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<pre>
 
 
 

 



 
 

 

 

 

 
 

PREGNANCY OUTCOME IN SOUTH AUSTRALIA 
2003 

 

 

 

 

 
Annabelle Chan   Joan Scott   Anh-Minh Nguyen   Leonie Sage 

 
 
 
 
 
 
 
 
 
 

June 2005 
 
 

Pregnancy Outcome Unit 
Epidemiology Branch 
Department of Health 

Adelaide 
ISSN 0819-3835 



ii 

 

Pregnancy Outcome Statistics Unit 
 Postal Address: 
Epidemiology Branch PO Box 6, Rundle Mall 

Department of Health ADELAIDE   5000 

162 Grenfell Street SOUTH AUSTRALIA 

ADELAIDE   5000 Telephone:  (08) 8226 6382 

SOUTH AUSTRALIA Fax: (08) 8226 6291 

 

Web: www.dh.sa.gov.au/pehs/pregnancyoutcome.htm 
Email: Pregnancy.Stats@health.sa.gov.au  

Staff 
Annabelle Chan Head / Senior medical consultant 

Joan Scott Senior midwife 

Leonie Sage Midwife (part-time) 

Maureen Fisher Clerical Officer 

Judith Thompson Clerical Officer (part-time) 

Robyn Kennare Senior midwife, Maternal, Perinatal &amp; Infant Mortality Committee 

 

Acknowledgements 
We would like to thank all midwives and nurses in South Australia who completed and 
submitted the Supplementary Birth Records on which the perinatal data collection is based. 
We thank them also for responding so efficiently to our queries. 

We would also like to express our sincere thanks to the following: 

  doctors who notified congenital abnormalities and terminations of pregnancy, 
  the pathology departments of teaching hospitals for autopsy information, 
  the Department of Cytogenetics and Molecular Genetics, Women s and Children s 

Hospital for cytogenetic reports, 

  the Births, Deaths and Marriages Registration Division for perinatal death certificates, 
  the Coroner's Office for burial orders and autopsy reports, 
  the South Australian Branch of the Australian Bureau of Statistics for assistance and for 

provision of statistics on births outside hospital, 

  Kevin Priest of the Health Statistics Unit for his assistance in programming and provision 
of perinatal data to the National Perinatal Statistics Unit and in data linkage,  

  Ann-Marie Twisk of the Health Statistics Unit for her assistance with responding to data 
requests, 

  Maureen Fisher and Judith Thompson for typing this Report, and Sandra Sowerby and 
Maureen Fisher for the graphics. 



iii 

Contents 

Executive summary ix 
1  Numbers and fertility rates ix 
2  Place of birth ix 
3  Teenage women ix 
4  Older mothers and first time mothers x 
5  Country of birth and race x 
6  Aboriginal women x 
7  Type of care and length of stay x 
8  Procedures x 
9  Method of delivery xi 
10  Multiple births xi 
11  Perinatal mortality xi 
12  Abortions xi 

I INTRODUCTION 1 
1  The Perinatal Statistics Collection 1 
2  The Abortion Statistics Collection 1 

II CONFINEMENTS AND BIRTHS: CHARACTERISTICS AND OUTCOMES 2 
1  Place of residence of mother 2 
2  Place of birth 3 
3  Maternal race 9 
4  Maternal age 9 
5  Country of birth 11 
6  Marital Status 12 
7  Occupation of father and mother 13 
8  Previous pregnancy outcomes 14 
9a  Antenatal care 14 
9b  Type of antenatal care 15 
10  Smoking 15 
11  Medical conditions 16 
12  Obstetric Complications 17 
13  Procedures performed in current pregnancy 17 
14a  Onset of labour 18 
14b Reasons for induction of labour 18 
15a Presentation and method of delivery 19 
15b Reason for caesarean section 21 



iv 

16  Complications of labour and delivery and perineal status after delivery 23 
17 Fetal monitoring during labour 23 
18  Analgesia for labour and anaesthesia for delivery 23 
19  Postnatal length of stay of mother 24 
20  Sex of baby 25 
21  Birthweight and gestation 25 
22  Birth injuries 27 
23  Treatment given in neonatal period 27 
24  Level of care utilised 27 
25  Length of stay of babies 28 
26  Congenital abnormalities 28 
27  Multiple births 29 
28  Perinatal mortality 30 
29  Home births 31 
30  Birthing unit births 33 

III  TERMINATIONS OF PREGNANCY 35 
1 Numbers and rates 35 
2 Age of women 36 
3 Marital status 38 
4 Place of residence and place where termination performed 38 
5 The reason for termination 39 
6 Gestation, method and complications 39 
7 Previous terminations. Total abortion rate and Total first abortion rate 40 

IV  OBSTETRIC PROFILES BY HOSPITAL CATEGORY 42 

V  CLINICAL AND MATERNITY PERFORMANCE INDICATORS 48 
1  Clinical indicators 48 
2  Maternity performance indicators 52 

VI  TRENDS IN PERINATAL STATISTICS IN SOUTH AUSTRALIA,       1981-2003 57 

VII  SUMMARY STATISTICS FOR 2003 62 

References 64 

Publications 65 

Appendix 1 : Definitions 72 

Appendix 2: Supplementary birth record 76 

Appendix 3: Congenital abnormality form 77 



v 

Tables 
Table 1: Births and crude birth rate by CURB regions, South Australia, 2003 2 
Table 2: Total births notified in 2003, by place of birth and plurality, South Australia  
(based on Supplementary Birth Records) 3 
Table 3a: Hospital births by category of hospital, South Australia, 2003 6 
Table 3b: Hospital births in South Australia in 2003 by race and hospital  
(as indicated by returned SBRs for hospital births) 7 
Table 4a: Confinements by race of mother, South Australia, 2003 9 
Table 4b: Confinements by race and birthplace category, South Australia, 2003 9 
Table 4c: Maternal age by race, South Australian confinements, 2003 10 
Table 4d: Age-specific fertility rates, South Australia, 2003 11 
Table 5a: Confinements by country of birth of mother, major groups,*  South Australia, 2003 11 
Table 5b: Confinements by specified country of birth* of mother, South Australia, 2003 12 
Table 6a: Marital status by age of mother, South Australia, 2003 12 
Table 6b: Type of patient by marital status of mother, South Australia, 2003 13 
Table 7: Occupation of father and mother,* South Australian confinements, 2003 13 
Table 8a: Parity by race of mother, South Australian confinements, 2003 14 
Table 8b: Previous pregnancy outcomes, South Australian confinements, 2003  
(multigravidae only, n= 12,009) 14 
Table 9a: Antenatal visits by race, South Australian confinements, 2003 15 
Table 9b: Type of antenatal care, South Australian confinements, 2003 (n = 17,517) 15 
Table 10a: Tobacco smoking status at first visit, South Australian confinements, 2003 16 
Table 10b: Average number of tobacco cigarettes smoked per day in second half of  
pregnancy, South Australian confinements, 2003 16 
Table 11: Medical conditions in current pregnancy, South Australian confinements, 2003 16 
Table 12: Frequency of some obstetric complications, South Australian confinements, 2003 17 
Table 13: Procedures performed in current pregnancy, South Australian confinements, 2003 17 
Table 14a Onset of labour, South Australian confinements, 2003 18 
Table 14b: Method of induction of labour, South Australian confinements, 2003 18 
Table 14c: Augmentation of labour after spontaneous onset, South Australian  
confinements, 2003 19 
Table 15a: Method of delivery, South Australian confinements, 2003 20 
Table 15b: Method of delivery by presentation, South Australian births, 2003 (n=17,844) 21 
Table 15c: Method of delivery in breech presentation, by plurality, South Australian  
births, 2003 (n = 904) 21 
Table 16: Frequency of some complications of labour and delivery, South Australian  
confinements, 2003 23 
Table 17a: CTG performed during labour, South Australian confinements, 2003 23 
Table 17b: Fetal scalp pH taken during labour, South Australian confinements, 2003 23 
Table 18a: Analgesia for labour,* South Australian confinements, 2003 24 
Table 18b: Anaesthesia for delivery,* South Australian confinements, 2003 24 



vi 

Table 19a: Postnatal length of stay of mother, South Australian hospital confinements, 2003 24 
Table 19b: Average postnatal length of stay of mother by type of patient &amp; type of  
delivery, South Australian hospital confinements, 2003 25 
Table 20: Sex of baby, South Australian births, 2003 25 
Table 21a: Birthweight distribution of all births, South Australia, 2003 25 
Table 21b: Perinatal mortality by birthweight, (all births) South Australia, 2003 26 
Table 21c: Perinatal mortality by gestational age at birth, South Australia, 2003 27 
Table 22: Birth injuries*(in 17,710 live births), South Australia, 2003 27 
Table 23: Neonatal treatment given (all live births), South Australia, 2003 27 
Table 24: Level of nursery care utilised by birthweight (all live births), South Australia, 2003 28 
Table 25: Length of stay of liveborn babies in hospital, South Australia, 2003 28 
Table 26: Selected congenital abnormalities notified to the perinatal statistics  
collection, 1993-2003,  South Australia 29 
Table 27a: Birthweight by plurality (all births), South Australia, 2003 30 
Table 27b Gestation at delivery, by plurality (all births) South Australia, 2003 30 
Table 27c: Perinatal outcome by plurality (all births) South Australia, 2003 30 
Table 28a: Perinatal mortality, South Australia, 2003 (all births of specified  
birthweight/gestation) 31 
Table 28b: Perinatal mortality by race, South Australian births, 2003 31 
Table 29: Planned home confinements by age of mother, South Australia, 2003 32 
Table 30: Method of delivery in planned home confinements, South Australia, 2003 32 
Table 31: Birthweight distribution of planned home birth, South Australia 2003 32 
Table 32: Perinatal outcome in planned home births, South Australia 2003 32 
Table 33: Planned birthing unit confinements by age of mother, South Australia 2003 33 
Table 34: Method of delivery in planned birthing unit confinements, South Australia, 2003 33 
Table 35: Birthweight distribution of planned birthing unit births, South Australia, 2003 34 
Table: 36 Perinatal outcome in planned birthing unit births, South Australia, 2003 34 
Table 37: Abortion rate per 1,000 women aged 15-44 years, South Australia, 1970-2003 35 
Table 38: Terminations of pregnancy by age, South Australia, 2003 36 
Table 39: Abortion and live birth rates and abortion proportions by age, South Australia, 2003 37 
Table 40: Terminations by marital status, South Australia, 2003 38 
Table 41: Terminations by place of residence,South Australia, 2003 38 
Table 42: Terminations by hospital category, South Australia, 2003 39 
Table 43: Terminations by category of doctor, South Australia, 2003 39 
Table 44: Reason for termination for suspected or identified abnormality of fetus,  
South Australia, 2003 39 
Table 45: Complications of terminations, South Australia, 2003 40 
Table 46a: Women with previous terminations by age, South Australia, 2003 40 
Table 46b: Calculation of total abortion rate (TAR) for 2003 for South Australia* 41 
Table 46c: Calculation of total first abortion rate (TFAR) for 2003 for South Australia* 41 



vii 

Table 47: Obstetric profiles by hospital category, South Australia, 2003,  
births of &gt;=400g or &gt;=20 weeks gestation 44 
Table 48: Socio-demographic aspects of perinatal statistics, South Australia,  
1981 and 1994   2003 58 
Table 49: Obstetric aspects of perinatal statistics, South Australia, 1981 and 1994   2003 59 

Figures 
1A South Australian hospitals with obstetric beds in 2003 
1B Central Regions   inset 
2 Distribution of hospital births by hospital category, SA, 2003 
3 Maternal age by race, SA confinements 2003 
4 Reasons for induction of labour, SA 2003 
5A Method of delivery in all confinements, SA 2003 
5B Reason for LSCS, SA 2003 
5C Reason for Elective LSCS, SA 2003 
5D Reason for Emergency LSCS, SA 2003 
6 Perinatal mortality rate by birthweight, SA births 2003 
7 Abortion rate in South Australia, 1970-2003 
8A Abortions and live births by age, SA, 2003 
8B Teenage pregnancy, abortion and birth rates, South Australia 1970-2003 
9 % Aboriginal mothers by hospital category, SA, 2003 
10 % Mothers with &lt;7 antenatal visits by hospital category, SA, 2003 
11 % Teenage mothers by hospital category, SA, 2003 
12 % Mothers 35 years or more by hospital category, SA, 2003 
13 % Single mothers by hospital category, SA, 2003 
14 % Mothers with 4 or more prior live births by hospital category, SA, 2003 
15 % Mothers with 1 or more prior perinatal deaths by hospital category, SA, 2003 
16 % Mothers with obstetric complications by hospital category, SA, 2003 
17 % Mothers with complications during labour or delivery by hospital category, SA, 2003 
18 % Mothers with induction of labour by hospital category, SA, 2003 
19 % Mothers having epidural analgesia by hospital category, SA, 2003 
20 % Breech deliveries by hospital category, SA, 2003 
21 % Emergency LSCS by hospital category, SA, 2003 
22 % Elective LSCS by hospital category, SA, 2003 
23 % Total LSCS by hospital category, SA, 2003 
24 % Births with birthweight below 2,500g by hospital category, SA, 2003 
25 % Births with gestation &lt;37 weeks by hospital category, SA, 2003 
26 % Births with prolonged hospitalisation by hospital category, SA, 2003 
27 % Live births requiring neonatal intensive care by hospital category, SA, 2003 
28 % Births with birth defects by hospital category, SA, 2003 
29A  Induction of labour: % of confinements of standard primiparae in which labour was induced, 

SA hospitals with &gt;=500 births per year, 2003 
29B Caesarean sections for standard primiparae: % of confinements of standard primiparae in 

which caesarean section was performed, SA hospitals with &gt;=500 births per year, 2003 



viii 

29C VBAC: proportion of women delivering vaginally following a previous primary (first) 
caesarean section and no intervening births, SA hospitals with &gt;=500 births per year, 2003 

29D PRIMIP no repair: proportion of primiparous women not requiring surgical repair following 
vaginal delivery, SA hospitals with &gt;=500 births per year, 2003 

29E TERM NICU: proportion of term babies admitted to NICU for reasons other than congenital 
abnormality, SA hospitals with &gt;=500 births per year, 2003 

29F SPMR (Standardizad Perinatal Mortality Ratio) for all births, SA hospitals with &gt;=500 births per 
year, 2003 

30 Trends in perinatal statistics in SA, 1985-2003 
30.1 % Teenage mothers among women giving birth in SA 
30.2 % Mothers aged 35 years and over among women giving birth in SA 
30.3 % Primigravid women aged 30 years and over in SA 
30.4 % Confinements of Aboriginal women and Asian women in SA 
30.5 % Mothers never married and with no de facto partner among women giving birth in SA 
30.6 % Multiple births among SA births 
30.7 % Low birthweight babies among SA births 
30.8 SA standardised perinatal mortality ratio 



ix 

 

Executive summary 
This report on pregnancy outcome in South Australia for 2003 provides statistics derived 
mainly from the South Australian perinatal data collection of births. These are notified by 
hospital and homebirth midwives and neonatal nurses. For a more complete picture of 
pregnancy outcome, some statistics from the abortion statistics collection are also included. 
More statistics on abortions in the state are provided in the First Annual Report of the 
Abortion Reporting Committee for the Year 2003. Comparisons of selected pregnancy 
characteristics are provided for five different hospital categories in the state. Individual 
hospital reports (Pregnancy and Neonatal Care Bulletins) with these comparisons made in 
greater detail are provided to hospitals in the state with at least 100 births per year. Group 
reports are prepared for hospitals with smaller numbers of births.  

1  Numbers and fertility rates 
The number of births notified in South Australia in 2003 was 17,844, which was 99 more than 
the previous year. The number of women who gave birth was 17,517. This is higher than in 
2002 and 2001 and closer to the number in 2000. The crude birth rate remained at 11.6 per 
1,000 population and was generally higher in country regions than the Central regions. 
However, Yorke and Lower North had the lowest rate, while the Central Northern Region 
had the highest. The total fertility rate was 1.75 per woman, a slight increase from 1.73 in 
2002.  Compared with 2002, there has been a fall in the fertility rate among the younger age 
groups under 25 years and an increase among older age groups of 30 years and above. The 
fertility rate was highest in the 30-34 years age group, followed closely by the 25-29 years age 
group. 

2  Place of birth 
Compared with 2002, the proportion of births increased in metropolitan teaching hospitals 
(from 49.6% to 50.4% of births in the state), decreased in country hospitals (22.2% to 21.3%) 
and remained stable in metropolitan private hospitals (at 27.9%). Six percent of women (966) 
gave birth in birthing units in teaching hospitals and another 5% (923) who intended to give 
birth in birthing units required transfer to labour wards before delivery. Sixty planned 
homebirths were notified, a slight increase in the number compared with the previous three 
years. However, our ascertainment of planned homebirths is incomplete, being about 85% in 
2003. 

3  Teenage women 
In 2003, 937 teenage women gave birth, accounting for 5% of confinements, and 1132 teenage 
women had terminations of pregnancy, accounting for 22% of terminations. The teenage 
pregnancy rate declined in the 1970s and 1980s, but increased in the early 1990s, with an 
increase in the teenage abortion rate. However, since 1996 it has declined mainly due to the 
decline in the teenage birth rate. Teenage abortions have exceeded teenage births each year 
since 1995, and in 2003 55% of known teenage pregnancies were terminated compared with 
23% of known pregnancies for all ages. 



x 

4  Older mothers and first time mothers 
Older women aged 35 years or more have been contributing an increasing proportion to 
confinements, from 5% in 1981 to 18% in 2003. Thirty-six percent of women giving birth in 
their first pregnancy were aged 30 years or more, compared with 9% in 1981: their mean age 
was 27.1 years.  As in the previous 2 years, more women gave birth in the age group 30-34 
years than in the 25-29 years age group. The mean age of all women giving birth was 29.3 
years. 

5  Country of birth and race 
Eighty-five percent of women who gave birth in 2003 were Australian-born.  Of women born 
overseas who gave birth, the largest proportions came from the United Kingdom and Ireland 
(4.1% of confinements in the state), Vietnam (1.7%), New Zealand (0.9%) and the Philippines 
(0.7%). 

Asian women accounted for 829 confinements, 5% of all confinements in the state in 2003, 
compared with 2% in 1981. They were slightly older than women of other races (19% being 
aged 35 years or more) and gave birth mainly in teaching hospitals. 

6  Aboriginal women 
Aboriginal women accounted for 468 confinements, 3% of confinements in the state, an increasing 
proportion. Twenty-two percent of Aboriginal women were teenagers (compared with 5% of non-
Aboriginal women) and 41% had less than seven antenatal visits during pregnancy (compared with 
6% of non-Aboriginal women). Smoking in pregnancy was more prevalent among Aboriginal 
mothers, with 59% smoking during pregnancy compared with 20% of non-Aboriginal women. 
Aboriginal women also had proportions of low birthweight births (&lt;2,500g) three times as high, and of 
preterm births (&lt;37 weeks gestation) more than twice as high as those of non-Aboriginal women. The 
perinatal mortality rate of babies of Aboriginal women, which was the lowest since 1995, was still 
nearly twice as high as that of births to non-Aboriginal women in 2003 (16.9 compared with 9.7 per 
1,000 births). 

7  Type of care and length of stay 
Although many women had more than one type of antenatal care, the most common types 
used were hospital clinics (41%), obstetricians in private practice (34%) and general 
practitioners (25%). Thirty-four percent of women were private patients, slightly more than 
the previous year (33%). The median length of stay of mothers after a birth was 4 days; it was 
3 days for those who had a vaginal delivery and 5 days for those who had a caesarean 
section.  It was 2 days longer among private patients for vaginal deliveries. 

8  Procedures 
At least ninety-six percent of women who gave birth had an ultrasound examination; 29% 
had labour induced while another 21% had spontaneous labour augmented; epidurals were 
used for pain relief during labour for 32% of women, and 13% (a declining proportion) had 
an episiotomy. The main reasons for induction of labour were prolonged pregnancy (25%), 
hypertension (17%), premature rupture of membranes (8%), intrauterine growth restriction 
(4%) and diabetes or gestational diabetes (4%). However, the proportion of inductions 
performed which was not for the defined indications has increased from 35% in 1998 to 44% 
in 2003.   



xi 

9  Method of delivery 
For the third year, the proportion of spontaneous normal vaginal deliveries (58%) was below 
60%. The proportion of women delivered by ventouse increased to 7% while forceps 
deliveries decreased to 5% (compared with 1% and 15% respectively in 1981). In 2003 the 
proportion of women delivered by caesarean section rose to 30%, with 13% of women having 
elective caesareans. Fifteen percent of women who gave birth had had a previous caesarean 
section. Only 20% of women had a vaginal delivery following a previous first caesarean 
without intervening births, compared with 21% the previous year. The main reasons given 
for caesarean section were previous caesarean section (32%), failure to progress in labour or 
cephalopelvic disproportion (31%), fetal distress (19%) and malpresentation (14%).  

10  Multiple births 
Multiple births accounted for 3.6% of births; confinements  with twins or triplets accounted 
for 1.8% of confinements in 2003, the same as in 2002. These proportions have been 
increasing since the 1980s as a result of the use of assisted conception and the increasing 
proportion of older mothers, who have higher rates of multiple pregnancies than younger 
mothers. 

11  Perinatal mortality 
The perinatal mortality rate for all births in 2003 was 9.9 per 1,000 births and  the neonatal 
mortality rate 2.4 per 1,000 live births. For international comparisons, the World Health 
Organization recommends including only births of at least 1,000g birthweight (or 28 weeks 
gestation if birthweight unavailable ) and early neonatal deaths within the first 7 days of life 
(instead of 28 days) in calculating the perinatal mortality rate. This rate for international 
comparisons for South Australia for 2003 was 3.9 per 1,000 births. This rate has declined by 
46% from 7.2 per 1,000 births in 1981. The decline has been even greater for neonatal deaths 
(a decline of 72% from 2.5 per 1,000 live births in 1981 to 0.7 per 1,000 live births in 2003). 

12  Abortions 
5,214 terminations of pregnancy were notified, 249 less than in 2002. The abortion rate was 
16.7 per 1,000 women aged 15-44 years, which shows a decline from 17.4 in 2002. There were 
declines in the abortion rates for younger age groups under 30 years. Approximately 92% of 
terminations were performed at metropolitan teaching hospitals, including the Pregnancy 
Advisory Centre, and 73% were in family advisory clinics in these hospitals. Ninety-three 
percent of terminations were performed within the first 13 weeks of pregnancy and 0.9% (49) 
were late terminations (at or after 20 weeks gestation). Forty-three percent of these late 
terminations were for congenital abnormalities. 

 



 
 

1

 

I INTRODUCTION 
This Report summarizes the statistics for 2003 from the South Australian perinatal statistics 
collection and the South Australian abortion statistics collection, both of which are held in 
the Pregnancy Outcome Unit. Some definitions used by the Pregnancy Outcome Unit are 
provided in Appendix 1. Guidelines1 with some of these definitions are issued to all South 
Australian obstetric units to promote the uniform completion of forms. 

1  The Perinatal Statistics Collection 
This collection utilises notifications of births in South Australia made by hospital and 
homebirth midwives and hospital neonatal nurses on the Supplementary Birth Record (SBR - 
Appendix 2). It includes all stillbirths of at least 20 weeks gestation or 400g birthweight and 
all live births. The SBRs are checked manually for completeness and data discrepancies and 
then go through a series of automated validation procedures during data entry in the 
Pregnancy Outcome Unit.  

Information on congenital abnormalities detected at birth or in the neonatal period (within 
28 days of birth) is provided by doctors using the Congenital Abnormality Form (Appendix 
3). Minimal statistics on birth defects are included in this report as these are included in the 
annual report of the South Australian Birth Defects Register at the Women s and Children s 
Hospital. The Register complements statistics on birth defects from the perinatal data and 
abortion statistics collections with statistics on birth defects detected and notified after 
discharge from the birth hospital up to the child s fifth birthday. Perinatal data are provided 
under legislation, the South Australian Health Commission (Pregnancy Outcome Statistics) 
Regulations 1999. The South Australian perinatal data collection includes all births occurring 
in South Australia, including those to women who normally reside interstate, mainly in New 
South Wales near the South Australian border and in the Northern Territory. Births of South 
Australian residents which occur in other states are not included. The perinatal data have 
been collected since 1981, but there have been changes in the data items collected over the 
years. The data items in the SBR have remained uniform since 1998.  

