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March 2012
Pregnancy Outcome Unit,
SA Health
Pregnancy
Outcome
in South Australia
2010
March 2012
Pregnancy Outcome in South Australia 2010
SA Health
Address:
Pregnancy Outcome (Statistics) Unit
Epidemiology Branch
SA Health, Government of South Australia
Citi Centre Building
11 Hindmarsh Square
Adelaide 5000
South Australia
Postal Address:
Pregnancy Outcome (Statistics) Unit
SA Health, Government of South Australia
PO Box 6, Rundle Mall,
Adelaide 5000
South Australia
Telephone: (08) 8226-6382
Fax: (08) 8226-6291
Web: www.health.sa.gov.au/pehs/pregnancyoutcome.htm
www.dh.sa.gov.au/pehs/pregnancyoutcome.htm
E-mail: Pregnancy.Stats@health.sa.gov.au
ISSN 0819-3835
Suggested citation: Scheil W, Scott J, Catcheside B, Sage L. Pregnancy Outcome in South Australia 2010.
Adelaide: Pregnancy Outcome Unit, SA Health, Government of South Australia, 2012.
Pregnancy Outcome in
South Australia 2010
Wendy Scheil
Joan Scott
Britt Catcheside
Leonie Sage
March 2012
Pregnancy Outcome Unit
SA Health
Staff
Wendy Scheil Head/Senior medical consultant
Joan Scott Senior midwife
Leonie Sage Senior midwife, Abortion statistics
Maureen Fisher Administrative officer
Judith Thompson Administrative officer
Kerry Jolly Midwife
Robyn Kennare Senior midwife, Maternal,
Perinatal & 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 births with congenital abnormalities and those who notified terminations of pregnancy;
> the pathology departments of teaching hospitals for autopsy information;
> the Cytogenetics and Molecular Genetics Unit, Women s and Children s Hospital, for cytogenetics reports;
> the Births, Deaths and Marriages Registration Division for data and perinatal death certificates;
> the Coroner s Office for Coroner s findings and autopsy reports;
> 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, Graeme Tucker, Anh Minh Nguyen and Britt Catcheside of the Health Statistics Unit for assistance
with responding to data requests and in data linkage;
> Alison Scott for assisting with data entry: and
> Maureen Fisher and the Communications Division of SA Health for the graphics.
Pregnancy Outcome in South Australia 2010page 2
Acknowledgements
Contents
Acknowledgements 2
Executive Summary 10
1. Numbers and fertility rates .......................................................................................................................... 10
2. Place of birth .............................................................................................................................................. 10
3. Teenage women ......................................................................................................................................... 10
4. Older women and first time mothers .......................................................................................................... 10
5. Country of birth and race ........................................................................................................................... 10
6. Smoking during pregnancy and Body Mass Index ....................................................................................... 11
7. Antenatal care and length of stay ............................................................................................................... 11
8. Aboriginal women ...................................................................................................................................... 11
9. Procedures ................................................................................................................................................. 11
10. Method of birth .......................................................................................................................................... 11
11. Multiple births ............................................................................................................................................ 12
12. Abortions ................................................................................................................................................... 12
13. Perinatal mortality ...................................................................................................................................... 12
14. Congenital Anomalies ................................................................................................................................ 12
I Introduction 13
1. The Perinatal Statistics Collection ................................................................................................................ 13
2. The Abortion Statistics Collection ............................................................................................................... 13
II Mothers and Babies: Characteristics & Outcomes 14
1. Place of residence of mother ...................................................................................................................... 14
2. Place of birth of baby ................................................................................................................................. 15
3. Maternal race ............................................................................................................................................. 20
4. Maternal age .............................................................................................................................................. 21
5. Country of birth ......................................................................................................................................... 22
6. Marital status and type of patient ............................................................................................................... 24
7. Occupation of father and mother ............................................................................................................... 25
8. Previous pregnancy outcomes ..................................................................................................................... 26
9a. Gestation at first antenatal visit .................................................................................................................. 27
9b. Body Mass Index (BMI) ................................................................................................................................ 27
9c . Antenatal visits ........................................................................................................................................... 28
9d. Type of antenatal care ................................................................................................................................ 28
10. Smoking ..................................................................................................................................................... 29
11. Medical conditions ..................................................................................................................................... 30
12. Obstetric complications .............................................................................................................................. 30
13. Procedures performed in current pregnancy ................................................................................................ 31
14a. Onset of labour .......................................................................................................................................... 31
Pregnancy Outcome in South Australia 2010 page 3
Contents
14b. Reasons for induction of labour .................................................................................................................. 32
15a. Presentation and method of birth ............................................................................................................... 33
15b. Reason for caesarean section ...................................................................................................................... 35
16. Complications of labour and birth and perineal status after birth ................................................................ 36
17. Fetal monitoring during labour ................................................................................................................... 37
18. Analgesia for labour and anaesthesia for birth ............................................................................................ 37
19. Postnatal length of stay of women ............................................................................................................. 38
20. Sex of baby ................................................................................................................................................ 39
