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

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

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

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

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

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.

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.

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.

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

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).

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.

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

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.

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

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.

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

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

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).

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

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)

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.

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.

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

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

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.

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).

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

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.

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

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

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

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

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

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

100

1000

Birthweight (g)

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

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.

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

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).

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

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.

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

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

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

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

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

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

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)

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

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.

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

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.

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

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).

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.

1 2 3 4 5
0

Hospital category

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

1 2 3 4 5
0

Hospital Category

1 2 3 4 5
0

Hospital Category

90th percentile

Mean

10th percentile

Figure 9: Percentage of Aboriginal mothers
by hospital category

1 2 3 4 5
0

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

Mean

90th percentile

Mean

1 2 3 4 5
0

Hospital Category

90th percentile

Mean

1 2 3 4 5
0

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

1 2 3 4 5
0

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

Hospital Category
1 2 3 4 5

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

0.4

0.8

1.2

1.6

90th Percentile

Mean

10th Percentile

Hospital Category

Figure 20: Percentage of breech deliv eries by hospital
category

10th Percentile

Mean

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

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

90th Percentile

Hospital Category

Mean

10th Percentile

90th Percentile

1 2 3 4 5
0

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

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

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%).

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%).

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%).

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%).

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.

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

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

Induction of labour %
*SA hospitals = 24.8%

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

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

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

VBAC %
*SA hospitals = 19.5%

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

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

0.5

1.5

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

Term NICU %
*SA hospitals = 0.7%

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

100

150

200

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

SPMR
*SA hospitals

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

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%

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

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

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

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

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

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

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

Year

103
99

91 91 93 92

77
86

79
72

76
72 72 69

60 62
71 70 68

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)

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

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

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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
+

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? ;

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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