Perinatal death certificates and Burial Orders in coronial cases are obtained from the Births, 
Deaths and Marriages Registration Division, chromosome analysis reports from the 
Cytogenetics Department at Women s and Children s Hospital and autopsy reports from 
pathology departments and the Coroner's Office. All these are linked with the SBRs to 
provide more complete information on births and deaths. All maternal, perinatal and infant 
deaths in the state are reviewed by the Maternal, Perinatal and Infant Mortality Committee 
and details of these are reported in the annual report of the Committee entitled  Maternal, 
Perinatal and Infant Mortality in South Australia 2003.   

2  The Abortion Statistics Collection 
Notifications made by doctors of medical terminations of pregnancy under the Criminal Law 
Consolidation (Medical Termination of Pregnancy) Regulations 1996, are included in this 
collection. 

The abortion statistics collection has been in existence, with minor changes, since 1970, when 
specific abortion legislation came into force under the Criminal Law Consolidation Act. 
Medical termination of pregnancy became legal in the state if performed in a prescribed 
hospital before 28 weeks gestation by a medical practitioner for a woman who has been 
resident at least two months in the state. The practitioner and another medical practitioner 
must have examined the woman and formed the opinion that the continuation of the 



 
 

2

pregnancy would involve greater risk to her life or greater risk of injury to her physical or 
mental health than if the pregnancy were terminated; or that there is a substantial risk that if 
the pregnancy were not terminated and the child were born, the child would suffer from 
such physical or mental abnormalities as to be seriously handicapped. 

II CONFINEMENTS AND BIRTHS: CHARACTERISTICS AND OUTCOMES 
The births in 2003 in South Australia described in this Report include live births of any 
gestation and stillbirths (including terminations of pregnancy) of at least 400g birthweight or 
20 weeks gestation. There was one stillbirth of unknown birthweight born at 23 weeks 
gestation. Thirty-five births of less than 400g birthweight have been included, consisting of 
seven live births (all of which were born at 20 weeks gestation and died in the neonatal 
period) and 28 stillbirths. Fourteen of these births were terminations of pregnancy, twelve 
having been undertaken for congenital abnormalities.  Five of the 35 babies were from 
multiple pregnancies: there was a set of twins; three others were intrauterine deaths which 
were retained in utero until their twin or triplet siblings were delivered at 28, 31 and 39 
weeks gestation respectively. SBRs were received for all 17,844 births reported by hospital 
and home birth midwives in their monthly notification lists. These comprised 17,710 live 
births and 134 stillbirths. The number of women confined was 17,517, closer to the number in 
2000, but higher than in 2001 and 2002. Findings relating to Aboriginal mothers and babies in 
the text of this Report have been italicised for easy identification, in response to the request of 
the Aboriginal Health Council. 

1  Place of residence of mother 
South Australia is divided into 9 CURB (Committee for Uniform Regional Boundaries) 
Regions, comprising 5 country Regions and 4 Central Regions. Each of the Central Regions 
(Northern, Eastern, Western, Southern) has a Metropolitan (Adelaide) and a non-
metropolitan component (Figures 1A and 1B). The distribution of births according to place of 
residence of mother by CURB Regions is provided in Table 1 together with the estimated 
resident population and crude birth rate. Only live births are used in calculating the crude 
birth rate (see Appendix 1). The crude birth rate in 2003 for South Australia was 11.6 per 
1,000 population. It was lowest in Yorke and Lower North and the Central Western, Eastern 
and Southern Regions, and highest in the Central Northern Region and the South East. 

Table 1: Births and crude birth rate by CURB regions, South Australia, 2003 

CURB Region 
(Mother's residence) Total births Live births 

Estimated resident 
population, June 30, 

2003+ 

Crude birth 
rate per 1,000 
population 

 Number Percent Number Number  

Central Northern 5,219 29.3 5,190 394,361 13.2 
Central Western 2,290 12.8 2,260 215,107 10.5 
Central Eastern 2,810 15.8 2,792 264,628 10.6 
Central Southern 3,949 22.1 3,920 364,450 10.8 
Yorke &amp; Lower North 419 2.4 413 44,537 9.3 
Murraylands 812 4.6 805 68,493 11.8 
South East 827 4.6 823 62,986 13.1 
Northern 981 5.5 973 78,184 12.4 
Eyre 415 2.3 412 34,402 12.0 
Interstate 122 0.7 122 na na 
Total 17,844 100.0 17,710 1,527,148 11.6 

+ Australian Bureau of Statistics. Population estimates by age  and sex, South Australia, 2003.  
 Canberra: ABS, 2004 (Catalogue No 3235.0). 



 
 

3

2  Place of birth 
Of the 17,844 births in 2003, 63 (0.3%) were home births. Sixty of these, including a set of 
twins, were planned home births. Three women were not booked at any hospital and 
delivered at home. The remaining 17,781 births took place in hospitals or (in 66 cases) before 
arrival at hospitals into which the mothers had been booked. These 66 Born Before Arrival 
(or BBA) births have been included in the statistics for those hospitals. The distribution of 
births by place of birth (home or hospital) and plurality is provided in Table 2. Locations of 
South Australian hospitals with obstetric beds in 2003 are provided in Figures 1A and 1B. 

 

Table 2: Total births notified in 2003, by place of birth and plurality, South Australia 
(based on Supplementary Birth Records) 

Condition at birth Home births Hospital births 
 Singleton Twin Singleton Twin Triplet 

Total 

Live birth 60* 2 17,016 612 20 17,710 
Stillbirth 1 0 120 12 1 134 
Total births 61* 2 17,136 624 21 17,844 

*  Includes 3 unplanned home births, not booked at any hospital 

Of the 17,781 hospital births, 79% occurred in metropolitan hospitals (teaching and private) 
and 21% in country hospitals. This distribution is summarized in Table 3a and Figure 2 and 
the numbers of births and confinements by race in individual hospitals are provided in Table 
3b. Metropolitan hospitals are listed in order of number of births and country hospitals in 
alphabetic order in their category of number of births. Fifty-one percent of births in South 
Australia in 2003 occurred in metropolitan teaching hospitals. Level III teaching hospitals - 
the Women s and Children s Hospital and Flinders Medical Centre - provide a high risk 
pregnancy service and neonatal intensive care. Two other teaching hospitals have neonatal 
special care units - Lyell McEwin Health Service and Modbury Hospital. The Queen 
Elizabeth Hospital provided only Level I services in 2003. These levels are defined in the 
Report  Operational Policy, Guidelines and Standards for Maternal and Neonatal Services in 
South Australia. 2 

Compared with 2002, the numbers of births in 2003 increased at all teaching hospitals  with 
obstetric beds with the exception of  The Queen Elizabeth Hospital. In metropolitan private 
hospitals, births decreased at Central Districts Private Hospital, were stable at North Eastern 
Community Hospital and increased in all others. 

Obstetric services in the country ceased during the year at Peterborough, Mannum, Kimba 
and Cowell Hospitals and the number of births fell in small country hospitals with less than 
100 births per year as a group (from 5.4% of births in 2002 to 4.2%). The numbers of births 
increased at Mount Gambier, Gawler Health Service, Port Augusta, South Coast District, 
Jamestown and Ceduna Hospitals, while decreases occurred at Whyalla, Port Lincoln, Port 
Pirie, Naracoorte, Renmark, Loxton, Wallaroo, Southern Yorke Peninsula and Streaky Bay 
Hospitals. 



 
 

4

 



 
 

5

 



 
 

6

 

Table 3a: Hospital births by category of hospital, South Australia, 2003 
Hospital category Number of births Percent hospital births 

Metropolitan teaching 8,999 50.6 
Level III (6,120) (34.4) 
Other teaching (2,879) (16.2) 
Metropolitan private 4,987 28.1 
Country 3,795 21.3 
Major country (835) (4.7) 
100-399 births per annum (2,208) (12.4) 
50-99 births per annum (541) (3.0) 

&lt;50 births per annum (211) (1.2) 
Total 17,781 100.0 

 

0 10 20 30 40 50 60

Figure 2: Distribution of hospital births by hospital category, South Australia, 2003
(n=17,781)

Percentage of births
Note: Hospital abbreviations as in Table 3b

 a          b      c       d      e  f     28.1%

 t   u  v w       x        y   z    21.3%

                   22.2%                    12.2%           8.7%     3.7% 3.7%   50.6%

a Ashford 8.4%
b Calv ary 5.2%
c Burnside War Memorial 4.9%
d Flinders Priv ate 4.5%
e North Eastern Community 3.7%
f Central Districts 1.4%

t Mt Gambier 3.1%
u Whyalla 1.6%
v  Gawler 2.2%
w Mount Barker 1.9%
x Other hospitals with 100-399 births per year 8.3%
y Hospitals with 50-99 births per year 3.0%
z Hospitals with &lt;50 births per year 1.2%

Teaching hospitals

Metropolitan private
hospitals

Country hospitals



 
 

7

 

Table 3b: Hospital births in South Australia in 2003 by race and hospital (as indicated by returned 
SBRs for hospital births) 
Hospital Caucasian Aboriginal Asian Other Total 

births 
Total 

confinements 

Metropolitan teaching       
Women s &amp; Children s Hospital (W&amp;CH) 3,318 146 315 167 3,946 3,807 
Flinders Medical Centre (FMC) 2,024 32 83 35 2,174 2,133 
Lyell McEwin Health Service (LMHS)* 1,348 58 125 17 1,548 1,519 
The Queen Elizabeth Hospital (TQEH) 479 32 126 26 663 663 
Modbury Hospital (MOD)* 603 7 32 23 665 659 
Royal Adelaide Hospital (RAH) 2 0 0 0 2 2 
Noarlunga Health Service 1 0 0 0 1 1 
Total 7,775 275 681 268 8,999 8,784 
Metropolitan private       
Ashford Community * 1,438 3 37 8 1,486 1,450 
Burnside War Memorial (BWMH)* 836 0 24 5 865 856 
Calvary* 903 1 25 2 931 920 
Central Districts 239 1 3 0 243 239 
Flinders Private* 768 1 17 11 797 783 
North Eastern Community (NECH)* 654 1 7 3 665 658 
Total 4,838 7 113 29 4,987 4,906 
Country       
Major country       
Mt. Gambier* 521 10 7 7 545 533 
Whyalla 263 24 2 1 290 285 
Subtotal 784 34 9 8 835 818 
100-399 births per annum       
Gawler Health Service** 381 4 3 1 389 387 
Millicent 99 2 0 1 102 102 
Mt. Barker 336 2 2 0 340 340 
Murray Bridge Soldiers' Memorial 217 13 3 6 239 239 
Naracoorte 116 0 3 2 121 120 
Pt. Augusta 132 75 2 9 218 215 
Pt. Lincoln 197 11 3 3 214 214 
Pt. Pirie 156 6 0 2 164 159 
Riverland Regional (Berri) 150 12 6 4 172 171 
South Coast District (Victor Harbor) 101 2 1 1 105 105 
Tanunda 139 2 2 1 144 144 
Subtotal 2,024 129 25 30 2,208 2,196 

*   These hospitals have neonatal special care nurseries. 

**  This is a metropolitan hospital situated at the metropolitan/country boundary; it has the characteristics  
 of a country hospital and has been included as such. 



 
 

8

 

Hospital Caucasian Aboriginal Asian Other Total 
births 

Total 
confinements 

50-99 births per annum       
Clare 85 0 0 0 85 85 
Crystal Brook 57 2 0 1 60 60 
Jamestown 50 2 0 0 52 52 
Kapunda 51 1 0 0 52 52 
Loxton 72 2 0 0 74 73 
Northern Yorke Peninsula Regional 
Health Service (Wallaroo) 

80 1 0 0 81 81 

Renmark 73 3 3 4 83 83 
Waikerie 54 0 0 0 54 54 
Subtotal 522 11 3 5 541 540 
1-49 births per annum       
Amata 0 1 0 0 1 1 
Angaston 1 0 0 0 1 1 
Booleroo Centre 16 0 0 0 16 16 
Ceduna 13 5 0 0 18 18 
Cleve 25 0 1 0 26 26 
Coober Pedy 0 2 0 0 2 2 
Cowell 3 0 0 0 3 3 
Cummins 20 0 0 0 20 20 
Ernabella 0 1 0 0 1 1 
Indulkana 0 1 0 0 1 1 
Kangaroo Island 33 0 1 1 35 35 
Kimba 2 0 0 0 2 2 
Mannum 18 2 0 0 20 20 
Mid West Health (Wudinna) 6 0 0 0 6 6 
Mid West Health (Streaky Bay) 11 0 0 0 11 11 
Meningie 1 0 0 0 1 1 
Quorn 9 1 0 0 10 10 
Roxby Downs 1 0 0 0 1 1 
Southern Yorke Peninsula 
(Yorketown) 

20 2 0 0 22 22 

Tumby Bay 14 0 0 0 14 14 
Subtotal 193 15 2 1 211 211 
       
Total (country) 3,523 189 39 44 3,795 3,765 
       
Grand total 16,136 471 833 341 17,781 17,455 

 

 



 
 

9

3  Maternal race 
The distribution of South Australian confinements by race of mother is provided in Table 4a 
and also by category of birthplace in Table 4b. In these tables and all others where distribution by 
race is shown,  Aboriginal  includes Aboriginal (451 women), Torres Strait Islander (5 women) and 
those who are Aboriginal and Torres Strait Islander (12 women). Aboriginal mothers accounted for 
2.7% of confinements and delivered mainly in country hospitals and metropolitan teaching hospitals. 
Asian mothers, accounting for 4.7% of confinements, delivered mainly in metropolitan 
teaching hospitals but 13.6% delivered in private hospitals. 

 

Table 4a: Confinements by race of mother, South Australia, 2003 

Race of mother Number of confinements % Confinements
Caucasian 15,885 90.7
Aboriginal 468 2.7
Asian 829 4.7
Other 335 1.9
Total 17,517 100.0
 

 

Table 4b: Confinements by race and birthplace category, South Australia, 2003 
 Race of mother 

Birthplace Caucasian Aboriginal Asian Other Total 
 Number % Number % Number % Number % Number % 

Metropolitan 
teaching hospital 

7,572 47.7 273 58.3 677 81.7 262 78.2 8,784 50.1 

Metropolitan 
private hospital 

4,757 30.0 7 1.5 113 13.6 29 8.7 4,906 28.0 

Country hospital 3,496 22.0 186 39.7 39 4.7 44 13.1 3,765 21.5 
Home 60 0.4 2 0.4 0 0 0 0 62 0.4 
Total 15,885 (90.7) 468 (2.7) 829 (4.7) 335 (1.9) 17,517 100.0 

 

 

4  Maternal age 
Among the five-year age groups the largest proportion of confinements (33.2%) was 
contributed by women in the 30-34 years age group (Table 4c). The proportion of women in 
this age group has exceeded that of the 25-29 years age group since 2001.  Confinements of 
teenagers comprised 5.3% and those of older women aged 35 years or more, 17.7% (Figure 3). 
Aboriginal mothers were generally younger than non-Aboriginal: 22.0% were teenagers and only 
7.1%were 35 years or older. Among Asian women, on the other hand, there were fewer 
teenagers (3.1%) and a larger proportion (19.4%) of older women.  

The age-specific fertility rates are provided in Table 4d. The age-specific fertility rate was 
highest in the age group 30-34 years (110.4 per 1,000 women), followed closely by the 25-29 
years age group (108.9 per 1,000 women). The general fertility rate (see Appendix 1) was 56.6 
per 1,000 women aged 15-44 years. The total fertility rate (see Appendix 1) was 1.75 per 
woman, slightly higher than in 2002 when it was 1.73. 



 
 

10

 

Table 4c: Maternal age by race, South Australian confinements, 2003 
Age 
(years) Caucasian Aboriginal Asian Other Total 

 Number % Number % Number % Number % Number % 

&lt;15 7 0 2 0.4 0 0 0 0 9 0.1 
15-19 787 5.0 101 21.6 26 3.1 14 4.2 928 5.3 
20-24 2,332 14.7 145 31.0 122 14.7 65 19.4 2,664 15.2 
25-29 4,522 28.5 123 26.3 254 30.6 99 29.6 4,998 28.5 
30-34 5,387 33.9 64 13.7 266 32.1 96 28.7 5813 33.2 
35-39 2,379 15.0 26 5.6 129 15.6 50 14.9 2,584 14.8 
40-44 454 2.9 6 1.3 31 3.7 9 2.7 500 2.9 
45+ 17 0.1 1 0.2 1 0.1 2 0.6 21 0.1 
Total 15,885 (90.7) 468 (2.7) 829 (4.7) 335 (1.9) 17,517 100.0 

 
 
 
 

Caucasian Aboriginal Asian Other Total
0

20

40

60

80

100

14-19 20-24 25-29 30-34 35+ Age (Years)

Figure 3: MATERNAL AGE BY RACE, SA CONFINEMENTS 2003
(n=17,517)

n=15,885 n=468 n=829 n=335 n=17,517

 



 
 

11

 

Table 4d: Age-specific fertility rates, South Australia, 2003 

Age (years) Number of live births 
Estimated resident female 

population*  
Age-specific fertility rate per 

1,000 women (ASFR) 

15-19 940** 50,796 18.5** 
20-24 2,678 48,498 55.2 
25-29 5,042 46,308 108.9 
30-34 5,906 53,520 110.4 
35-39 2,614 54,453 48.0 
40-44 527** 59,060 8.9** 
Total 17,707 312,635 56.6** 

* Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 2003. Canberra:  
 ABS, 2004 (Catalogue No 3235.0). 

**  the fertility rate for women aged 15-19 years includes live births for younger ages, and the rate for women  
 aged 40-44 years includes live births for older ages, while the total rate (general fertility rate) include all live  
 births. Live births in this table exclude terminations of pregnancy.  

Sum of 5-year ASFRs =349.9 per 1,000 women. Total fertility rate = 349.9X5 = 1749.5 per 1,000 women = 1.75 per woman.  

 

5  Country of birth 
The distribution of women by country of birth is provided in Table 5a and by specified 
countries of birth with 40 or more confinements in Table 5b. Of the 14.8% of women born 
outside Australia, the largest proportion was born in the United Kingdom and Ireland 
(4.1%). Other countries contributing relatively large proportions of migrant women were 
Vietnam (1.7% of confinements), New Zealand (0.9%), the Philippines (0.7%), Cambodia and 
Malaysia (0.4% each),  China, Germany, India, South Africa, Thailand, the United States of 
America and Yugoslavia (0.3% each). 

 

Table 5a: Confinements by country of birth of mother, major groups,*  
South Australia, 2003 
 Country of birth Number % 

1 Oceania and Antarctica 15,147 86.5 

2 Europe and the USSR 1,116 6.4 

3 The Middle East and North Africa 132 0.8 

4 Southeast Asia 663 3.8 

5 Northeast Asia 112 0.6 

6 Southern Asia 114 0.7 

7 Northern America 77 0.4 

8 South America, Central America and the Caribbean 49 0.3 

9 Africa (excluding North Africa) 107 0.6 

 Total 17,517 100.0 

* Australian Bureau of Statistics. Australian Standard Classification of Countries for Social Statistics  
 (ASCCSS).  Canberra: ABS, 1990 (Catalogue No 1269.0). 

 



 
 

12

 

Table 5b: Confinements by specified country of birth* of mother, South Australia, 2003 

Specified country of birth Number % of confinements 
% of confinements of migrant 

women (n=2,590) 

1100 Australia 14,927 85.2 na 
4102 Cambodia 69 0.4 2.7 
5101 China 53 0.3 2.0 
2305 Germany 53 0.3 2.0 
6104 India 49 0.3 1.9 
4105 Malaysia 73 0.4 2.8 
1301 New Zealand 165 0.9 6.4 
4107 Philippines 114 0.7 4.4 
2504 Poland 42 0.2 1.6 
9220 South Africa  56 0.3 2.2 
4109 Thailand 44 0.3 1.7 
2101-2107 The United Kingdom and Ireland 726 4.1 28.0 
4110 Vietnam 290 1.7 11.2 
7104 United States of America 44 0.3 1.7 
2212 Yugoslavia 46 0.3 1.8 

All other countries 766 4.4 29.6 
Total 17,517 100.0 100.0 

* ASCCSS, Australian Bureau of Statistics 

 

6  Marital Status 
 While 86.6% of women who delivered in 2003 were married or in a de facto relationship, 
11.9% were never married and 1.5% were widowed, separated or divorced (Table 6a).  Of 
never married women, a quarter was teenage and another third was in the early twenties age 
group.  Relatively more single women were hospital/public patients than married women 
and women in de facto relationships (91.7% v 62.2%, Table 6b). 

 

Table 6a: Marital status by age of mother, South Australia, 2003 
 Marital status of mother 

Age of mother 
(years) 

Never married Married/de facto Widowed/ 
separated/divorced 

Unknown Total 

 Number % Number % Number % Number % Number % 
&lt;20 521 25.0 413 2.7 3 1.2 0 0 937 5.4 
20-24 701 33.6 1,928 12.7 34 13.4 1 16.7 2,664 15.2 
25-29 441 21.1 4,493 29.6 62 24.4 2 33.3 4,998 28.5 
30-34 264 12.7 5,460 36.0 87 34.3 2 33.3 5,813 33.2 
35-39 131 6.3 2,409 15.9 43 16.9 1 16.7 2,584 14.8 
40-44 27 1.3 449 3.0 24 9.5 0 0 500 2.9 
45+ 2 0.1 18 0.1 1 0.4 0 0 21 0.1 
Total 2,087 (11.9) 15,170 (86.6) 254 (1.5) 6 (0) 17,517 100.0 

 



 
 

13

 

Table 6b: Type of patient by marital status of mother, South Australia, 2003 
 Marital status of mother  

Type of patient Never married Married/ de facto Widowed/ 
separated/divorced 

Unknown Total 

 Number % Number % Number % Number % Number % 

Hospital/public 1,911 91.6 9,428 62.2 236 92.9 5 83.3 11,580 66.1 
Private 176 8.4 5,742 37.9 18 7.1 1 16.7 5,937 33.9 
Total 2,087 (11.9) 15,170 (86.6) 254 (1.5) 6 (0) 17,517 100.0 

 

 

7  Occupation of father and mother 
This distribution is based on the Australian Statistical Classification of Occupations (ASCO) 
of the Australian Bureau of Statistics and is provided in Table 7. Unclassified occupations 
have been assigned a separate category (Category 9).  

A much larger proportion of mothers than fathers (27.6% v 0.4%) was included in the 
occupation 'home duties'. Larger proportions were also found for the groups of 
paraprofessionals, clerks, salespersons and personal service workers and students. More 
fathers were managers and administrators, professionals, tradespersons, plant and machine 
operators and labourers, but occupation was unknown for 10.9% of fathers. 

 

Table 7: Occupation of father and mother,* South Australian confinements, 2003 
 Occupation Father Mother 

  Number % Number % 

1 Managers and administrators 3,072 17.5 1,400 8.0 
2 Professionals 2,193 12.5 2,000 11.4 
3 Para professionals 771 4.4 912 5.2 
4 Tradespersons 3,028 17.3 585 3.3 
5 Clerks 489 2.8 2,235 12.8 
6 Salespersons and personal service workers 935 5.3 2,540 14.5 
7 Plant and machine operators and drivers 1,057 6.0 110 0.6 
8 Labourers and related workers 2,381 13.6 719 4.1 
9 Students 325 1.9 552 3.2 
 Pensioners 131 0.8 68 0.4 
 Home duties 61 0.4 4,834 27.6 
 Unemployed 855 4.9 672 3.8 
 Other 317 1.8 161 0.9 
 Unknown 1,902 10.9 729 4.2 
 Total 17,517 100.0 17,517 100.0 

 * Australian Bureau of Statistics. ASCO. First Edition. Occupation Definitions. Canberra: ABS,1990. 
 (Catalogue No. 1223.0) 



 
 

14

 

8  Previous pregnancy outcomes 
Forty-two percent of women had no previous birth and 31.4% were pregnant for the first 
time. Among Aboriginal women, these proportions were lower, with 31.0% giving birth for the first 
time.  
The proportion of women of parity 4 or greater was higher among Aboriginal women (16.0%) than 
among Caucasian women (2.6%) and Asian women (1.8%) (Table 8a). 

