Ongzalima, CO, Greenland, M, Vaughan, G, Ng, A, Fitz-Gerald, JA, Sanfilippo, FM, Dickinson, JE, Hung, J & Katzenellenbogen, JM 2020, 'Rheumatic heart disease in pregnancy: Profile of women admitted to a Western Australian tertiary obstetric hospital.', The Australian & New Zealand journal of obstetrics & gynaecology.View/Download from: Publisher's site
This retrospective study assessed maternal and perinatal outcomes for women with rheumatic heart disease (RHD) admitted to the largest tertiary obstetric hospital in Western Australia from 2009 to 2016. Of 54 women identified, 75.9% were Indigenous, 59.3% lived in rural areas and 40.7% had severe RHD. Heart failure developed in 10% who gave birth. Indigenous women were younger, had higher gravidity (P = 0.0305), were more likely to receive secondary prophylaxis (P = 0.0041) and have sub-optimal antenatal clinic attendance (P = 0.0078). There were no maternal deaths and two perinatal deaths (4.0%), reflecting vigilance in the obstetric management of women with RHD in Western Australia.
Pollock, W, Peek, MJ, Wang, A, Li, Z, Ellwood, D, Homer, CSE, Jackson Pulver, L, McLintock, C, Vaughan, G, Knight, M & Sullivan, EA 2020, 'Eclampsia in Australia and New Zealand: A prospective population-based study.', The Australian & New Zealand journal of obstetrics & gynaecology.View/Download from: Publisher's site
BACKGROUND:Eclampsia is a serious consequence of pre-eclampsia. There are limited data from Australia and New Zealand (ANZ) on eclampsia. AIM:To determine the incidence, management and perinatal outcomes of women with eclampsia in ANZ. MATERIALS AND METHODS:A two-year population-based descriptive study, using the Australasian Maternity Outcomes Surveillance System (AMOSS), carried out in 263 sites in Australia, and all 24 New Zealand maternity units, during a staggered implementation over 2010-2011. Eclampsia was defined as one or more seizures during pregnancy or postpartum (up to 14 days) in any woman with clinical evidence of pre-eclampsia. RESULTS:Of 136 women with eclampsia, 111 (83%) were in Australia and 25 (17%) in New Zealand. The estimated incidence of eclampsia was 2.2 (95% confidence interval (CI) 1.9-2.7) per 10 000 women giving birth. Aboriginal and Torres Strait Islander women were over-represented in Australia (n = 9; 8.1%). Women with antepartum eclampsia (n = 58, 42.6%) were more likely to have a preterm birth (P = 0.04). Sixty-three (47.4%) women had pre-eclampsia diagnosed prior to their first eclamptic seizure of whom 19 (30.2%) received magnesium sulphate prior to the first seizure. Nearly all women (n = 128; 95.5%) received magnesium sulphate post-seizure. No woman received prophylactic aspirin during pregnancy. Five women had a cerebrovascular haemorrhage, and there were five known perinatal deaths. CONCLUSIONS:Eclampsia is an uncommon consequence of pre-eclampsia in ANZ. There is scope to reduce the incidence of this condition, associated with often catastrophic morbidity, through the use of low-dose aspirin and magnesium sulphate in women at higher risk.
