Collaborative maternity and newborn dashboard (CoMaND) for the COVID-19 pandemic: a protocol for timely, adaptive monitoring of perinatal outcomes in Melbourne, Australia

BackgroundThe COVID-19 pandemic has resulted in a range of unprecedented disruptions to maternity care with documented impacts on perinatal outcomes such as stillbirth and preterm birth. Metropolitan Melbourne has endured one of the longest and most stringent lockdowns in globally. This paper presents the protocol for a multicentre study to monitor perinatal outcomes in Melbourne, Australia, during the COVID-19 pandemic.MethodsMulticentre observational study analysing monthly deidentified maternal and newborn outcomes from births >20 weeks at all 12 public maternity services in Melbourne. Data will be merged centrally to analyse outcomes and create run charts according to established methods for detecting non-random ‘signals’ in healthcare. Perinatal outcomes will include weekly rates of total births, stillbirths, preterm births, neonatal intensive care admissions, low Apgar scores and fetal growth restriction. Maternal outcomes will include weekly rates of: induced labour, caesarean section, births before arrival to hospital, postpartum haemorrhage, length of stay, general anaesthesia for caesarean birth, influenza and COVID-19 vaccination status, and gestation at first antenatal visit. A prepandemic median for all outcomes will be calculated for the period of January 2018 to March 2020. A significant shift is defined as ≥6 consecutive weeks, all above or below the prepandemic median. Additional statistical analyses such as regression, time series and survival analyses will be performed for an in-depth examination of maternal and perinatal outcomes of interests.Ethics and disseminationEthics approval for the collaborative maternity and newborn dashboard project has been obtained from the Austin Health (HREC/64722/Austin-2020) and Mercy Health (ref. 2020-031).Trial registration numberACTRN12620000878976; Pre-results.

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A collaborative maternity dashboard (CoMaND) for the COVID-19 pandemic: a protocol for timely, adaptive monitoring of perinatal outcomes in Melbourne, Australia

10.1101/2021.07.22.21261008 ◽

2021 ◽

Author(s):

Lisa Hui ◽

Stephanie Potenza ◽

Melvin B Marzan ◽

Joanne M Said ◽

Kirsten R Palmer ◽

...

Keyword(s):

Health Care ◽

Maternity Care ◽

Perinatal Outcomes ◽

Rapid Analysis ◽

Significant Shift ◽

Survival Analyses ◽

Newborn Outcomes ◽

Adaptive Monitoring ◽

Clinical Trials Registry ◽

Maternal And Newborn

Background: The COVID-19 pandemic has resulted in a range of unprecedented disruptions to the delivery of maternity care globally and has been associated with regional changes in perinatal outcomes such as stillbirth and preterm birth. Metropolitan Melbourne endured one of the longest and most stringent lockdowns in 2020. This paper presents the protocol for a collaborative maternity dashboard project to monitor perinatal outcomes in Melbourne, Australia, during the COVID-19 pandemic. Methods: De-identified maternal and newborn outcomes will be collected monthly from all public maternity services in Melbourne, allowing rapid analysis of a multitude of perinatal indicators. Weekly outcomes will be displayed as run charts according to established methods for detecting non-random (signals) in health care. A pre-pandemic median for all indicators will be calculated for the period of January 2018 to March 2020. A significant shift is defined as > six consecutive weeks, all above or below the pre-pandemic median. Additional statistical analyses such as regression, time-series, and survival analyses will be performed for an in-depth examination of maternal and perinatal outcomes of interests. Ethics and Dissemination: This study has been registered as an observational study with the Australian and New Zealand Clinical Trials Registry (ACTRN12620000878976).

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The Effect of Betamethasone Dosing Interval on Perinatal Outcomes: 12 Hours or 24 Hours Apart

American Journal of Perinatology ◽

10.1055/s-0041-1735962 ◽

2021 ◽

Author(s):

Ayca Nazli Bulut ◽

Venhar Ceyhan ◽

Cevat Rifat Cundubey ◽

Emine Aydin

Keyword(s):

