Luckett, T, Wang, AY, Lovell, M & Phillips, JL 2018, 'Cancer pain management needs and perspectives of patients from Chinese backgrounds: a systematic review of the Chinese and English literature', PALLIATIVE & SUPPORTIVE CARE, vol. 16, no. 6, pp. 785-799.View/Download from: UTS OPUS or Publisher's site
Baldwin, R, Chenoweth, L, Dela Rama, M & Wang, AY 2017, 'Does size matter in aged care facilities? A literature review of the relationship between the number of facility beds and quality.', Health care management review, vol. 42, no. 4, pp. 315-327.View/Download from: UTS OPUS or Publisher's site
Theory suggests that structural factors such as aged care facility size (bed numbers) will influence service quality. There have been no recent published studies in support of this theory, and consequently, the available literature has not been useful in assisting decision makers with investment decisions on facility size.The study aimed to address that deficit by reviewing the international literature on the relationships between the size of residential aged care facilities, measured by number of beds, and service quality.A systematic review identified 30 studies that reported a relationship between facility size and quality and provided sufficient details to enable comparison. There are three groups of studies based on measurement of quality-those measuring only resident outcomes, those measuring care and resident outcomes using composite tools, and those focused on regulatory compliance.The overall findings support the posited theory to a large extent, that size is a factor in quality and smaller facilities yield the most favorable results. Studies using multiple indicators of service quality produced more consistent results in favor of smaller facilities, as did most studies of regulatory compliance.The theory that aged care facility size (bed numbers) will influence service quality was supported by 26 of the 30 studies reviewed.The review findings indicate that aged care facility size (number of beds) may be one important factor related to service quality. Smaller facilities are more likely to result in higher quality and better outcomes for residents than larger facilities. This has implications for those who make investment decisions concerning aged care facilities. The findings also raise implications for funders and policy makers to ensure that regulations and policies do not encourage the building of facilities inconsistent with these findings.
Koller-Smith, LI, Shah, PS, Ye, XY, Sjörs, G, Wang, YA, Chow, SSW, Darlow, BA, Lee, SK, Håkanson, S, Lui, K, Australian and New Zealand Neonatal Network, Canadian Neonatal Network & Swedish Neonatal Quality Register 2017, 'Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants.', BMC Pediatrics, vol. 17, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes.Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared.VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and ≥32 weeks, AUC 0.50-0.65; ≥1500 g and <32 weeks, AUC 0.60-0.62).There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking.
Oei, JL, Saugstad, OD, Lui, K, Wright, IM, Smyth, JP, Craven, P, Wang, YA, McMullan, R, Coates, E, Ward, M, Mishra, P, De Waal, K, Travadi, J, See, KC, Cheah, IGS, Lim, CT, Choo, YM, Kamar, AA, Cheah, FC, Masoud, A & Tarnow-Mordi, W 2017, 'Targeted Oxygen in the Resuscitation of Preterm Infants, a Randomized Clinical Trial', Pediatrics, vol. 139, no. 1.View/Download from: UTS OPUS or Publisher's site
Copyright © 2017 by the American Academy of Pediatrics. BACKGROUND AND OBJECTIVES: Lower concentrations of oxygen (O abstract 2) (≤30%) are recommended for preterm resuscitation to avoid oxidative injury and cerebral ischemia. Effects on long-term outcomes are uncertain. We aimed to determine the effects of using room air (RA) or 100% O2 on the combined risk of death and disability at 2 years in infants <32 weeks' gestation. METHODS: A randomized, unmasked study designed to determine major disability and death at 2 years in infants <32 weeks' gestation after delivery room resuscitation was initiated with either RA or 100% O2 and which were adjusted to target pulse oximetry of 65% to 95% at 5 minutes and 85% to 95% until NICU admission. RESULTS: Of 6291 eligible patients, 292 were recruited and 287 (mean gestation: 28.9 weeks) were included in the analysis (RA: n = 144; 100% O2: n = 143). Recruitment ceased in June 2014, per the recommendations of the Data and Safety Monitoring Committee owing to loss of equipoise for the use of 100% O2. In non-prespecified analyses, infants <28 weeks who received RA resuscitation had higher hospital mortality (RA: 10 of 46 [22%]; than those given 100% O2: 3 of 54 [6%]; risk ratio: 3.9 [95% confidence interval: 1.1-13.4]; P = .01). Respiratory failure was the most common cause of death (n = 13). CONCLUSIONS: Using RA to initiate resuscitation was associated with an increased risk of death in infants <28 weeks' gestation. This study was not a prespecified analysis, and it was underpowered to address this post hoc hypothesis reliably. Additional data are needed.