Sullivan, EA, Vaughan, G, Li, Z, Peek, MJ, Carapetis, JR, Walsh, W, Frawley, J, Rémond, M, Remenyi, B, Jackson Pulver, L, Kruske, S, Belton, S & McLintock, C 2020, 'The high prevalence and impact of rheumatic heart disease in pregnancy in First Nations populations in a high-income setting: a prospective cohort study.', BJOG: an International Journal of Obstetrics and Gynaecology, vol. 127, no. 1, pp. 47-56.View/Download from: Publisher's site
OBJECTIVE:To describe the epidemiology of rheumatic heart disease (RHD) in pregnancy in Australia and New Zealand (A&NZ). DESIGN:Prospective population-based study. SETTING:Hospital-based maternity units throughout A&NZ. POPULATION:Pregnant women with RHD with a birth outcome of ≥20 weeks of gestation between January 2013 and December 2014. METHODS:We identified eligible women using the Australasian Maternity Outcomes Surveillance System (AMOSS). De-identified antenatal, perinatal and postnatal data were collected and analysed. MAIN OUTCOME MEASURES:Prevalence of RHD in pregnancy. Perinatal morbidity and mortality. RESULTS:There were 311 pregnancies associated with women with RHD (4.3/10 000 women giving birth, 95% CI 3.9-4.8). In Australia, 78% were Aboriginal or Torres Strait Islander (60.4/10 000, 95% CI 50.7-70.0), while in New Zealand 90% were Māori or Pasifika (27.2/10 000, 95% CI 22.0-32.3). One woman (0.3%) died and one in ten was admitted to coronary or intensive care units postpartum. There were 314 births with seven stillbirths (22.3/1000 births) and two neonatal deaths (6.5/1000 births). Sixty-six (21%) live-born babies were preterm and one in three was admitted to neonatal intensive care or special care units. CONCLUSION:Rheumatic heart disease in pregnancy persists in disadvantaged First Nations populations in A&NZ. It is associated with significant cardiac and perinatal morbidity. Preconception planning and counselling and RHD screening in at-risk pregnant women are essential for good maternal and baby outcomes. TWEETABLE ABSTRACT:Rheumatic heart disease in pregnancy persists in First Nations people in Australia and New Zealand and is associated with major cardiac and perinatal morbidity.
Cullen, P, Vaughan, G, Li, Z & Sullivan, E 2019, 'Counting Dead Women in Australia: An In-Depth Case Review of Femicide', Journal of Family Violence, vol. 34, no. 1, pp. 1-8.View/Download from: Publisher's site
© 2018 Springer Science+Business Media, LLC, part of Springer Nature Gender-based fatal violence (femicide) is a preventable cause of premature death. The Counting Dead Women Australia (CDWA) campaign is a femicide census counting violent deaths of women in Australia from 2014. We conducted a cross-sectional in-depth review of CDWA cases Jan-Dec 2014 to establish evidence of antecedent factors and describe femicide in Australia. Victim (n = 81) and perpetrator (n = 83) data were extracted from the CDWA register, law databases and coronial reports. Mixed methods triangulation of socio-demographic and incident characteristics. Women ranged in age from 20 to 82 years of age (44 ± 15.4). There were 83 perpetrators, of which 13 were unknown (not yet apprehended). Known perpetrators (n = 70) ranged in age from 16 to 72 years of age (40 ± 12.7) and 89% were male (62/70). The location of the crime was most frequently the victim’s home (49/70). In cases where the relationship between the victim and perpetrator was known (n = 59), over half of femicides were committed by intimate-partners (33/59). Intimate-partner perpetrators were more likely to have a history of violence and commit murder-suicide than other perpetrators. Femicide is overwhelmingly perpetrated by males, with women most vulnerable in their own home and with their intimate partners. Furthermore, intimate-partner femicide is associated with modifiable risk factors, including previous violence and mental health issues, which represents opportunities for early intervention within healthcare settings as practitioners are well-placed to identify risk and provide support. In line with recommendations for multi-sectoral approach, future research should target identification of risk and protective factors, and improved coordination of data collection.