 

Table 8a: Parity by race of mother, South Australian confinements, 2003 
 Race of mother  
Parity Caucasian Aboriginal Asian Other Total 

 Number % Number % Numbe
r 

% Number % Number % 

0-PRIMIGRAVIDA 5,018     31.6 107 22.9 304 36.7 79 23.6 5,508 31.4 
0-MULTIGRAVIDA 1,690 10.6 38 8.1 88 10.6 40 11.9 1,856 10.6 
1 5,656 35.6 131 28.0 274 33.1 109 32.5 6,170 35.2 
2 2,317 14.6 63 13.5 120 14.5 59 17.6 2,559 14.6 
3 786 5.0 54 11.5 28 3.4 26 7.8 894 5.1 
4 251 1.6 36 7.7 9 1.1 10 3.0 306 1.8 

?5 167 1.1 39 8.3 6 0.7 12 3.6 224 1.3 
Total 15,885 (90.7) 468 (2.7) 829 (4.7) 335 (1.9) 17,517 100.0 

 
Among women with previous pregnancies (multigravid women), the proportions who have 
had previous adverse pregnancy outcomes are shown in Table 8b. 

 

Table 8b: Previous pregnancy outcomes, South Australian 
confinements, 2003 (multigravidae only, n= 12,009) 

Previous pregnancy outcome Number % 

Miscarriage 3,852 32.1 

Termination of pregnancy 2,361 19.7 

Stillbirth 179 1.5 

Neonatal death 74 0.6 

Ectopic pregnancy 281 2.3 

 

9a  Antenatal care 
Women who delivered a baby are grouped in Table 9a according to the number of reported 
antenatal visits: no visits, only 1 - 6 visits, 7 or more visits. If we exclude women for whom the 
number of antenatal visits was unknown, 41.3% of Aboriginal women compared with 6.2% of 
Caucasian women were reported to have made less than 7 visits. Among Asian women this 
proportion was 7.2%. A low frequency of antenatal visits may be taken, particularly in term 
births, as an indication of inadequate antenatal care. However, for 10.0% of women (19.9% of 
Aboriginal women), the number of antenatal visits made was not known. It is hoped that this 
proportion will be reduced by wider use of the Pregnancy Hand-held Record,3 which will 
also facilitate continuity of care. 

 



 
 

15

 

Table 9a: Antenatal visits by race, South Australian confinements, 2003 
 Race of mother  
Antenatal visits Caucasian Aboriginal Asian Other Total 

 Number % Number % Number % Number % Number % 

None 44 0.3 17 3.6 2 0.2 1 0.3 64 0.4 
1-6 852 5.4 138 29.5 52 6.3 31 9.3 1,073 6.1 

?7 13,448 84.7 220 47.0 698 84.2 261 77.9 14,627 83.5 
Unknown 1,541 9.7 93 19.9 77 9.3 42 12.5 1,753 10.0 
Total 15,885 (90.7) 468 (2.7) 829 (4.7) 335 (1.9) 17,517 100.0 

 

9b  Type of antenatal care 
Table 9b shows that the main types of antenatal care used were hospital clinics (41.1%), 
obstetricians in private practice (34.2%), general practitioners (25.0%) and birth centres 
(9.2%). There were 91 women (0.5%) who had no antenatal care at all. Individual women 
may have used more than one type of antenatal care. 

 

Table 9b: Type of antenatal care, South Australian confinements, 2003 
(n = 17,517) 
Type of care Number % 

No antenatal care 91 0.5 
Hospital clinic 41.1 
Obstetrician in private practice  34.2 
General practitioner (GP) 25.0 
Birth centre 9.2 
Home birth midwife 0.4 
Obstetrician/midwife (shared care) in private practice 1.0 
GP/midwife (shared care) 2.9 
Other 0.8 
Not stated 0.3 

 

10  Smoking 
In 1998 two new items were added to the Supplementary Birth Record to ascertain the 
smoking status of pregnant women, an important factor in pregnancy outcome. The first 
item requested information on the woman s tobacco smoking status at her first antenatal 
visit (Table 10a), and the second on the average number of tobacco cigarettes smoked daily 
in the second half of her pregnancy (Table 10b).  

Table 10a shows that 20.4% of women were reported to be smokers at their first antenatal 
visit, and 4.1% had quit smoking before their first visit.  Smoking status was unknown for 
1.6% of women. The highest rates of smoking were among teenagers (42.7%) and women 
aged 20-24 years (34.6%). A higher proportion of Aboriginal women was reported to be smokers at 
their first antenatal visit (55.8%) and 3.4% reported that they had quit smoking, while smoking status 
was unknown for 6.0%. If those of unknown smoking status are excluded, 59.3% were smoking at 
their first antenatal visit compared with 19.8% among non-Aboriginal women. Smoking rates were 
high among all age groups of Aboriginal women: the lowest rate was 47.6% - in the 35-39 years age 
group. 



 
 

16

In the second half of pregnancy 18.1% of women were reported to be smokers and 1.1% 
smoked more than 20 cigarettes per day, but the number of cigarettes smoked was not 
known for 2.8% of women.  In the second half of pregnancy 50.2%of Aboriginal women smoked, 
compared with 17.2% of non-Aboriginal women. A higher proportion of Aboriginal women 
(4.7%compared with 1.0%) was also smoking more than 20 cigarettes per day, but the number of 
cigarettes smoked was not known for 11.1% of Aboriginal women and 2.5% of non-Aboriginal 
women. 
 

Table 10a: Tobacco smoking status at first visit, South 
Australian confinements, 2003 

Smoking status Number % of confinements 

Smoker 3,580 20.4 

Quit in pregnancy before first visit 725 4.1 

Non-smoker 12,940 73.9 

Unknown smoking status 272 1.6 
17,517 100.0 

 

Table 10b: Average number of tobacco cigarettes smoked per day in 
second half of pregnancy, South Australian confinements, 2003 
Average number per day Number % of confinements (n=17,517) 

None 13,863 79.1 

Occasional (&lt;1) 86 0.5 

1-10 1,941 11.1 

11-20 952 5.4 

21-30 165 0.9 

31-40 13 0.1 

41+ 12 0.1 
485 2.8 

 

11  Medical conditions 
A medical condition was recorded in the current pregnancy for 5,039 women (28.8%). The 
frequencies of specified medical conditions are provided in Table 11. 

 

Table 11: Medical conditions in current pregnancy, South Australian 
confinements, 2003 
 Medical condition Number % of confinements 

(n = 17,517) 

1 None 12,478 71.2 
2 Anaemia 1,204 6.9 
3 Urinary tract infection 480 2.7 
4 Hypertension (pre-existing) 217 1.2 
5 Diabetes (pre-existing) 105 0.6 
6 Epilepsy 115 0.7 
7 Asthma 1,248 7.1 
8 Other 2,645 15.1 

 



 
 

17

12  Obstetric Complications 
An obstetric complication was recorded in 5,379 confinements (30.7%). The reported 
frequencies of the more common complications are presented in Table 12. There were two 
maternal deaths  (cf definition in Appendix 1) notified to the Maternal, Perinatal and Infant 
Mortality Committee in 2003.4 

 

Table 12: Frequency of some obstetric complications, South Australian 
confinements, 2003 
Obstetric complication Number % of confinements 

(n= 17,517) 

No complication 12,138 69.3 
Threatened miscarriage 372 2.1 
Antepartum haemorrhage (APH) - Abruption 167 1.0 
APH - Placenta praevia 88 0.5 
APH   Other &amp; unknown causes 455 2.6 
Pregnancy hypertension 1,351 7.7 
Intrauterine growth restriction (suspected) 490 2.8 
Gestational diabetes 619 3.5 
Other complications (including 74 women with impaired 
glucose tolerance) 

2,895 16.5 

 

13  Procedures performed in current pregnancy 
Procedures performed are listed as reported in Table 13.  At least one ultrasound 
examination was performed for 96.2% of women, amniocentesis for 6.3% and chorion villus 
sampling for 0.8%. 

For quite a large proportion of women it was not known whether a specific procedure had 
been performed, eg 9.8% for maternal serum alpha feto-protein (MSAFP) screening.  The 
figures for MSAFP and Down s syndrome screening are believed to be underestimates, when 
compared with statistics from the Chemical Pathology Department of the Women s and 
Children s Hospital. It is hoped that the use of the Pregnancy Hand-held Record will reduce 
the number of  unknown  entries. 

 

Table 13: Procedures performed in current pregnancy, South Australian confinements, 
2003 
Procedure Yes No Unknown 

Number % Number % Number % 

MSAFP (Neural tube defect screen etc) 24 45.8 7,780 44.4 1,713 9.8 
Triple/Quadruple screen (Down s etc) 9,384 53.6 6,493 37.1 1,640 9.4 
Ultrasound 16,854 96.2 338 1.9 325 1.9 
Chorion villus sampling 134 0.8 16,791 95.9 592 3.4 
Amniocentesis 1,096 6.3 15,852 90.5 569 3.3 
Cordocentesis 10 0.1 16,908 96.5 599 3.4 
Other surgical procedure 55 0.3 17,462 99.7 0 0 

 



 
 

18

14a  Onset of labour 
Labour occurred spontaneously in 55.4% of confinements (Table 14a).  It was induced in 
29.0%, and the methods of induction used were artificial rupture of membranes (ARM) in 
61.9% of inductions, prostaglandins in 63.0% and oxytocics in 45.5% (Table 14b).  More than 
one method was used in many cases. 

 

Table 14a Onset of labour, South Australian confinements, 2003 
Onset of labour Number %

Spontaneous 9,708 55.4 
No labour - LSCS* 2,724 15.6 
Induction 5,085 29.0 
Total 17,517 100.0 

*Lower segment caesarean section 

 

Table 14b: Method of induction of labour, South Australian confinements, 2003 
Method of induction Number % of confinements 

(n =17,517) 
% of inductions 

(n =5,085) 

No induction 12,432 71.0 - 
ARM 3,146 18.0 61.9 
Oxytocics 2,312 13.2 45.5 
Prostaglandins 3,204 18.3 63.0 

 

14b Reasons for induction of labour 
Up to two reasons could be provided for reason for induction. These reasons for induction of 
labour are the ones listed in the Australian Council for Healthcare Standards  Clinical 
Indicators   A Users  Manual : Obstetrics and Gynaecology Indicators Version 2  (cf p 52). 

Fig 4 demonstrates that 24.6% of women were induced for prolonged pregnancy (41 or more 
completed weeks), 16.6% for hypertension, 7.7% for premature rupture of membranes 
(PROM), 3.8% for intrauterine growth restriction (IUGR) and 4.4% for diabetes (including 
gestational diabetes and glucose intolerance), but in 45.4% of cases the reasons were not one 
of these. 

 



 
 

19

Other
Prolonged pregnancy

Chorioamnionitis
Fetal death

Fetal distress
Isoimmunisation

IUGR
Hypertensive disorders

PROM
Diabetes*

0 10 20 30 40 50
percentage

*includes diabetes mellitus, gestational diabetes and glucose intolerance

Figure 4: REASONS FOR INDUCTION OF LABOUR, SA 2003
(n-5,085)

 
 

Labour was augmented for 3,721 (38.3%) of the 9,708 women who went into spontaneous 
labour. Methods used in augmentation were artificial rupture of membranes (ARM) (75.0%), 
oxytocics (37.7%) and prostaglandins (1.9%).  More than one method may be used for a 
woman. It should be noted that prostaglandins are not recommended by the manufacturers 
as a method of augmenting labour. The proportion of women delivered who had labour 
augmented was 21.2%. 

 

Table 14c: Augmentation of labour after spontaneous onset, South Australian 
confinements, 2003 

 Method of augmentation Number % of confinements
(n=17,517) 

% of augmentations
(n=3,721) 

 Any augmentation 3,721 21.2 100.0 
1 ARM 2,789 15.9 75.0 
2 Oxytocics 1,401 8.0 37.7 
3 Prostaglandins 70 0.4 1.9 

 

15a Presentation and method of delivery 
Of the women who delivered, 57.8% had normal spontaneous vaginal deliveries (Table 15a 
and Figure 5A). Caesarean section (LSCS) was performed for 30.0% of women, with 13.3% of 
deliveries being elective sections; forceps were utilised for 4.8%, ventouse for 6.9% and 
breech delivery for the remaining 0.4%. The method of delivery given for confinements in 
multiple births is that for the first birth. The method of delivery by presentation for all births 
is provided in Table 15b. Breech presentation occurred in 5.1% of births and caesarean 
section was the method of delivery for 88.4% of breech presentations. Caesarean section was 
utilised for 90.1% of breech presentations in singletons (Table 15c).  



 
 

20

 

Table 15a: Method of delivery, South Australian 
confinements, 2003 
Method of delivery Number % 

Normal spontaneous vaginal 10,125 57.8 
Forceps 844 4.8 
Assisted breech 29 0.2 
LSCS (elective) 2,334 13.3 
LSCS (emergency) 2,929 16.7 
Ventouse 1,212 6.9 
Breech extraction 9 0.1 
Breech spontaneous 35 0.2 
Total 17,517 100.0 

 
 
 

Normal spont vaginal (57.8%)

Ventouse (6.9%)

LSCS (30.0%)

Breech delivery (0.4%)

Forceps (4.8%)

Figure 5A: METHOD OF DELIVERY IN ALL CONFINEMENTS, SOUTH AUSTRALIA,  2003
n = 17,517

 



 
 

21

 

Table 15b: Method of delivery by presentation, South Australian births, 2003 (n=17,844) 
  Presentation  

Method of 
delivery 

Vertex Breech Other Unknown Total 

  Number % Number % Number % Number % Number % 

1 Normal 
   spontaneous 

10,135 60.7 0 0 22 11.1 7 20.0 10,164 57.0 

2 Forceps 841 5.0 0 0 13 6.6 0 0 854 4.8 
3 Assisted  
   breech 

0 0 44 4.9 0 0 0 0 44 0.3 

4 Elective 
   LSCS 

1,899 11.4 477 52.8 41 20.7 17 48.6 2,434 13.6 

5 Emergency 
   LSCS 

2,609 15.6 322 35.6 120 60.6 11 31.4 3,062 17.2 

6 Ventouse 1,222 7.3 0 0 1 0.5 0 0 1,223 6.9 
7 Breech  
   extraction 

0 0 19 2.1 1 0.5 0 0 20 0.1 

8 Breech 
   spontaneous 

0 0 42 4.7 0 0 0 0 42 0.2 

9 Unknown 1 0 0 0 0 0 0 0 1 0 
Total 16,707 (93.6) 904 (5.1) 198 (1.1) 35 (0.2) 17,844 100.0 

 

 

Table 15c: Method of delivery in breech presentation, by plurality, South Australian births, 
2003 (n = 904) 
Plurality Assisted 

breech 
Elective LSCS Emergency LSCS Breech 

extraction 
Breech 

spontaneous 
Total 

Singleton 27 395 234 8 34 698 
Twins 17 79 82 11 8 197 
Triplets 0 3 6 0 0 9 
Total 44 (4.9%) 477 (52.8%) 322 (35.6%) 19 (2.1%) 42 (4.7%) 904 (100.0%) 

 

15b Reason for caesarean section 
Up to two reasons may be provided on the supplementary birth record for caesarean section, 
and these have been collated in Figure 5B (all caesarean sections), Figure 5C (elective sections 
only) and Figure 5D (emergency sections only). The main reasons given for all caesarean 
sections were failure to progress/cephalopelvic disproportion (CPD) (30.9%), previous 
caesarean section (31.7%), fetal distress (19.3%) and malpresentation (13.7%). The main 
reasons for elective sections were previous section (60.3%), malpresentation (17.7%) and CPD 
(7.3%), and the main reasons given for emergency sections were failure to progress or CPD 
(49.7%), fetal distress (34.6%) and malpresentation (10.5%).  14.7% of women had had a 
previous caesarean section. 

 



 
 

22

 

 

Other
IUGR

Multiple pregnancy
APH

Pregnancy hypertension/hypertension
Malpresentation

Fetal distress
Previous LSCS

CPD/Failure to progress

0 10 20 30 40 50 60

Figure 5C: REASON FOR ELECTIVE LSCS, 2003 (n=2,334)

Other
IUGR

Multiple pregnancy
APH

Pregnancy hypertension/hypertension
Malpresentation

Fetal distress
Previous LSCS

CPD

0 10 20 30 40 50 60 70

Figure 5D: REASON FOR EMERGENCY LSCS, 2003 (n=2,929)

Other
IUGR

Multiple pregnancy
APH

Pregnancy hypertension/hypertension
Malpresentation

Fetal distress
Previous LSCS

CPD/Failure to progress

0 10 20 30 40 50 60

Percentage

Percentage

Percentage

Figure 5B: REASON FOR LSCS, 2003 (n=5,263)

 
 



 
 

23

16  Complications of labour and delivery and perineal status after delivery 
A complication of labour or delivery was recorded in 6,094 confinements (34.8%).  The 
reported frequency of some complications is presented in Table 16. Episiotomy was 
performed for 2,353 women (13.4%), a decreasing proportion (14.6% in 2002). More than half 
the women who gave birth (9,006 or 51.4%) had an intact perineum after delivery and 4,433 
(25.3%) had a repair of a perineal tear. One hundred and ninety-seven women (1.1%) had a 
third or fourth degree tear. 

 

Table 16: Frequency of some complications of labour and delivery, South Australian 
confinements, 2003 
Complication of labour  Number of confinements % of confinements (n=17,517) 

None 11,423 65.2 
Post-partum haemorrhage (PPH) - primary 1,099 6.3 
Fetal distress 2,323 13.3 
Retained placenta 225 1.3 
Prolonged labour 187 1.1 
Cord prolapse 15 0.1 
Wound infection 50 0.3 
Third degree tear (178) or fourth degree tear (19)  197 1.1 
Failure to progress 1,973 11.3 
Other 3,599 20.5 

 

17 Fetal monitoring during labour 
Cardiotocography (CTG) was performed during labour for 60.0% of women. The majority of 
these (52.2% of women) were external CTGs (Table 17a) while a scalp clip was used for 7.8%.  

A fetal scalp pH was taken during labour in 408 confinements (2.3%, Table 17b). 

 

Table 17a: CTG performed during labour, South Australian confinements, 2003 
 CTG during labour Number of confinements % of confinements (n=17,517) 

1 None 7,018 40.0 
2 External 9,138 52.2 
3 Scalp clip 1,361 7.8 

 

Table 17b: Fetal scalp pH taken during labour, South Australian confinements, 2003 
 Fetal scalp pH taken Number of confinements % of confinements (n=17,517) 

1 No 17,109 97.7 
2 Yes 408 2.3 

 

18  Analgesia for labour and anaesthesia for delivery 
These distributions are provided in Tables 18a and 18b. Epidurals were used for analgesia in 
labour for 31.9% and for anaesthesia in delivery for 27.2% of women. The proportion of 
women who had an epidural for either was 33.6% (5,879 women). The proportion of women 
who had a spinal anaesthetic increased between 1991 and 2003 from 0.2% to 1.0% for 
analgesia and from 0.5% to 19.9% for anaesthesia.  General anaesthesia was used for 3.0% of 



 
 

24

deliveries. A third of the women who delivered (33.1%) received none of the specified 
methods for analgesia during labour. 

 

Table 18a: Analgesia for labour,* South Australian confinements, 2003 
 Analgesia Number % of confinements 

1 None 5,801 33.1 
2 Nitrous oxide and oxygen 6,265 35.8 
3 Narcotic (parenteral) 4,585 26.2 
4 Epidural (lumbar/caudal) 5,585 31.9 
5 Spinal 170 1.0 
6 Other 93 0.5 

 * more than one method may be used for each woman 

 

Table 18b: Anaesthesia for delivery,* South Australian confinements, 2003 
 Anaesthesia Number % of confinements 

1 None 6,906 39.4 
2 Local anaesthesia 2,089 11.9 
3 Pudendal 223 1.3 
4 Epidural (lumbar/caudal) 4,768 27.2 
5 Spinal 3,487 19.9 
6 General anaesthesia 524 3.0 
7 Other 98 0.6 

* more than one method may be used for each woman 

 

19  Postnatal length of stay of mother 
The distribution of length of stay of mothers who delivered in hospitals is presented in Table 
19a for public and private patients. The median duration for all women was four days. It was 
three days for vaginal deliveries and five days for caesarean deliveries (Table 19b). The 
median duration of stay was two days longer for private patients for vaginal deliveries and 
one day longer for caesarean deliveries (three and five days respectively, for public patients 
compared with five and six days respectively for private patients). 

 

Table 19a: Postnatal length of stay of mother, South Australian hospital 
confinements, 2003 
Postnatal length of 
stay (days) 

Public Private Total 

 Number % Number % Number % 

&lt;1 407 3.5 14 0.2 421 2.4 
  1 1,337 11.5 63 1.1 1,400 8.0 
  2 2,378 20.5 162 2.8 2,540 14.5 
  3 2,921 25.3 423 7.2 3,344 19.2 
  4 2,079 18.0 1,131 19.2 3,210 18.4 
  5 1,420 12.3 1,875 31.8 3,295 18.9 
  6 562 4.9 978 16.6 1,540 8.8 
  7 or more 462 4.0 1,247 21.1 1,705 9.8 
Total 11,566 100.0 5,889 100.0 17,455 100.0 

 



 
 

25

 

Table 19b: Average postnatal length of stay of mother by type of patient &amp; type of delivery, South 
Australian hospital confinements, 2003 

 Public Private Total 

Average length of stay Vaginal 
(n=8,607) 

LSCS 
(n=2,959) 

Total 
(n=11,566)

Vaginal 
(n=3,585)

LSCS 
(n=2,304)

Total 
(n=5,889)

    Vaginal 
(n=12,192) 

LSCS 
(n=5,263)

Total 
(n=17,455)

Mean number of days 2.74 4.77 3.26 4.47 6.33 5.19 3.25 5.45 3.91

 ( SD) ( 1.69) ( 2.33) ( 2.07) ( 1.30) ( 1.43) ( 1.63) ( 1.77) ( 2.13) ( 2.14)

Median number of days 3 5 3 5 6 5 3 5 4

 

20  Sex of baby 
The sex distribution of babies is provided in Table 20; the male:female sex ratio was 1.06:1. 

 

Table 20: Sex of baby, South Australian births, 2003 
Sex of baby Number % 

Male 9,196 51.5 
Female 8,645 48.5 
Indeterminate 2 0 
Unknown 1 0 
Total 17,844 100.0 

 

21  Birthweight and gestation 
The birthweight distribution of all births is presented in Table 21a. The percentage of low 
birthweight babies (&lt;2,500g) was 7.0%, and that of very low birthweight babies (&lt;1,500g) 
was 1.6%. The mean birthweight was 3,347g (SD 623.9g), with birthweights ranging from 
160g to 5,780g.  Among babies of Aboriginal mothers, the proportion of low birthweight babies was 
18.0%. 

 

Table 21a: Birthweight distribution of all births, South Australia, 2003 
Birthweight (g) Number of births Percentage of births 

&lt;500* 58* 0.3 
500-749** 61** 0.3 
750-999 46 0.3 
1,000-1,499 118 0.7 
1,500-1,999 235 1.3 
2,000-2,499 732 4.1 
2,500-2,999 2,707 15.2 
3,000-3,499 6,414 36.0 
3,500-3,999 5,398 30.2 
4,000-4,499 1,747 9.8 
4,500+ 328 1.8 
Total 17,844 100.0 

*  includes 35 births of &lt;400g birthweight (all stillbirths or neonatal deaths)  described on page 2. 

**includes one stillbirth of unknown birthweight born at 23 weeks gestation 



 
 

26

 

The improvement in perinatal mortality with increasing birthweight is demonstrated in 
Table 21b and Figure 6. The perinatal mortality rate for babies of normal birthweight (2,500g 
or more) was 2.5 per 1,000 births. In 2003, 1,250 babies were of low birthweight and 1,504 
(8.4%) were preterm (&lt;37 weeks gestation). The improvement in perinatal mortality with 
increasing gestation is demonstrated in Table 21c. 

