Selina Brown

Uptake and adherence to long-acting reversible contraception post-abortion

BACKGROUND This study aimed to increase use of long-acting reversible contraceptive (LARC) methods by women post-abortion. STUDY DESIGN Ten-week intervention at a public abortion clinic involving free access to three LARC methods (DMPA, LNG-IUS, Multiload Cu375); posters promoting LARC; updated information for clinic staff. OUTCOME MEASURES change in the proportion of women choosing LARC prior to and during the intervention; rate of follow-up and method retention at 6 weeks and at 6 months post-abortion. RESULTS Use of post-abortion LARC increased significantly from 44% at baseline (226/510) to 61% (310/510) during the intervention (p<.001). Use of LNG-IUS increased almost sixfold from 6% to 36%. Follow-up rates were 71% at 6 weeks (221/310) and 74% at 6 months (184/249). Method retention was 89% at 6 weeks (197/221) and 86% at 6 months (159/184). CONCLUSION Uptake of LARC by women post-abortion can be achieved by increasing access to these methods - by eliminating cost and raising awareness and benefits of long-acting methods among both clinicians and patients.

Preventability of severe acute maternal morbidity

OBJECTIVE We sought to assess potential preventability of severe acute maternal morbidity (SAMM) cases admitted to intensive-care units (ICUs) or high-dependency units (HDUs). STUDY DESIGN Inclusion criteria were admissions to ICUs or HDUs of women who were pregnant or within 42 days of delivery in 4 District Health Board areas (accounting for a third of annual births in New Zealand) during a 17-month period. Cases were reviewed by external multidisciplinary panels using a validated model for assessing preventability. RESULTS In all, 98 SAMM cases were assessed; 38 (38.8%) cases were deemed potentially preventable, 36 (36.7%) not preventable but improvement in care was needed, and 24 (24.5%) not preventable. The most frequent preventable factors were clinician related: delay or failure in diagnosis or recognition of high-risk status (51%); and delay or inappropriate treatment (70%). The most common causes of preventable severe morbidity were blood loss and septicemia. CONCLUSION The majority of SAMM cases were potentially preventable or required improvement in care. Themes around substandard care related to delay in diagnosis and treatment for postpartum hemorrhage and septicemia. These findings can inform clinical educational programs and policies to improve maternal outcomes. This study has now been expanded to a national New Zealand audit of all SAMM cases admitted to an ICU/HDU.

Audit of severe acute maternal morbidity describing reasons for transfer and potential preventability of admissions to ICU

Background:  Maternal mortality is a rare event in the developed world. Assessment of severe acute maternal morbidity (SAMM) is therefore an appropriate measure of the quality of maternity care.

Developing a Kaupapa Māori Research Project to Help Reduce Health Disparities Experienced by Young Māori Women and their Babies

Young Māori mothers experience stigma and their babies experience poor health outcomes. Interventions to reduce these health disparities need to understand the lives of these young women. This paper describes consultation to seek agreement for research with young Māori mothers to be conducted in two regions. Consultation occurred with tribal authorities, Māori health providers, district health boards, and community stakeholders. Endorsement was gained for strength-based research with young pregnant Māori women and their babies. The research also includes service provider interviews, and analysis of policy. Project oversight is by three advisory groups: Māori elders, young Māori mothers, and an academic group. Community feedback occurs throughout the project. Consultation is an ongoing process conducted within a relationship context. It enhances the development, implementation and translation of research that seeks to represent the lives of those who are vulnerable, and eliminate health disparities.

Uterine cancer: exploring access to services in the public health system

Māori are the indigenous peoples of New Zealand and experience higher rates of uterine cancer and poorer survival rates. Postmenopausal bleeding (PMB) is the most common presenting symptom for uterine cancer. Prompt investigation is essential with 28 days being viewed as an appropriate time from first medical contact (FMC) to first specialist appointment (FSA).