Vaughan, G, Dawson, A, Peek, MJ, Carapetis, JR & Sullivan, EA 2019, 'Standardizing clinical care measures of rheumatic heart disease in pregnancy: A qualitative synthesis', BIRTH-ISSUES IN PERINATAL CARE, vol. 46, no. 4, pp. 560-573.View/Download from: Publisher's site
Belton, S, Kruske, S, Jackson Pulver, L, Sherwood, J, Tune, K, Carapetis, J, Vaughan, G, Peek, M, McLintock, C & Sullivan, E 2018, 'Rheumatic heart disease in pregnancy: How can health services adapt to the needs of Indigenous women? A qualitative study.', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 58, no. 4, pp. 425-431.View/Download from: Publisher's site
To study rheumatic heart disease health literacy and its impact on pregnancy, and to identify how health services could more effectively meet the needs of pregnant women with rheumatic heart disease.Researchers observed and interviewed a small number of Aboriginal women and their families during pregnancy, childbirth and postpartum as they interacted with the health system. An Aboriginal Yarning method of relationship building over time, participant observations and interviews with Aboriginal women were used in the study. The settings were urban, island and remote communities across the Northern Territory. Women were followed interstate if they were transferred during pregnancy. The participants were pregnant women and their families. We relied on participants' abilities to tell their own experiences so that researchers could interpret their understanding and perspective of rheumatic heart disease.Aboriginal women and their families rarely had rheumatic heart disease explained appropriately by health staff and therefore lacked understanding of the severity of their illness and its implications for childbearing. Health directives in written and spoken English with assumed biomedical knowledge were confusing and of limited use when delivered without interpreters or culturally appropriate health supports.Despite previous studies documenting poor communication and culturally inadequate care, health systems did not meet the needs of pregnant Aboriginal women with rheumatic heart disease. Language-appropriate health education that promotes a shared understanding should be relevant to the gender, life-stage and social context of women with rheumatic heart disease.
Vaughan, G, Tune, K, Peek, MJ, Jackson Pulver, L, Remenyi, B, Belton, S & Sullivan, EA 2018, 'Rheumatic heart disease in pregnancy: strategies and lessons learnt implementing a population-based study in Australia.', International health, vol. 10, no. 6, pp. 480-489.View/Download from: Publisher's site
Background:The global burden of rheumatic heart disease (RHD) is two-to-four times higher in women, with a heightened risk in pregnancy. In Australia, RHD is found predominantly among Aboriginal and Torres Strait Islander peoples. Methods:This paper reviews processes developed to identify pregnant Australian women with RHD during a 2-year population-based study using the Australasian Maternity Outcomes Surveillance System (AMOSS). It evaluates strategies developed to enhance reporting and discusses implications for patient care and public health. Results:AMOSS maternity coordinators across 262 Australian sites reported cases. An extended network across cardiac, Aboriginal and primary healthcare strengthened surveillance and awareness. The network notified 495 potential cases, of which 192 were confirmed. Seventy-eight per cent were Aboriginal and/or Torres Strait Islander women, with a prevalence of 22 per 1000 in the Northern Territory. Discussion:Effective surveillance was challenged by a lack of diagnostic certainty, incompatible health information systems and varying clinical awareness among health professionals. Optimal outcomes for pregnant women with RHD demand timely diagnosis and access to collaborative care. Conclusion:The strategies employed by this study highlight gaps in reporting processes and the opportunity pregnancy provides for diagnosis and re/engagement with health services to support better continuity of care and promote improved outcomes.
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: 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.