 

Table 21b: Perinatal mortality by birthweight, (all births) South Australia, 2003 
Birthweight 
(g) 

Total 
births 

Live 
births 

Stillbirths Neonatal deaths Perinatal deaths 

   Number Deaths per 
1,000 births 

Number Deaths per 1,000 
live births 

Number Deaths per 
1,000 births 

&lt;400 35 7 28 800.0 7 1,000.0 35 1,000.0 
400-499 23 7 16 695.7 3 428.6 19 826.1 
500-749* 61* 33 28* 459.0 14 424.2 42* 688.5 
750-999 46 40 6 130.4 1 25.0 7 152.2 
1,000-1,499 118 108 10 84.7 3 27.8 13 110.2 
1,500-1,999 235 230 5 21.3 0 0 5 21.3 
2,000-2,499 732 724 8 10.9 5 6.9 13 17.8 
2,500-2,999 2,707 2,692 15 5.5 4 1.5 19 7.0 
3,000-3,499 6,414 6,400 14 2.2 1 0.2 15 2.3 
3,500-3,999 5,398 5,395 3 0.6 3 0.6 6 1.1 
4,000-4,499 1,747 1,746 1 0.6 0 0 1 0.6 
4,500+ 328 328 0 0 1 3.0 1 3.0 
Total 17,844 17,710 134 7.5 42 2.4 176 9.9 

* includes one stillbirth of unknown birthweight born at 23 weeks gestation. 

 

&lt;500 500- 750- 1000- 1500- 2000- 2500- 3000- 3500- 4000 4500+
0.1

1

10

100

1000

Birthweight (g)

Figure 6:  PERINATAL MORTALITY RATE BY BIRTHWEIGHT
 South Australian births, 2003

 



 
 

27

 

Table 21c: Perinatal mortality by gestational age at birth, South Australia, 2003 

Gestational age 
at birth (weeks) 

Total 
births 

Live 
births 

Stillbirths Neonatal deaths Perinatal deaths 

   Number Deaths per 
1,000 births 

Number Deaths per 
1,000 live births 

Number Deaths per 
1,000 births 

&lt;24 76 21 55 723.7 18 857.1 73 960.5 

24-27 70 54 16 228.6 7 129.6 23 328.6 

28-31 163 150 13 79.8  4 26.7 17 104.3 

32-36 1,195 1,177 18 15.1  5 4.2 23 19.2 

37-41 16,190 16,159 31 1.9 8 0.5 39 2.4 

42+ 150 149 1 6.7  0 0 1 6.7 

TOTAL 17,844 17,710 134 7.5 42 2.4 176 9.9 

 

22  Birth injuries 
Birth injuries were reported in 157 live births (0.9%). The most common injury reported was 
cephalhaematoma. Fracture, nerve injury and dislocation occurred less frequently (Table 22). 

 
Table 22: Birth injuries*(in 17,710 live births), South Australia, 2003 
Birth injury Number of births % of births 

None 17,553 99.1 
Fracture 14 0.1 
Dislocation 5 0 
Nerve Injury 18 0.1 
Cephalhaematoma 91 0.5 
Other 34 0.2 

* More than one injury may occur in each birth. 

23  Treatment given in neonatal period 
The proportions of live births who received specified treatments in the neonatal period are 
provided in Table 23: 83.0% of neonates did not receive any of the treatments. 

 

Table 23: Neonatal treatment given (all live births), South Australia, 2003 
Neonatal treatment Number % of live births 

None of the treatments listed below 14,693 83.0 
Oxygen therapy for more than 4 hours 1,144 6.5 
Phototherapy for jaundice 1,379 7.8 
Gavage feeding more than once 1,419 8.0 
Any intravenous therapy 1,693 9.6 

 

24  Level of care utilised 
Table 24 shows that 83.2% of neonates utilised Level I care only. Level II care was used by 
16.6% of neonates, Level III care at the Women s and Children s Hospital or Flinders Medical 
Centre by 2.7% and paediatric intensive care at the Women s and Children's Hospital by 
0.2% of neonates. As would be expected, with decreasing birthweight, an increasing 
percentage of babies required Level II and Level III care. 



 
 

28

 

Table 24: Level of nursery care utilised by birthweight (all live births), South Australia, 2003 
 Birthweight (g)  
Level of care utilised &lt;1,500    (n=195) 1,500-2,499 (n=954) 2,500+ (n=16,561) Total (n=17,710) 

 Number % Number % Number % Number % 

Level I only 22 11.3 195 20.4 14,517 87.7 14,734 83.2 
Level II 164 84.1 754 79.0 2,018 12.2 2,936 16.6 
Level III (W&amp;CH &amp; FMC) 160 82.1 140 14.7 184 1.1 484 2.7 
Level III (W&amp;CH  
Paediatric intensive care) 

1 0.5 6 0.6 33 0.2 40 0.2 

 

25  Length of stay of babies 
The distribution of length of stay of liveborn babies in hospital is presented in Table 25 for 
preterm (&lt;37 weeks gestation) and term births (?37 weeks gestation). The mean duration of 
stay for all liveborn babies was 5.5 days (SD 9.3) and the median duration 4 days. The mean 
duration was 4.1 days (SD 4.0) for term births and 21.9 days (SD 24.8) for preterm births, 
while the median durations were 4 and 14 days respectively. 

 

Table 25: Length of stay of liveborn babies in hospital, South Australia, 2003 
Length of stay (days) Preterm births Term births Total 

 Number % Number % Number % 

&lt;1 30 2.1 365 2.2 395 2.2 
  1 15 1.1 1,283 7.9 1,298 7.3 
  2 30 2.1 2,408 14.8 2,438 13.8 
  3 50 3.6 3,132 19.3 3,182 18.0 
  4 68 4.8 2,960 18.2 3,028 17.2 
  5 98 7.0 3,036 18.7 3,134 17.8 
  6 85 6.1 1,393 8.6 1,478 8.4 
  7-13 318 22.7 1,536 9.4 1,854 10.5 
  14-20 208 14.9 75 0.5 283 1.6 
  21-27 162 11.6 28 0.2 190 1.1 
  28 or more 336 24.0 32 0.2 368 2.1 
Total 1,400 100.0 16,248 100.0 17,648 100.0 

 

26  Congenital abnormalities 
Among the 17,844 births in 2003 there were 419 births (2.3%) notified with congenital 
abnormalities; 395 (2.2%) of these births had abnormalities notified in the congenital 
anomalies range 74000-75999 of the British Paediatric Association (BPA) Classification of 
Diseases.* This is a 5-digit extension of the ICD-9** 4-digit classification. Table 26 includes 
births with the more readily identifiable defects used for international monitoring (sentinel 
defects) notified to the perinatal statistics collection in 1993-2003. Terminations of pregnancy 
are not included in this table unless they meet a criterion for inclusion in the perinatal data 
collection, ie at least 400g birthweight or 20 weeks gestation. Notifications of births with 
birth defects identified after discharge from the hospital of birth but within the first 5 years 
of life are made to the South Australian Birth Defects Register at the Women s and 
Children s Hospital, and more complete statistics on birth defects in South Australia are 
available from the Register's Annual Report.5 



 
 

29

 

Table 26: Selected congenital abnormalities notified to the perinatal statistics collection, 1993-2003,  
South Australia 
Congenital abnormality Year 

BPA CODE 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 

Number of births =  19,969 19,801 19,620 19,111 18,674 18,734 18,519 17,87
1 

17,704 17,745 17,844 

74000-74029 Anencephalus 1 1 3 1 0 1 2 3 1 4 0 
74100-74199 Spina bifida 5 1 7 5 3 9 4 5 9 4 7 
74200-74209 Encephalocele 2 1 1 1 1 0 1 0 0 1 0 
74230-74239 Hydrocephalus 5 4 5 0 3 5 7 4 4 3 7 
74900-74909 Cleft palate 8 11 12 14 14 16 8 10 14 17 9 
74910-74929 Cleft lip and palate 
(Total cleft lip) 

21 12 24 18 19 20 17 16 15 16 14 

75030-75038 Tracheo-oesophageal 
fistula, oesophageal atresia and 
stenosis 

12 8 8 8 5 7 6 2 10 3 2 

75120-75124 Atresia and stenosis of 
large intestine, rectum and anal 
canal 

9 3 4 9 4 13 5 9 3 9 6 

75260-75261 Hypospadias and 
epispadias 

52 53 47 53 43 46 43 40 40 42 34 

75300-75301 Renal agenesis and 
dysgenesis 

5 6 7 4 6 2 4 5 7 5 10 

75520-75549 Limb reduction defects 8 9 14 9 5 9 9 11 6 7 5 
75660-75669 Anomalies of 
diaphragm 

7 3 3 5 5 3 4 7 6 7 4 

75670-75679 Anomalies of 
abdominal wall 

14 3 8 7 7 12 8 8 13 10 13 

75800-75809 Down s syndrome 18 16 20 11 24 25 25 19 21 19 13 

* British Paediatric Association Classification of Diseases. London: The British Paediatric Association, 1979. 

** International Classification of Diseases. Manual of the International Statistical Classification of Diseases, Injuries and  
 Causes of Death, 1975 Revision. Geneva: World Health Organisation, 1977. 

 

27  Multiple births 
There were 313 twin and 7 triplet confinements compared with 17,197 singleton ones. Thus 
there was one twin confinement in every 56 and 1 triplet confinement in every 2502 
confinements, and confinements with twins or triplets comprised 1.8% of all confinements. 
The total number of multiple births was 647 (3.6% of total births). 

A comparison of multiple births with singleton ones shows that multiple births were of 
lower birthweight (with 53.0% being of low birthweight compared with 5.3% for singletons, 
Table 27a), and gestation (with 54.6% being preterm births compared with 6.7% for 
singletons, Table 27b). The proportion in hospital at 28 days was 16.8% for multiple births 
compared with 1.6% for singletons, and the perinatal death rate for multiple births was also 
elevated (30.9 compared with 9.1 deaths per 1,000 births for singletons, Table 27c). 



 
 

30

 

Table 27a: Birthweight by plurality (all births), South Australia, 2003 
Birthweight (g) Singleton births Multiple births 

 Number % Number % 

&lt;400 30 0.2 5 0.8 
400-499 20 0.1 3 0.5 
500-749* 50* 0.3 11 1.7 
750-999 31 0.2 15 2.3 
1,000-1,499 81 0.5 37 5.7 
1,500-1,999 167 1.0 68 10.5 
2,000-2,499 528 3.1 204 31.5 
2,500-2,999 2,477 14.4 230 35.5 
3,000-3,499 6,351 36.9 63 9.7 
3,500-3,999 5,388 31.3 10 1.6 
4,000-4,499 1,746 10.1 1 0.2 
4,500+ 328 1.9 0 0 
Total 17,197 100.0 647 100.0 

* includes one stillbirth of unknown birthweight born at 23 weeks gestation 

 

Table 27b Gestation at delivery, by plurality (all births) South Australia, 2003 
Gestation (weeks) Singleton births Multiple births Total 

 Number % Number % Number % 

&lt;24 68 0.4 8 1.2 76 0.4 
24-27 58 0.3 12 1.9 70 0.4 
28-31 112 0.7 51 7.9 163 0.9 
32-36 913 5.3 282 43.6 1,195 6.7 
37-41 15,897 92.4 294 45.4 16,191 90.7 
42+ 149 0.9 0 0 149 0.8 
Total 17,197 100.0 647 100.0 17,844 100.0 

 

Table 27c: Perinatal outcome by plurality (all births) South Australia, 2003 
Perinatal outcome Singleton births Multiple births Total 

 Number % Number % Number % 

Stillbirth 121 0.7 13 2.0 134 0.8 
Discharged within 28 days 16,762 97.5 518 80.1 17,280 96.8 
In hospital at 28 days 279 1.6 109 16.8 388 2.2 
Neonatal death 35 0.2 7 1.1 42 0.2 
Total 17,197 100.0 647 100.0 17,844 100.0 

 

28  Perinatal mortality 
High crude perinatal mortality rates were associated with low birthweight births (Table 21b), 
low gestation births (Table 21c) and multiple births (Table 27c). The perinatal mortality rate 
for all births (of at least 400g birthweight/20 weeks gestation) in 2003 was 9.9 per 1,000 births 
and the neonatal mortality rate was 2.4 per 1,000 live births. The perinatal mortality rates for 
other specified minimum birthweights or gestational ages (where birthweight was 
unavailable) are provided in Table 28a. The perinatal mortality rate recommended by the 
World Health Organisation (WHO) for use in international comparisons refers only to births 
of at least 1,000g birthweight (or, if birthweight is unavailable, 28 weeks gestation) and to 



 
 

31

neonatal deaths within the first 7 days of life. This rate was 3.9 per 1,000 births in 2003, with 
a neonatal mortality rate of 0.7 per 1,000 live births. 

 

Table 28a: Perinatal mortality, South Australia, 2003 (all births of specified birthweight/gestation) 
Specified 
birthweight/gestation 

Total 
births 

Live 
births 

Stillbirths Neonatal deaths Perinatal deaths 

 Number Number Number Deaths per 
1,000 births 

Number Deaths per 
1,000 live 

births 

Number Deaths per 
1,000 births 

?400g/20 weeks* 17,844 17,710 134 7.5 42 2.4 176 9.9 
?500g/22 weeks 17,786 17,696 90 5.1 32 1.8 122 6.9 
(WHO National Statistics)     26** 1.5 116** 6.5 

?1,000g/28 weeks  17,679 17,623 56 3.2 17 1.0 73 4.1 
(WHO International Statistics)     13** 0.7 69** 3.9 

* includes 35 births of birthweight &lt;400g, all of which were stillbirths or neonatal deaths 

** only neonatal deaths within the first 7 days of life are included 

 
The perinatal mortality rate for births to Aboriginal mothers was 16.9 per 1,000 births in 2003 
compared with 9.7 per 1,000 births for births to non-Aboriginal mothers (Table 28b). 

 

Table 28b: Perinatal mortality by race, South Australian births, 2003  
Race Total births Stillbirths Neonatal deaths Alive at 28 days Perinatal deaths 

 Number Number Number Number Number Deaths per 1,000 
births 

Caucasian 16,197 116 37 16,044 153 9.4 
Aboriginal 473 5 3 465 8 16.9 
Asian 833 9 1 823 10 12.0 
Other 341 4 1 336 5 14.7 
Total 17,844 134 42 17,688 176 9.9 

 

29  Home births 
Supplementary Birth Records were received from home birth midwives for 59 planned home 
confinements which occurred at home in 2003 and included one twin confinement. There 
were three unplanned home births which were not booked at any hospital. These have not 
been included with the planned home births in the tables below. 

Ascertainment of planned home births occurring at home in South Australia for the year 
2003 is estimated to be 84.5% (60 out of 71 home births). This estimate has been derived from 
a comparison with data from the Births, Deaths and Marriages Registration Division on 
births registered, which did not occur in hospital (and were not BBAs - babies born before 
arrival at the hospital into which the mother had been booked). In addition, 28 women who 
planned to deliver at home were transferred to hospital care before delivery.  Statistics for all 
87 planned home confinements (88 planned home births) in 2003 are provided in Tables 29-
32. 



 
 

32

 

 

Table 29: Planned home confinements by age of mother, South Australia, 2003 
Age  Delivered at home Delivered in hospital Total 

(years) Number % Number % Number % 

&lt;20 0 0 1 3.6 1 1.2 
20-24 5 8.5 3 10.7 8 9.2 
25-29 17 28.8 6 21.4 23 26.4 
30-34 22 37.3 13 46.4 35 40.2 
35-39 12 20.3 4 14.3 16 18.4 
40-44 3 5.1 1 3.6 4 4.6 
Total 59 100.0 28 100.0 87 100.0 

 

 

Table 30: Method of delivery in planned home confinements, South Australia, 2003 
Method of delivery Delivered at home Delivered in hospital Total 

 Number % Number % Number % 

Normal spontaneous vaginal 58 98.3 22 78.6 80 91.9 
LSCS elective 0 0 1 3.6 1 1.2 
LSCS emergency 0 0 4 14.3 4 4.6 
Breech spontaneous 1 1.7 1 3.6 2 2.3 
Total 59 100.0 28 100.0 87 100.0 

 

 

Table 31: Birthweight distribution of planned home birth, South Australia 2003 
Birthweight Delivered at home Delivered in hospital Total 

 Number % Number % Number % 

&lt;1,500 0 0 1 3.6 1 1.1 
1,500-1,999 1 1.7 0 0 1 1.1 
2,000-2,499 1 1.7 2 7.1 3 3.4 
2,500-2,999 1 1.7 6 21.4 7 8.0 
3,000-3,499 20 33.3 9 32.1 29 33.0 
3,500-3,999 22 36.6 6 21.4 28 31.8 
4,000-4,499 11 18.3 4 14.3 15 17.0 
4,500+ 4 6.7 0 0 4 4.6 
Total 60 100.0 28 100.0 88 100.0 

 
 

Table 32: Perinatal outcome in planned home births, South Australia 2003 
Perinatal outcome Delivered at home Delivered in hospital Total 

 Number % Number % Number % 

Stillbirth 1 1.7 2 7.1 3 3.4 
Live birth, survived neonatal period 59 98.3 26 92.9 85 96.6 
Total 60 100.0 28 100.0 88 100.0 

 



 
 

33

30  Birthing unit births 
Statistics presented for births in birthing units in South Australia (Tables 33-36) relate to the 
birthing units at The Queen Elizabeth Hospital, the Women s and Children s Hospital, the 
Lyell McEwin Health Service and Flinders Medical Centre. The units at the Women s and 
Children s Hospital and the Lyell McEwin Health Service were established in 1992 and 1993 
respectively under the Alternative Birthing Services Programme.  In October 1996 the 
birthing unit at Flinders Medical Centre commenced deliveries. These statistics relate to all 
1,889 planned birthing unit confinements. Of these, 966 confinements occurred in the 
birthing units while 923 women (48.9%) were transferred to labour wards before delivery. Of 
the women transferred to labour wards, 26.9% had Caesarean sections and 15.9% had 
instrumental deliveries. These statistics have also been included in the statistics for the 
respective hospitals.  Three percent of all the babies were low birthweight and there were 16 
perinatal deaths (perinatal mortality rate 8.5 per 1,000 births).  

 

Table 33: Planned birthing unit confinements by age of mother, South Australia 2003 
Age  Delivered in birthing unit Delivered in labour ward Total 

(years) Number % Number % Number % 

&lt;20 83 8.6 92 10.0 175 9.3 
20-24 221 22.9 187 20.2 408 21.6 
25-29 284 29.4 295 32.0 579 30.6 
30-34 253 26.2 232 25.1 485 25.7 
35-39 109 11.3 97 10.5 206 10.9 
40-44 15 1.5 20 2.2 35 1.8 
45+ 1 0.1 0 0 1 0.1 
Total 966 100.0 923 100.0 1,889 100.0 

 

 

Table 34: Method of delivery in planned birthing unit confinements, South Australia, 2003 
Method of delivery Delivered in birthing unit Delivered in labour ward Total 

 Number % Number % Number % 

Normal spontaneous vaginal 957 99.1 527 57.1 1,484 78.6 
Forceps 0 0 65 7.0 65 3.4 
LSCS elective 0 0 31 3.4 31 1.6 
LSCS emergency 0 0 217 23.5 217 11.5 
Ventouse 8 0.8 82 8.9 90 4.8 
Breech extraction 1 0.1 0 0 1 0.1 
Breech spontaneous 0 0 1 0.1 1 0.1 
Total 966 100.0 923 100.0 1,889 100.0 

 



 
 

34

 

Table 35: Birthweight distribution of planned birthing unit births, South Australia, 2003 
Birthweight (g) Delivered in birthing unit Delivered in labour ward Total 

 Number % Number % Number % 

&lt;,1500 0 0 12 1.3 12 0.6 
1,500-1,999 0 0 9 1.0 9 0.5 
2,000-2,499 8 0.8 28 3.0 36 1.9 
2,500-2,999 93 9.6 117 12.7 210 11.1 
3,000-3,499 386 40.0 309 33.4 695 36.8 
3,500-3,999 335 34.7 311 33.6 646 34.2 
4,000-4,499 125 12.9 113 12.2 238 12.6 
4,500+ 19 2.0 26 2.8 45 2.4 
Total 966 100.0 925 100.0 1,891 100.0 

 

Table: 36 Perinatal outcome in planned birthing unit births, South Australia, 2003 
Perinatal outcome Delivered in birthing unit Delivered in labour ward Total 
 Number % Number % Number % 
Stillbirth 0 0 11 1.2 11 0.6 
Discharged within 28 days 965 99.9 895 96.8 1,860 98.4 
Prolonged hospitalisation  
(in hospital at 28 days) 

0 0 15 1.6 15 0.8 

Neonatal death 1 0.1 4 0.4 5 0.2 
Total 966 100.0 925 100.0 1,891 100.0 

 



 
 

35

III  TERMINATIONS OF PREGNANCY 

1 Numbers and rates 
There were 5,214 terminations of pregnancy notified in South Australia in 2003. The abortion 
rate  was 16.7 abortions per 1,000 women aged 15-44 years. This rate demonstrated a rapid 
rise in the early years after specific abortion legislation was introduced in 1970 to a peak of 
13.9 in 1980. There was a period of relative stability in the 1980s (between 12.9 and 13.9 per 
1,000 women) before the rise commencing in 1991 (Table 37 and Fig 7) to a peak of 17.8 in 
1999. After being relatively stable over the last few years, the rate declined in 2003. 

 

Table 37: Abortion rate per 1,000 women aged 15-44 years, South Australia, 1970-2003 
Year Number of abortions Abortions per 1,000 women aged 15-44 years 
1970 1,440 6.0 
1971 2,409 9.6 
1972 2,692 10.6 
1973 2,847 11.1 
1974 2,867 10.9 
1975 3,000 11.1 
1976 3,289 11.9 
1977 3,494 12.4 
1978 3,895 13.6 
1979 3,880 13.3 
1980 4,081 13.9 
1981 4,096 13.7 
1982 4,061 13.4 
1983 4,036 13.1 
1984 4,091 13.1 
1985 4,079 12.9 
1986 4,327 13.5 
1987 4,229 13.1 
1988 4,263 13.0 
1989 4,342 13.2 
1990 4,463 13.4 
1991 4,696 14.1 
1992 4,717 14.2 
1993 4,959 15.0 
1994 5,140 15.7 
1995 5,475 16.9 
1996 5,546 17.2 
1997 5,608 17.5 
1998 5,485 17.2 
1999 5,663 17.8 
2000 5,572 17.6 
2001 5,572 17.7 
2002 5,463 17.4 
2003 5,214 16.7 

 



 
 

36

 

0

4

8

12

16

20

YEAR

ABORTIONS PER 1,000 WOMEN AGED 15-44 YEARS

FIGURE 7: ABORTION RATE IN SOUTH AUSTRALIA, 1970-2003

 

2 Age of women 
The age distribution of women who had terminations is shown in Table 38. Among the 5-
year age groups (Table 39), the highest abortion rate was among women aged 20-24 years 
(29.4 per 1,000 women) followed by teenage women (22.3 per 1,000 women) and women 
aged 25-29 years (21.9 per 1,000 women). The abortion proportion (abortions as a proportion 
of abortions and live births) was 0.23; it was highest among teenagers (0.55), and was also 
high among women aged 20-24 years (0.35) and older women aged 40 years or more (0.33). 
This indicates that about 55% of known teenage pregnancies were terminated. This 
proportion was highest for younger teenagers (0.74 for those aged 13-14 years). Some of the 
abortion rates for 1997-2001 have been amended, resulting in slight differences from earlier 
reports due to a few late abortion notifications received, but largely due to the revision of the 
ABS estimated resident population figures after the 2001 Census. 

