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Risk of perinatal mortality in the first year of midwifery practice in New Zealand: analysis of a retrospective national cohort.

ABSTRACT: OBJECTIVES:To determine whether there was an increased risk of perinatal mortality among mothers booked for care with community lead maternity carer (LMC) midwives in their first compared with later years of practice. DESIGN:Retrospective cohort study using linked national maternity, mortality and workforce data; adjusted analysis using logistic regression. SETTING:New Zealand. PARTICIPANTS:Women under community LMC midwifery care birthing 2008-2014. MAIN OUTCOME MEASURES:Perinatal mortality (stillbirths and neonatal deaths of babies born from 20 weeks' gestation to the 27th day of postnatal life), excluding terminations and deaths associated with congenital abnormalities. RESULTS:There were 2045 deaths among 344?910 births booked with midwives.First year of practice midwives cared for women with higher risk of perinatal mortality, including M?ori, Pacific, Indian, <20-year-old mothers, nullipara, smokers, women living in socioeconomic deprivation and with high body mass index, than midwives beyond first year of practice.There was a significant reduction in unadjusted odds of perinatal mortality among women under the care of midwives beyond the first year compared with those within the first year (OR 0.79, 95% CI 0.67 to 0.93) but no significant reduction in risk remained after adjusting for known risk factors, (OR 0.89, 95% CI 0.74 to 1.07).There was a significant increase in the adjusted odds of perinatal mortality among midwives booking a caseload of 15 or fewer mothers per year (1.34, 1.01 to 1.78) and 16 to 30 (1.25, 1.04 to 1.50) compared with midwives booking 51 to 80. CONCLUSIONS:Findings suggest that the first year of midwifery practice is not associated with an increased risk of perinatal mortality but there is evidence that early career midwives are caring for higher-risk women. These findings suggest inequity of access for higher-risk women to experienced midwives and highlight an opportunity to improve support for vulnerable women and new midwives.

SUBMITTER: Sadler LC

PROVIDER: S-EPMC5892737 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Risk of perinatal mortality in the first year of midwifery practice in New Zealand: analysis of a retrospective national cohort.

Sadler Lynn C LC McAra-Couper Judith J Pittam Deborah D Wise Michelle R MR Thompson John M D JMD

BMJ open 20180407 4

<h4>Objectives</h4>To determine whether there was an increased risk of perinatal mortality among mothers booked for care with community lead maternity carer (LMC) midwives in their first compared with later years of practice.<h4>Design</h4>Retrospective cohort study using linked national maternity, mortality and workforce data; adjusted analysis using logistic regression.<h4>Setting</h4>New Zealand.<h4>Participants</h4>Women under community LMC midwifery care birthing 2008-2014.<h4>Main outcome ...[more]

PMID: 29627807

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Project description:BackgroundOver the last decade, a trend towards high utilisation of primary maternity care was observed in high-income countries. There is limited research with contradictory results regarding frequent attendance (FA) and perinatal outcomes in midwifery care. Therefore, this study examined possible associations between FA in midwifery care and obstetric interventions and perinatal outcomes.MethodsA retrospective cohort study was performed in a medium-sized midwifery-led care practice in an urban region in the Netherlands. Frequent attenders (FAs) were categorised using the Kotelchuck-Index Revised. Regression analyses were executed to examine the relationship between FAs and perinatal outcomes, stratified by antenatal referral to an obstetrician. Main outcomes of interest were Apgar score ≤ 7 and perinatal death, birth weight, mode of delivery, haemorrhage, place of birth, transfer during labour, and a requirement for pain relief.ResultsThe study included 1015 women, 239 (24%) FAs and 776 (76%) non-FAs, 538 (53%) were not referred and 447 (47%) were referred to an obstetrician. In the non-referred group, FA was significantly associated with a requirement for pain relief (OR 1.98, 95% CI 1.24-3.17) and duration of dilatation (OR 1.20, 95% CI 1.04-1.38). In the referred group, FA was significantly associated with induction of labour (OR 1.86, 95% CI 1.17-2.95), ruptured perineum (OR 0.50, 95% CI 0.27-0.95) and episiotomy (OR 0.48, 95% CI 0.24-0.95). In the non-referred and the referred group, FA was not associated with the other obstetric and neonatal outcomes. Due to small numbers, we could not measure possible associations of FA with an Apgar score ≤ 7 and perinatal death.ConclusionIn our study, perinatal outcomes differed by FA and antenatal referral to an obstetrician. In the non-referred group, FA was significantly associated with medical pain relief and duration of dilatation. In the referred group, FA was significantly associated with induction of labour, ruptured perineum, and episiotomy. Further research with a larger study population is needed to look for a possible association between FA and primary adverse birth outcomes such as perinatal mortality.