Neonatal Intensive Care ◽

Perinatal Outcomes ◽

Preterm Births ◽

Dose Interval ◽

Fetal Lung ◽

Lung Maturation ◽

Dosing Interval ◽

Interval Group ◽

Antenatal Steroids ◽

Significant Difference

Objective Antenatal steroids are commonly used to stimulate fetal lung maturation, particularly in pregnancies at risk of early preterm labor. This study aimed to compare the effects of administering betamethasone at a 12- versus 24-hour interval on perinatal outcomes. Study Design This retrospective study included 423 early preterm births from 26+0/7 to 33+6/7 weeks of gestation. Patients received betamethasone at either a 12- or 24-hour dosing interval. Results When all patients in each group were evaluated together, there was no statistically significant difference between both groups for complications of prematurity, including respiratory distress syndrome (RDS). When the two groups were divided by gestational age (GA), the 32+0/7 to 33+6/7-week group that received betamethasone at a 24-hour interval had statistically lower 1- and 5-minute APGAR scores (p = 0.06 and p = 0.02, respectively). They also had a greater need for neonatal intensive care unit (NICU), NICU length of stay, RDS, and need for surfactant (p = 0.20, p = 0.09, p = 0.27, and p = 0.23, respectively) than did the infants at 32+0/7 to 33+6/7 weeks, who received betamethasone at a 12-hour interval. In the group with GA between 28+0/7 and 29+6/7 weeks, the 1-minute APGAR score was lower (p = 0.22), and the durations of hospital stay, and mechanical ventilation were longer (p = 0.048, p = 0.21, respectively) in the 24-hour interval group. No statistically significant difference was observed for all parameters in other GA groups. Conclusion A 12-hour dosing interval for betamethasone appears to be more appropriate, as it results in a reduction in some neonatal complications and provides a short dose interval. Key Points

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The Rate of Preterm Twin Births (22–27 Weeks) As a Criterion for Measuring the Quality of Prenatal Care

Twin Research ◽

10.1375/twin.4.6.426 ◽

2001 ◽

Vol 4 (6) ◽

pp. 426-430 ◽

Cited By ~ 1

Author(s):

Emile Papiernik

Keyword(s):

Perinatal Outcomes ◽

Preterm Births ◽

Medical Intervention ◽

New Approach ◽

Caesarean Birth ◽

Extremely Preterm ◽

Level 3 ◽

Twin Pregnancies ◽

Recent Policy

AbstractWhile the true figures are not well established, outcomes of twin pregnancies are directly dependent on a small number of preterm births between 22 and 27 weeks. Observation of perinatal outcomes in twin pregnancies yields two contradictory results. Firstly, it shows an improvement in perinatal mortality figures. Secondly, it reveals an increase in the rates of preterm deliveries. These findings result from the observation of 783 twin pregnancies followed and delivered in a level 3 perinatal centre in Paris between 1993 and 1998. Women followed since the beginning of pregnancy through the outpatient clinic of the institution are included in this number, as are women who were referred or transferred to the centre at a later date due to complications. This analysis reflects the influence of two contrasting policies. The first, and less recent policy is devoted to the prevention of preterm births, and is reflected by the low number of extremely preterm deliveries at 22–32 weeks. The second is the effect of our new approach to the prevention of foetal deaths in relation to foetal growth retardation in twins which has resulted in increased medical intervention such as the induction of labour or scheduled Caesarean birth. This has resulted in an increase in twin preterm births from 33 to 36 weeks, with the expected result of fewer foetal deaths.

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Pregnancy Outcomes and SARS-CoV-2 Infection: The Spanish Obstetric Emergency Group Study

Viruses ◽

10.3390/v13050853 ◽

2021 ◽

Vol 13 (5) ◽

pp. 853

Author(s):

Sara Cruz Melguizo ◽

María Luisa de la Cruz Conty ◽

Paola Carmona Payán ◽

Alejandra Abascal-Saiz ◽

Pilar Pintando Recarte ◽

...

Keyword(s):

Pregnant Women ◽

Perinatal Outcomes ◽

Preterm Births ◽

Hypertensive Disorder ◽

Obstetric Emergency ◽

Increased Risk ◽

Emergency Group ◽

Adverse Perinatal Outcomes ◽

Maternal Disease ◽

The Relationship

Pregnant women who are infected with SARS-CoV-2 are at an increased risk of adverse perinatal outcomes. With this study, we aimed to better understand the relationship between maternal infection and perinatal outcomes, especially preterm births, and the underlying medical and interventionist factors. This was a prospective observational study carried out in 78 centers (Spanish Obstetric Emergency Group) with a cohort of 1347 SARS-CoV-2 PCR-positive pregnant women registered consecutively between 26 February and 5 November 2020, and a concurrent sample of PCR-negative mothers. The patients’ information was collected from their medical records, and the association of SARS-CoV-2 and perinatal outcomes was evaluated by univariable and multivariate analyses. The data from 1347 SARS-CoV-2-positive pregnancies were compared with those from 1607 SARS-CoV-2-negative pregnancies. Differences were observed between both groups in premature rupture of membranes (15.5% vs. 11.1%, p < 0.001); venous thrombotic events (1.5% vs. 0.2%, p < 0.001); and severe pre-eclampsia incidence (40.6 vs. 15.6%, p = 0.001), which could have been overestimated in the infected cohort due to the shared analytical signs between this hypertensive disorder and COVID-19. In addition, more preterm deliveries were observed in infected patients (11.1% vs. 5.8%, p < 0.001) mainly due to an increase in iatrogenic preterm births. The prematurity in SARS-CoV-2-affected pregnancies results from a predisposition to end the pregnancy because of maternal disease (pneumonia and pre-eclampsia, with or without COVID-19 symptoms).