 

Table 38: Terminations of pregnancy by age, South Australia, 2003 
Age (years) Number % 
12 0 0 
13 1 0 
14 24 0.5 
15 76 1.5 
16 157 3.0 
17 218 4.2 
18 318 6.1 
19 338 6.5 
20-24 1,426 27.3 
25-29 1,016 19.5 
30-34 848 16.3 
35-39 535 10.3 
40-44 237 4.5 
45+ 20 0.4 
Total 5,214 100.0 

 



 
 

37

The distribution of abortions and live births by age in South Australia in 2003 (Table 39 and 
Figure 8A) demonstrates that the largest proportion of abortions occurred in the age group 
20-24 years while the largest proportion of live births occurred among those 30-34 years, who 
had the highest fertility (live birth) rate of 110.4 per 1,000 women. Teenagers accounted for 
21.7% of the abortions and 5.3% of the confinements in South Australia in 2003. The teenage 
pregnancy rate (per 1,000 women aged 15-19 years) declined in the 1970s and 1980s with the 
decline in the teenage birth rate but increased in the 1990s till 1996 with the increase in the 
teenage abortion rate.  Since then it has declined  again  with a decline in the teenage birth 
rate (Figure 8B). The teenage pregnancy rate was 40.7 per 1,000 women in 2003, lower than in 
2002 (when it was 43.5) and the lowest since 1991. 

Table 39: Abortion and live birth rates and abortion proportions by age, South Australia, 2003 
Age 
(years) 

Number of 
abortions 

Estimated resident 
female population  

June 30 2003* 

Abortion rate per 
1,000 women 

Number of 
live births** 

Fertility rate 
per 1,000 

women 

Abortions 
+ live 
births 

Abortion 
proportion 

&lt;15 25 na na 9 na 34 0.74 
15-19 1,107 50,796 22.3** 931 18.5** 2038 0.54 
20-24 1,426 48,498 29.4 2,678 55.2 4104 0.35 
25-29 1,016 46,308 21.9 5,042 108.9 6058 0.17 
30-34 848 53,520 15.8 5,906 110.4 6754 0.13 
35-39 535 54,453 9.8 2,614 48.0 3149 0.17 
40-44 237 59,060 4.4** 505 8.9** 742 0.32 
45+ 20 na na 22 na 42 0.48 
Total 5,214 312,635 16.7** 17,707 56.6** 22,921 0.23 

*Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 2003. Canberra: ABS, 2004 (Catalogue 
No 3235.0). 

**Terminations of pregnancy are excluded from the numbers of live births. The abortion and live birth rates for women aged 15-
19 years include terminations and live births at younger ages, and the rates for women aged 40-44 years include terminations 
and live births at older ages, while the total rates include all terminations and live births 

 

0

20

40

60

80

100

0

20

40

60

80

100

Age (years)

      n=17,707 n=22,921

Figure 8A: ABORTIONS AND LIVE BIRTHS BY AGE SOUTH AUSTRALIA, 2003

Abortions
n=5,214

Live births Abortions &amp; live births

&lt;20 20-24 25-29 30-34 35-39 40+

Age (years)
 

 



 
 

38

0

10

20

30

40

50

60

YEAR

Abortion rate*

Birth rate*

Pregnancy rate*

*Abortions and births to women aged less than 15  years
are included in the numerator

Rate per 1,000 women aged 15-19 years

Figure 8B: TEENAGE PREGNANCY, ABORTION AND BIRTH RATES,
SOUTH AUSTRALIA, 1970-2003

 
 

3 Marital status 
Terminations were performed in the majority of cases (62.2%) for single women (Table 40).   

In 3.9% of cases the marital status was not known. 

 

Table 40: Terminations by marital status, South Australia, 2003 
Marital status Number % 

Never married 2,582 49.5 
Married 1,211 23.2 
De facto 554 10.6 
Widowed 5 0.1 
Divorced/Separated 658 12.6 
Not known 204 3.9 
Total 5,214 100.0 

 

4 Place of residence and place where termination performed 
While 83.0% of terminations were performed for metropolitan residents (Table 41), a larger 
proportion (95.2%) was performed in metropolitan hospitals (Table 42), which include the 
Pregnancy Advisory Centre at which 2,938 terminations (56.3% in the state) were performed. 

 

Table 41: Terminations by place of residence,South Australia, 2003 
Residence of women Number % 

Metropolitan  4,327 83.0 
Country 887 17.0 
Total 5,214 100.0 

 

 



 
 

39

Table 42: Terminations by hospital category, South Australia, 2003 
Hospital where termination performed Number % 

Metropolitan teaching 4,788 91.8 
Metropolitan private 176 3.4 
Country 250 4.8 
Total 5,214 100.0 

 
The proportion of terminations performed by obstetricians was 23.3%, which has declined 
from 68.5% in 1991, while the proportion performed by medical practitioners in family 
advisory clinics has increased from 23.8% in 1991 to 73.2% in 2003 (Table 43).  

 

Table 43: Terminations by category of doctor, South Australia, 2003 
Category of doctor performing termination Number % 

Obstetrician/gynaecologist 1,213 23.3 
Trainee obstetrician/gynaecologist 45 0.9 
Medical practitioner in family advisory clinic 3,817 73.2 
General practitioner 139 2.7 
Total 5,214 100.0 

 

5 The reason for termination 
The number of terminations performed for suspected or identified abnormalities of the fetus 
was 112 (2.2% of terminations), of which 109 (97.3%) were for specified fetal or chromosomal 
abnormalities (Table 44). 

 
Table 44: Reason for termination for suspected or identified abnormality of 
fetus, South Australia, 2003 
Reason for termination Number % 

Possibility of hereditary disease or congenital abnormality 1 0.9 
Identified chromosomal abnormality 54 48.2 
Other identified fetal abnormality 55 49.1 
Possibility of damage from maternal infection (other than Rubella) 1 0.9 
Possibility of damage from irradiation 1 0.9 
Total 112 100.0 

 

6 Gestation, method and complications 
The majority of terminations (92.8%) was performed within the first 13 weeks of pregnancy 
and most frequently (in 91.0% of cases) by vacuum aspiration. Thirteen complications were 
reported for 13 women (0.2%). The types of complications are listed in Table 45. 
Complications are believed to be undernotified as the notification forms are usually 
completed about the time the woman is discharged from hospital after the procedure. 



 
 

40

 

Table 45: Complications of terminations, South Australia, 2003 
Complications Number % of 

complications 

Haemorrhage  - intra-operative 6 46.2 
                        - post-operative 1 7.7 
Perforation of or trauma to body of uterus 3 23.1 
Other 3 23.1 
Total 13 100.0 

 

7 Previous terminations. Total abortion rate and Total first abortion rate 
Of the 5,214 women who had terminations, 1,968 (37.7%) had had a previous termination 
(Table 46a). Among the teenagers 18.1% had had a previous termination, while more than 
40% of women in all the 5-year age groups of 25 years and above had had previous 
terminations. The total abortion rate (TAR) for 2003 was 518.0 per 1,000 women aged 15-44 
years (Table 46b). This represents the number of abortions 1,000 women would have during 
their lifetime if they experienced the abortion rates of the different age groups for 2003. As a 
woman may have more than one abortion in her lifetime, to estimate how prevalent abortion 
is at these age-specific abortion rates for 2003, a total first abortion rate (TFAR, Table 46c) 
may be calculated after exclusion of women with repeat terminations. This TFAR for 2003 
was 322.5 per 1,000 women aged 15-44 years. This suggests that about 1 in 3 women would 
have an abortion in their lifetime if they experienced the abortion rates of the different age 
groups for 2003. 

 

Table 46a: Women with previous terminations by age, South Australia, 2003 
Age (years) Number % % of age group 

&lt; 15 2 0 8.0 
15 - 19 203 10.3 18.3 
20 - 24 534 27.1 37.4 
25 - 29 470 23.9 46.3 
30 - 34 424 21.5 50.0 
35 - 39 232 11.8 43.4 
40+ 103 5.3 40.1 
Total 1,968 100.0 37.7 

 
Further details of abortions in South Australia in 2003 may be obtained from the First 
Annual Report of the South Australian  Abortion Reporting Committee   for the year 2003.6 



 
 

41

 
 

Table 46b: Calculation of total abortion rate (TAR) for 2003 for South Australia* 
Age (years) Number of women who had 

terminations 
Estimated female resident 
population 30th June 2003 

Abortion rate per 1,000 
women 

15-19 1,132 50,796 22.3 
20-24 1,426 48,498 29.4 
25-29 1,016 46,308 21.9 
30-34 848 53,520 15.8 
35-39 535 54,453 9.8 
40-44 257 59,060 4.4 
Total 5,214 312,635 16.7 

 

*In these calculations, abortions to women under 15 years are included in the age group 15-19 yrs and abortions to women 
aged 45 years or more are included in the age group 40-44 years, as is traditional. 

Total abortion rate = sum of abortion rates for 5-year age groups x 5 = 103.6X5=518.0 per 1,000 women aged 15-44 years. 

 
 

Table 46c: Calculation of total first abortion rate (TFAR) for 2003 for South Australia* 

Age (years) 

Number of 
women who 

had 
terminations 

(A) 

Number of 
women who 

had previous 
terminations

(B) 

Number of 
women who had 
first termination

(A)   (B) 

Estimated female 
resident 

population  
June 30th 2003 

First 
abortion rate 

per 1,000 
women 

15-19 1,132 205 927 50,796 18.2 
20-24 1,426 534 892 48,498 18.4 
25-29 1,016 470 546 46,308 11.8 
30-34 848 424 424 53,520 7.9 
35-39 535 232 303 54,453 5.6 
40-44 257 103 154 59,060 2.6 
Total 5,214 1,968 3,246 312,635 10.4 

* In these calculations, abortions to women under 15 years are included in the age group 15-19 yrs and abortions to women  
aged 45 years or more are included in the age group 40-44 years, as is traditional. 

Total first abortion rate (TFAR) = sum of first abortion rates for 5-year age groupsX5 = 64.5 x 5 = 322.5 per 1,000 women 
aged 15-44 yrs.  



 
 

42

IV  OBSTETRIC PROFILES BY HOSPITAL CATEGORY 
Obstetric profiles for 5 hospital categories for 2003 are provided in Table 47 and Figures 9-28. 

These hospital categories are: 

1. Metropolitan teaching Level III hospitals with neonatal intensive care facilities, ie the 
Women s &amp; Children s Hospital and Flinders Medical Centre, 

2. Other metropolitan teaching hospitals, ie The Queen Elizabeth Hospital, Lyell 
McEwin Health Service and Modbury Hospital, 

3. Metropolitan private hospitals, 

4. The two major country hospitals (Mount Gambier and Whyalla) and 

5. Other country hospitals (mainly smaller). 

A list of maternal and baby factors identified either as risk factors for poor perinatal outcome 
in earlier analyses,7 or of general interest, is provided with  means  for all state hospital 
births as well as proportions for the 5 hospital categories. 

The  mean  is the proportion for all state hospital confinements (for maternal factors) or 
births (for baby factors), 

e.g. % Aboriginal mothers 

     x100
hospitals statein  tsconfinemen Total

hospitals statein  mothers Aboriginal of tsconfinemen of Number
 

 

Where indicated (+) in Table 47, it is the mean (number of confinements or births) for the 26 
hospitals or groups of hospitals for which obstetric profiles have been provided, and which 
have also been included in the provision of the 10th and 90th percentile values. These are as 
follows: 

1. Women s &amp; Children s Hospital 

2. Flinders Medical Centre 

3. Lyell McEwin Health Service 

4. The Queen Elizabeth Hospital 

5. Modbury Hospital 

6. Ashford Community Hospital Inc 

7. Burnside War Memorial Hospital Inc 

8. Calvary Hospital Adelaide Inc 

9. Central Districts Private Hospital 

10. Flinders Private Hospital 

11. North Eastern Community Hospital Inc 

12. Mount Gambier &amp; District Health Service Inc 

13. The Whyalla Hospital &amp; Health Services Inc 

14. Gawler Health Service 

15. Millicent &amp; District Hospital &amp; Health Services Inc 

16. Mount Barker District Soldiers  Memorial Hospital Inc 

17. Murray Bridge Soldiers  Memorial Hospital Inc 



 
 

43

18. Naracoorte Health Service Inc 

19. Port Augusta Hospital &amp; Regional Health Service Inc 

20. Port Lincoln Health Service Inc 

21. Port Pirie Regional Health Service Inc 

22. Riverland Regional Health Service (Berri) 

23. South Coast District Hospital (Victor Harbor) 

24. Tanunda War Memorial Hospital 

25. Country hospitals with 50-99 births per year 

26. Country hospitals with &lt;50 births per year 

 
The 10th percentile is the proportion below which 10% of the 26 hospital proportions, ie the 
two lowest hospital proportions, would be found if the 26 proportions were ranked from 
highest to lowest. The 90th percentile is the proportion above which 10% of the 26 hospital 
proportions, ie the two highest proportions, would be found if the 26 proportions were 
ranked from highest to lowest. As the two Level III hospitals which account for 34.4% of 
hospital births have proportions of some factors (such as prolonged hospitalisation and use 
of neonatal intensive care) which are much greater than for the other 24 hospitals, 
occasionally the mean for all hospitals will be seen to be higher than the 90th percentile. 

The table and figures provide obstetric profiles for the 5 different categories of hospitals. 
These have been provided since 1986 to hospitals with 100 or more births per year, together 
with their individual hospital profiles, including crude and standardized perinatal mortality 
ratios,8 the latter with exclusion of perinatal deaths from congenital abnormalities4 and 
terminations of pregnancy. For country hospitals with less than 100 births per year, group 
reports have been provided. 

It is possible for each hospital to compare its statistics for each factor with those for state 
hospitals and for categories of hospitals. It is also possible to note whether a hospital's 
proportion for any factor falls within the range of the more common proportions prevailing 
in hospitals in the state (ie between the 10th and the 90th percentiles). 



 
 

44

 

Table 47: Obstetric profiles by hospital category, South Australia, 2003, births of &gt;=400g or &gt;=20 weeks 
gestation 
 All state hospitals Metropolitan hospitals Country hospitals 

Factors Mean 10th percentile 
90th 

percentile 
Level III

teaching 
Other

teaching Private Major Other 

Maternal factors         
Confinements (n=17,455) 671+ 120 1,519 5,940 2,844 4,906 818 2,947 
% Aboriginal mothers 2.7 0.1 7.1 3.0 3.4 0.1 4.0 5.2 
% Antenatal visits &lt;7* 7.2 0.2 13.4 11.8 8.3 0.7 6.0 8.9 
% Teenage mothers 5.4 0.3 13.8 5.8 9.7 0.5 9.4 7.3 

% Mothers ?35 years 17.7 9.2 27.8 17.3 12.2 26.0 11.3 11.9 
% Single mothers 13.4 2.9 22.1 19.7 19.0 2.7 14.1 13.1 
%  4+ prior live births 2.8 0.7 5.6 3.1 4.7 0.8 3.4 3.7 
%  1+ prior perinatal deaths 1.4 0 2.2 2.0 1.7 0.7 1.8 1.2 
% Obstetric complications 30.8 15.2 35.8 41.0 32.8 24.5 27.1 19.8 
% Labour complications 34.9 19.9 41.9 44.7 36.2 30.5 23.0 24.5 
% Induction 29.1 20.9 34.6 29.7 29.0 31.4 23.0 26.0 
% Emergency LSCS 16.8 9.4 21.3 18.3 14.0 19.7 12.2 13.0 
% Elective LSCS 13.4 8.0 22.1 9.7 10.5 20.0 12.8 12.6 
% Total LSCS 30.2 20.5 43.1 28.0 24.5 39.7 25.1 25.6 
% Ultrasound examination* 98.1 94.0 99.2 98.8 97.5 98.5 98.4 96.9 
% Amniocentesis* 6.5 1.7 11.0 6.5 4.7 10.5 3.4 2.8 
% Episiotomy 13.5 3.7 25.4 10.0 12.6 20.0 9.1 11.6 
% Repair of perineal tear 25.4 18.4 31.8 27.7 21.2 26.1 26.8 23.0 
% Epidural analgesia 32.0 11.3 44.4 33.6 25.9 45.9 14.4 16.3 
% Spinal analgesia 1.0 0 2.3 0.7 0.7 1.3 0.5 1.3 
% Private patients 33.7 0.4 100.0 9.5 3.0 100.0 12.8 7.8 
% Primiparous women 42.1 32.7 46.5 43.7 37.8 46.7 39.5 36.2 
% Previous LSCS 14.8 10.5 19.8 13.8 11.7 18.1 14.4 14.0 
% PPH 6.3 2.8 6.3 10.7 5.0 3.1 6.0 3.8 
Baby factors          
Births (n=17,781) 684+ 121 1,548 6,120 2,879 4,987 835 2,960 
% Birthweight &lt;2,500g 7.0 0.6 8.1 11.8 6.3 4.3 5.6 2.8 
% Gestational age &lt;37 weeks 
    at birth 8.5 0.6 9.8 14.5 7.5 5.1 7.3 2.9 

% Prolonged hospitalisation  
    (&gt;27 days) 2.2 0 2.8 5.1 0.7 0.6 0.8 0.6 

% Neonatal intensive         
    care (Level  III or W&amp;CH         
    paediatric intensive care) 2.9 0.2 2.8 6.2 1.4 0.9 2.2 1.2 
% Birth defect 2.4 0.7 2.9 3.2 1.6 2.1 2.2 1.9 

*  adjusted for missing values. 
+  mean number of confinements or births for the 26 hospitals or groups of hospitals. 

 



 
 

45

 

1 2 3 4 5
0

2

4

6

8

10

12

14

Hospital category

Figure 10:  Percentage of mothers with &lt;7
antenatal v isits by hospital category

1 2 3 4 5
0

2

4

6

8

10

12

14

Hospital Category

1 2 3 4 5
0

2

4

6

8

Hospital Category

90th percentile

Mean

10th percentile

Figure 9:  Percentage of Aboriginal mothers
by hospital category

1 2 3 4 5
0

5

10

15

20

25

30

35

Hospital Category

Figure 12:  Percentage of mothers 35 years or
more by hospital category

Figure 11:  Percentage of teenage mothers by
hospital category

90th Percentile

Mean

10th Percentile

10th Percentile

10th Percentile

Mean

90th percentile

90th percentile

Mean

 
 

1 2 3 4 5
0

5

10

15

20

25

Hospital Category

90th percentile

Mean

1 2 3 4 5
0

2

4

6

8

90th percenti le

Mean

Hospital Category

Figure 13: Percentage of single mothers by hospital
category

Figure 14: Percentage of mothers with 4 or more prior
liv ebirths by hospital category

Hospital Category Hospital Category

Figure 15: Percentage of mothers with 1 or more prior
perinatal deaths by hospital category

Figure 16: Percentage of mothers with obstetric
complications by hospital category

10th Percentile10th Percentile

1 2 3 4 5
0

0.5
1

1.5
2

2.5
3

3.5
4

4.5
5

1 2 3 4 5
0
5

10
15
20
25
30
35
40
45
50

90th percentile

Mean

10th Percentile

90th percentile

Mean

10th Percentile

 



 
 

46

 

1 2 3 4 5
0

5

10

15

20

25

30

35

40

45

50

 Figure 19: Percentage of mothers hav ing epidural
 analgesia  by hospital category

Hospital Category
1 2 3 4 5

0

5

10

15

20

25

30

35

Mean

Hospital Category

Figure 18: Percentage of mothers with induction of labour
by  hospital category

Mean

90th Percentile

1 2 3 4 5
0
5

10
15
20
25
30
35
40
45
50
55

 Figure 17: Percentage of mothers with complications
 during labour or deliv ery by hospital category

Hospital Category
1 2 3 4 5

0

0.4

0.8

1.2

1.6

2

90th Percentile

Mean

10th Percentile

Hospital Category

Figure 20: Percentage of breech deliv eries by  hospital
category

10th Percentile

Mean

90th Percentile

90th Percentile

10th Percentile

10th Percenti le

 

1 2 3 4 5 . .
0
2
4
6
8

10
12
14
16
18
20
22

Figure 21: Percentage of emergency LSCS by
hospital category

Hospital Category

90th Percentile

Mean

10th Percentile

1 2 3 4 5 . .
0
2
4
6
8

10
12
14
16
18
20
22
24

Figure 22: Percentage of electiv e LSCS by hospital
category

Hospital Category

90th Percentile

Mean

10th Percentile

1 2 3 4 5 . .
0
5

10
15
20
25
30
35
40
45

Figure 23: Percentage of total LSCS by hospital category

Hospital Category

Mean

10th Percentile

1 2 3 4 5 . .
0

2

4

6

8

10

12

14

Figure 24: Percentage of births with birthweight
below 2500g by hospital category

90th Percentile

Hospital Category

Mean

10th Percentile

90th Percentile

 



 
 

47

 

 

1 2 3 4 5
0

2

4

6

8

10

12

14

16

Figure 25: Percentage of births with gestation less
than 37 weeks by hospital category

Hospital Category

90th Percentile

Mean

10th Percentile

Figure 26: Percentage of births with prolonged
hospitalisation by hospital category

Hospital Category

1 2 3 4 5
0

0.5
1

1.5
2

2.5
3

3.5
4

4.5
5

5.5
6

6.5
7

Figure 27: Percentage of liv ebirths requiring
neonatal intensiv e care by hospital category

Hospital Category

90th Percentile

Mean

10th Percentile

1 2 3 4 5
0

1

2

3

4

5

Figure 28: Percentage of births w ith birth defects by
hospital category

Hospital Category

90th Percentile

Mean

10th Percentile

1 2 3 4 5
0

0.5
1

1.5
2

2.5
3

3.5
4

4.5
5

5.5
6

90th Percentile

Mean

10th Percentile

 

 

 



 
 

48

V  CLINICAL AND MATERNITY PERFORMANCE INDICATORS 

1  Clinical indicators 
These clinical indicators of the Australian Council for Healthcare Standards (Australian 
Council for Healthcare Standards. Clinical Indicators   A Users  Manual: Obstetrics and 
Gynaecology Indicators Version 2) are reported for the state in pages 52-55. They are also 
reported for hospital categories and individual hospitals in the Pregnancy and Neonatal 
Care Bulletin 2003. 
 

INDICATOR 1: INDUCTION OF LABOUR OTHER THAN FOR DEFINED 
INDICATIONS 

Rationale:  These indicators have been included because induction of labour is a common 
obstetric intervention and one which is often stated by community critics to be 
unnecessarily high. 

Clinical indicator 1.1: Induction of labour other than for defined indications among 
all inductions 

Numerator: The number of women undergoing induction of labour for indications other 
than those defined (n=2,221). These are diabetes, premature rupture of 
membranes, hypertensive disorders (including chronic renal disease), 
intrauterine growth restriction, isoimmunisation, fetal distress (as documented 
by the clinician), fetal demise, chorioamnionitis and prolonged pregnancy (41 
completed weeks or more). Patients having augmentation of labour are 
excluded in both numerator and denominator data. 

Denominator:  The total number of women undergoing induction of labour for any reason 
(excluding augmentation of labour) (n = 5,085). 

Clinical indicator  1.1 = 43.7%
5,085

100 x 2,221 =  (95%CI 42.3%-45.1%). 

Clinical indicator 1.2: Induction of labour other than for defined indications among 
all women who delivered 

Numerator: The number of women undergoing induction of labour for indications other 
than those listed above (excluding augmentation of labour) (n=2,221). 

Denominator:  The total number of women delivering (including augmentation of labour) 
(n=17,517). 

Clinical indicator 1.2 = 12.7%
17,517

100 x 2,221 =  (95%CI 12.2%-13.2%). 

 

 

 

 



 
 

49

 

 

INDICATOR 2: RATE OF VAGINAL DELIVERY FOLLOWING PRIMARY 
CAESAREAN SECTION 

Rationale: This indicator has been included to monitor the conduct of labour and trial of 
scar in those women who have had a previous primary (first) caesarean 
section. 

Clinical indicator 2.1: Rate of vaginal delivery following primary caesarean section 

Numerator: The number of women delivering vaginally following a previous primary 
(first) caesarean section and having no intervening pregnancies greater than 20 
weeks gestation (n=358). 

Denominator:  The total number of women delivering who have had a previous primary 
(first) caesarean section and no intervening pregnancies greater than twenty 
weeks gestation  (n=1,820). 

Clinical indicator 2.1 = %.
,
x 719
8201

100358 =  (95%CI 17.9%-21.6%). 