Sanderson, E, Yeo, KT, Wang, AY, Callander, I, Bajuk, B, Bolisetty, S, Lui, K, Bowen, J, Bajuk, B, Sedgley, S, Carlisle, H, Kent, A, Smith, J, Craven, P, Cruden, L, Argomand, A, Rieger, I, Malcolm, G, Lutz, T, Reid, S, Stack, J, Medlin, K, Marcin, K, Shingde, V, Chin, MF, Bonzer, K, Badawi, N, Halliday, R, Karskens, C, Paradisis, M, Kluckow, M, Jacobs, C, Numa, A, Williams, G, Young, J, Luig, M, Baird, J, Lui, K, Oei, JL & Cameron, D 2017, 'Dwell time and risk of central-line-associated bloodstream infection in neonates', Journal of Hospital Infection, vol. 97, no. 3, pp. 267-274.View/Download from: UTS OPUS or Publisher's site
© 2017 The Healthcare Infection Society Background Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs), widely used in high-risk neonates, may have a threshold dwell time for subsequent increased risk of central-line-associated bloodstream infection (CLABSI). Aim To evaluate the CLABSI risks in neonates having either UVC, PICC, or those having both sequentially. Methods The study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional neonatal intensive care units: 1392 having UVC only (group 1), 1317 PICC only (group 2), and 1276 both UVC and PICC (group 3). Findings There were 403 CLABSIs among 6000 venous catheters inserted, totalling 43,302 catheter-days. CLABSI rates were higher in group 3 infants who were of lowest gestation (16.9 per 1000 UVC-days and 12.5 per 1000 PICC-days; median: 28 weeks) when compared with group 1 (3.3 per 1000 UVC-days; 37 weeks) and group 2 (4.8 per 1000 PICC-days; 30 weeks). Life table and Kaplan–Meier hazard analysis showed that UVC CLABSI rate increased stepwise to 42 per 1000 UVC-days by day 10, with the highest rate in group 3 (85 per 1000 UVC-days). PICC CLABSI rates remained relatively stable at 12–20 per 1000 PICC-days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk than late replacement. Conclusion There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 might be considered.