21. Birthweight and gestation .......................................................................................................................... 39
22. Birth injuries ............................................................................................................................................... 40
23. Treatment given in neonatal period ............................................................................................................. 40
24. Level of care utilised ................................................................................................................................... 40
25. Length of stay of babies ............................................................................................................................. 41
26. Congenital anomalies ................................................................................................................................. 41
27. Multiple births ............................................................................................................................................ 42
28. Perinatal mortality ...................................................................................................................................... 44
29. Home births ............................................................................................................................................... 46
30. Birthing unit births ...................................................................................................................................... 47
III Terminations of Pregnancy 50
1. Numbers and rates ..................................................................................................................................... 50
2. Age of women ........................................................................................................................................... 51
3. Place of residence and place where termination performed ......................................................................... 53
4. The reason for termination ......................................................................................................................... 54
5. Gestation, method and complications ......................................................................................................... 54
6. Previous terminations. Total termination of pregnancy rate and total first termination of pregnancy rate ..... 56
IV Obstetric Profiles by Hospital Category 58
V Clinical and Maternity Performance Indicators 67
1. Clinical indicators ....................................................................................................................................... 67
1: Outcome of selected primiparae ........................................................................................................... 67
2: Vaginal birth following caesarean section (VBAC) ................................................................................. 68
3: Major perineal tears & surgical repair of the perineum - selected primiparae with an intact perineum ...68
4: General anaesthesia for caesarean section ............................................................................................ 68
5: Antibiotic prophylaxis & caesarean section ............................................................................................ 68
6: Pharmacological thromboprophylaxis & caesarean section .................................................................... 68
7: Postpartum haemorrhage / blood transfusion ....................................................................................... 69
8: Intrauterine growth restriction (IUGR) ................................................................................................... 69
9: Apgar score .......................................................................................................................................... 69
10: Term babies transferred or admitted to a neonatal intensive care unit for reasons other than
congenital abnormality ........................................................................................................................ 70
Pregnancy Outcome in South Australia 2010page 4
Contents
2. Maternity performance indicators, hospitals with at least 500 births per year ................................................. 70
VI Trends in Perinatal Statistics in South Australia, 1981-2010 74
Trends in Perinatal Statistics in South Australia (SA), 1985-2010 ......................................................................... 77
VII Summary Statistics For 2010 80
1. Number of births ........................................................................................................................................ 80
2. Place of birth .............................................................................................................................................. 80
3. Sex ............................................................................................................................................................. 80
4. Plurality and condition at birth .................................................................................................................... 80
5. Race of women .......................................................................................................................................... 80
6. Obstetric interventions in 19,667 women who gave birth ........................................................................... 80
7. Low birthweight (<2,500g) ......................................................................................................................... 81
8. Congenital abnormalities ............................................................................................................................ 81
9. Perinatal mortality rates (numbers of deaths in parentheses) ....................................................................... 81
10. Terminations of pregnancy .......................................................................................................................... 81
References 82
Publications 82
Annual Reports .................................................................................................................................................. 82
Other reports/papers .......................................................................................................................................... 83
1 Birth defects ........................................................................................................................................... 83
2 Termination of pregnancy ....................................................................................................................... 85
3 Perinatal epidemiology ........................................................................................................................... 85
4 Perinatal mortality .................................................................................................................................. 88
5 Caesarean section .................................................................................................................................. 88
Appendix 1: Definitions 89
Appendix 2: 2010 Supplementary Birth Record Form 93
Appendix 3: Congenital Abnormality Form 94
Tables
Table 1: Births and crude birth rate by CURB regions .......................................................................................... 14
Table 2: Total births notified in 2010, by place of birth and plurality, South Australia .......................................... 15
Table 3a: Hospital births by category of hospital ................................................................................................... 18
Table 3b: Hospital births by race and hospital ....................................................................................................... 19
Table 4a: Race of women who gave birth ............................................................................................................ 20
Table 4b: Race and birthplace category of women who gave birth ....................................................................... 21
Table 4c: Age and race of women who gave birth ............................................................................................... 21
Pregnancy Outcome in South Australia 2010 page 5
Tables
Table 4d: Age-specific fertility rates ...................................................................................................................... 22
Table 5a: Country of birth, major groups ............................................................................................................. 23