 
 

 

INDICATOR 3: PRIMARY CAESAREAN SECTION FOR FAILURE TO PROGRESS 

Rationale: This indicator is to monitor the adequacy of trial of labour. There are two 
indicators, one for failure to progress after a period of labour with cervical 
dilatation of 3cm or less and the other with cervical dilatation of more than 
3cm. As information  on cervical dilatation is not collected, the two indicators 
have been combined. 

Clinical indicator 3.0: Primary caesarean section for failure to progress among 
primary non-elective caesarean section 

Numerator: The number of women undergoing primary (first) caesarean section for failure 
to progress (clinician s documented statement), which may include CPD, 
uterine inertia, persistent occipitoposterior position (n=1,290). 

Denominator: The total number of women undergoing primary non-elective caesarean 
section (n=2,408). 

Clinical indicator 3.0 = 53.6%
2,408

100 x 1,290 =  (95%CI 51.6%-55.6%). 

 
 



 
 

50

 

INDICATOR 4: PRIMARY CAESAREAN SECTION FOR FETAL DISTRESS 

Rationale: To determine the comparative frequency of caesarean section for fetal distress. 

Clinical indicator 4.1: Primary caesarean section for fetal distress among all women 
who delivered 

Numerator: The number of women undergoing primary caesarean section for fetal distress 
in labour as evidenced by the clinician s documented diagnosis of fetal distress 
(n=920). 

Denominator:  The total number of women delivering including those delivering vaginally 
(n=17,517). 

Clinical indicator 4.1 = 
17,517

100 x 920  = 5.3% (95% CI 4.9%-5.6%). 

Clinical indicator 4.2: Primary caesarean section for fetal distress among primary 
caesarean sections 

Numerator: The number of women undergoing primary caesarean section for fetal distress 
as defined above (n=920). 

Denominator:  The total number of women delivering by primary caesarean section only  
(n = 3,234). 

Clinical indicator 4.2 = %.428
3,234

100 x 920 =  (95%CI 26.9%-30.0%). 

 
 

INDICATOR 5: INCIDENCE OF AN INTACT LOWER GENITAL TRACT IN 
PRIMIPAROUS PATIENTS DELIVERING VAGINALLY 

Rationale: This indicator has been included because a high incidence of an intact 
perineum is considered a desirable outcome. 

Clinical indicator 5.1: Incidence of an intact lower genital tract in primiparous 
women delivering vaginally 

Numerator: The number of primiparous patients not requiring surgical repair or suture of 
the lower genital tract (those structures below and not including the cervix) 
following delivery (n=1,438). 

Denominator:  The total number of primiparous women delivering vaginally (n=4,966). 

Clinical indicator 5.1 = 29.0%
4,966

100 x 1,438 =  (95%CI 27.7%-30.2%). 

 
 



 
 

51

 
 
 
 
 
 

INDICATOR 6: APGAR SCORE 

Rationale: This indicator has been included as a measure of the outcome of labour, with 
particular emphasis on the assessment of baby well-being. 

Clinical indicator 6.1: Apgar score of 4 or below at five minutes after delivery among 
all babies except antepartum fetal deaths 

Numerator: The number of babies born with an Apgar score of 4 or below at five minutes 
post delivery (n=69). 

Denominator:  The total number of babies born (excluding fetal deaths in utero diagnosed 
prior to commencement of labour) (n=17,767). 

Clinical indicator 6.1 = %.
,
x 40
76717
10069 =  (95%CI 0.3%-0.5%). 

 
 

 

INDICATOR 7: TERM BABIES TRANSFERRED OR ADMITTED TO A NEONATAL 
INTENSIVE CARE UNIT FOR REASONS OTHER THAN CONGENITAL 

ABNORMALITY 

Rationale:  This indicator has been included as an index of the overall management of 
labour in terms of outcome. 

Clinical indicator 7.1: Term babies transferred or admitted to a neonatal intensive 
care unit for reasons other than congenital abnormality 

Numerator: The number of term babies (37 weeks gestation or later) transferred/admitted 
to a neonatal intensive care unit for reasons other than congenital abnormality 
(n=122). 

Denominator:  The total number of term live babies born (n=16,308). 

Clinical indicator 7.1 = %.
,
x 70
30816
100122 =  (95%CI 0.6%-0.9%). 

 
 
 
 



 
 

52

2  Maternity performance indicators 
The first two of these indicators have been selected from the Victorian set of maternity 
performance indicators,* while the rest are ACHS clinical indicators. These six indicators are 
as follows: 

1  Induction of labour proportion for standard primiparae 
=  Number of standard primiparae undergoing induction of labour 
 Number of standard primiparae who give birth 

2  Caesarean section rate for standard primiparae 
= Number of standard primiparae undergoing caesarean section 
 Number of standard primiparae who give birth 

The standard primipara is aged &gt;=20 and &lt;=34 years, with a singleton pregnancy, delivered 
at gestation &gt;=37 and &lt;=41 weeks, with an infant not small for gestational age (classified 
using birthweight percentiles rather than clinical suspicion of light for dates).* The 
birthweight percentiles used are the national birthweight gestation percentiles.** 

 Using the standard primipara (rather than all women giving birth) as the basis for internal 
hospital comparison of maternity care controls for substantial differences in case mix (pre 
risk-adjustment) and increases the validity of those comparisons. * 

3 VBAC: proportion of women delivering vaginally following a previous primary (first 
caesarean section and no intervening births. 

This is as defined for Clinical indicator 2 (page 53) and was 19.7% for the state in 2003 (19.5% 
for state hospitals). 

4 PRIMIP no repair: proportion of primiparous women not requiring surgical repair 
following vaginal delivery. This is as defined for Clinical indicator 5 (page 54) and was 29.0% 
for the state in 2003 (28.8% for state hospitals). 

5 TERM NICU: proportion of term babies admitted to neonatal intensive care (NICU) for 
reasons other than congenital abnormality. 
This is as defined for Clinical indicator 7 (page 55) and was 0.7% for the state (and state 
hospitals) for 2003. 

*Victorian Department of Human Services. Measuring Maternity care. The Final Set of Performance Indicators   2002. 
www.health.vic.gov.au/maternitycare/measuring 

**Roberts CL, Lancaster PAL. Australian national birthweight percentiles by gestational age. MJA 1999;170:114-118 

6 SPMR: Standardized perinatal mortality ratio for all births. 
This is as defined8 in the Pregnancy and Neonatal Care Bulletin 2003. It adjusts for the difference between the distribution of 
births by birthweight between the hospital and state hospital births. As perinatal mortality is much higher in babies of low 
birthweight, this adjustment ensures that a hospital is directly comparable with other hospitals and state hospitals as a whole if 
it has a higher proportion of low birthweight babies than state hospital births. 

SPMR   = 
deaths ofnumber  Expected
deaths ofnumber  Observed  x 100 

 
To obtain the expected number of deaths for a hospital, the state hospital perinatal mortality 
rate for 2003 for each of the birthweight groups in Table 21b is applied to the number of 
births in each corresponding birthweight group for the hospital.  This gives an expected 
number of deaths in each birthweight group.  These expected deaths are then totalled to give 
a total number of expected deaths for the hospital. 



 
 

53

SPMRs provided in this report exclude deaths attributed to congenital abnormalities (as 
determined by the Maternal, Perinatal and Infant Mortality Committee4), which are the least 
preventable, as well as terminations of pregnancy. An SPMR above 100 means that after 
adjustment for birthweight differences and deaths attributed to congenital abnormalities and 
terminations of pregnancy, perinatal mortality for that hospital is higher than that for state 
hospital births eg an adjusted SPMR of 120 means that it is 20% higher. 

A 95% confidence interval (CI) which includes the value 100 in its range means that the 
hospital s perinatal mortality is not (statistically) significantly different from that for state 
hospital births for 2003. These confidence intervals have been calculated using tabular values 
of 95% confidence limit factors for estimates of a poisson distributed variable.9  

Statistics for the six maternity performance indicators for 2003 are provided for eleven 
hospitals, 

A   K, with at least 500 births in 2003 in Figures 29A   29E. Metropolitan teaching hospitals 
have been named with their permission and are as follows: 

A Women s and Children s 

B Flinders Medical Centre 

C Lyell McEwin Health Service 

D  The Queen Elizabeth 

E Modbury  

 

 

Fig 29A:   Induction of labour: % of confinements of standard 
primiparae in which labour was induced, SA hospitals with &gt;=500 

births per year, 2003

0

10

20

30

40

50

A B C D E F G H I J K
Hospital

%

Induction of labour %
*SA hospitals = 24.8%

 
 



 
 

54

Fig 29B:  Caesarean sections for standard primiparae: % of 
confinements of standard primiparae in which caesarean section was 

performed, SA hospitals with &gt;=500 births per year, 2003

0

10

20

30

40

50

A B C D E F G H I J K
Hospital

%

Caesarean section %
*SA hospitals = 22.1%

 
 

 

 

Fig 29C:   VBAC: Proportion of women delivering vaginally following a 
previous primary (first) caesarean section and no intervening births,

 SA hospitals with &gt;=500 births per year, 2003

0

10

20

30

40

A B C D E F G H I J K
Hospital

%

VBAC %
*SA hospitals = 19.5%

 



 
 

55

Fig 29D:  PRIMIP no repair: proportion of primiparous women not requiring 
surgical repair following vaginal delivery, SA hospitals

 with &gt;=500 births per year, 2003

0

10

20

30

40

50

A B C D E F G H I J K

Hospital

%

Primip no repair %
*SA Hospitals = 28.8%

 
 
 
 
 

 

 

 

 

 

 

 

 

Fig 29E:  TERM NICU: proportion of term babies admitted to NICU 
for reasons other than congenital abnormality,  SA hospitals with 

&gt;=500 births per year, 2003

0

0.5

1

1.5

2

A B C D E F G H I J K
Hospital

%

Term NICU %
*SA hospitals = 0.7%



 
 

56

Fig 29F:  SPMR (Standardized Perinatal Mortality Ratio) for all births,
 SA hospitals with &gt;=500 births per year, 2003 

0

50

100

150

200

A B C D E F G H I J K
Hospital

   SPMR
*SA hospitals 

 
 



 
 

57

VI  TRENDS IN PERINATAL STATISTICS IN SOUTH AUSTRALIA,  
     1981-2003 

Perinatal statistics are presented in Tables 48 and 49 for both socio-demographic and 
obstetric aspects for each year from 1994-2003, as well as for 1981, when the perinatal data 
collection was commenced.  The trends noted between 1981 and 2003 are as follows, and 
some features are illustrated in Fig 30.1   30.8: 

1 The fall in the crude birth rate, from 14.3 to 11.6 per 1,000 population.  The annual 
number of births has declined since 1995, but the numbers were relatively stable in the 
last 4 years, with a small increase in 2003 compared with 2001 and 2002. 

2 The increase in the proportion of confinements of Asian mothers from 1.8% to 4.7% and 
of Aboriginal mothers from 1.5% to 2.7% in 2003. 

3 The decrease in the proportion of teenage confinements from 7.8% in 1981 to 5.3% in 
2003, but this proportion has been relatively stable since 1993. The teenage pregnancy 
rate declined in the 1970s and 1980s and then rose, with the teenage abortion rate, in the 
1990s till 1996, after which it has declined mainly due to the decline in the teenage birth 
rate. 

4 The increase in the proportion of confinements of older women (35 years and over) from 
4.6% to 17.7%. 

5 The increase in mean age among primigravid women, from 23.77 years to 27.14 years. 
The proportion of primigravidae aged 30 years and over increased from 8.9% to 36.3%. 

6 The increase in the proportion of confinements of never married women, from 7.6% to 
the peak of 13.2% in 1996, after which it decreased to 12.0% in 1999-2000: this proportion 
has been relatively stable in recent years. 

7 The number of home births has increased in the last 2 years, almost to the number in 
1981. The proportion of births in private hospitals declined in the late 1990s, but 
increased over the last 3 years to 27.9%, while births in country hospitals declined to 
21.3%.  The number of births in birthing units in teaching hospitals has increased steadily 
from 125 (0.6%) in 1992 to 966 (5.5%) in 2003: the peak was 1,000 births (5.6%) in 2002. 
Nearly as many more women planned to deliver in birthing units but were transferred to 
labour wards before delivery. 

8 The increase in the proportion of multiple births, related to assisted conception 
pregnancies, and the older age of mothers, from 2.0% in 1981 to 3.6% in 2003. 

9 The induction rate increased from 22.1% in 1981 to 29.0% in 2003, and 44% of inductions 
in 2003 were performed for other than defined indications. 

10 The fall in the proportion of normal spontaneous vaginal deliveries (from 66.1% to 
57.8%), breech deliveries (from 1.1% to 0.4%) and forceps deliveries (from 15.2% to 4.8%), 
with an increase in the proportion delivered by ventouse, from 0.7% to 6.9%, and by 
caesarean section, from 16.9% to 30.0%. 

11 The increase in the proportions of low birthweight (from 5.8% to 7.0%) and preterm 
babies (from 5.5% to 8.4%). However, both proportions have been stable in recent years. 

12 The proportion of births with congenital abnormalities has been relatively stable at 
around 2.3% over the last decade. 

13 The increase in the proportion of babies utilising Level II care from 6.7% in 1982 to 16.6% 
in 2003.  

14 The considerable fall in the perinatal mortality rate, despite the increasing proportion of 
preterm births. This fall is reflected in the standardized perinatal mortality ratio which 



 
 

58

has been calculated for each year utilising perinatal mortality rates for 500g birthweight 
groups for the years 1981-1989 combined as the standard. It was 68.1 in 2003 compared 
with 117.6 in 1981. The fall in neonatal mortality has been particularly outstanding. 

 
 
 
 

Table 48: Socio-demographic aspects of perinatal statistics, South Australia, 1981 and 1994   2003 
 Characteristic Year 

  1981 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 

1 Total births 19,052 19,801 19,620 19,111 18,674 18,734 18,519 17,871 17,704 17,745 17,844 
2 Live births 18,905 19,673 19,472 18,979 18,535 18,613 18,404 17,765 17,584 17,623 17,710 
3 Confinements 18,857 19,519 19,310 18,784 18,394 18,421 18,233 17,577 17,427 17,421 17,517 
4 Crude birth rate 

per 1,000 
population 

14.3 13.4 3.2 12.9 12.5 12.5 12.3 11.9 11.6 11.6 11.6 

5 Place of birth (%)            
  Teaching hospital 52.2% 48.9% 49.6% 50.7% 50.9% 53.4% 53.6% 54.6% 51.6% 49.6% 50.6% 
  Private hospital 19.7% 27.3% 26.3% 24.9% 24.2% 22.6% 22.3% 21.9% 25.2% 27.9% 28.1% 
  Country hospital 27.8% 23.6% 24.1% 24.4% 24.9% 24.0% 24.0% 23.5% 22.9% 22.2% 21.3% 
  Domiciliary 0.3% 0.2% 0.3% 0.3% 0.2% 0.2% 0.2% 0.2% 0.2% 0.3% 0.3% 
  (65) (31) (52) (52) (44) (36) (39) (35) (37) (48) (60) 
6 Race (%)            
  Aboriginal 1.5% 2.0% 2.0% 1.9% 2.1% 2.2% 2.4% 2.5% 2.3% 2.5% 2.7% 
  Asian 1.8% 4.0% 3.9% 3.8% 3.8% 4.1% 4.3% 4.5% 4.4% 4.8% 4.7% 
7 Age (%)            
  Teenage     (%) 7.8% 5.3% 5.3% 5.9% 5.4% 5.1% 5.6% 5.3% 5.4% 5.5% 5.3% 
   ?35 years   (%) 4.6% 11.6% 12.5% 13.5% 14.2% 15.0% 15.0% 16.3% 16.5% 17.1% 17.7% 
8 Marital status (%)            
   Never married 7.6% 12.1% 12.0% 13.2% 12.3% 11.6% 12.0% 12.0% 12.3% 12.3% 11.9% 
   Widowed/ 

divorced/ 
separated (%) 

2.0% 1.4% 1.7% 1.7% 1.6% 1.7% 1.5% 1.7% 1.6% 1.6% 1.5% 

   (Single) (9.6%) (13.5%) (13.7%) (14.9%) (13.8%) (13.3%) (13.5%) (13.7%) (13.9%) (13.9%) (13.3%) 
9 Primigravidae            
  Mean age (years) 23.77 26.02 26.24 26.10 26.40 26.52 26.66 26.88 27.00 27.04 27.14 
  Teenage 16.2% 11.5% 11.7% 13.6% 12.2% 11.2% 12.2% 11.5% 11.3% 11.9% 11.9% 
   ?30 years 8.9% 24.3% 26.2% 26.5% 27.3% 28.0% 29.9% 31.9% 34.3% 34.9% 36.3% 



 
 

59

 

Table 49: Obstetric aspects of perinatal statistics, South Australia, 1981 and 1994   2003 
      Characteristic                                                                                                     Year 

  1981 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 

1 Plurality            
 Multiple births 

(%) 2.0% 2.8% 3.1% 3.4% 3.0% 3.3% 3.1% 3.3% 3.1% 3.6% 3.6% 

    Twins (363) (526) (608) (606) (528) (614) (564) (560) (550) (632) (626) 
    Triplets (21) (24) (9) (36) (24) (9) (6) (21) (3) (12) (21) 
    Quadruplets (0) (4) (0) (0) (0) (0) (0) (0) (0) (0) (0) 
2 Induction of 

labour (%) 22.1% 23.6% 23.5% 23.5% 25.0% 27.3% 27.9% 27.3% 28.3% 29.3% 29.0% 

3 Method of 
delivery            

 Normal 
spontaneous 66.1% 62.6% 63.5% 63.5% 62.5% 62.8% 62.3% 61.7% 59.5% 58.7% 57.8% 

 LSCS elective 8.2% 10.0% 10.3% 9.7% 10.3% 10.0% 10.4% 10.4% 11.9% 12.6% 13.3% 
 LSCS emerg 8.7% 13.7% 12.9% 13.4% 13.3% 13.8% 14.5% 14.8% 15.8% 16.6% 16.7% 
 Forceps 15.2% 10.4% 9.2% 8.8% 9.3% 8.2% 7.1% 6.4% 6.1% 5.9% 4.8% 
 Breech 1.1% 0.7% 0.7% 0.6% 0.7% 0.4% 0.5% 0.4% 0.4% 0.4% 0.4% 
 Ventouse 0.7% 2.6% 3.4% 4.0% 4.0% 4.7% 5.2% 6.3% 6.3% 5.9% 6.9% 
 Total LSCS (16.9%) (23.7%) (23.2%) (23.1%) (23.5%) (23.9%) (24.9%) (25.2%) (27.8%) (29.2%) (30.0%) 
4 Birthweight 

&lt;2,500g 5.8% 6.7% 6.8% 7.4% 7.0% 7.0% 6.6% 7.2% 6.8% 7.1% 7.0% 

 Singletons 4.9% 5.3% 5.3% 5.6% 5.5% 5.3% 5.2% 5.6% 5.5% 5.4% 5.3% 
 Multiples 52.1% 53.8% 52.8% 57.0% 56.5% 54.7% 49.6% 55.9% 46.3% 50.5% 53.0% 
5 Gestational age 

&lt;37 weeks 5.5% 7.3% 7.8% 8.1% 7.8% 8.0% 8.1% 8.6% 8.1% 8.3% 8.4% 

 Singletons 4.8% 6.1% 6.3% 6.5% 6.4% 6.4% 6.7% 6.9% 6.7% 6.6% 6.7% 
 Multiples 41.1% 50.4% 54.9% 53.9% 55.8% 54.4% 51.8% 57.3% 50.8% 52.2% 54.6% 
6 Congenital 

abnormalities 3.4% 2.3% 2.5% 2.3% 2.3% 2.5% 2.5% 2.3% 2.5% 2.4% 2.3% 

7 Level II care na 13.8% 14.2% 13.8% 13.5% 14.5% 16.6% 15.8% 15.2% 15.8% 16.6% 
8 Level III care 3.3% 2.5% 2.5% 2.5% 2.5% 2.8% 2.6% 3.0% 2.6% 2.8% 2.7% 
9 W&amp;CH ICU 

care na 0.4% 0.3% 0.2% 0.2% 0.2% 0.3% 0.2% 0.3% 0.2% 0.2% 

10 Hospitalisation 
for 28 days or 
more 

4.2% 2.2% 2.2% 2.0% 2.0% 2.0% 2.1% 2.5% 2.1% 2.2% 2.2% 

11 Neonatal 
deaths 96 66 71 70 59 46 38 57 64 54 42 

12 Stillbirths 147 128 148 132 139 121 115 106 120 122 134 
13 Perinatal 

deaths 243 194 219 202 198 167 153 163 184 176 176 

14 Perinatal 
mortality rate 
per 1,000 births 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 ?400g/20 
weeks 12.8 9.8 11.2 10.6 10.6 8.9 8.3 9.1 10.4 9.9 9.9 

 ?500g/22 
weeks* 11.6 7.4 8.3 7.6 6.6 6.5 5.7 6.1 6.9 6.8 6.9 

 ?1,000g/28 
  weeks* 7.2 3.8 4.5 4.0 4.0 3.5 3.1 3.6 3.9 4.0 3.9 

15 Standardized 
perinatal 
mortality ratio 

117.6 72.5 76.5 72.5 72.1 69.1 60.2 62.0 70.6 70.3 68.1 

*only neonatal deaths within the first 7 days of life are included. 
 



 
 

 

6 6.2 5.9 6 6.2 5.8 5.9 5.9 5.6 5.3 5.3
5.9

5.4 5.1
5.6 5.3 5.4 5.5 5.3

0

2

4

6

8

Year

6 6.6
7.4 8

8.7 8.7 9.3
10.410.8

11.6
12.5

13.514.2
15 15

16.316.5
17.117.7

0

4

8

12

16

20

Year

13.7 14.7
17.2 17.6 18.1

19.7 20.1
22.2 22.5

24.3
26.2 26.5 27.3

28
29.9

31.9
34.3 34.9

36.3

0

10

20

30

40

Year

2.7 2.4 2.6
2.9 2.9

3.3
2.8

3.6 3.5
4 3.9 3.8 3.8 4.1

4.3 4.5 4.4
4.8 4.7

1.8 1.7 1.8
2.1 2 2.2 2.1 2.2 2 2 2 1.9 2.1 2.2

2.4 2.5 2.3 2.5
2.7

0

2

4

6

8

YearAsian

Aboriginal

FIGURE 30: TRENDS IN PERINATAL STATISTICS IN SA, 1985 - 2003

Figure 30.3: Percentage of primigravid women aged 30 years and
over in S.A.

Figure 30.1: Percentage of teenage mothers among women giving
birth in S.A.

Figure 30.4: Percentage of confinements of Aboriginal  women and
Asian women in S.A.

Figure 30.2: Percentage of mothers aged 35 years and over among
women giving birth in S.A.

 
 

 



 
 

10.7
11.6

11 11.3
12.2

12.9
12.2

12.7
12.2 12.1 12

13.2
12.3

11.6 12 12
12.3 12.3 11.9

0

3

6

9

12

15

Year

2.6
2.4

2.7 2.7 2.7
3

2.8 2.8 2.8 2.8
3.1

3.4

3
3.3

3.1
3.3

3.1

3.6 3.6

0

1

2

3

4

Year

6.5 6.5 6.5 6.5
7.1

6.7 6.5 6.7
6.8 6.7 6.8

7.4
7 7

6.6
7.2

6.8
7.1 7

0

2

4

6

8

Year

103
99

91 91 93 92

77
86

79
72

76
72 72 69

60 62
71 70 68

0

50

100

Year

Figure 30.5: Percentage of mothers never married and with no
defacto partner among women giving birth in S.A.

Figure 30.6: Percentage of multiple births among S.A. births

Figure 30.7: Percentage of low birthweight babies among S.A. births Figure 30.8: S.A. standardised perinatal mortality ratio (SPMR)

 
 



 
 

62

VII  SUMMARY STATISTICS FOR 2003 
These statistics refer to all live births as well as stillbirths of at least 400g birthweight, or of at 
least 20 weeks gestation. Thirty-five babies of less than 400g birthweight have been included, 
as well as one stillbirth of unknown birthweight at 23 weeks gestation, as described on page 
2. 