Project description:IntroductionThe prevalence of cancer is growing rapidly in all parts of the word and Ethiopia is no exception. Secondary prevention, as simple as monthly breast self-examination, is the best option to tackle the rising of this epidemic. Health awareness programs on screening and early detection are the corner stones to reduce the morbidity and mortality resulting from breast cancer.ObjectiveThe aim of the study is to assess the effectiveness of planned teaching program on knowledge and practice of breast self-examination among first year female midwifery students in Hawassa health Sciences College.Methods and materialsA pre-experimental one group pre-posttest design was used among 61 students who were selected by systematic random sampling technique. Data was collected using structured questionnaire and adapted and approved checklist. Data was entered using Epi-Info and analyzed using SPSS version 20. Pre-and post-intervention results were calculated using paired t-test.ResultsThe mean age of the study participants was 20.13(±2.27) and 77% of the study participants were single. Before the intervention 14(23%) of respondents had information and practiced breast self-examination, only 8(13.1%) performed breast self -examination on a regular monthly basis. The number and percentage of the knowledgeable respondents pre-post intervention is 23(37.7%) and 35(57.4%), respectively. The mean knowledge difference for the pre-post intervention is 0.18±0.695 (P < 0.05). The respondents' pre- post interventions score of satisfactory practical competency were 10(16.4%) and 43(70.5%), respectively as well. The mean net gain for the pre-post breast self-examination intervention is 0.51± 0.62 (P < 0.001). Both the knowledge and practical competency scores showed highly significant increment after the intervention, showing that the research hypothesis was accepted.Conclusion and recommendationsPlanned teaching intervention on knowledge and Breast self-examination of students has resulted in an increment of both knowledge and the practice of breast self-examination. Teaching breast self-examination with demonstration to all at risk groups as a secondary prevention for breast cancer and large scale studies on heterogeneous groups is important.

Project description:ObjectivesClinical risk calculators (CRCs), such as NZRisk, are used daily by clinicians to guide clinical decisions and explain individual risk to patients. The utility and robustness of these tools depends on the methods used to create the underlying mathematical model, as well as the stability of that model in relation to changing clinical practice and patient populations over time. The later should be checked by temporal validation using external data. Few if any of the clinical prediction models in current clinical use have published temporal validation. Here, we use a large external dataset to temporally validate NZRisk; a perioperative risk prediction model used in the New Zealand population.MethodsA sample of 1 976 362 adult non-cardiac surgical procedures collected over 15 years from the New Zealand Ministry of Health National Minimum Dataset, was used to temporally validate NZRisk. We divided the dataset into 15 single year cohorts and compared 13 of these to our NZRisk model (2 years used for the model building were excluded). We compared the area under the curve (AUC) value, calibration slope and intercept for each single year cohort, to the same values produced by the data used to create NZRisk, by fitting a random effects meta-regression with each year cohort acting as a separate study point. In addition, we used two-sided t-tests to compare each measure across the cohorts.ResultsThe AUC values for the 30-day NZRisk model applied to our single year cohorts ranged from 0.918 to 0.940 (NZRisk AUC was 0.921). There were eight statistically different AUC values for the following years 2007-2009, 2016 and 2018-2021. The intercept values ranged from -0.004 to 0.007 and 7 years had statistically significant different intercepts during leave-one-out t-tests; 2007-2010, 2012, 2018 and 2021. The slope values ranged from 0.72 to 1.12 and 7 years had statistically significant different slopes during leave-one-out t-tests; 2010, 2011, 2017, 2018 and 2019-2021. The random effects meta-regression upheld our results related to AUC (0.54 (95% CI 0.40 to 0.99), I2 67.57 (95% CI 40.67 to 88.50), Cochran's Q<0.001) and slope (τ 0.14 (95% CI 0.01 to 0.23), I2 98.61 (95% CI 97.31 to 99.50), Cochran's Q<0.001) between year difference.ConclusionThe NZRisk model shows differences in AUC and slope but not intercept values over time. The biggest differences were in the calibration slope. The models maintained excellent discrimination over time as shown by the AUC values. These findings suggest we update our model in the next 5 years. To our knowledge, this is the first temporal validation of a CRC in current use.

Project description:IntroductionPlacental dysfunction can lead to perinatal hypoxic events including stillbirth. Unless there is overt severe fetal growth restriction, placental dysfunction is frequently not identified in (near) term pregnancy, particularly because fetal size is not necessarily small. This study aimed to evaluate, among (near) term births, the burden of hypoxia-related adverse perinatal outcomes reflected in an association with birth weight centiles as a proxy for placental function.Material and methodA nationwide 5-year cohort of the Dutch national birth registry (PeriNed) including 684,938 singleton pregnancies between 36+0 and 41+6 weeks of gestation. Diabetes, congenital anomalies, chromosomal abnormalities and non-cephalic presentations at delivery were excluded. The main outcome was antenatal mortality rate according to birthweight centiles and gestational age. Secondary outcomes included perinatal hypoxia-related outcomes, including perinatal death and neonatal morbidity, analyzed according to birthweight centiles.ResultsBetween 2015 and 2019, 1,074 perinatal deaths (0.16%) occurred in the study population (n = 684,938), of which 727 (0.10%) antenatally. Of all antenatal- and perinatal deaths, 29.4% and 27.9% occurred in birthweights below the 10th centile. The incidence of perinatal hypoxia-related outcomes was highest in fetuses with lowest birthweight centiles (18.0%), falling gradually up to the 50th and 90th centile where the lowest rates of hypoxia-related outcomes (5.4%) were observed.ConclusionPerinatal hypoxia-related events have the highest incidence in the lowest birthweight centiles but are identifiable throughout the entire spectrum. In fact, the majority of the adverse outcome burden in absolute numbers occurs in the group with a birthweight above the 10th centile. We hypothesize that in most cases these events are attributable to reduced placental function. Additional diagnostic modalities that indicate placental dysfunction at (near) term gestation throughout all birth weight centiles are eagerly wanted.

Dataset Information

Risk of perinatal mortality in the first year of midwifery practice in New Zealand: analysis of a retrospective national cohort.

Publications

Risk of perinatal mortality in the first year of midwifery practice in New Zealand: analysis of a retrospective national cohort.

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