Wang, AY, Chughtai, AA, Lui, K & Sullivan, EA 2017, 'Morbidity and mortality among very preterm singletons following fertility treatment in Australia and New Zealand, a population cohort study.', BMC Pregnancy and Childbirth, vol. 17, no. 50, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Due to high rates of multiple birth and preterm birth following fertility treatment, the rates of mortality and morbidity among births following fertility treatment were higher than those conceived spontaneously. However, it is unclear whether the rates of adverse neonatal outcomes remain higher for very preterm (<32 weeks gestational age) singletons born after fertility treatment. This study aims to compare adverse neonatal outcomes among very preterm singletons born after fertility treatment including assisted reproductive technology (ART) hyper-ovulution (HO) and artificial insemination (AI) to those following spontaneous conception. METHODS: The population cohort study included 24069 liveborn very preterm singletons who were admitted to Neonatal Intensive Care Unit (NICU) in Australia and New Zealand from 2000 to 2010. The in-hospital neonatal mortality and morbidity among 21753 liveborn very preterm singletons were compared by maternal mode of conceptions: spontaneous conception, HO, ART and AI. Univariate and multivariate binary logistic regression analysis was used to examine the association between mode of conception and various outcome factors. Odds ratio (OR) and adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated. RESULTS: The rate of small for gestational age was significantly higher in HO group (AOR 1.52, 95% CI 1.02-2.67) and AI group (AOR 2.98, 95% CI 1.53-5.81) than spontaneous group. The rate of birth defect was significantly higher in ART group (AOR 1.71, 95% CI 1.36-2.16) and AI group (AOR 3.01, 95% CI 1.47-6.19) compared to spontaneous group. Singletons following ART had 43% increased odds of necrotizing enterocolitis (AOR 1.43, 95% CI 1.04-1.97) and 71% increased odds of major surgery (AOR 1.71, 95% CI 1.37-2.13) compared to singletons conceived spontaneously. Other birth and NICU outcomes were not different among the comparison groups. CONCLUSIONS: Compared to the spontaneous conception group, risk of conge...
Yeo, KT, Safi, N, Wang, AW, Le Marsney, R, Schindler, T, S, B, Haslam, R & Lui, K 2017, 'Prediction of outcomes of extremely low gestational age newborns in Australia and New Zealand', BMJ Paediatrics Open, vol. 1, no. 1, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
Objective To determine the accuracy of the National Institute of Child Health and Human Development (NICHD) calculator in predicting death and neurodevelopmental impairment in Australian and New Zealand infants.
Design Population-based cohort study.
Setting Australia and New Zealand.
Patients Preterm infants 22–25 completed weeks gestation.
Interventions Comparison of NICHD calculator predicted rates of death and death or neurodevelopmental impairment, with actual rates recorded in the Australian and New Zealand Neonatal Network cohort.
Main outcome measures Infant death and death or neurodevelopmental impairment rates.
Results A total of 714 infants were included in the study. Of these infants, 100 (14.0%) were <24 weeks, 389 (54.5%) male, 529 (74.1%) were singletons, 42 (5.9%) had intrauterine growth restriction, 563 (78.9%) received antenatal steroids and 625 (87.5 %) were born in a tertiary hospital. There were 288 deaths (40.3%), 75 infants (10.5%) with neurodevelopment impairment and 363 (50.8%) with death or neurodevelopmental impairment. The area under the curve (AUC) for prediction of death and the composite death or neurodevelopmental impairment by the NICHD calculator in our population was 0.65(95% CI 0.61 to 0.69) and 0.65 (95% CI 0.61 to 0.69), respectively. When stratified and compared with gestational age outcomes, the AUC did not change substantially for the outcomes investigated. The calculator was less accurate with outcome predictions at the extreme categories of predicted outcomes—underestimation of outcomes for those predicted to have the lowest risk (<20%) and overestimation for those in the highest risk category (>80%).
Conclusion In our recent cohort of extremely preterm infants, the NICHD model does not accurately predict outcomes and is marginally better than gestational age based outcomes.
Dalinjong, PA, Wang, A & Homer 2017, 'The operations of the free maternal care policy and out of pocket payments during childbirth in rural Northern Ghana.', Health Economics Review, vol. 7, no. 41, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
To promote skilled attendance at births and reduce maternal deaths, the government of Ghana introduced the free maternal care policy under the National Health Insurance Scheme (NHIS) in 2008. The objective is to eliminate financial barriers associated with the use of services. But studies elsewhere showed that out of pocket (OOP) payments still exist in the midst of fee exemptions. The aim of this study was to estimate OOP payments and the financial impact on women during childbirth in one rural and poor area of Northern Ghana; the Kassena-Nankana municipality. Costs were taken from the perspective of women.