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Maternal Thinness and Obesity and Customized Fetal Weight Charts

Fetal Diagnosis and Therapy ◽

10.1159/000515251 ◽

2021 ◽

pp. 1-9

Author(s):

Nieves L. González González ◽

Enrique González Dávila ◽

Agustina González Martín ◽

Erika Padrón ◽

José Ángel García Hernández

Keyword(s):

At Risk ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Perinatal Outcomes ◽

Adverse Outcomes ◽

Analysis Of Covariance ◽

Large For Gestational Age ◽

Perinatal Morbidity ◽

Accurate Identification ◽

Cephalopelvic Disproportion

Objective: The aim of the study was to determine if customized fetal growth charts developed excluding obese and underweight mothers (CC(18.5–25)) are better than customized curves (CC) at identifying pregnancies at risk of perinatal morbidity. Material and Methods: Data from 20,331 infants were used to construct CC and from 11,604 for CC(18.5–25), after excluding the cases with abnormal maternal BMI. The 2 models were applied to 27,507 newborns and the perinatal outcomes were compared between large for gestational age (LGA) or small for gestational age (SGA) according to each model. Logistic regression was used to calculate the OR of outcomes by the group, with gestational age (GA) as covariable. The confidence intervals of pH were calculated by analysis of covariance. Results: The rate of cesarean and cephalopelvic disproportion (CPD) were higher in LGAonly by CC(18.5−25) than in LGAonly by CC. In SGAonly by CC(18.5−25), neonatal intensive care unit (NICU) and perinatal mortality rates were higher than in SGAonly by CC. Adverse outcomes rate was higher in LGAonly by CC(18.5−25) than in LGAonly by CC (21.6%; OR = 1.61, [1.34–193]) vs. (13.5%; OR = 0.84, [0.66–1.07]), and in SGA only by CC(18.5−25) than in SGAonly by CC (9.6%; OR = 1.62, [1.25–2.10] vs. 6.3%; OR = 1.18, [0.85–1.66]). Conclusion: The use of CC(18.5–25) allows a more accurate identification of LGA and SGA infants at risk of perinatal morbidity than conventional CC. This benefit increase and decrease, respectively, with GA.

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Selective IUGR in dichorionic twins: what can Doppler assessment and growth discordancy say about neonatal outcomes?

Journal of Perinatal Medicine ◽

10.1515/jpm-2017-0253 ◽

2018 ◽

Vol 46 (9) ◽

pp. 1028-1034 ◽

Cited By ~ 1

Author(s):

Paola Algeri ◽

Matteo Frigerio ◽

Maria Lamanna ◽

Petya Vitanova Petrova ◽

Sabrina Cozzolino ◽

...

Keyword(s):

Intrauterine Growth Restriction ◽

Neonatal Intensive Care ◽

Neonatal Resuscitation ◽

Perinatal Outcomes ◽

Growth Restriction ◽

Abdominal Circumference ◽

Doppler Study ◽

Umbilical Artery Doppler ◽

Nicu Admission ◽

Twin Pregnancies

Abstract Objective: The aim of the present study was to assess, in a population of dichorionic twin pregnancies with selective growth restriction, the effect of inter-twin differences by use of Doppler velocimetry and fetal growth discordancy on perinatal outcomes. Methods: This was a retrospective study including dichorionic twin pregnancies from January 2008 to December 2015 at the Department of Obstetrics and Gynecology of Fondazione MBBM. Only dichorionic twin pregnancies affected by selective intrauterine growth restriction (IUGR) delivering at ≥24 weeks were included in the study. Results: We found that twin pregnancies with inter-twin estimated fetal weight (EFW) discordance ≥15% were significantly associated with a higher risk of preterm delivery before 32 (P=0.004) and 34 weeks (P=0.04). Similarly, twin pregnancies with inter-twin abdominal circumference (AC) discordance ≥30° centiles were associated with a higher rate of neonatal intensive care unit (NICU) admission (P=0.02), neonatal resuscitation (P=0.02) and adverse neonatal composite outcome (P=0.04). Of interest, when comparing twin pregnancies according to Doppler study, growth restricted twins had a higher rate of composite neonatal outcome and in multivariate analysis, an abnormal Doppler was an independent risk factor for this outcome. Conclusions: Our study associated growth discrepancy with specific pregnancy outcomes, according to defined cut-offs. In addition, we demonstrated that an abnormal umbilical artery Doppler is independently associated with a composite neonatal adverse outcome in growth restricted fetuses.