Table 5b: Specified country of birth ...................................................................................................................... 23
Table 6a: Marital status and age .......................................................................................................................... 24
Table 6b: Type of patient and marital status ......................................................................................................... 24
Table 7: Occupation of father and mother .......................................................................................................... 25
Table 8a: Parity by race, women who gave birth .................................................................................................. 26
Table 8b: Previous pregnancy outcomes (multigravidae only) ................................................................................ 26
Table 9a: Gestation at first antenatal visit ............................................................................................................. 27
Table 9b: BMI of women who gave birth .............................................................................................................. 27
Table 9c: Antenatal visits by race, women who gave birth .................................................................................... 28
Table 9d: Type of antenatal care ........................................................................................................................... 28
Table 10a: Tobacco smoking status at first antenatal visit, non-Aboriginal and Aboriginal women .......................... 29
Table 10b: Average number of tobacco cigarettes smoked per day in the second half of pregnancy,
non-Aboriginal and Aboriginal women ................................................................................................. 29
Table 11: Medical conditions in current pregnancy ............................................................................................... 30
Table 12: Frequency of some obstetric complications ........................................................................................... 30
Table 13: Procedures performed in current pregnancy .......................................................................................... 31
Table 14a: Onset of labour ..................................................................................................................................... 31
Table 14b: Method of induction of labour .............................................................................................................. 31
Table 14c: Augmentation of labour after spontaneous onset ................................................................................. 32
Table 15a: Method of birth .................................................................................................................................... 33
Table 15b: Method of birth by presentation ........................................................................................................... 34
Table 15c: Method of birth in breech presentation, by plurality .............................................................................. 34
Table 16: Frequency of some complications of labour and birth ............................................................................ 36
Table 17a: CTG performed during labour ............................................................................................................... 37
Table 17b: Fetal scalp pH taken during labour ........................................................................................................ 37
Table 18a: Analgesia for labour .............................................................................................................................. 37
Table 18b: Anaesthesia for birth ............................................................................................................................. 38
Table 19a: Postnatal length of stay by type of patient ............................................................................................ 38
Table 19b: Average postnatal length of stay by type of patient & type of birth ....................................................... 39
Table 20: Sex of baby ........................................................................................................................................... 39
Table 21: Birthweight distribution of all births ...................................................................................................... 39
Table 22: Birth injuries .......................................................................................................................................... 40
Table 23: Neonatal treatment given, all live births ................................................................................................ 40
Table 24: Level of nursery care utilised by birthweight, all live births ..................................................................... 41
Table 25: Length of stay of liveborn babies in hospital .......................................................................................... 41
Table 26: Selected congenital abnormalities notified to the perinatal statistics collection ...................................... 42
Table 27a: Birthweight by plurality ......................................................................................................................... 43
Pregnancy Outcome in South Australia 2010page 6
Tables
Table 27b: Gestation at birth by plurality ................................................................................................................ 43
Table 27c: Perinatal outcome by plurality ............................................................................................................... 43
Table 28a: Perinatal mortality by birthweight ......................................................................................................... 44
Table 28b: Perinatal mortality by gestational age at birth ........................................................................................ 45
Table 28c: Perinatal mortality (all births of specified birthweight/gestation) ............................................................ 45
Table 28d: Perinatal mortality by race, all births ...................................................................................................... 46
Table 29: Planned home births by age of women ................................................................................................. 46
Table 30: Method of birth in planned home births ............................................................................................... 46
Table 31: Birthweight distribution of planned home births ................................................................................... 47
Table 32: Perinatal outcome in planned home births ............................................................................................ 47
Table 33: Planned birthing unit births by age of women ....................................................................................... 48
Table 34: Method of birth in planned birthing unit births ..................................................................................... 48
Table 35: Birthweight distribution of planned birthing unit births ......................................................................... 48
Table 36: Perinatal outcome in planned birthing unit births .................................................................................. 49
Table 37: Termination of pregnancy rate per 1,000 women aged 15-44 years, 1970-2010 ................................... 50
Table 38: Terminations of pregnancy by age ......................................................................................................... 51
Table 39: Termination of pregnancy and live birth rates and termination of pregnancy proportions by age ........... 52
Table 40: Terminations by place of residence ........................................................................................................ 53
Table 41: Terminations by hospital category ......................................................................................................... 53
Table 42: Terminations by category of doctor ....................................................................................................... 54
Table 43: Reason for termination for fetal reasons ................................................................................................ 54
Table 44a: Women with previous terminations by age............................................................................................ 55