Quantitative and qualitative data collection techniques were used in a convergent parallel mixed methods study. The study used structured questionnaire (n = 353) and focus group discussions (FGDs =7) to collect data from women who gave birth in health facilities. Quantitative data from the questionnaire were analysed, using descriptive statistics. Qualitative data from the FGDs were recorded, transcribed and analysed to determine common themes.
The overall mean OOP payments during childbirth was GH¢33.50 (US$17), constituting 5.6% of the average monthly household income. Over one-third (36%, n = 145) of women incurred OOP payments which exceeded 10% of average monthly household income (potentially catastrophic). Sixty-nine percent (n = 245) of the women perceived that the NHIS did not cover all expenses incurred during childbirth; which was confirmed in the FGDs. Both survey and FGDs demonstrated that women made OOP payments for drugs and other supplies. The FGDs showed women bought disinfectants, soaps, rubber pads and clothing for newborns as well. Seventy-five percent (n = 264) of the women used savings, but 19% had to sell assets to finance the payments; this was supported in the FGDs.
The NHIS policy has not eliminated financial barriers associated with childbirth which impacts the welfare of some women. Women con...
Dalinjong, PA, Wang, A & Homer, C 2017, 'Demand- and supply-side factors affecting the availability of maternal health services during pregnancy in the era of the free maternal health policy: Views and perceptions of women and health providers in rural Northern Ghana', International Journal of Health Policy and Management.
Farquhar, CM, Li, Z, Lensen, S, McLintock, C, Pollock, W, Peek, MJ, Ellwood, D, Knight, M, Homer, CS, Vaughan, G, Wang, A & Sullivan, E 2017, 'Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case-control study.', BMJ Open, vol. 7, no. 10, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
Estimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes.Case-control study.Sites in Australia and New Zealand with at least 50 births per year.Cases were women giving birth (≥20 weeks or fetus ≥400 g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a case. A total of 295 cases were included and 570 controls.Data were collected using the Australasian Maternity Outcomes Surveillance System.Incidence, risk factors (eg, prior caesarean section (CS), maternal age) and clinical outcomes of placenta accreta (eg CS, hysterectomy and death).The incidence of placenta accreta was 44.2/100 000 women giving birth (95% CI 39.4 to 49.5); however, this may overestimated due to the case definition used. In primiparous women, an increased odds of placenta accreta was observed in older women (adjusted OR (AOR) women≥40 vs <30: 19.1, 95% CI 4.6 to 80.3) and current multiple birth (AOR: 6.1, 95% CI 1.1 to 34.1). In multiparous women, independent risk factors were prior CS (AOR ≥2 prior sections vs 0: 13.8, 95% CI 7.4 to 26.1) and current placenta praevia (AOR: 36.3, 95% CI 14.0 to 93.7). There were two maternal deaths (case fatality rate 0.7%).Women with placenta accreta were more likely to have a caesarean section (AOR: 4.6, 95% CI 2.7 to 7.6) to be admitted to the intensive care unit (ICU)/high dependency unit (AOR: 46.1, 95% CI 22.3 to 95.4) and to have a hysterectomy (AOR: 209.0, 95% CI 19.9 to 875.0). Babies born to women with placenta accreta were more likely to be preterm, be admitted to neonatal ICU and require resuscitation.