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Randomised cross-over study of automated oxygen control for preterm infants receiving nasal high flow

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2018-315342 ◽

2018 ◽

pp. fetalneonatal-2018-315342 ◽

Cited By ~ 3

Author(s):

Peter R Reynolds ◽

Thomas L Miller ◽

Leonithas I Volakis ◽

Nicky Holland ◽

George C Dungan ◽

...

Keyword(s):

Preterm Infants ◽

Neonatal Intensive Care ◽

Primary Outcome Measure ◽

High Flow ◽

Target Range ◽

Manual Control ◽

Oxygen Control ◽

Automated Control ◽

Registration Number ◽

Preterm Babies

ObjectiveTo evaluate a prototype automated controller (IntellO2) of the inspired fraction of oxygen (FiO2) in maintaining a target range of oxygen saturation (SpO2) in preterm babies receiving nasal high flow (HF) via the Vapotherm Precision Flow.DesignProspective two-centre order-randomised cross-over study.SettingNeonatal intensive care units.PatientsPreterm infants receiving HF with FiO2 ≥25%.InterventionAutomated versus manual control of FiO2 to maintain a target SpO2 range of 90%–95% (or 90%–100% if FiO2=21%).Main outcome measuresThe primary outcome measure was per cent of time spent within target SpO2 range. Secondary outcomes included the overall proportion and durations of SpO2 within specified hyperoxic and hypoxic ranges and the number of in-range episodes per hour.ResultsData were analysed from 30 preterm infants with median (IQR) gestation at birth of 26 (24–27) weeks, study age of 29 (18–53) days and study weight 1080 (959–1443) g. The target SpO2 range was achieved 80% of the time on automated (IntellO2) control (IQR 70%–87%) compared with 49% under manual control (IQR 40%–57%; p<0.0001). There were fewer episodes of SpO2 below 80% lasting at least 60 s under automated control (0 (IQR 0–1.25)) compared with manual control (5 (IQR 2.75–14)). There were no differences in the number of episodes per hour of SpO2 above 98% (4.5 (IQR 1.8–8.5) vs 5.5 (IQR 1.9–14); p=0.572) between the study arms.ConclusionsThe IntellO2 automated oxygen controller maintained patients in the target SpO2 range significantly better than manual adjustments in preterm babies receiving HF.Trial registration numberNCT02074774.

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Association between the Degree of Twin Birthweight Discordance and Perinatal Outcomes

American Journal of Perinatology ◽

10.1055/s-0038-1675769 ◽

2018 ◽

Vol 36 (09) ◽

pp. 969-974 ◽

Cited By ~ 2

Author(s):

Lena H. Kim ◽

Aaron B. Caughey ◽

Lynn M. Yee ◽

Yvonne W. Cheng

Keyword(s):

Neonatal Intensive Care ◽

Primary Outcome ◽

Random Effect ◽

Birth Certificate ◽

Perinatal Outcomes ◽

Neonatal Morbidity ◽

Vital Statistics ◽

Adverse Outcomes ◽

Neonatal Seizure ◽

Breech Delivery

Background Twin birthweight discordance is associated with adverse outcomes. Objective To determine what degree of twin birthweight discordance is associated with adverse outcomes. Study Design This is a retrospective cohort study of twins with vertex twin A delivered vaginally at 36 to 40 weeks (U.S. Vital Statistics Natality birth certificate registry data 2012–2014). The primary outcome was a composite of neonatal morbidity: 5-minute Apgar < 7, neonatal intensive care unit admission, neonatal mechanical ventilation > 6 hours, neonatal seizure, and/or neonatal transport to a higher level of care. Effect estimates were expressed as incidence rate and adjusted odds ratio (aOR) controlling for confounding using multivariate clustered analysis for between-pair effects, and multilevel random effect generalized estimating equation regressions to account for within-pair effects. We adjusted for sex discordance, breech delivery of the second twin, maternal race/ethnicity, nulliparity, age, marital status, obesity, and socioeconomic status. Results In comparison to birthweight discordance of ≤20%, aORs with 95% confidence intervals (CIs) by weight discordance of the primary outcome among 27,276 twin deliveries were as follows: 20.01 to 25% (aOR: 1.46 [95% CI: 1.29–1.65]); 25.01 to 30% (aOR: 1.96 [95% CI: 1.68–2.29]); and 30.01 to 60% (aOR: 2.97 [95% CI: 2.52–3.50]). Conclusion Twin birthweight discordance >20% was associated with increased odds of adverse neonatal outcome.

