Emily C. Olive

Trends in postpartum haemorrhage

Objective: To assess trends and outcomes of postpartum haemorrhage (PPH) in New South Wales (NSW).

Delayed versus early pushing in women with epidural analgesia: a systematic review and meta-analysis

Epidural analgesia is highly effective in relieving the pain of labour and childbirth, but it also interferes with the normal mechanism of labour. Trials of delayed pushing have occurred in response to concerns about the association between epidural analgesia and unwanted and potentially harmful outcomes, particularly instrumental delivery. Instrumental deliveries, especially forceps, have been associated with increased risk of urinary and faecal incontinence, sexual problems and organ prolapse. The mechanism for the association between epidural analgesia and increased instrumental deliveries is likely to be multifactorial but may include a weakened desire to push due to diminution of the bearing down reflex, reduced uterine activity and altered clinical practice. Contemporary obstetric practice has women begin pushing as soon as the cervix is fully dilated. Delaying the onset of pushing has been proposed as an alternative that may allow spontaneous descent and rotation of the fetal head, thereby reducing the instrumental delivery rate. On the other hand, delayed pushing prolongs the second stage of labour and this too has been implicated in pelvic floor trauma and subsequent maternal morbidity. Further, second stage is considered to be a time of particular risk to the fetus. A systematic review and meta-analysis of three small studies published in 1992 found both a tendency towards decreased perineal trauma and a decrease in rotational forceps with a policy of delayed pushing, however, there were insufficient data on infant outcomes and no data on pelvic floor morbidity. Since then several more trials of delayed pushing have been published and we undertook to update the systematic review and metaanalysis with the aim of assessing the effectiveness of delayed pushing among women with epidural analgesia in reducing instrumental deliveries and on other measures of maternal and infant morbidity. We aimed to compare the potential benefits and harms of a policy of delayed pushing among women with uncomplicated pregnancies and effective epidural analgesia established in the first stage of labour.

Placenta praevia: maternal morbidity and place of birth

Background:  International guidelines recommend that women with placenta praevia should be delivered by an experienced operator at a hospital with an on‐site blood bank.

Impact of first‐stage ambulation on mode of delivery among women with epidural analgesia

Background: New techniques for administering epidural analgesia allow increased mobility for labouring women with epidurals.

Test characteristics of placental location screening by transabdominal ultrasound at 18–20 weeks

To determine the test characteristics of a second‐trimester transabdominal fetal anomaly scan in screening for placenta previa.

Trends and recurrence of placenta praevia: A population-based study

We determined recent trends and recurrence rates of placenta praevia in 790,366 deliveries in NSW. From 2001 to 2009, the rate of placenta praevia increased by 26%, from 0. 69% to 0. 87% (trend P < 0.001). The placenta praevia recurrence rate in a second birth was 4.8%. Two‐thirds of the increase in placenta praevia was accounted for by trends in known risk factors, and the unexplained portion may reflect changes in unidentified risk factors or in the threshold for placenta praevia diagnosis.

Birth at hospitals with co‐located paediatric units for infants with correctable birth defects

Objectives: To determine the percentage of liveborn infants with selected antenatally identifiable and correctable birth defects who were delivered at hospitals with co‐located paediatric surgical units (co‐located hospitals). Additionally, to determine the survival rates for these infants.