Costello, MF, Chew, CYM, Lindsay, K, Wang, A & McNally, G 2016, 'Effect of polycystic ovaries on in vitro fertilization and intra-cytoplasmic sperm injection treatment outcome', Asian Pacific Journal of Reproduction, vol. 5, no. 3, pp. 182-187.View/Download from: Publisher's site
© 2016 Hainan Medical College. Objective: The reproductive performance of women with polycystic ovaries (PCO) with regular ovulatory menstrual cycles undergoing in vitro fertilization and intra-cytoplasmic sperm injection (IVF/ICSI) treatment has not been well described. This study aimed to investigate the outcome of IVF/ICSI in ovulatory women with PCO. Methods: A retrospective cohort study of women aged ≤ 42 years with infertility and regular ovulatory menstrual cycles who underwent their first IVF/ICSI cycle using the long down regulation protocol at IVF Australia-EAST in Sydney between 2000 and 2011. A pre-treatment baseline transvaginal pelvic ultrasound (TVS) had been performed by a single tertiary level diagnostic ultrasound center. Patients were divided into either group NO (normal ovaries) or group PCO according to the pre-treatment TVS. The primary outcome measure was live birth rate per patient. Results: A total of 200 patients (135 in group NO and 65 in group PCO) were included in the data analysis. There was no difference in live birth rate per patient between the two groups (25.2% vs 26.2%) with both raw (OR [95% CI] = 1.05 [0.54-2.07]) and logistic regression adjusted (for maternal age) (Adjusted OR [95% CI] = 0.99 [0.50-1.98]) data. Conclusions: The presence of PCO in ovulatory women did not adversely affect IVF/ICSI outcome at our unit. However, the results are not conclusive and further large, well-designed prospective cohort studies are required in order to confirm our findings.
Wang, AY, Dill, SK, Bowman, M & Sullivan, EA 2016, 'Gestational surrogacy in Australia 2004-2011: treatment, pregnancy and birth outcomes', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 56, no. 3, pp. 255-259.View/Download from: UTS OPUS or Publisher's site
Wang, YA, Chughtai, AA, Farquhar, CM, Pollock, W, Lui, K & Sullivan, EA 2016, 'Increased incidence of gestational hypertension and preeclampsia after assisted reproductive technology treatment', FERTILITY AND STERILITY, vol. 105, no. 4, pp. 920-+.View/Download from: UTS OPUS or Publisher's site
Li, Z, Sullivan, EA, Chapman, M, Farquhar, C & Wang, YA 2015, 'Risk of ectopic pregnancy lowest with transfer of single frozen blastocyst', HUMAN REPRODUCTION, vol. 30, no. 9, pp. 2048-2054.View/Download from: UTS OPUS or Publisher's site
Chambers, GM, Chughtai, AA, Farquhar, CM & Wang, YA 2015, 'Risk of preterm birth after blastocyst embryo transfer: a large population study using contemporary registry data from Australia and New Zealand', Fertility and Sterility, vol. 104, no. 4, pp. 997-1003.View/Download from: UTS OPUS or Publisher's site
To investigate whether there is an increased risk of preterm birth with blastocyst transfer compared with cleavage-stage embryo transfer (ET) after assisted reproductive technology (ART).
Yeo, KT, Lee, QY, Quek, WS, Wang, YA, Bolisetty, S & Lui, K 2015, 'Trends in Morbidity and Mortality of Extremely Preterm Multiple Gestation Newborns', PEDIATRICS, vol. 136, no. 2, pp. 263-271.View/Download from: UTS OPUS or Publisher's site
Sullivan, EA, Dickinson, JE, Vaughan, GA, Peek, MJ, Ellwood, D, Homer, CSE, Knight, M, McLintock, C, Wang, A, Pollock, W, Pulver, LJ, 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.View/Download from: UTS OPUS or Publisher's site
Chenoweth, L, Stein-Parbury, J, Lapkin, S & Wang, A 2015, 'Organisational interventions for promoting person-centred care for people with dementia', The Cochrane Library, vol. 2015, no. 11, pp. 1-11.View/Download from: UTS OPUS or Publisher's site
This is the protocol for a review and there is no abstract. The objectives are as follows:
Primary objective: To determine the effectiveness of organisation-wide interventions to implement person-centred care for people with dementia, in relation to reduction of behavioural symptoms such as agitation and depression, improvement in quality of life and functional capabilities, alterations in the use of restraint (physical and/or chemical) and reduction in adverse events.
Secondary objective: To identify the variety, quality, and feasibility of person-centred care approaches for people with dementia, with specific reference to organisational factors which promote and constrain the implementation of person-centred care.
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.View/Download from: Publisher's site
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.
