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, p. hoz004.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....
McCall, SJ, Li, Z, Kurinczuk, JJ, Sullivan, E & Knight, M 2019, 'Maternal and perinatal outcomes in pregnant women with BMI > 50: An international collaborative study', PLOS ONE, vol. 14, no. 2.View/Download from: Publisher's site
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.
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: UTS OPUS or 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.
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,...
McCall, SJ, Li, Z, Kurinczuk, JJ, Sullivan, E & Knight, M 2018, 'Binational cohort study comparing the management and outcomes of pregnant women with a BMI >50-59.9 kg/m2 and those with a BMI ≥60 kg/m2.', BMJ open, vol. 8, no. 8, pp. e021055-e021055.View/Download from: UTS OPUS or Publisher's site
To compare the management, maternal and perinatal outcomes of women with a body mass index (BMI) ≥60 kg/m2 with women with a BMI >50-59.9 kg/m2.International collaborative cohort study.Binational study in the UK and Australia.UK: all pregnant women, and Australia: women who gave birth (birth weight ≥400 g or gestation ≥20 weeks) METHODS: Data from the Australasian Maternity Outcomes Surveillance System and UK Obstetric Surveillance System. Management, maternal and infant outcomes were compared between women with a BMI ≥60 kg/m2 and women with a BMI >50-59.9 kg/m2, using unconditional logistic regression.The sociodemographic characteristics and previous medical histories were similar between the 111 women with a BMI ≥60 kg/m2 and the 821 women with a BMI >50-59.9 kg/m2. Women with a BMI ≥60 kg/m2 had higher odds of thromboprophylaxis usage in both the antenatal (24% vs. 12%; OR 2.25, 95% CI 1.39 to 3.64) and postpartum periods (78% vs. 66%; OR 1.68, 95% CI 1.04 to 2.70). Women with BMI ≥60 kg/m2 had nearly double the odds of pre-eclampsia/eclampsia (adjusted OR 1.83 (95% CI 1.01 to 3.30)). No other maternal or perinatal outcomes were statistically significantly different. Severe adverse outcomes such as perinatal death were uncommon in both groups thus limiting the power of these comparisons. The rate of perinatal deaths was 18 per 1000 births for those with BMI ≥60 kg/m2; 12 per 1000 births for those with BMI >50-59.9 kg/m2; those with BMI ≥60 kg/m2 had a non-significant increased odds of perinatal death (unadjusted OR 1.46, 95% CI 0.31 to 6.74).Women are managed differently on the basis of BMI even at this extreme as shown by thromboprophylaxis. The pre-eclampsia result suggests that future research should examine whether weight reduction of any amount prior to pregnancy could reduce poor outcomes even if women remain extremely obese.
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).
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.
Sullivan, EA, Javid, N, Duncombe, G, Li, Z, Safi, N, Cincotta, R, Homer, CSE, Halliday, L & Oyelese, Y 2017, 'Vasa Previa Diagnosis, Clinical Practice, and Outcomes in Australia.', Obstetrics and Gynecology, vol. 130, no. 3, pp. 591-598.View/Download from: UTS OPUS or Publisher's site
To estimate the incidence of women with vasa previa in Australia and to describe risk factors, timing of diagnosis, clinical practice, and perinatal outcomes.A prospective population-based cohort study was undertaken using the Australasian Maternity Outcomes Surveillance System between May 1, 2013, and April 30, 2014, in hospitals in Australia with greater than 50 births per year. Women were included if they were diagnosed with vasa previa during pregnancy or childbirth, confirmed by clinical examination or placental pathology. The main outcome measures included stillbirth, neonatal death, cesarean delivery, and preterm birth.Sixty-three women had a confirmed diagnosis of vasa previa. The estimated incidence was 2.1 per 10,000 women giving birth (95% CI 1.7-2.7). Fifty-eight women were diagnosed prenatally and all had a cesarean delivery. Fifty-five (95%) of the 58 women had at least one risk factor for vasa previa with velamentous cord insertion (62%) and low-lying placenta (60%) the most prevalent. There were no perinatal deaths in women diagnosed prenatally. For the five women with vasa previa not diagnosed prenatally, there were two perinatal deaths with a case fatality rate of 40%. One woman had an antepartum stillbirth and delivered vaginally and the other four women had cesarean deliveries categorized as urgent threat to the life of a fetus with one neonatal death. The overall perinatal case fatality rate was 3.1% (95% CI 0.8-10.5). Two thirds (68%) of the 65 neonates were preterm and 29% were low birth weight.The outcomes for neonates in which vasa previa was not diagnosed prenatally were inferior with higher rates of perinatal morbidity and mortality. Our study shows a high rate of prenatal diagnosis of vasa previa in Australia and associated good 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: 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.