McDonnell, N, Knight, M, Peek, MJ, Ellwood, D, Homer, CS, McLintock, C, Vaughan, G, Pollock, W, Li, Z, Javid, N & Sullivan, E 2015, 'Amniotic fluid embolism: an Australian-New Zealand population-based study.', BMC Pregnancy and Childbirth, vol. 15, no. 1.View/Download from: Publisher's site
Amniotic fluid embolism (AFE) is a major cause of direct maternal mortality in Australia and New Zealand. There has been no national population study of AFE in either country. The aim of this study was to estimate the incidence of amniotic fluid embolism in Australia and New Zealand and to describe risk factors, management, and perinatal outcomes.A population-based descriptive study using the Australasian Maternity Outcomes Surveillance System (AMOSS) carried out in 263 eligible sites (>50 births per year) covering an estimated 96 % of women giving birth in Australia and all 24 New Zealand maternity units (100 % of women giving birth in hospitals) between January 1 2010-December 31 2011. A case of AFE was defined either as a clinical diagnosis (acute hypotension or cardiac arrest, acute hypoxia and coagulopathy in the absence of any other potential explanation for the symptoms and signs observed) or as a post mortem diagnosis (presence of fetal squames/debris in the pulmonary circulation).Thirty-three cases of AFE were reported from an estimated cohort of 613,731women giving birth, with an estimated incidence of 5.4 cases per 100 000 women giving birth (95 % CI 3.5 to 7.2 per 100 000). Two (6 %) events occurred at home whilst 46 % (n = 15) occurred in the birth suite and 46 % (n = 15) in the operating theatre (location not reported in one case). Fourteen women (42 %) underwent either an induction or augmentation of labour and 22 (67 %) underwent a caesarean section. Eight women (24 %) conceived using assisted reproduction technology. Thirteen (42 %) women required cardiopulmonary resuscitation, 18 % (n = 6) had a hysterectomy and 85 % (n = 28) received a transfusion of blood or blood products. Twenty (61 %) were admitted to an Intensive Care Unit (ICU), eight (24 %) were admitted to a High Dependency Unit (HDU) and seven (21 %) were transferred to another hospital for further management. Five woman died (case fatality rate 15 %) giving an estimated maternal morta...
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: Publisher's site
Vaughan, GA & Sullivan, E 2014, 'PT436 Review of Australian hospital birth admissions of women with rheumatic heart disease (RHD)', Global Heart, vol. 9, no. 1, pp. e257-e258.View/Download from: Publisher's site
Vaughan, G, Pollock, W, Peek, M, Knight, M, Ellwood, D, Homer, CS, Pulver, LJ, McLintock, C, Ho, MT & Sullivan, E 2012, 'Ethical issues: The multi-centre low-risk ethics/governance review process and AMOSS', The Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 52, no. 2, pp. 195-203.View/Download from: Publisher's site
The Australasian Maternity Outcomes Surveillance System (AMOSS) conducts surveillance and research of rare and serious conditions in pregnancy. This multi-centre population health study is considered low risk with minimal ethical impact. Objective: To describe the ethics/governance review pathway undertaken by AMOSS. Method: Prospective, descriptive study during 2009- 2011 of the governance/ethical review processes required to gain approval for Australian and New Zealand (ANZ) maternity units with more than 50 births per year (n = 303) to participate in AMOSS. Results: Review processes ranged from a single application for 24 NZ sites, a single application for eligible hospitals in two Australian states, full Health Research Ethics Committee (HREC) applications for individual hospitals, through simple letters of support. As of September 2011, 46 full/expedited ethics applications, 131 site governance applications and 136 letters of support requests were made over 33 months, involving an estimated 3261 hours by AMOSS staff/investigators, and an associated resource burden by participating sites, to obtain approval to receive nonidentifiable data from 291 hospitals. Conclusion: The AMOSS research system provides an important resource to enhance knowledge of conditions that cause rare and serious maternal morbidity. Yet the highly variable ethical approval processes required to implement this study have been excessively repetitive and burdensome. This process jeopardises timely, efficient research project implementation, without corresponding benefits to research participants. The resource burden to establish research governance for AMOSS confirms the urgent need for the Harmonisation of Multi- centre Ethical Review (HoMER) to further streamline ethics/governance review processes for multi- centre research.
Homer, CS, Biggs, JB, Vaughan, G & Sullivan, E 2011, 'Mapping Maternity Services In Australia: Location, Classification And Services', Australian Health Review, vol. 35, no. 2, pp. 222-229.View/Download from: Publisher's site
Abstract Objective. To describe maternity services available to Australian women and, in particular, the location, classification of services and support services available. Design. A descriptive study was conducted using an online survey that was emailed to eligible hospitals. Inclusion criteria for the study included public and private maternity units with greater than 50 births per year. In total, 278 maternity units were identified. Units were asked to classify their level of acuity (Levels 26). Results. A total of 150 (53%) maternity units responded. Those who responded were reasonably similar to those who did not respond, and were representative of Australian maternity units. Almost three-quarters of respondents were from public maternity units and almost 70% defined themselves as being in a rural or remote location. Maternity units with higher birth rates were more likely to classify themselves as providing higher acuity services, that is, Levels 5 and 6. Private maternity units were more likely to have higher acuity classifications. Interventions such as induction of labour, either using an artificial rupture of membranes (ARM) and oxytocin infusion or with prostaglandins, were common across most units. Although electronic fetal monitoring (EFM) was also widely available, access to fetal scalp pH monitoring was low. Conclusion. Maternity service provision varies across the country and is defined predominately by location and annual birth rate.