Li, Z, Wang, YA, Ledger, W, Edgar, DH & Sullivan, EA 2014, 'Clinical outcomes following cryopreservation of blastocysts by vitrification or slow freezing: a population-based cohort study', HUMAN REPRODUCTION, vol. 29, no. 12, pp. 2794-2801.View/Download from: UTS OPUS or Publisher's site
Xu, XK, Wang, YA, Li, Z, Lui, K & Sullivan, EA 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.View/Download from: UTS OPUS or Publisher's site
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...
Chen, Z, Wong, V, Wang, A & Moore, KH 2014, 'Nine-year objective and subjective follow-up of the ultra-lateral anterior repair for cystocele.', International Urogynecology Journal, vol. 25, no. 3, pp. 387-392.View/Download from: UTS OPUS or Publisher's site
INTRODUCTION AND HYPOTHESIS: The aim of this study was to determine the long-term objective and subjective outcomes of the native tissue ultra-lateral anterior repair for cystocele. METHODS: An observational study of patients from a single tertiary centre was carried out from January 1994 to December 2006. Patients who underwent an ultra-lateral anterior repair during this period were sent the Pelvic Floor Distress Inventory (PFDI) questionnaire and invited to return for a POP-Q examination. Symptoms of prolapse, stage of cystocele recurrence and reoperation rate were assessed at follow-up. RESULTS: Of the 135 patients recruited, 53 also had a POP-Q examination. Mean follow-up was 9.25 years (SD 3.2). The anatomical recurrence rate was 45 % at 9.25 years, but only 26 % of patients had recurrent prolapse symptoms. Most recurrences (43 %) occurred at between 1 and 5 years. The reoperation rate for cystocele was 7.4 %. CONCLUSION: Despite these rates of anatomical and symptomatic recurrence, only 7.4 % of patients underwent repeat cystocele surgery. Thus, symptomatic/anatomical recurrence of prolapse often does not mandate surgical correction. Considering that mesh complications require surgical management in approximately 10–15 %, this study supports the notion that the use of mesh in anterior vaginal repairs to reduce the risk of 'recurrence' needs careful discussion with each patient.
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.View/Download from: UTS OPUS or Publisher's site
Chughtai, AA, MacIntyre, CR, Wang, YA, Gao, Z & Khan, W 2013, 'Treatment outcomes of various types of tuberculosis in Pakistan, 2006 and 2007', Eastern Mediterranean Health Journal, vol. 19, no. 6, pp. 535-541.View/Download from: UTS OPUS
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, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
There is a need to have uniformed reporting of perinatal mortality for births following assisted reproductive technology (ART) treatment to enable international comparison and benchmarking of ART practice.
The Australian and New Zealand Assisted Reproduction Database was used in this study. Births of ≥ 20 weeks gestation and/or ≥ 400 grams of birth weight following embryos transfer cycles in Australia and New Zealand during the period 2004 to 2008 were included. Differences in the mortality rates by different perinatal periods from a gestational age cutoff of ≥ 20, ≥ 22, ≥ 24, or ≥ 28 weeks (wks) to a neonatal period cutoff of either < 7 or < 28 days after birth were assessed. Crude and specific (number of embryos transferred and plurality) rates of perinatal mortality were calculated for selected gestational and neonatal periods.
When the perinatal period is defined as ≥ 20 wks gestation to < 28 days after birth, the perinatal mortality rate (PMR) was 16.1 per 1000 births (n = 630). A progressive contraction of the gestational age groups resulted in marked reductions in the PMR for deaths at < 28 days (22 wks 11.0; 24 wks 7.7; 28 wks 5.6); and similarly for deaths at < 7 days (20 wks 15.6, 22 wks 10.5; 24 wks 7.3; 28 wks 5.3). In contrast, a contraction of the perinatal period from < 28 to < 7 days after birth only marginally reduced the PMR from 16.2 to 15.6 per 1000 births which was consistent across all gestational ages.