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Prelabor rupture of membranes at term: A possible hematological triage in addition to vagino-rectal beta-hemolytic streptococcus screening for early labor induction

PLoS ONE ◽

10.1371/journal.pone.0261906 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0261906

Author(s):

Francesco D’Ambrosi ◽

Nicola Cesano ◽

Enrico Iurlaro ◽

Alice Ronchi ◽

Ilaria Giuditta Ramezzana ◽

...

Keyword(s):

High Risk ◽

Cesarean Section ◽

Neonatal Intensive Care ◽

Perinatal Outcomes ◽

Expectant Management ◽

Low Risk ◽

Clinical Protocol ◽

Hemolytic Streptococcus ◽

Beta Hemolytic Streptococcus ◽

Prelabor Rupture Of Membranes

Introduction A potential complication of term prelabor rupture of membranes (term PROM) is chorioamnionitis with an increased burden on neonatal outcomes of chronic lung disease and cerebral palsy. The purpose of the study was to analyze the efficacy of a standing clinical protocol designed to identify women with term PROM at low risk for chorioamnionitis, who may benefit from expectant management, and those at a higher risk for chorioamnionitis, who may benefit from early induction. Material and methods This retrospective study enrolled all consecutive singleton pregnant women with term PROM. Subjects included women with at least one of the following factors: white blood cell count ≥ 15×100/μL, C-reactive protein ≥ 1.5 mg/dL, or positive vaginal swab for beta-hemolytic streptococcus. These women comprised the high risk (HR) group and underwent immediate induction of labor by the administration of intravaginal dinoprostone. Women with none of the above factors and those with a low risk for chorioamnionitis waited for up to 24 hours for spontaneous onset of labor and comprised the low-risk (LR) group. Results Of the 884 consecutive patients recruited, 65 fulfilled the criteria for HR chorioamnionitis and underwent immediate induction, while 819 were admitted for expectant management. Chorioamnionitis and Cesarean section rates were not significantly different between the HR and LR groups. However, the prevalence of maternal fever (7.7% vs. 2.9%; p = 0.04) and meconium-stained amniotic fluid was significantly higher in the HR group than in LR group (6.1% vs. 2.2%; p = 0.04). This study found an overall incidence of 4.2% for chorioamnionitis, 10.9% for Cesarean section, 0.5% for umbilical artery blood pH < 7.10, and 1.9% for admission to the neonatal intensive care unit. Furthermore, no confirmed cases of neonatal sepsis were encountered. Conclusions A clinical protocol designed to manage, by immediate induction, only those women with term PROM who presented with High Risk factors for infection/inflammation achieved similar maternal and perinatal outcomes between such women and women without any risks who received expectant management. This reduced the need for universal induction of term PROM patients, thereby reducing the incidence of maternal and fetal complications without increasing the rate of Cesarean sections.

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Short Term Outcomes of Neonates Born after Prolonged Premature Rupture of Membranes < 34 Weeks Gestation

Research in Health Science ◽

10.22158/rhs.v4n2p83 ◽

2019 ◽

Vol 4 (2) ◽

pp. 83

Author(s):

Isam Bsisu ◽

Alaa Aldalaeen ◽

Rawan Elrajabi ◽

Ala AlZaatreh ◽

Rama Jadallah ◽

...

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Preterm Births ◽

University Hospital ◽

High Rate ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Gestational Week ◽

The Mean

Background: Preterm premature rupture of membranes (PPROM) is responsible for one?third of all preterm births worldwide. This aim of this study was to investigate the outcome of neonates born after prolonged PPROM with gestational age below 34 weeks. Materials and methods: This retrospective study included 65 patients who were born to mothers with Prolonged PPROM <34 weeks gestation between January 2011 and December 2015 and admitted to the neonatal intensive care unit (NICU) at Jordan University Hospital. Results: The mean gestational age of included patients was (31.9 ± 2.5 weeks), mean birth weight was (1840 ± 583 g) and 43 (66.2%) were males. The mortality rate in those infants was 12.3 %. Gestational age, birth weight, and Apgar score were significantly lower among mortality cases compared to surviving cases (P < 0.05). Conclusion: Prolonged PPROM before the 34th gestational week is associated with high rate of morbidity and mortality, for which early identification of risk factors for developing PPROM can help in reducing the risk for preterm labors and subsequent burden on healthcare system.

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