Table 44b: Calculation of total induced abortion rate (TAR) .................................................................................... 55
Table 45a: Women with previous terminations by age............................................................................................ 56
Table 45b: Calculation of total induced abortion rate (TAR) .................................................................................... 56
Table 45c: Calculation of total first induced abortion rate (TFAR) ........................................................................... 57
Table 46: Obstetric profiles by hospital category, South Australia, 2010: live births of any gestation and
stillbirths of >=400g or >=20 weeks gestation** .................................................................................. 60
Table 47: Socio-demographic aspects of perinatal statistics, 1981 and 2001-2010 ............................................... 75
Table 48: Obstetric aspects of perinatal statistics, 1981 and 2001-2010 ............................................................... 76
Figures
Figure 1a: Map showing SA hospitals with obstetric beds in 2010 ......................................................................... 16
Figure 1b: Map showing Central Regions of SA ..................................................................................................... 17
Figure 2: Distribution of hospital births by hospital category ................................................................................ 18
Figure 3: Age and race of women who gave birth ............................................................................................... 22
Figure 4: Reasons for induction of labour ............................................................................................................ 32
Figure 5a: Method of birth, women who gave birth .............................................................................................. 33
Pregnancy Outcome in South Australia 2010 page 7
Tables
Figure 5b: Reason for caesarean section ................................................................................................................ 35
Figure 5c: Reason for elective caesarean section .................................................................................................... 35
Figure 5d: Reason for emergency caesarean section .............................................................................................. 36
Figure 6: Perinatal mortality rate by birthweight, all births ................................................................................... 44
Figure 7: Termination of pregnancy rate in South Australia, 1970-2010 ............................................................... 50
Figure 8a: Termination of pregnancy and live births by age .................................................................................... 52
Figure 8b: Teenage pregnancy, termination of pregnancy and birth rates, South Australia, 1970-2010 .................. 53
Figure 9: Percentage of Aboriginal women by hospital category .......................................................................... 61
Figure 10: Percentage of women with <7 antenatal visits by hospital category....................................................... 61
Figure 11: Percentage of teenage women by hospital category .............................................................................. 61
Figure 12: Percentage of women 35 years or more by hospital category ................................................................ 61
Figure 13: Percentage of single women by hospital category ................................................................................. 62
Figure 14: Percentage of women with 4 or more prior livebirths by hospital category ............................................ 62
Figure 15: Percentage of women with 1 or more prior perinatal deaths by hospital category ................................. 62
Figure 16: Percentage of women with obstetric complications by hospital category ............................................... 63
Figure 17: Percentage of women with complications during labour or birth by hospital category ........................... 63
Figure 18: Percentage of women with induction of labour by hospital category ..................................................... 63
Figure 19: Percentage of women having epidural analgesia by hospital category ................................................... 64
Figure 20: Percentage of breech births by hospital category ................................................................................... 64
Figure 21: Percentage of emergency caesarean sections by hospital category ......................................................... 64
Figure 22: Percentage of elective caesarean sections by hospital category .............................................................. 64
Figure 23: Percentage of total caesarean sections by hospital category .................................................................. 65
Figure 24: Percentage of births with birthweight below 2,500g by hospital category ............................................. 65
Figure 25: Percentage of births with gestation less than 37 weeks by hospital category ......................................... 65
Figure 26: Percentage of births with prolonged hospitalisation by hospital category ............................................... 66
Figure 27: Percentage of live births requiring neonatal intensive care by hospital category ..................................... 66
Figure 28: Percentage of births with birth defects by hospital category .................................................................. 66
Figure 29a: Induction of labour for selected primiparae, SA hospitals with >=500 births per year ............................ 71
Figure 29b: Caesarean section rate for selected primiparae, SA hospitals with >=500 births per year ......................... 72
Figure 29c: VBAC: Proportion of women who had a vaginal birth following a previous primary (first) caesarean
section & no intervening births, SA hospitals with >=500 births per year ............................................... 72
Figure 29d: Proportion of selected primiparae with an intact perineum after a vaginal birth, SA hospitals
with >=500 births per year ................................................................................................................... 72
Figure 29e: TERM NICU: proportion of term babies admitted to NICU for reasons other than congenital
abnormality, SA hospitals with >=500 births per year ............................................................................ 73
Figure 29f: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with >=500 births per year, .... 73
Figure 29g: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with >=500 births per year,
2006-2010 ........................................................................................................................................... 73
Figure 30.1: Percentage of teenage women among women giving birth in SA .......................................................... 77
Pregnancy Outcome in South Australia 2010page 8
Figures
Figure 30.2: Percentage of women aged 35 years and over among women giving birth in SA .................................. 77
Figure 30.3: Percentage of primiparous women aged 35 years and over in SA .......................................................... 77
Figure 30.4: Percentage of Aboriginal women and Asian women among women giving birth in SA ......................... 78
Figure 30.5: Percentage of women never married and with no de facto partner among women giving birth in SA....78
Figure 30.6: Percentage of multiple births among births in SA .................................................................................. 78
Figure 30.7: Percentage of low birthweight babies among births in SA ..................................................................... 79
Figure 30.8: SA standardised perinatal mortality ratio (SPMR) ................................................................................... 79
Pregnancy Outcome in South Australia 2010 page 9
Figures
Executive Summary
This report on pregnancy outcome in South Australia for 2010 provides statistics derived mainly from the South
Australian perinatal statistics 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 in 2010 are available in the Eighth Annual Report of the
Abortion Reporting Committee. Comparisons of selected pregnancy characteristics and outcomes are provided for
six 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 provided for hospitals with smaller numbers of births. Comparisons of maternity performance indicators
are also provided for hospitals with at least 500 births per year.