1  Number of births 

Reported number of births (from monthly notifications): 17,844 
Notified births with Supplementary Birth Records: 17,844 
Notified confinements with SBRs: 17,517 
Crude birth rate: 11.6 per 1,000 population. 
Total fertility rate: 1.75 per woman 

2  Place of birth 

Home births: 60 planned home births were notified (0.3% of births in the state). There were 
three unplanned births at home which were not booked at any hospital or with a home birth 
midwife. 
Hospital births:  
Of hospital births, distribution by category of hospital: 

  Metropolitan teaching: 8,999 (50.6%) 
  Metropolitan private: 4,987 (28.1%) 
  Country: 3,795 (21.3%) 

3  Sex 

Males 9,196, Females 8,645, Indeterminate 2, Unknown 1. Male: Female sex ratio = 
 1.06:1 

4  Plurality and condition at birth 

Condition at birth Plurality  

 Singleton Twins Triplets Total 

Live birth 17,076 614 20 17,710 
Stillbirth 121 12 1 134 
Total 17,197 626 21 17,844 

5  Race of mother 

Race Number of 
confinements 

% 

Caucasian 15,885 90.7 
Aboriginal 468 2.7 
Asian 829 4.7 
Other 335 1.9 
Total 17,517 100.0 



 
 

63

6  Obstetric interventions in 17,517 confinements 

Induction of labour was performed in 5,085 (29.0%) and labour was augmented in another 
3,721 (21.2%) confinements. 

Forceps were utilised in 844 (4.8%), ventouse in 1,212 (6.9%) and episiotomy was performed 
in 2,353 confinements (13.4%). 

Caesarean section was performed in 5,263 confinements (30.0%), of which 2,334 (13.3%) were 
elective, and 2,929 (16.7%) emergency operations. 

7  Low birthweight (&lt;2500g) 

  Number of singleton births of low birthweight =907 (5.3% of singleton births). 
  Number of multiple births of low birthweight =343 (53.0% of multiple births). 
  Number of all births of low birthweight =1,250 (7.0% of all births). 

8  Congenital Abnormalities 

Births notified with congenital abnormalities : 419 (2.3 %). 

9  Perinatal morality rates (numbers of deaths in parentheses) 

 Birthweight/Gestation Stillbirth rate per 
1,000 births 

Neonatal death rate per 
1,000 live births 

Perinatal mortality rate 
per 1,000 births 

1 ?400g/20 weeks (134)    7.5 (42)    2.4 (176)    9.9 
2 ?500g/22 weeks 

(WHO National Statistics*) (90)    5.1 (26)    1.5* (116)    6.5* 

3 ?1,000g/28 weeks if birthweight 
unavailable 
(WHO International/ Standard 
Statistics*) 

(56)    3.2 (13)    0.7* (69)    3.9* 

* Only neonatal deaths within the first 7 days of life are included. 

10  Terminations of pregnancy 

  Total number of terminations notified : 5,214 
  Abortion rate per 1,000 women (15-44 years): 16.7 
  Total abortion rate per 1,000 women (15-44 years): 518.0 
  Total first abortion rate per 1,000 women (15-44 years): 322.5 
  Abortion proportion: 0.23 

 



 
 

64

References 
1. Pregnancy Outcome Unit. Guidelines for the Supplementary Birth Record. Adelaide: 

South Australian Health Commission,1997. 

2. Strategy and Operations Service, Statewide Services Division. Operational Policy, 
Guidelines and Standards for Maternal and Neonatal Services in South Australia. 
Adelaide: Department of Human Services, 2000. 

3. South Australian Health Commission. Report of the South Australian Birthing Services 
Working Group. Adelaide: Social Health and Policy Development Branch, South 
Australian Health Commission, 1994. 

4. Maternal, Perinatal and Infant Mortality Committee. Maternal, Perinatal and Infant 
Mortality in South Australia 2003. Adelaide: Department of Health, 2005. 

5. The South Australian Birth Defects Register. Annual Report 2002. Adelaide: Women's 
and Children's Hospital, 2005. 

6. South Australian Abortion Reporting Committee. First Annual Report - For the Year 
2003. Adelaide: Parliament of South Australia, 2005. 

7. South Australian Health Commission Epidemiology Branch. Risk factors for adverse 
perinatal outcome: determination from a perinatal statistics collection. Adelaide: South 
Australian Health Commission, December 1986. 

8. Mallett R, Knox EG. Standardized perinatal mortality ratios: technique, utility and 
interpretation. Community Med 1979; 1: 6-13. 

9. Haenszel, W., Loveland, D.B., Sirken, M.G. Lung-cancer mortality as related to 
residence and smoking histories. 1.White males. J Nat Cancer Inst 1962; 28:947  1001. 
Appendix C. 

 

 



 
 

65

Publications 
The following is a list of publications from 1985 from the Pregnancy Outcome Unit or which 
utilised data from the Unit. 

Annual Reports 

1. Pregnancy Outcome in South Australia (from 1981). 

2. Maternal, Perinatal and Infant Mortality in South Australia. Annual Report of the 
Maternal, Perinatal &amp; Infant Mortality Committee (from 1985). 

3. Committee appointed to examine and report on abortions notified in South Australia 
(from 1985 to 2002). South Australian Abortion Reporting Committee Annual Report 
(from 2003). 

4. Pregnancy and Neonatal Care Bulletin (from 1983): for individual hospitals. 

The Unit provides birth defects data to the South Australian Birth Defects Register at the 
Women s and Children s Hospital and perinatal and birth defects data to the National 
Perinatal Statistics Unit in Sydney. The latter in turn provides congenital abnormality data to 
the International Clearinghouse for Birth Defects Monitoring Systems (currently in Rome). 
These reports are as follows: 

1. The South Australian Birth Defects Register Annual Report (from 1986). Clinical 
GeneticsService, Women s and Children s Hospital, King William Road, North 
Adelaide, SouthAustralia 5006. Telephone (08) 81616518. 

2. Australia s Mothers and Babies (from 1991). AIHW National Perinatal Statistics Unit, 
Sydney Children s Hospital, Level 2, McNevin Dickson Building, Randwick Hospital 
Campus, Randwick NSW 2031. Telephone (02) 9382 1014 (website 
http://www.aihw.gov.au/npsu/).  

3. Congenital Malformations Australia (from 1981).  AIHW National Perinatal Statistics 
Unit. 

Other reports/papers 

1 Birth defects 

1. Jonas O, Stern LM, Macharper T. A South Australian Study of Pregnancy and Birth 
Risk Factors associated with Cerebral Palsy. Int J Rehab Research 1989; 12 (2): 159-166. 

2. Chan A, Robertson EF, Haan EA, Keane RJ, Ranieri E, Carney A. Prevalence of neural 
tube defects in South Australia, 1966   91: effectiveness and impact of prenatal 
diagnosis. BMJ 1993; 307: 703-6. 

3. Bower C, Norwood F, Knowles S, Chambers H, Haan E, Chan A. Amniotic band 
syndrome: a population-based study in two Australian States. Paediatr Perinat Epidemiol 
1993; 7: 395-403. 

4. Chan A, Robertson E, Haan E, Ranieri E, Keane R. The sensitivity of ultrasound and 
serum alpha-fetoprotein in population-based antenatal screening for neural tube defects 
in South Australia 1986-1991. Br J Obstet Gynaecol 1995; 102 :370-376. 

5. Chan A, Keane RJ, Hanna M, Abbott M. Terminations of pregnancy for exposure to 
oral retinoids in South Australia, 1985-1993. Aust NZ J Obstet Gynaecol. 1995; 35 : 
422-426. 



 
 

66

6. Byron-Scott R, Chan A, Haan EA, Bower C, Scott H, Clark K. A population-based study of 
abdominal wall defects in South Australia and Western Australia. Proceedings, 14th 
Annual  Congress Australian Perinatal Society, Adelaide, March 1996, P82. 

7. Chan A, Hanna M, Abbott M, Keane RJ. Oral retinoids and pregnancy. MJA 1996;165: 
164-167. 

8. Chan A, McCaul KA, Cundy P, Haan EA, Byron-Scott R. Perinatal risk factors for 
developmental dysplasia of the hip. Arch Dis Child 1997; 76 : F94   F100. 

9. Yiv BC, Saidin R, Cundy PJ, Tgetgel JD, Aguilar J, McCaul KA, Keane RJ, Chan A, Scott 
H. Developmental dysplasia of the hip in South Australia in 1991: Prevalence and risk 
factors. J. Paediatr Child Health 1997; 33: 151-6. 

10. Cheffins T, Chan A, Keane RJ. The effects of rubella immunisation in South Australia. 
Proceedings, Rights to Health 29th Annual Conference, Public Health Association of 
Australia Inc., Melbourne, 5-8 October 1997. 

11. Byron-Scott R, Haan E, Chan A, Bower C, Scott H, Clark K. A population-based study 
of abdominal wall defects in South Australia and Western Australia. Paediatr Perinat 
Epidemiol. 1998; 12: 136-151. 

12. Cheffins T, Chan A, Keane RJ, Haan EA, Hall R. The impact of rubella immunisation 
on the incidence of rubella, congenital rubella syndrome and rubella-related 
terminations of pregnancy in South Australia. Br J Obstet Gynaecol 1998; 105: 998-1004 

13. Chan A, McCaul K, Keane RJ, Haan EA. Effect of parity, gravidity, previous 
miscarriage, and age on the risk of Down s syndrome : population-based study. BMJ 
1998; 317: 923-4. 

14. Byron-Scott R. et al. A validation study of congenital heart defects in South Australia. 
Proceedings, Australian Birth Defects Society. Annual Scientific Meeting. Sydney 1998. 

15. Byron-Scott R. et al. A comparison of selected birth defects in Aboriginal and non-
Aboriginal babies in South Australia. Proceedings, Australian Birth Defects Society. 
Annual Scientific Meeting, Sydney 1998. 

16. Byron-Scott R. Richardson M, Hiller J, Chan A, Haan E, Knight B, Adams P. The 
prevalence and validation of congenital heart defects in South Australia, 1986-94. 
Proceedings of the 3rd Annual Congress of the Perinatal Society of Australia and New 
Zealand, Melbourne, 1999. P153. 

17. Chan A, Cundy PJ, Foster BK, Keane RJ, Byron-Scott R. Late diagnosis of congenital 
dislocation of the hip and presence of a screening programme. South Australian 
population-based study. Lancet 1999;354:1514-17. 

18. Chan A, Cundy PJ, Foster BK, Keane RJ, Byron-Scott R. Screening for congenital 
dislocation of the hip (letter). Lancet 2000;355:232-33. 

19. Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, Keane RJ.  Folate 
before pregnancy : the impact of a South Australian health promotion campaign on 
women and health professionals. Western Australian Birth Defects Registry Twentieth 
Anniversary Scientific Symposium April 27-28, 2000. Perth, Western Australia. 
Teratology 2000;62: 365. 

20. Cheffins T, Chan A, Haan EA, Ranieri E, Ryall RG, Keane RJ, Byron-Scott R, Scott H, 
Gjerde EM, Nguyen A-M, Ford JH, Sykes S. The impact of maternal serum screening 
on the birth  revalence of Down s syndrome and the use of amniocentesis and 
chorionic villus sampling in South Australia. Br J Obstet Gynaecol 2000;107:1453-9. 



 
 

67

21. Chan A, Pickering J, Haan EA, Netting M, Burford A, Johnson A, Keane RJ.  Folate 
before pregnancy :the impact on women and health professionals of a population-
based health promotion campaign in South Australia. MJA 2001; 174:631-636. 

22. Chan A, Foster BK, Cundy PJ. Invited commentary. Problems in the diagnosis of 
neonatal hip instablity. Acta Paediatr 2001;90:836-9. 

23. Metz MP, Ranieri E, Gerace RL, Priest KR, Luke CG, Chan A. Newborn screening in 
South Australia: is it universal? MJA 2003;179:412-415. 

24. Chan A. Invited commentary: Parity and the risk of Down syndrome   caution in 
interpretation. Am J Epidemiol 2003;158:509-511. 

25.  Gibson CS, MacLennan AH, Hague WM, Rudzki Z, Sharpe P, Chan A, Dekker GA. 
Fetal thrombophilic polymorphisms are not a risk factor for cerebral palsy. Perinatal 
Society of Australia and New Zealand 8th Annual Congress, Convention Centre, 
Darling Harbour, Sydney, Australia, 15th-18th March 2004, A41. 

26. Gibson CS, MacLennan AH, Rudzki Z, Hague WM, Haan EA, Sharpe P, Priest K, Chan 
A, Dekker GA. The prevalence of inherited thrombophilias in a Caucasian Australian 
population. Pathology  2005;37(2):160-163. 

27. Byron-Scott R, Sharpe P, Hasler C, Cundy P, Hirte C, Chan A, Scott H, Baghurst PB, 
Haan E. A South Australian population-based study of congenital talipes equivarus. 
Paediatr Perinat Epidemiol  2005;19:227-237. 

28. Gibson CS, MacLennan AH, Hague WM, Haan E, Priest K, Chan A, Dekker GA. 
Associations between Inherited Thrombophilias, Gestational age and Cerebral Palsy. 
Am J Obstet Gynecol (In press). 

29. Sharpe PB, Chan A, Haan EA, Hiller JE. Maternal diabetes and congenital anomalies in 
South Australia 1986-2000: a population-based cohort study. Birth Defects Research 
Part A (In press). 

2 Termination of pregnancy 

1. Hart G, Macharper T. Medical termination of pregnancy in South Australia 1970-1984. 
Adelaide: South Australian Health Commission, 1986. 

2. Chan A, Taylor A. Medical Termination of Pregnancy in South Australia - The First 20 
Years 1970-1989. Adelaide: Pregnancy Outcome Unit, South Australian Health 
Commission, December 1991. 

3. Chan A, McColl M, Versteeg J, Gameau B, Scanlan C, Pridmore B. A South Australian 
Study on Contraception and Abortion. Public and Environmental Health Service, 
South Australian Health Commission and Department of Obstetrics and Gynaecology, 
The Queen Elizabeth Hospital, Adelaide, March 1994. 

4. Hart G, Macharper T. Clinical aspects of induced abortion in South Australia from 1970-
1984. Aust. NZ J Obstet Gynaecol 1986; 26: 219-224. 

5. Hart G, Macharper T. Induced abortion trends in South Australia. Am J Public Health 
1987; 77: 200-202. 

6. Chan A, Keane RJ. Prevalence of induced abortion in a reproductive lifetime. Am J 
Epidemiol 2004;159:475-480. 

7. Chan A, Sage LC. Estimating Australia s abortion rates 1985-2003. MJA  2005;182:447-
452. 



 
 

68

3 Perinatal epidemiology 

1. Connon AF, Macharper T. Teenage pregnancies in South Australia. Adelaide: South 
Australian Health Commission, September 1986. 

2. South Australian Health Commission, Epidemiology Branch:  Characteristics of 
pregnancies and births among migrant women in South Australia. Adelaide : South 
Australian Health Commission, October 1986. 

3. South Australian Health Commission, Epidemiology Branch. Risk factors for adverse  
 perinatal outcome: determination from a perinatal statistics collection. Adelaide: South 

Australian Health Commission, December 1986. 
4. South Australian Health Commission, Epidemiology Branch. Variation in perinatal 

risk by place of residence of mother in South Australia. Adelaide: South Australian 
Health Commission, December 1986. 

5. South Australian Health Commission, Epidemiology Branch. Variations in Perinatal 
Risk by Hospital of Birth in South Australia. Adelaide: South Australian Health 
Commission, January 1987. 

6. South Australian Health Commission, Epidemiology Branch. Aboriginal Births in 
South Australia, 1981-1986: An Analysis of Perinatal Outcomes, Adelaide: South 
Australian Health Commission, May 1988. 

7. South Australian Health Commission, Epidemiology Branch: Pregnancy Outcome 
Attributes by Postcode: South Australia 1981-1986. South Australian Health 
Commission, Adelaide: August 1988. 

8. Jonas O, Scott J, Chan A, Macharper T, Lister J. A validation study of the 1986 perinatal 
data collection form. Adelaide: Pregnancy Outcome Unit, South Australian Health 
Commission, 1991. 

9. South Australian Cancer Registry. Associations between perinatal characteristics and 
risk of childhood cancer: South Australian cancer cases born in 1981-1993. In: 
Epidemiology of Cancer in South Australia. Incidence, Mortality and Survival 1977 to 
1994. Adelaide South Australian Health Commission, 1995. 

10. Taylor A, Twisk A-M, Chan A. Perinatal risk factors by postcode in South Australia 
1989-1992. Epidemiology Branch, South Australian Health Commission, Adelaide: June 
1995. 

11. Pregnancy Outcome Unit. Perinatal Statistics Collection. Guidelines for the 
Supplementary Birth Record. Adelaide: South Australian Health Commission, 
December 1997. 

12. McLean A, Scott J, Keane RJ, Sage L, Chan A. Validation of the 1994 South Australian 
perinatal data collection form. Adelaide: Pregnancy Outcome Unit, Department of 
Human Services, 2001. 

13. Hart G, MacHarper T, Moore D, Roder D. Aboriginal pregnancies and births in South 
Australia. MJA 1985; 143: S54-56. 

14. Chan A, Roder D, Macharper, T. Obstetric Profiles of Immigrant Women from Non-
English Speaking Countries in South Australia, 1981-83. Aust NZ J Obstet Gynaecol 
1988; 28: 90-95. 

15. Jonas O, Roder D, Esterman A, Macharper T, Chan A. Pregnancy and Birth Risk 
Factors for Intellectual Disability in South Australia. Eur J Epidemiol 1989; 5: 322-327. 

16. Jonas O, Chan A, Macharper T, Roder D. Pregnancy and Perinatal Factors associated 
with persistently low Apgar scores: an analysis of the birth records of infants born in 
South Australia. Eur J Epidemiol 1990; 6: 136-141. 



 
 

69

17. Crotty M, Ramsay AT, Smart R, Chan A. Planned Homebirths in South Australia 1976-
1987 MJA 1990; 153: 664-671. 

18. Jonas O, Chan A, Roder D, Macharper T. Pregnancy Outcomes in primigravid women 
aged 35 years and over in South Australia, 1986-1988.  MJA 1991; 154: 246-249. 

19. Zhang B, Chan A. Teenage Pregnancy in South Australia, 1986-1988. Aust. NZ J Obstet 
Gynaecol 1991; 31: 291-298. 

20. Jonas O, Roder D, Chan A. The Association of Maternal and Socioeconomic 
Characteristics in Metropolitan Adelaide with Medical, Obstetric and Labour 
Complications and Pregnancy Outcomes. Aust NZ J Obstet Gynaecol 1992; 32: 1-5. 

21. Chan A, Roder D, Priest K, Esterman A. A perinatal perspective on South Australia in 
the 1980s. MJA 1992; 157: 515-518. 

22. Jonas O, Roder D, Chan A. The association of low socio-economic status in 
Metropolitan Adelaide with maternal demographic and obstetric characteristics and 
pregnancy outcome. Eur J Epidemiol 1992; 8:708. 

23. Jonas O, Roder D. Breech Presentation in South Australia, 1987-1989. Aust NZ J Obstet 
Gynaecol 1993; 33: 17-21. 

24. Scott J, Chan A. Planned birthing unit deliveries in South Australia. Proceedings, 14th 
Annual Congress Australian Perinatal Society, Adelaide, March 1996, P21. 

25. Dal Grande E, Chan A, Keane R. Asian, but different: Obstetric characteristics of 
women born in Vietnam and Philippines who delivered in South Australia in 1991-
1994. Proceedings, 14th Annual Congress Australian Perinatal Society, Adelaide, March 
1996, P22. 

26. Keane R, Dal Grande E, Chan A, McCaul K. Episiotomy   a decline in the cutting edge. 
Proceedings, 14th Annual Congress Australian Perinatal Society, Adelaide, March 1996, 
P75. 

27. Chan A, McPhee AJ. A safer leap into this dangerous world. Lancet 1996; 348 (suppl II) 
:12. 

28. Carter JR, Hiller JE, Ryan P, Chan A. The Association between maternal age and 
preterm births to primiparous women in South Australia, 1991-1993, Proceedings, First 
Annual Congress, Perinatal Society of Australia and New Zealand, Fremantle, Western 
Australia, 16-24 March 1997. 

29. Zhang B, Hiller JE, Chan A. Asthma in pregnancy in South Australia. Proceedings, 
First Annual Congress, Perinatal Society of Australia and New Zealand, Fremantle, 
Western Australia, 16-24 March 1997. 

30. Roder D, Nguyen A-M, Chan A. Trends in perinatal characteristics in South Australia, 
1981 to 1994, by place of residence of mother. Aust NZ J Public Health 1997; 21: 483-8. 

31. Zhang B, Hiller JE, Chan A. Asthma in pregnancy: Association with Spontaneous 
Preterm Birth. Proceedings of the 3rd Annual Congress of the Perinatal Society of 
Australia and New Zealand, Melbourne, 1999, A113. 

32. McLean AP, Hiller JE, Chan A. Maternal epilepsy and fetal outcomes in South 
Australia. Perinatal Society of Australia and New Zealand 4th Annual Congress. 
Brisbane Convention and Exhibition Centre, Brisbane, Australia, 12-15 March 2000, 
P192. 

33. Chan A, Keane RJ, Robinson JS. The contribution of maternal smoking to preterm 
birth, small for gestational age and low birthweight among Aboriginal and non-
Aboriginal births in South Australia. MJA 2001;174: 389-93. 



 
 

70

34. van der Klis KAM, Westenberg L, Chan A, Dekker G, Keane RJ. Teenage pregnancy: 
trends,characteristics and outcomes in South Australia and Australia. Aust N Z J 
Public Health 2002; 26: 125-31. 

35. Westenberg L, van der Klis KAM, Chan A, Dekker G, Keane RJ. Aboriginal teenage 
pregnancies compared with non-Aboriginal in South Australia 1995-1999. Aust N Z J 
Obstet Gynaecol 2002;42: 187-191. 

36. Wang JX, Knottnerus A-M, Schuit G, Norman RJ, Chan A, Dekker GA. Surgically 
obtained sperm and risk of gestational hypertension and pre-eclampsia. Lancet 
2002;359: 673-4. 

37. Jacobs DJ, Vreeburg SA, Dekker GA, Heard AR, Priest KR, Chan A. Risk factors for 
hypertension during pregnancy in South Australia. Aust NZ J Obstet Gynaecol 2003; 3: 
421-428. 

38. Heard AR, Dekker GA, Chan A, Jacobs DJ, Vreeburg SA, Priest KR. Hypertension 
during pregnancy in South Australia, Part 1: Pregnancy outcomes. Aust NZ J Obstet 
Gynaecol 2004;44 :404-409. 

39. Vreeburg SA, Jacobs DJ, Dekker GA, Heard AR, Priest KR, Chan A. Hypertension 
during pregnancy in South Australia, Part 2: Risk factors for adverse maternal and/or 
perinatal outcome   results of multivariable analysis. Aust NZ J Obstet Gynaecol 
2004;44: 410-418. 

40. Leahy K, Elliot E, Kennare R, Chan A. Characteristics and pregnancy outcomes of first 
time mothers aged 35 years and over compared to younger first time mothers in South 
Australia 1991-2002. Before and Beyond Birth. Abstract Book. Perinatal Society of 
Australia and New Zealand 9th Annual Congress. Adelaide Convention Centre, 
Adelaide, South Australia, 13-16 March 2005, A144. 

41. Kennare R, Heard A, Chan A. Substance use during pregnancy: risk factors and 
obstetric and perinatal outcomes in South Australia. Aust NZ J Obstet Gynaecol  
2005;45:220-225. 



 
 

71

4 Perinatal mortality 

1. Roder D, Chan A, Esterman A. Birthweight   specific trends in perinatal mortality by 
hospital category in South Australia, 1985   1990. MJA 1993; 158: 664-667. 

2. Connon AF, Chan A on behalf of the Postneonatal Subcommittee, maternal, perinatal 
and Inmfant Mortality Committee. Accidental deaths of babies in the postneonatal 
period in South Australia (letter). MJA 1994;161:397.  

3. Roder D, Chan A, Priest K. Perinatal mortality trends among South Australian 
Aboriginal births 1981-92. J Paediatr Child Health 1995; 31: 446-450. 