Mu, Y, McDonnell, N, Li, Z, Liang, J, Wang, Y, Zhu, J & Sullivan, E 2016, 'Amniotic fluid embolism as a cause of maternal mortality in China between 1996 and 2013: a population-based retrospective study.', BMC Pregnancy and Childbirth, vol. 16, no. 1, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: To analyse the maternal mortality ratio, demographic and pregnancy related details in women who suffered a fatal amniotic fluid embolism (AFE) in China. METHODS: A retrospective population based study using data collected as part of the National Maternal Mortality Surveillance System between 1996 and 2013. Data were collected onto a standardised form from women whose cause of death was listed as being secondary to AFE. RESULTS: Records were available for 640 deaths. Over the 17 year period the maternal mortality ratio for AFE decreased from 4.4 per 100,000 births (95 % confidence interval (CI):2.72-6.12) to 1.9 per 100,000 births (95 % CI:1.35-2.54). Over the same period the proportion of maternal deaths secondary to AFE increased from 6.8 to 12.5 %. The mean age of women who died was 30.1 years and the onset of the AFE occurred prior to delivery in 39 %. The most prominent presenting features included premonitory symptoms (29 %), acute fetal compromise (28 %), maternal haemorrhage (16 %) and shortness of breath (15 %). CONCLUSIONS: Maternal mortality secondary to AFE has decreased in China, however at a slower rate than mortality secondary to other conditions. Active surveillance is recommended to assess case fatality rates, risk factors and other lessons specific to this population.
Souza, J, Betran, A, Dumont, A, de Mucio, B, Gibbs Pickens, C, Deneux-Tharaux, C, Ortiz-Panozo, E, Sullivan, E, Ota, E, Togoobaatar, G, Carroli, G, Knight, H, Zhang, J, Cecatti, J, Vogel, J, Jayaratne, K, Leal, M, Gissler, M, Morisaki, N, Lack, N, Oladapo, O, Tunçalp, O, Lumbiganon, P, Mori, R, Quintana, S, Costa Passos, A, Marcolin, A, Zongo, A, Blondel, B, Hernández, B, Hogue, C, Prunet, C, Landman, C, Ochir, C, Cuesta, C, Pileggi-Castro, C, Walker, D, Alves, D, Abalos, E, Moises, E, Vieira, E, Duarte, G, Perdona, G, Gurol-Urganci, I, Takahiko, K, Moscovici, L, Campodonico, L, Oliveira-Ciabati, L, Laopaiboon, M, Danansuriya, M, Nakamura-Pereira, M, Costa, M, Torloni, M, Kramer, M, Borges, P, Olkhanud, P, Pérez-Cuevas, R, Agampodi, S, Mittal, S, Serruya, S, Bataglia, V, Li, Z, Temmerman, M & Gülmezoglu, A 2016, 'A global reference for caesarean section rates (C-Model): A multicountry cross-sectional study', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 123, no. 3, pp. 427-436.View/Download from: Publisher's site
© 2015 RCOG. Objective: To generate a global reference for caesarean section (CS) rates at health facilities. Design: Cross-sectional study. Setting: Health facilities from 43 countries. Population/Sample: Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10 045 875 women giving birth from 43 countries for model testing. Methods: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. Main outcome measures: Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. Results: According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c…). Conclusions: This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS.