1. Numbers and fertility rates
The number of births notified in South Australia in 2010 was 20,002, which was 101 more than the previous year.
The number of women who gave birth was 19,667. The total fertility rate was 1.84 live births per woman, a decrease
from 1.91 in 2007 and 2008 and 1.87 in 2009. The fertility rate decreased slightly in all age groupings other than the
40-44 years age grouping which remained stable and there was a slight increase in the group of women aged 30-34
years.
2. Place of birth
Compared to 2009, the numbers of births increased at all metropolitan teaching hospitals. Births increased at three of
the metropolitan private hospitals and decreased at two. Six percent of women (1,214 women) gave birth in birthing
units in teaching hospitals and 136 women (0.7%) had planned home births.
3. Teenage women
789 teenage women gave birth, accounting for 4.0% of women who gave birth, and 871 teenage women had
terminations of pregnancy, accounting for 17.2% of terminations. In 2010, the proportion of known pregnancies
terminated was 52% for teenagers compared with 20% for women of all ages. The teenage pregnancy rate declined
in the 1970s and 1980s, but increased in the early 1990s. It declined again after 1996. The teenage pregnancy rate of
31.7 per 1,000 women in 2010 was the lowest rate recorded since 1970.
4. Older women and first time mothers
The mean age of women giving birth increased from 26.6 years in 1981 to 30.1 years in 2010, and, among first time
mothers, from 24.4 years to 28.3 years. The proportion of women aged 35 years or more increased from 4.6% in
1981 to 21.1% in 2009 and was 20.5% in 2010. Among first time mothers, this proportion increased from 1.2% to
12.8% in 2009 and was 12.2% in 2010. As in the previous eight years, more women gave birth in the 30-34 years
than in the 25-29 years age group.
5. Country of birth and race
Eighty percent of women who gave birth in 2010 were Australian-born. Of women born overseas who gave birth,
the largest proportions came from India (3.2% of women), the United Kingdom and Ireland (2.9%), China (1.3%),
Vietnam (1.2%), New Zealand (1.0%), the Philippines (0.9%) and Sudan (0.7%). Of the women who gave birth in
the state in 2010 9.6% (1,894 women) were Asian, compared with 2% in 1981. They gave birth mainly in teaching
hospitals.
6. Smoking during pregnancy and Body Mass Index
The proportion of women smoking at the first antenatal visit has declined steadily from 25% in 1998 to 13.5% in
2010. About 4% each year quit smoking before the first antenatal visit.
While statistics on Body Mass Index were available only for 71% of women who gave birth in 2010 (an improvement
from 42% in 2007), and must be interpreted with caution, these show that 35.9% of all women giving birth were
overweight and 16.7% were obese, including 6.9% who were severely or morbidly obese.
Pregnancy Outcome in South Australia 2010page 10
Executive Summary
7. Antenatal care and length of stay
Statistics on gestation at first antenatal visit were available only for 90% of women who gave birth. These show that
80% of women attended for antenatal care within the first 14 weeks of pregnancy. Eighty-seven percent of women
attended at least seven antenatal visits and although many women had more than one type of antenatal care, the
most common types used were hospital clinics (45%), obstetricians in private practice (31%) and general practitioners
(15%). Thirty-one percent of women were private patients. The median length of stay of women after a birth was
three days; it was three days for those who had a vaginal birth and four days for those who had a caesarean section.
It was two days longer among private patients for vaginal births and one day longer for caesarean births.
8. Aboriginal women
625 Aboriginal women gave birth in South Australia in 2010, accounting for 3.2% of all women who gave birth in
the state. Eighteen percent of Aboriginal women were teenagers (compared with 3.6% of non-Aboriginal women).
