Summary
Background
Maternal morbidity comprises medical conditions, risk factors and complications arising from or related to obstetric interventions. For this report, a priority list of 7 conditions have been identified based on prevalence and health burden: pre-existing diabetes, gestational diabetes, pre-existing hypertension, gestational hypertension, pre-eclampsia, antepartum haemorrhage and postpartum haemorrhage.
Each state and territory has a perinatal data collection, based on different collection and reporting practices, that includes information on all women who give birth within their jurisdiction. These differences have been cited as the main reason for the varied prevalence of the priority maternal morbidity conditions across states and territories.
Findings
- National guidelines exist for 6 of the 7 conditions. However, these are not endorsed or adhered to in every state and territory.
- Data on diabetes conditions affecting pregnancy have a high degree of standardisation across jurisdictions.
- Hypertensive conditions affecting pregnancy are routinely under-reported in perinatal data collections compared with hospital data collections.
- There is evidence of systematic misclassification of gestational hypertension and pre- eclampsia.
- Antepartum haemorrhage does not have a nationally endorsed guideline, although there are a number of reasonably consistent guidelines in use that could be used to formulate a national guideline.
- Data on postpartum haemorrhage is the most variable due to differences in definition as well as inconsistencies between jurisdictions in the assessment of blood volume loss.
- Not all jurisdictions publish perinatal data validation studies.
Recommendations
- Advise the National Perinatal Data Development Committee (NPDDC) to consider collection and reporting of data relating to pre-existing diabetes and gestational diabetes using the existing National Health Data Dictionary (NHDD) standard.
- Encourage the adoption by jurisdictions of the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) guidelines and NHDD definitions for pre-existing and gestational hypertension and pre-eclampsia.
- Promote discussion among clinical stakeholders, in particular obstetricians and midwives, to develop consensus definitions and guidelines for reporting antenatal and postnatal haemorrhage.
- Promote discussion among jurisdictional perinatal data managers about standardizing the linkage of information about birth episodes in hospital data collections with perinatal data.