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
Li, Z, Umstad, MP, Hilder, L, Xu, F & Sullivan, EA 2015, 'Australian national birthweight percentiles by sex and gestational age for twins, 2001-2010', BMC PEDIATRICS, vol. 15.View/Download from: UTS OPUS or Publisher's site
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: UTS OPUS or 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: UTS OPUS or Publisher's site
Bonello, MR, Xu, F, Li, Z, Burns, L, Austin, M-P & Sullivan, EA 2014, 'Mental and behavioral disorders due to substance abuse and perinatal outcomes: a study based on linked population data in New South Wales, Australia', International Journal of Environmental Research and Public Health, vol. 11, no. 5, pp. 4991-5005.View/Download from: UTS OPUS or Publisher's site
Background: The effects of mental and behavioral disorders (MBD) due to substance use during peri-conception and pregnancy on perinatal outcomes are unclear. The adverse perinatal outcomes of primiparous mothers admitted to hospital with MBD due to substance use before and/or during pregnancy were investigated. Method: This study linked birth and hospital records in NSW, Australia. Subjects included primiparous mothers admitted to hospital for MBD due to use of alcohol, opioids or cannabinoids during peri-conception and pregnancy. Results: There were 304 primiparous mothers admitted to hospital for MBD due to alcohol use (MBDA), 306 for MBD due to opioids use (MBDO) and 497 for MBD due to cannabinoids (MBDC) between the 12 months peri-conception and the end of pregnancy. Primiparous mothers admitted to hospital for MBDA during pregnancy or during both peri-conception and pregnancy were significantly more likely to give birth to a baby of low birthweight (AOR = 4.03, 95%CI: 1.97-8.24 for pregnancy; AOR = 9.21, 95%CI: 3.76-22.57 both periods); preterm birth (AOR = 3.26, 95% CI: 1.52-6.97 for pregnancy; AOR = 4.06, 95%CI: 1.50-11.01 both periods) and admission to SCN or NICU (AOR = 2.42, 95%CI: 1.31-4.49 for pregnancy; AOR = 4.03, 95%CI: 1.72-9.44 both periods). Primiparous mothers admitted to hospital for MBDO, MBDC or a combined diagnosis were almost three times as likely to give birth to preterm babies compared to mothers without hospital admissions for psychiatric or substance use disorders. Babies whose mothers were admitted to hospital with MBDO before and/or during pregnancy were six times more likely to be admitted to SCN or NICU (AOR = 6.29, 95%CI: 4.62-8.57). Conclusion: Consumption of alcohol, opioids or cannabinoids during peri-conception or pregnancy significantly increased the risk of adverse perinatal outcomes. © 2014 by the authors; licensee MDPI, Basel, Switzerland.
Li, Z, Wang, Y, W, L & Sullivan, E 2014, 'Birthweight percentiles by gestational age for births following assisted reproductive technology in Australia and New Zealand, 2002-2010', Human Reproduction, vol. 29, no. 8, pp. 1787-1800.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, F, Li, Z, Binns, C, Bonello, M, Austin, M-P & Sullivan, E 2014, 'Does infant feeding method impact on maternal mental health?', Breastfeeding Medicine, vol. 9, pp. 215-221.View/Download from: UTS OPUS or Publisher's site
Xu, F, Sullivan, EA, Li, Z, Burns, L, Austin, M-P & Slade, T 2014, 'The increased trend in mothers' hospital admissions for psychiatric disorders in the first year after birth between 2001 and 2010 in New South Wales, Australia', BMC Women's Health, vol. 14, pp. 1-6.View/Download from: UTS OPUS or Publisher's site
The burden of mental and behavioural disorders in Australia has increased significantly over the last decade. The aim of the current study is to describe the hospital admission rates for mental illness over a 10-year period for primiparous mothers in the first year after birth.
This is an Australian population-based descriptive study with linked data from the New South Wales Midwives Data Collection and Admitted Patients Data Collection. The study population included primiparous mothers who gave birth between 1 January 2001 and 31 December 2010. All hospital admissions with a mental health diagnosis in the first year after birth were recorded.
There were 6,140 mothers (1.67%) admitted to hospital with a principal diagnosis of mental health in the first year after birth between 2001 and 2010 in New South Wales (7,884 admissions, 2.15%). The hospital admission rates increased significantly over time, particularly from 2005. The increase in hospital admissions was mainly attributed to the diagnoses of unipolar depression, adjustment disorders and anxiety disorders.
This study shows that hospital admissions for mothers with a mental health diagnosis after birth in New South Wales has significantly increased in the last decade. Possible reasons for this change need to be studied further.
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...