Fifty-four percent of Aboriginal women attended for antenatal care within the first 14 weeks of pregnancy (compared
with 81% of non-Aboriginal women) and 64% attended at least seven antenatal visits during pregnancy (compared
with 88% of non-Aboriginal women). In 2010, at the first antenatal visit, 52.8% of Aboriginal women reported that
they smoked, while in Non-Aboriginal women this proportion dropped to 12.2%. In 2010 the proportion of preterm
births (<37 weeks gestation), and low birthweight births (<2,500g) were twice as high for Aboriginal women as
for non-Aboriginal births. The perinatal mortality rate of babies of Aboriginal women was the lowest recorded, just
slightly higher than that of babies of non-Aboriginal women (9.5 compared with 8.1 per 1,000 births). While this is
pleasing it must be remembered there can be fluctuations from year to year because of small numbers.
9. Procedures
Ninety-nine percent of women who gave birth had an ultrasound examination; 30% had labour induced while
another 21% had spontaneous labour augmented; epidurals were used for pain relief during labour for 32% of
women, and 13% had an episiotomy (19% of women who gave birth vaginally). The main reasons for induction of
labour were prolonged pregnancy (19%), hypertension (14%), diabetes or gestational diabetes and poor fetal growth
(7%) and premature rupture of membranes (5%). Fifty-two percent of inductions of labour were performed for other
than defined indications.
10. Method of birth
Fifty-five percent of women had normal spontaneous vaginal births. Seven percent gave birth by ventouse and 5%
by forceps (compared with 1% and 15% respectively in 1981). In 2010 the proportion of women giving birth by
caesarean section was 32%, a proportion which has been relatively stable for four years. Of those who had previously
given birth, 30% had previously had a caesarean section. Only 18% of women had a vaginal birth following a
previous first caesarean without intervening births, compared with 30% in 1998. The main reasons given for
caesarean section were previous caesarean section (38%), failure to progress in labour or cephalopelvic disproportion
(28%), fetal distress (15%) and malpresentation (12%).
11. Multiple births
Multiple births accounted for 3.3% of births; women with twins or triplets accounted for 1.7% of women who gave
birth in 2010. These proportions increased in the 1980s and 1990s as a result of the use of assisted conception and
the increasing proportion of older women, who have higher rates of multiple pregnancies than younger women. The
peak proportion of multiple births was recorded in 2002 and 2003 (3.6%). The subsequent decline in the proportion
of multiple births was probably related to the increasing use of single embryo transfer in assisted conception practice.
12. Abortions
5,048 terminations of pregnancy were notified, six less than in 2009. The induced abortion rate was 15.5 per 1,000
women aged 15-44 years, a slight decrease from 2009 (15.6 per 1,000 women aged 15-44 years). It has declined
significantly since 2001, when it was 17.7 per 1,000 women. Approximately 95% of terminations were performed
in metropolitan public hospitals, including the Pregnancy Advisory Centre, and 78% were performed by doctors
in family advisory clinics in these hospitals. Ninety-two percent of terminations were performed within the first 14
weeks of pregnancy and 1.8% (89) were performed at or after 20 weeks gestation. Forty-six percent of terminations
performed at or after 20 weeks gestation were for fetal abnormalities. Approximately 20% of reported pregnancies
ended as terminations in 2010.
Pregnancy Outcome in South Australia 2010 page 11
Executive Summary
13. Perinatal mortality
The perinatal mortality rate for all births in 2010 was 8.1 per 1,000 births, the stillbirth rate 5.9 per 1,000 births and
the neonatal mortality rate 2.2 per 1,000 live births. For international comparison, the World Health Organisation
recommends including only stillbirths 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 comparison for South Australia for 2010 was 3.2 per 1,000 births, with an early neonatal
mortality rate of 0.7 per 1,000 live births.
14. Congenital Anomalies
In 2010 there were 562 births (2.8%) notified at birth with congenital anomalies, compared with an average of 2.5%
over the past decade. In 2010 there were 11 cases of spina bifida reported at birth, compared with 18 cases reported
in 2009, and four cases in 2008. No reason for the sudden increase in 2009 could be determined.
Pregnancy Outcome in South Australia 2010page 12
Executive Summary
I. Introduction
This report summarises the statistics for 2010 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 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). The SBRs are checked manually for
completeness and data discrepancies and then go through a series of automated validation procedures during
data entry.
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). Few statistics on birth defects are included
in this report as these are reported annually by the South Australian Birth Defects Register at the Women s and
Children s Hospital.2 The Register complements statistics on birth defects from the perinatal 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 Care Regulations 2008, Part 5 Pregnancy
outcome data and statistics. The South Australian perinatal statistics 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.
Perinatal death certificates are obtained from the Births, Deaths and Marriages Registration Division, chromosome
analysis reports from the Cytogenetics and Molecular Genetics Unit at Women s and Children s Hospital, autopsy
reports from pathology departments and Coroner s autopsy reports and findings from 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 2010.3
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. It commenced in 1970, when specific
abortion legislation was introduced under the Criminal Law Consolidation Act. Termination of pregnancy became
legal in the state if performed in a prescribed hospital 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. A termination may not be performed on a woman who is pregnant
with a child capable of being born alive unless it is performed to save the woman s life. The legislation states that
evidence that a woman has been pregnant for a period of 28 weeks or more is prima facie proof that she was
pregnant with a child that was capable of being born alive.
