The elements of success in a comprehensive state-wide program to safely reduce the rate of preterm birth.

BACKGROUND: In 2014, a whole-of-population and multi-faceted preterm birth prevention program was introduced in Western Australia with the single aim of safely lowering the rate of preterm birth. The program included new clinical guidelines, print and social media, and a dedicated new clinic. In the first full calendar year the rate of preterm birth fell by 7.6% and the reduction extended from the 28-31 week gestational age group upwards. OBJECTIVE: The objective of this study was to evaluate outcomes in greater depth and to also include the first three years of the program. STUDY DESIGN: This was a prospective population-based cohort study of perinatal outcomes in singleton pregnancies before and after commencement of the program. RESULTS: There was a significant reduction in preterm birth in the tertiary center which extended from 28 weeks gestation onwards and was ongoing. In non-tertiary centers there was an initial reduction, but this was not sustained past the first year. The greatest reduction was observed in pregnancies classified at first attendance as low risk. No benefit was observed in the private sector, but a significant reduction was seen in the remote region of the Kimberley where the program was first launched and vaginal progesterone had been made free-of-charge. CONCLUSION: Preterm birth rates can be safely reduced by a multi-faceted and whole-of-population program but the effectiveness requires continuing effort and will be greatest where the strategies are most targeted.

Is tissue an issue? Current practice and opinion in Western Australia for routine histopathology on products of conception.

An anonymous questionnaire-based survey was used to determine current practices and opinions of senior health professionals working in Western Australian (WA) hospitals performing gynaecological procedures, regarding the routine use of histopathology for products of conception (POC) obtained either from the surgical management of miscarriage or termination of pregnancy. Sixty-one senior health professionals completed the survey. Tissue histopathology on POC was routinely requested for miscarriage and termination of pregnancy (TOP) by 87 and 59% of respondents, respectively. Respondents listed the main reasons for requesting routine histopathology as avoidance of misdiagnosis, medico-legal and quality assurance. There were inconsistent practices among WA health professionals regarding sending POC for histopathology; 63% of gynaecology head of departments recommend the introduction of state or national guidelines for the use of histopathology in the surgical management of miscarriages or terminations of pregnancy.

Looking for the second patient: current practice and opinion on pre-operative pregnancy testing in Western Australia.

INTRODUCTION: To determine current hospital practices and the opinions of senior health professionals working in Western Australian (WA) hospitals performing gynaecological procedures regarding pre-operative pregnancy testing. METHODS: Anonymous questionnaire survey sent to all WA public and private hospitals' senior clinical staff (38 units where gynaecological surgery was performed in WA). RESULTS: Sixty-one senior health professionals (heads of department, medical directors, theatre nurse managers), completed the survey (estimated response rate 71%). Thirty-eight (68%) of respondents' units had guidelines for pre-operative pregnancy testing and 55% respondents worked in hospitals which tested all women of reproductive potential. Nineteen (33%) respondents reported cases in which patients had presented for surgery unaware they were pregnant. Forty-one (76%) respondents believed that all women of reproductive potential should have routine pre-operative pregnancy testing. Fifty-four (89%) supported the introduction of national or statewide guidelines. DISCUSSION: There are inconsistent processes of pre-operative assessment of pregnancy status in WA hospitals performing gynaecological surgery potentially resulting in adverse incidents. The majority of senior clinical staff surveyed supported routine pre-operative testing and the need for national or statewide guidelines.