Li, Z, Chen, M, Guy, R, Wand, H, Oats, J & Sullivan, E 2013, 'Chlamydia Screening In Pregnancy In Australia: Integration Of National Guidelines Into Clinical Practice And Policy', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 53, no. 4, pp. 338-346.View/Download from: UTS OPUS or Publisher's site
Background Chlamydia trachomatis is the most common reportable infection in Australia. Since 2006, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) have recommended chlamydia screening in pregnant women aged <25years. Aims To assess clinical uptake and policy integration of the 2006 RANZCOG recommendation on chlamydia testing in pregnant women aged <25years. Methods A mixed method approach was used involving a literature review, a survey of obstetricians and gynaecologists, and survey of hospital managers from April 2010 to May 2010. Results Of the 1644 participating RANZCOG Fellows, Trainees, and Diplomates, 21.2% reported universal screening for pregnant women <25years (25% of primary care clinicians, 23% of those working in the public hospital sector, 16% of those working in both public and private hospitals, and 13% of those in private hospitals or private practice). There was a strong association between members who agreed with the guideline and offering universal screening to pregnant women aged <25years (adjusted odds ratio=17.1, 95% CI: 6.0-49.2, P<0.01). Of the 143 participating hospital managers who completed the hospital policy questionnaire; 20% reported that their hospital had a formal screening guideline. There were two national and four state/local policy documents recommending chlamydia screening in pregnancy. Conclusions This study shows low uptake of chlamydia screening of young pregnant women by RANZCOG Fellows, Trainees, and Diplomates involved in antenatal care and highlights the need for national clinical leadership regarding screening for chlamydia among pregnant women aged <25years.
Xu, F, Bonello, M, Burns, L, Austin, M-P, Li, Z & Sullivan, E 2013, 'Hospital Admissions for Alcohol Use Disorders Before, During, and After Pregnancy: A Study Based on Linked Population Data in New South Wales, Australia', Alcoholism: Clinical and Experimental Research, vol. 37, no. 10, pp. 1706-1712.View/Download from: UTS OPUS or Publisher's site
Alcohol use disorders (AUD) during pregnancy can have profound lifelong effects on the baby, including fetal alcohol spectrum disorders (FASD). Hospital admission for AUD during pregnancy provides an opportunity for intervention. Characterization of women along the AUD spectrum during pregnancy aids the development of prevention strategies, policy, and clinical management guidelines aimed at this population. This study describes the hospital admission levels for AUD between the sixth month before pregnancy and the first year after birth and explores risk factors associated with the hospital admissions.
This study was based on linked population data between 2002 and 2005 using the New South Wales (NSW) Midwives Data Collection (MDC) and the NSW Admitted Patients Data Collection (APDC), Australia. The study subjects included primiparous mothers who were admitted to hospital in the period from the sixth month before pregnancy to 1 year after birth with at least 1 of the following diagnoses (ICD-10-AM): mental and behavioral disorders due to the use of alcohol (MBDA) (F10.0–10.9); toxic effects of alcohol (T51.0–51.9); maternal care for suspected damage to fetus from alcohol (O35.4); or alcohol rehabilitation (Z50.2).
A total of 175 new mothers had 287 hospital admissions with the principal or stay AUD diagnoses during the study period in NSW. Of the 287 admissions, 181 admissions (63.07%) were reported for an alcohol-related disorder as the principal diagnosis. The hospital admission rate for AUD was 1.76/1,000 person-years (PY) (95% CI: 1.45 to 2.07) during the 6 months prepregnancy. The rate decreased to 0.49/1,000 PY (95% CI: 0.36 to 0.63) during pregnancy and to 0.82/1,000 PY (95% CI: 0.67 to 0.97) in the first year after birth. Women who smoked during pregnancy, lived in a remote area and were younger than 25 years, were more likely to be admitted to hospital with AUD diagnoses. Women in the middle disadvantaged quintile and born i...
Li, Z, Zeki, R, Hilder, L & Sullivan, EA AIHW National Perinatal Epidemiology and Statistics Unit 2013, Australia's mothers and babies 2011, Perinatal statistics series no 4, no. Cat. no. PER 59., Canberra.
Li, Z, Zeki, R, Hilder, L & Sullivan, E AIHW National Perinatal Epidemiology and Statistics Unit 2012, Australia's mothers and babies 2010, Perinatal statistics series no. 27, no. Cat. no. PER 57, Canberra.
Li, Z, McNally, L, Hilder, L & Sullivan, E AIHW National Perinatal Epidemiology and Statistics Unit 2011, Australia's mothers and babies 2009, Perinatal statistics series no. 25, no. Cat. no. PER 52, Sydney.