Pregnancy Outcome in South Australia 2010 page 13
Introduction
II. Mothers And Babies: Characteristics & Outcomes
The births in 2010 in South Australia described in this report include live births of any gestation, and stillbirths and
terminations of pregnancy of at least 400g birthweight or 20 weeks gestation. There was one birth of unknown
birthweight. Fifty four births of less than 400g birthweight have been included, consisting of 43 stillbirths and eleven
live births. The eleven live births were born at 19-27 weeks gestation and all but a severely growth restricted baby
died in the neonatal period. SBRs were received for all 20,002 births reported by hospital and home birth midwives
in their monthly notification lists. These comprised 19,883 live births and 119 stillbirths. The number of women who
gave birth was 19,667, 63 more women than in 2009. Findings relating to Aboriginal women and babies in the text
of this report have been italicised for easy identification, in accordance with the request of the Aboriginal Health
Council.
1 Place of residence of mother
South Australia is divided into nine CURB (Committee for Uniform Regional Boundaries) Regions, comprising five
country Regions and four 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 the mother s place of residence by CURB Regions is provided in Table 1 together with the estimated resident
population and crude birth rate. The crude birth rate in 2010 for South Australia was 12.2 per 1,000 population.
It was lowest in the Yorke & Lower North and the Central Eastern Regions. It was highest in the Central Northern
Region and was also high in the South East Region and Eyre.
Table 1: Births and crude birth rate by CURB regions, South Australia, 2010
CURB Region
(Mother s residence) Total births Live births
Estimated resident
population, June
30, 2010+
Crude birth
rate per 1,000
population
Number Percent Number Number
Central Northern 6,112 30.6 6,077 435,505 14.0
Central Western 2,602 13.0 2,587 226,301 11.5
Central Eastern 2,998 15.0 2,983 288,431 10.4
Central Southern 4,656 23.3 4,628 392,438 11.9
Yorke & Lower North 491 2.5 489 47,585 10.3
Murraylands 786 3.9 779 70,705 11.1
South East 811 4.1 805 66,724 12.2
Northern 942 4.7 937 81,001 11.6
Eyre 462 2.3 458 35,892 12.9
Interstate 142 0.7 140 na na
Total 20,002 100.0 19,883 1,644,582 12.2
+ Australian Bureau of Statistics. Population estimates by age and sex, South Australia, 2010. Canberra: ABS, 2010 (Catalogue No 3235.0).
na: not applicable
Pregnancy Outcome in South Australia 2010page 14
Mothers and Babies
2 Place of birth of baby
Of the 20,002 births in 2010, 144 (0.7%) were home births and of those 138 were planned homebirths. The
remaining 19,858 births occurred in hospitals or in 87 cases, before arrival at hospitals into which the women had
been booked. These 87 Born Before Arrival (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 2010 are provided in Figures 1a and 1b.
Table 2: Total births notified in 2010, by place of birth and plurality, South Australia
Condition
at birth
Home births Hospital births
Total
Singleton Twin Singleton Twin Triplet Quad
Live birth 137 6 19,084 637 15 4 19,883
Stillbirth 1 0 117 1 0 0 119
Total births 138 6 19,201 638 15 4 20,002
Of the 19,858 hospital births, 80.5% occurred in metropolitan hospitals (teaching and private) and 19.5% in country
hospitals. This distribution is summarised in Table 3a and Figure 2. Table 3b provides the numbers of births and
women by race in individual hospitals. Metropolitan hospitals are listed in order of number of births and country
hospitals in alphabetic order within their category of number of births. Fifty-five percent of hospital births in South
Australia in 2010 occurred in metropolitan teaching hospitals. Maternity and neonatal services at SA hospitals are
delineated according to six levels of service, as defined in the policy, Standards for Maternal and Neonatal Services
in SA 2010 .4 The Women s and Children s Hospital is defined as providing Level 5 maternity services and Level 6
neonatal services, as it provides a high risk pregnancy service and neonatal intensive care, but has no maternity
intensive care facility on site. The Lyell McEwin Hospital provides Level 6 maternity services and Level 5 neonatal
services with maternity intensive care services and special care neonatal services. Flinders Medical Centre provides
Level 6 maternity and neonatal services with both maternity and neonatal intensive care services.
Compared with 2009, births increased at the three metropolitan teaching hospitals. The total number of births in
metropolitan private hospitals increased slightly, with Burnside, Calvary and Flinders Private Hospital showing a small
increase. Births at Ashford and North Eastern Community Hospital decreased slightly.