The PMR for single embryo transfer (SET) births (≥ 20 weeks gestation to < 7 days post-birth) was significantly lower (12.8 per 1000 SET births) compared to double embryo transfer (DET) births (PMR 18.3 per 1000 DET births; p < 0.001, Fisher's Exact Test). Similarly, the PMR for SET births (≥ 22 weeks gestation to < 7 days post-birth) was significantly lower (8.8 per 1000 SET births, p < 0.001, Fisher's Exact Test) when compared to DET births (12.2 per 1000 DET births). The highest PMR (50.5 per 1000 SET births, ...
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.View/Download from: UTS OPUS or Publisher's site
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.
Wang, YA, Nikravan, R, Smith, HC & Sullivan, EA 2013, 'Higher prevalence of gestational diabetes mellitus following assisted reproduction technology treatment', HUMAN REPRODUCTION, vol. 28, no. 9, pp. 2554-2561.View/Download from: UTS OPUS or Publisher's site
Yao, Q-Q, Dong, X-L, Wang, X-C, Ge, S-X, Hu, A-Q, Liu, H-Y, Wang, YA, Yuan, Q & Zheng, Y-J 2013, 'Hepatitis B Virus Surface Antigen (HBsAg)-Positive and HBsAg-Negative Hepatitis B Virus Infection among Mother-Teenager Pairs 13 Years after Neonatal Hepatitis B Virus Vaccination', CLINICAL AND VACCINE IMMUNOLOGY, vol. 20, no. 2, pp. 269-275.View/Download from: UTS OPUS or Publisher's site
Moore, KH, Shahab, RB, Walsh, CA, Kuteesa, WMA, Sarma, S, Cebola, M, Allen, W, Wang, YA & Karantanis, E 2012, 'Randomized controlled trial of cough test versus no cough test in the tension-free vaginal tape procedure: effect upon voiding dysfunction and 12-month efficacy', INTERNATIONAL UROGYNECOLOGY JOURNAL, vol. 23, no. 4, pp. 435-441.View/Download from: UTS OPUS or Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
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.
Barbaro, PM, Johnston, K, Dalla-Pozza, L, Cohn, RJ, Wang, YA, Marshall, GM & Ziegler, DS 2011, 'Reduced incidence of second solid tumors in survivors of childhood Hodgkin's lymphoma treated without radiation therapy', ANNALS OF ONCOLOGY, vol. 22, no. 12, pp. 2569-2574.View/Download from: UTS OPUS or Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
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.
Farquhar, CM, Wang, YA & Sullivan, EA 2010, 'A comparative analysis of assisted reproductive technology cycles in Australia and New Zealand 2004-2007', HUMAN REPRODUCTION, vol. 25, no. 9, pp. 2281-2289.View/Download from: Publisher's site
Lai, PK, Wang, YA & Welsh, AW 2010, 'Reproducibility of regional placental vascularity/perfusion measurement using 3D power Doppler', ULTRASOUND IN OBSTETRICS & GYNECOLOGY, vol. 36, no. 2, pp. 202-208.View/Download from: Publisher's site
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.View/Download from: UTS OPUS or Publisher's site
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)
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.View/Download from: UTS OPUS or Publisher's site
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.
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.View/Download from: UTS OPUS or Publisher's site
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.
Sullivan, E, Ellwood, D, Peek, M, Knight, M, Jackson Pulver, LR, Homer, CS, 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.View/Download from: UTS OPUS
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, 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.View/Download from: UTS OPUS
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, 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, vol. 23, no. 7, pp. 1639-1643.View/Download from: Publisher's site
Wang, YA, Healy, D, Black, D & Sullivan, EA 2008, 'Age-specific success rate for women undertaking their first assisted reproduction technology treatment using their own oocytes in Australia, 2002-2005', HUMAN REPRODUCTION, vol. 23, no. 7, pp. 1633-1638.View/Download from: Publisher's site
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, SK, Dahlen, H, Caplice, SL, Laws, P, Wang, Y, Tracy, MB & 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.View/Download from: UTS OPUS or Publisher's site
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, SK, Sullivan, E, Wang, YA, Black, D & Tracy, M 2007, 'Birth outcomes associated with interventions in labour amongst low risk women: A population-based study', Women and Birth, vol. 20, no. 2, pp. 41-48.View/Download from: Publisher's site
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. © 2007.