4. Haslam R, McPhee A, Chan A, Keane R. Neonatal mortality   a system of classification 
and trends in South Australia. Proceedings of the 3rd Annual Congress of the Perinatal 
Society of Australia and New Zealand, Melbourne, 1999. P86. 

5. Robson S, Chan A, Keane RJ, Luke CG. Subsequent birth outcomes after an 
unexplained stillbirth: preliminary population-based retrospective cohort study. Aust 
NZ J Obstet Gynaecol 2001;41: 29-35. 

6. Flenady V, Chan A, Haslam R, King J, Tudehope D, McCowan L. Cause specific 
perinatal mortality in Australia and New Zealand using a new clinical classification 
system (ANZACPM and ANZNDC). Perinatal Society of Australia and New Zealand 
7th Annual Congress, Hotel Grand Chancellor, Hobart, Tasmania, March 9th-12th 2003, 
A87. 

7. Dodd JM, Robinson JS, Crowther CA, Chan A. Stillbirth and neonatal outcomes in 
South Australia, 1991-2000. Am J Obstet Gynecol 2003;189: 1731-1736. 

8. Chan A, King JF, Flenady V, Haslam RH, Tudehope DI. Classification of perinatal 
deaths: Development of the Australian and New Zealand classifications. J Paediatr 
Child Health 2004;40: 340-347. 

9. Flenady V, King J, Chan A, McCowan L, Tudehope D, Haslam R, Charles A, Roberts C 
for the Perinatal Mortality Audit Guidelines Working Party of the PSANZ Perinatal 
Mortality Special Interest Group. Development of Clinical Practice Guideline for 
Perinatal Mortality Audit incorporating psychological and social aspects of perinatal 
bereavement. Before and Beyond Birth. Abstract Book. Perinatal Society of Australia 
and New Zealand 9th Annual Congress, Adelaide Convention Centre, Adelaide, South 
Australia, 13-16 March 2005, P58. 

5 Caesarean section 

1. Jonas O, Chan A, Macharper T. Caesarean Section in South Australia, 1986. Aust NZ J 
Obstet Gynaecol 1989; 29: 99-106. 

2. Chan A. Epidemiology of the rising Caesarean section rate. Proceedings, 14th Annual 
Congress Australian Perinatal Society, Adelaide, March 1996, A70. 

3. Chan A, Keane RJ, Scott J. Elective Caesarean section and child deprivation (letter). Lancet 
1996; 347: 1196. 

4. Kennare, R. Why is the caesarean section rate rising? MIDIRS Midwifery Digest 2003; 13 
(4): 503-508. 

5. Kennare R, Heard A, Chan A. Is caesarean section in the first birth a problem for women 
in the next birth? Before and Beyond Birth. Abstract Book. Perinatal Society of Australia 
and New Zealand 9th Annual Congress. Ade;laide Convention Centre, Adelaide, South 
Australia, March 13-16 2005, A 127.  



 
 

72

Appendix 1 : Definitions 

Confinements:  The number of women giving birth 

Primigravida: A woman pregnant for the first time 

Multigravida:  A woman who has been pregnant more than once 

Parity:   The total number of previous pregnancies resulting in live births or 
stillbirths. 

Primipara:  Pregnant woman who has had no previous pregnancy resulting in a 
live birth or stillbirth. 

Induction of labour:   An intervention undertaken to stimulate the onset of labour by 
pharmacological or other means. 

Caesarean section:  Delivery of a child by an abdominal operation. 

Elective caesarean section:   One which takes place as a planned procedure before the spontaneous 
onset of labour. 

Emergency caesarean section:   One which is undertaken for a complication: 
(a)  before the onset of labour or 
(b)  during labour, whether that labour is of spontaneous onset or 
following  
      induction of labour. 

Gestational age:   The duration of pregnancy in completed weeks from the first day of the 
last normal menstrual period. 

Preterm: Less than 37 completed weeks gestation. 

Birthweight:  The first weight of a fetus or newborn obtained after birth.  This is 
preferably measured within the first hour of life before significant post-
natal weight loss has occurred. 

Low birthweight:   Birthweight of less than 2,500g. 

Very low birthweight:   Birthweight of less than 1,500g. 

Congenital abnormality:  Any defect probably of prenatal origin; thus structural, chromosomal 
and biochemical defects are included. An exclusion list of isolated 
minor abnormalities is provided by the Unit. Abnormalities are 
classified as major if they are either lethal or significantly affect the 
individual's function or appearance. 

Apgar score: A numerical scoring system applied after birth (usually at 1 minute and 
again at 5 minutes) to evaluate the condition of the baby, as specified 
below: 

 
Sign Score 

 0 1 2 

Heart rate Absent Slow (below 100) Over 100 
Respiratory effort Absent Slow, irregular Good, crying 
Muscle tone Flaccid Some flexion of extremities Active motion 
Reflex irritability No response Grimace Vigorous cry 
Colour Blue, pale Body pink, extremities blue Completely pink 



 
 

73

 

Live birth:  The complete expulsion or extraction from its mother of a product of 
conception, irrespective of the duration of pregnancy, which after such 
separation breathes or shows any other evidence of life, such as beating 
of the heart, pulsation of the umbilical cord or definite movement of 
voluntary muscles, whether or not the umbilical cord has been cut or 
the placenta is attached. 

Crude birth rate  =  
 yearthatin  population Average
 yearanyin  births live of Number

 x 1,000 

Age-specific fertility rate: 

 
 yearsame thein  group age that ofwomen  of population resident Estimated

 yearain  group agean in women  to births live of Number x 1,000 

General fertility rate: 

 yearsame thein   years44-15 agedwomen  of population resident Estimated
 yearain  births live of number Total x 1,000 

Total fertility rate (TFR): the sum of age-specific fertility rates (live births at each age of mother 
per female population of that age). It represents the number of children 
a woman would bear during her lifetime if she experienced current age-
specific fertility rates at each age of her reproductive life.  

Neonatal death:  Death of a liveborn infant within 28 days of birth. 

Neonatal death rate  = 
 yearthatin  births live of Number

 yearanyin  deaths neonatal of Number
 x 1,000 

Fetal death:  Death prior to the complete expulsion or extraction from its mother of a 
product of conception, irrespective of the duration of pregnancy; the 
death is indicated by the fact that after such separation the fetus does 
not breathe or show any other evidence of life, such as beating of the 
heart, pulsation of the umbilical cord, or definite movement of 
voluntary muscles. 

Early fetal death:   Death in a fetus of less than 400g birthweight, or of less than 20 weeks 
gestation.  A miscarriage is a spontaneous early fetal death. 

Late fetal death or stillbirth:   Death in a fetus of at least 400g birthweight, or of at least 20 weeks 
gestation. 

Late fetal death rate or stillbirth rate: 

  =    
 yearthatin  sstillbirth and births live of Number

 yearanyin  sstillbirth or deaths fetal late of Number
  x 1,000 

Perinatal death:  Includes late fetal death (stillbirth) and neonatal death. 

Perinatal mortality rate (PMR): 

  =   
births live and sstillbirth of Number

deaths neonatal and sstillbirth of Number
  x 1,000 

 For South Australian statistics, the rate refers to all births of at least 
400g birthweight or 20 weeks gestation. 



 
 

74

 For national statistics, the rate refers to all births of at least 500g 
birthweight, or when birthweight is unavailable, of at least 22 weeks 
gestation (as recommended by WHO) and neonatal deaths occurring 
within seven days of birth. 

 For international comparisons, the rate refers to all births of at least 
1,000 g birthweight or, when birthweight is unavailable, of at least 28 
weeks gestation and neonatal deaths occurring within seven days of 
birth (as recommended by WHO). 

Maternal death: Defined as the death of a woman while pregnant or within 42 days of 
termination of pregnancy, irrespective of the duration and the site of 
the pregnancy, from any cause related to or aggravated by the 
pregnancy or its management  but not from accidental or incidental 
causes.* 

 Maternal deaths are divided into two groups: 

 1. Direct obstetric deaths: those resulting from obstetric complications 
of the pregnant state (pregnancy, labour and puerperium) from 
interventions, omissions, incorrect treatment, or from a chain of events 
resulting from any of the above. 

 2. Indirect obstetric deaths: those resulting from previous existing 
disease or disease that developed during pregnancy and which was not 
due to direct obstetric causes, but which was aggravated by physiologic 
effects of pregnancy. 

 As an extension of the WHO definition, accidental and incidental 
deaths occurring in pregnant women are also reviewed by the 
Maternal, Perinatal and Infant Mortality Committee so as to avoid 
missing indirect deaths which may be difficult to distinguish from 
incidental deaths. Examples of incidental deaths are deaths from 
drowning and road accidents, where the pregnancy is unlikely to have 
contributed significantly to the death, although it may be possible to 
postulate a remote association. 

*World Health Organization. International Statistical Classification of Diseases and Related Health Problems. Tenth Revision. 
Volume 2. Geneva: WHO, 1993, p 134. 

Termination of pregnancy: Termination performed by a medical practitioner in a prescribed 
hospital in South Australia, on specified grounds before 28 weeks 
gestation, under the Criminal Law Consolidation Act and notified 
under the Criminal Law Consolidation (Medical Termination of 
Pregnancy) Regulations 1996. Fetuses of at least 400g birthweight or 20 
weeks gestation aborted for congenital abnormalities or medical 
reasons are included in the South Australian perinatal data collection. 

Abortion rate =      
 yearsame thein  group same of population resident Estimated

 yearain women  of group ain  abortions induced of Number
 x 1,000 

 The abortion rate per 1,000 women in the reproductive age group 15-44 
years has been calculated in this report using as the numerator all 
abortions; the denominator used has been the estimated resident 
population for women aged 15-44 years in that year. 

Abortion proportion  =
births live  Abortions

Abortions
+  



 
 

75

 This is often called the abortion ratio, which is strictly      
births Live

Abortion  

Total abortion rate  = the sum of the 5-year age-specific abortion rates multiplied by 5.  
This represents the number of abortions 1,000 women would have 
during their lifetime if they experienced the rates of the year shown. 

 
Race 

1. Caucasian:  individuals of European descent. 

2. Aboriginal:  this includes part-Aboriginals as well as full blood Aboriginals.  An 
Aboriginal is a person of Aboriginal descent who identifies as an Aboriginal and is 
accepted as such by the community in which he or she lives. 

3. Asian:  (exclude Asia Minor) - In this category, include women originating from all 
Asian countries, including the Indian subcontinent (India, Bangladesh, Pakistan, Nepal, 
Sri Lanka), who were formerly listed as 'Other' race. 

4. Torres Strait Islander (TSI): A Torres Strait Islander is a person of Torres Strait Islander 
descent who identifies as a Torres Strait Islander and is accepted as such by the 
community in which he or she lives. 

5. Aboriginal &amp; TSI: persons of both Aboriginal and Torres Strait Islander descent.  

6.  Other:  Races other than (1) - (5).  Include women from the Middle East and Africa. 

 Guidelines for use regarding Indigenous Status - categories (2), (4) and (5). 

There are three components to the definition: 

  descent 
  self identification 
  community acceptance 

 It is not possible to collect the three components of the definition in a single question. The 
Australian Bureau of Statistics (ABS) proposes that the focus of a single question should be 
the descent, the first component of the definition. The ABS therefore proposes the use of 
the following alternative questions, depending on whether the person is present or not. 

 Where the person is present 

  Are you of Aboriginal or Torres Strait Islander origin? ; 

 or 

 where the person is not present and someone who knows the person well responds for 
him/her 

  Is the person of Aboriginal or Torres Strait Islander origin?  

 If the response is  Yes , then clarify whether the person is of Aboriginal origin (2), Torres 
Strait Islander origin (4) or both Aboriginal and Torres Strait Islander origin (5). 

 Self reporting of descent is not equivalent to self reporting of identity but because of the 
absence of a second  identity  question some respondents will interpret the  origin  
question to mean both descent and identification. What identification in the context of the 
variable Indigenous Status should measure is an individual s self assessed historical and 
cultural affiliation. 



18 Tobacco smoking status at first visit
 1.  Smoker
 2.  Quit in pregnancy before first visit
 3.  Non smoker
 4.  Unknown smoking status
19 Average no. of tobacco cigarettes  
 smoked per day in 2nd half of pregnancy
  ? None
  ? No. per day =  ...................................
  ? &lt;1 (occasional)
  ? Unknown no. 
20 Medical conditions present in this  
 pregnancy

1. ? None
2. ? Anaemia
3. ? Urinary tract  
  infection
4. ? Hypertension  
  (pre-existing)
5. ? Diabetes  
  (pre-existing)
6. ? Epilepsy
7. ? Asthma
8. ? Other (specify)

  ................................................................
21 Obstetric complications

1. ? None
2. ? Threatened 
  miscarriage
3. ? APH - Abruption
4. ? APH - Placenta  
  praevia
5. ? APH - Other &amp;  
  unknown cause
6. ? Pregnancy hypertension (all types)
7. ? Suspected IUGR
8. ? Gestational diabetes
9. ? Other (specify, including impaired  
  glucose tolerance)

  ................................................................
22 Date of admission prior to delivery

 day month year

23  Procedures performed in this pregnancy
Tick if Yes        Tick if Unknown

1. ? MSAFP (NTD etc) ?
2. ? Triple/Quadruple screen ?  
  (Down s etc) 
3. ? Ultrasound examination ?
4. ? Chorion villus sampling ?
5. ? Amniocentesis ?
6. ? Cordocentesis ?
7. ? Other surgical procedures (specify)

  ................................................................
LABOUR  AND  DELIVERY

24 Onset of labour
 1.  Spontaneous

 2.  No labour (LSCS)

 3.  Induction (excluding augmentation) 
  Give reason/s for induction 
  (If postdates, state T+ ..............  days)

  ................................................................

  ................................................................
25 If induction, or augmentation after  
 spontaneous onset, specify method/s

1. ? ARM
2. ? Oxytocics
3. ? Prostaglandins
4. ? Other (specify)

  ................................................................
26 Presentation prior to delivery
 1.  Vertex 
 2.  Breech
 3.  Face 
 4.  Brow
 5.  Other 
 6.  Unknown

Please return top copy to 
Pregnancy Outcome Unit,  

PO Box 6, Rundle Mall,  
Adelaide SA  5000

5 Sex
 1.  Male  
 2.  Female  
 3.  Indeterminate
6 Birthweight (grams)

7 Gestation at birth 
 (best clinical estimate in weeks)

CONDITION  AT  BIRTH

8 Apgar Score   1 minute

     5 minute
9 Time to establish regular  
 breathing (to nearest minute)

10 Resuscitation at delivery
 1. ? None     
 2. ? Aspiration
 3. ? Oxygen 
 4. ? IPPV - bag &amp; mask
 5. ? IPPV - intubation
 6. ? Narcotic antagonist
 7. ? Sodium bicarbonate
 8. ? Ext. cardiac massage
 9. ? Other (specify)

  ................................................................
11 Condition occurring during birth
 1. ? None    
 2. ? Fracture
 3. ? Dislocation    
 4. ? Nerve injury
 5. ? Other (specify)

  ................................................................
12 Congenital abnormalities
 1. ? Nil apparent     
 2. ? Yes (specify)

  ................................................................

  ................................................................

  ................................................................

  ................................................................

  ................................................................

  ................................................................
13 Treatment given
 1. ? None of the treatments below
 2. ? Oxygen therapy &gt; 4 hours
 3. ? Phototherapy for jaundice
 4. ? Gavage feeding more than once
 5. ? Any intravenous therapy

14 Nursery care required
 1. ? Level 1 only
 2. ? Special nursery (Level 2)

 No. of days ..................

 3. ? Neonatal Intensive Care Unit (NICU) 
  - FMC/WCH (Level 3)

 No. of days ..................

 4. ? Paediatric Intensive Care Unit (PICU)  
  - WCH

 No. of days ..................

15 Was transfer to NICU/PICU for a  
 congenital abnormality?
  ? Yes 
  ? No

OUTCOME OF BABY

16 Outcome of baby
 1.  Fetal death
 2.  Discharged
 3.  In hospital at 28 days
 4.  Neonatal death
17 Baby transferred to

  ................................................................
 on

   day  month   year

18 Date of final discharge (or death)

   day month  year

2003 SUPPLEMENTARY BIRTH RECORD
FOR COMPLETION BY MIDWIVES AND NEONATAL NURSES

Mother s name .............................................................................................................. Hospital/Place of birth ...............................................................
 Surname Initials

Child s surname (if different) ......................................................................................... Mother s Case Record Number ................................................

Mother s address .......................................................................................................... Plurality  (1=single, 2=twin, 3=triplet, 4=quad)

 ..........................................................................     Postcode                   For multiple births,  please complete a separate baby form for each baby.

Personal information above this line is con?dential      SLA

MOTHER S  INFORMATION

1 Mother s date of birth

 day month year
2 Race
 1.  Caucasian    
 2.  Aboriginal    
 3.  Asian
 4.  Torres Strait Islander (TSI)
 5.  Aboriginal &amp; TSI    
 6.  Other
3 Country of birth

  ................................................................
4 Type of patient
 1.  Hospital/Public    
 2.  Private
5 Marital status
 1.  Never married    
 2.  Married/De facto 
  3.  Widowed            
 4.  Divorced 
 5.  Separated

OCCUPATION
6 Baby s father

  ................................................................

 Baby s mother

  ................................................................
PREVIOUS  PREGNANCY  OUTCOMES

7 No. of previous pregnancies 

8 No. of previous pregnancies resulting 
 in births ? 20 weeks (parity)

9 Number of previous outcomes
   Singleton  Multiple 
Livebirths, not neonatal deaths

Livebirths, neonatal deaths

Stillbirths

Miscarriages

Ectopic pregnancies

Terminations of pregnancy

10 Outcome of last pregnancy

  ................................................................
11 Date of delivery/termination of last  
 pregnancy

                             month         year
12 Method of delivery in last birth
 0.  No previous birth     
 1.  Vaginal
 2.  Caesarean  
 9.  Not known
13 No. of previous caesareans

THIS  PREGNANCY

14 Date of last menstrual period 

             day          month         year
15 Intended place of birth
 1.  Hospital          
 2.  Birth centre
 3.  Home        
 4.  Other (specify)   .....................................
 5.  Not booked

16 Number of antenatal visits
17 Type of antenatal care
 1. ? No antenatal care
 2. ? Hospital clinic
 3. ? Obstetrician in private  
   practice
 4. ? General practitioner
 5. ? Birth centre
 6. ? Home birth midwife
 7. ? Obstetrician/midwife  
   (shared care) in private practice
 8. ? GP/midwife (shared care)
 9. ? Other (specify)

  ................................................................
 10.? Not stated

27 Method of delivery
 1.  Normal spontaneous
 2.  Forceps
 3.  Assisted breech
 4.  LSCS (elective)
 5.  LSCS (emergency)  
  If LSCS state reason/s 

  ................................................................
 6.  Ventouse 
 7.  Breech extraction            
 8.  Breech spontaneous
 9. Unknown
28 Complications of labour, delivery and 
 puerperium
 1. ? None
 2. ? PPH (Primary)  
   (600mls or more)
 3. ? Fetal distress
 4. ? Retained placenta
 5. ? Prolonged labour  
   (&gt;18 hrs)
 6. ? Cord prolapse
 7. ? Wound infection
 8. ? Failure to progress (specify)

  ................................................................
 9. ? Other (specify)

  ................................................................
29 Perineal status after delivery
 Tick tear, repair &amp; episiotomy if all
 1. ? Intact
 2. ? 1st degree tear/vaginal graze    
 3. ? 2nd degree tear
 4. ? 3rd degree tear
 5. ? 4th degree tear
 6. ? Repair of tear 
 7. ? Episiotomy
 8. ? Other (specify) ...................................  
 9. ? Not stated
30 CTG performed during labour
 1.  None               
 2.  External    
 3.  Scalp clip
31 Fetal scalp pH taken during labour
 1.  No                   
 2.  Yes
32 Analgesia for labour
 1. ? None
 2. ? Nitrous oxide and oxygen
 3. ? Narcotic (parenteral)
 4. ? Epidural (lumbar/caudal)
 5. ? Spinal 
 6. ? Other (specify)

  ................................................................
33 Anaesthesia for delivery
 1. ? None
 2. ? Local anaesthesia to perineum
 3. ? Pudendal
 4. ? Epidural (lumbar/caudal)
 5. ? Spinal 
 6. ? General anaesthesia
 7. ? Other (specify)

  ................................................................
34 Mother s outcome for birth hospital/  
 home birth
 1. ? Discharged    
 2. ? Transferred   
 3. ? Died
 Transferred to

  ................................................................
 on

 day month year
35 MOTHER S  FINAL  DISCHARGE/ DEATH
 Date

 day month year

BABY  DETAILS

1 Case record  number

2 Place of birth
 1.  Hospital     
 2.  BBA
 3.  Domicilary   
 4.  Birthing unit/centre
3 Date of delivery

 day month year
4 Hour of birth 
 (24 hour clock)

4    0    3

APPENDIX 2



HAS THE FATHER OF THIS CHILD  A HISTORY OF EXPOSURE TO ANY 
POTENTIAL TERATOGENS?  Yes No Not known

(specify)  ...................................................................................................

ADDITIONAL INFORMATION (eg drinking water supply/local epidemics)

..................................................................................................................

PRENATAL DIAGNOSIS

Please tick all tests performed              Please tick if 
during this pregnancy           abnormal result

1.        MSAFP (NTD etc) 
2.        Triple/Quadruple screen (Down s, etc) 
3.        Ultrasound (morphology) 
4.        Chorion villus sampling 
5.        Amniocentesis 
6.        Cordocentesis

8.        Other (specify) ............................................................  
9.        Not known

Comments ...................................................................................................    

.....................................................................................................................

1.............................................................................................  --

2.............................................................................................  --

3.............................................................................................  --

4.............................................................................................  --

5.............................................................................................  --

6.............................................................................................  --

7.............................................................................................  --

8.............................................................................................  --

9.............................................................................................  --

10...........................................................................................  --

SPECIFIC SYNDROME/S (if  known) ...................................  --

...............................................................................................  --

FAMILY HISTORY OF CONGENITAL ABNORMALITY        Yes   No  Not known

1. Parents (specify) ................................................................

2. Siblings of this baby (including known stillbirths 
   and 2nd trimester terminations of pregnancy)

(specify) .................................................................................

3. Other relatives (specify) .....................................................

......................................................................................  ........

RESIDENCE OF MOTHER DURING THE FIRST 16 WEEKS OF PREGNANCY

...............................................................................................  --

S.A. PREGNANCY OUTCOME STATISTICS UNIT, SOUTH AUSTRALIAN HEALTH COMMISSION,  
PO Box 6, Rundle Mall, Adelaide SA  5000

CONGENITAL ABNORMALITY FORM

BABY S SURNAME .....................................................................................  

BABY S FIRST NAME .................................................................................  

SEX ....................IF MULTIPLE BIRTH, BIRTH ORDER .............................  

DATE OF BIRTH ............. / ............/ .......... UR NO. ....................................

HOSPITAL ...................................................................................................  

ADDRESS OF MOTHER .............................................................................

.....................................................................................................................

ACC NO.    4 

CONGENITAL ABNORMALITIES / BIRTH DEFECTS PRESENT  
(Please list all defects &amp; specify where relevant right/left, anterior/posterior) 
....................................................................                        Of?ce use only

NAME OF NOTIFYING DOCTOR ................................................................................ Signed ....................................................................Date .......................................

NAME &amp; ADDRESS OF OBSTETRICIAN/MIDWIFE (if not the same) .......................?  

EXPOSURE TO TERATOGENS  
DURING THE FIRST 16 WEEKS OF PREGNANCY   
This information can be provided by the doctor undertaking antenatal care 
   Yes   If yes, details

1. Infection (including viral)  ..........................................................

2. Xrays    ..........................................................

3. Environmental chemicals    ..........................................................

4. Prescribed drugs   ..........................................................

5. Over-the-counter drugs   ..........................................................

6. Alcohol    ..........................................................

7. Other addictive substances   ..........................................................

8. Any other substances   ..........................................................

Comments ................................................................................................

..................................................................................................................

APPENDIX 3


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