O'Sullivan, EA, Peek, M, Knight, M, Ellwood, D, Homer, CSE, Pulver, LJ, Vaughan, GA & Callaway, L 2011, 'Extreme morbid obesity in pregnancy: Risk management and resources', WOMEN AND BIRTH, vol. 24, pp. S25-S25.View/Download from: Publisher's site
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.
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.
Vaughan, G, Belton, S, La Vincente, S, Bootle, L & Sullivan, E 2019, 'Using Research: Educational Resources for Rheumatic Heart Disease in Women', Heart Lung and Circulation, Cardiac Society of Australia and New Zealand (CSANZ) 3rd Indigenous Cardiovascular Health Conference, Elsevier, Wellington NZ.View/Download from: Publisher's site
Background: A study of Aboriginal women’s journeys
with Rheumatic Heart Disease (RHD) in Australia found that
women and their families rarely had a deep understanding of
the cause or implications of their disease. Despite contact with
health staff, often since childhood, participants lacked under-
standing of the severity of their illness and its implications
for childbearing. Several information/educational initiatives
were developed to improve health literacy and have informed
Methods: Content review related to an evidence-base of
selected educational resources developed for and by women
with RHD, health services and researchers since 2015.
Results: Three resources were selected for review. The
ﬁrst, an information ﬂier on RHD in pregnancy for health
professionals, was co-designed by Australasian Maternity
Outcomes Surveillance System (AMOSS) researchers, mid-
wives and Aboriginal health practitioners.
The second, ‘Sharing a heartbeat’ is a two-part video in
multiple Aboriginal languages, which explores fertility, preg-
nancy and family for Indigenous women with RHD. It was
written and directed by Aboriginal women in partnership
The third is a ﬂipchart with brief text and corresponding
illustrations, that guides interaction between health providers
and women with RHD in primary health low/middle-income
settings. It was developed by Reach, a global RHD technical
assistance organisation, building on the AMOSS resource.
Discussion: A shared understanding of RHD is essential to
improve knowledge and decision-making about the disease
and its impact for women’s health. The resources described
show how research can learn from and inform a collaborative
approach to health literacy at both local and global levels.
Vaughan, G, Dawson, A, Peek, M, Carapetis, J & Sullivan, E 2019, 'Better Care for Pregnant Women With RHD: What Works?', Heart Lung and Circulation, Cardiac Society of Australia and New Zealand (CSANZ) 3rd Indigenous Cardiovascular Health Conference, Elsevier, Wellington NZ.
Vaughan, G, Wheeler, M, Bootle, L, Wade, V, Noonan, S, Slade, B, Sullivan, E & Vaughan, G 2019, 'CSANZ 3rd Indigenous Cardiovascular Health Conference', Heart Lung and Circulation, Cardiac Society of Australia and New Zealand (CSANZ) 3rd Indigenous Cardiovascular Health Conference, Elsevier, Wellington New Zealand.View/Download from: UTS OPUS or Publisher's site
Cullen, P, Vaughan, G, Li, Z, Price, J, Yu, D & Sullivan, E 2018, 'COUNTING DEAD WOMEN: A REVIEW OF INTIMATE-PARTNER FEMICIDE IN AUSTRALIA', INJURY PREVENTION, BMJ PUBLISHING GROUP, pp. A111-A111.View/Download from: Publisher's site