Tracy, SK, Sullivan, E, Dahlen, H, Black, D, Wang, YPA & Tracy, MB 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.View/Download from: Publisher's site
Henry, A, Birch, MR, Sullivan, EA, Katz, S & Wang, YPA 2005, 'Primary postpartum haemorrhage in an Australian tertiary hospital: a case-control study', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 45, no. 3, pp. 233-236.View/Download from: Publisher's site
Wang, YA, Sullivan, EA, 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.View/Download from: Publisher's site
Yu, H, Wang, YA, Lu, Y & Wang, Y 2002, 'Syphilis in Entry-Exit Population in Ningbo Port (1995–1999)', Journal For China AIDS/STD Prevention And Control, vol. 6, no. 6, pp. 374-376.
Sun, D, Wang, YA & Hong, C 1996, 'Talk about the Administrative Punishment of Frontier Health & Quarantine', Chinese Journal of Frontier Health & Quarantine.
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.
Victorian Assisted Reproductive Treatment Authority 2017, VARTA Annual Report 2017: Outcome of treatment procedures., Melbourne, VARTA.
Victorian Assisted Reproductive Treatment Authority 2016, VARTA Annual Report 2016: Outcome of treatment procedures., Melbourne, VARTA.
Victorian Assisted Reproductive Treatment Authority 2015, VARTA Annual Report 2015: Outcome of treatment procedures., Melbourne, VARTA.
Macaldowie, A, Wang, YA, Chughtai, AA & Chambers, GM University of New South Wales 2014, Assisted reproductive technology in Australia and New Zealand 2012, Sydney, National Perinatal Epidemiology and Statistics Unit.
Victorian Assisted Reproductive Treatment Authority 2014, VARTA Annual Report 2014: Outcome of treatment procedures., Melbourne, VARTA.
2.Macaldowie, A, Wang, A, Chambers, GM & Sullivan, EA University of New South Wales 2013, Assisted reproductive technology in Australia and New Zealand 2011, Sydney: National Perinatal Epidemiology and Statistics Unit.
Victorian Assisted Reproductive Treatment Authority 2013, VARTA Annual Report 2013: Outcome of treatment procedures., Melbourne, VARTA.
Australian Institute of Health and Welfare & Wang, A 2012, Australia's health 2012, no. Cat. no. AUS 156, Canberra: AIHW.
Macaldowie, A, Wang, YA, Chambers, GM & Sullivan, E AIHW 2012, Assisted reproductive technology in Australia and New Zealand 2010, Assisted reproduction technology series, no. Cat. no. PER 55, Canberra.
Victorian Assisted Reproductive Treatment Authority 2012, VARTA Annual Report 2012: Outcome of treatment procedures, Melbourne, VARTA.
Victorian Assisted Reproductive Treatment Authority 2011, VARTA Annual Report 2011: Outcome of treatment procedures., Melbourne, VARTA.
Wang, YA, Macaldowie, A, Chambers, GM & Sullivan, EA AIHW 2011, Assisted Reproductive Technology in Australia and New Zealand 2009, Assisted reproduction technology Series No. 15, no. Cat No. PER 49, Canberra.
Wang, YA, Chambers, GM, Dieng, M & Sullivan, EA 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.
Wang, YA, Dean, JH, 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.
Wang, YA, Dean, JH & 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.
- Fudan University (Shanghai, China)
- University of New South Wales
- Victorian Assisted Reproductive Treatment Authority