The total number of births in country hospitals decreased overall by 102. In the two major country centres, births
increased slightly at Mount Gambier, while births decreased at Whyalla. Increases occurred at some hospitals with
100-450 births per year, eg Barossa Health Service (Tanunda), Gawler Health Service and Naracoorte, while decreases
were seen at Port Pirie and Riverland Regional (Berri). Numbers remained relatively constant at Lower North Health
(Clare), Mount Barker, Murray Bridge, Port Augusta, Port Lincoln, Northern Yorke Peninsula Regional Health Service
(Wallaroo) and South Coast (Victor Harbor). At smaller country centres, births increased at Kapunda, Loxton and
Mid North Health (Jamestown campus), while numbers of births fell at Ceduna, Cummins, Millicent, Peterborough,
Southern Flinders Health Service (Crystal Brook) and Waikerie.
Pregnancy Outcome in South Australia 2010 page 15
Mothers and Babies
Figure 1a: Map showing SA hospitals with obstetric beds in 2010
W
A
N
SW
NORTHERN
EYRE
Ceduna
Q
LD
NT
V
ic
Kangaroo Island
Pt Lincoln
Pt Augusta
Pt Pirie YORKE &
LOWER
NORTH
MURRAY
LANDS
Wallaroo
Whyalla
Clare
Riverland
Regional
(Berri)
Murray Bridge
Naracoorte
Mt Gambier
SOUTH EAST
SEE INSET
Figure 1b
CENTRAL REGIONS
0 40 80 120 160 Km
Metropolitan Adelaide
CURB Regions - Boundaries
> 2000 births per annum
1000-1999 births per annum
500-999 births per annum
100-450 births per annum
< 100 births per annum
* The six centres near the
north-western border
are Aboriginal clinics
Pregnancy Outcome in South Australia 2010page 16
Mothers and Babies
Figure 1b: Map showing Central Regions of SA
CENTRAL EASTERN
Mt Barker
SCDH
(Victor Harbor)
CENTRAL WESTERN
(includes Kangaroo Island)
0 10 20 30 40
Metropolitan Adelaide
Hospital abbreviations
as in Table 3B
> 2000 births per annum
1000-1999 births per annum
500-999 births per annum
100-450 births per annum
< 100 births per annum
kilometres
CENTRAL NORTHERN
CENTRAL SOUTHERN
Tanunda
Kapunda
Gawler Health Service
Lyell
McEwin
FMC
Calvary
Ashford
Flinders
Private
W&CH
BWMH
NECH
Pregnancy Outcome in South Australia 2010 page 17
Mothers and Babies
Table 3a: Hospital births by category of hospital, South Australia, 2010
Hospital category Number of births Percent hospital births
Metropolitan teaching 10,870 54.7
Women s & Children s Hospital (W&CH) (4,887) (24.6)
Flinders Medical Centre (FMC) (2,888) (14.5)
Lyell McEwin Hospital (LMH)** (3,088) (15.6)
Metropolitan private 5,123 25.8
Country 3,865 19.5
Major country (816) (4.1)
100-399 births per annum (2,625) (13.2)
50-99 births per annum (252) (1.3)
<50 births per annum (172) (0.9)
Total 19,858 100.0
Figure 2: Distribution of hospital births by hospital category, South Australia, 2010 (n=19,858)
14.5%
0 10 20 30 40 50 60
Country hospitals
Metropolitan private
hospitals
Teaching hospitals
Percentage of hospital births
19.5%
25.8%
54.7%
a Ashford 7.4%
b Burnside 6.6%
c Calvary 4.6%
d Flinders Private 3.4%
e North Eastern Community 3.7%
r Mt Gambier 2.7%
s Gawler 2.1%
t Mount Barker 3.4%
u Port Lincoln 1.6%
v Murray Bridge 1.4%
w Whyalla 1.4%
x Other hospitals with 100-450 births per year 6.5%
y Hospitals with 50-99 births per year 1.3%
z Hospitals with <50 births per year 0.9%
W&CH FMC LMHS
e
u
24.6% 15.6%
a c
r s x y zt v w
b d
Pregnancy Outcome in South Australia 2010page 18
Mothers and Babies
Table 3b: Hospital births in South Australia in 2010 by race and hospital
Hospital Caucasian Aboriginal Asian Other Total births
Total number of
women who gave birth
Metropolitan teaching n n n n n n
Women s & Children s Hospital
(W&CH)
3,080 188 1,127 492 4,887 4,751
Flinders Medical Centre (FMC) 2,520 62 195 111 2,888 2,828
Lyell McEwin Hospital (LMH)** 2,507 138 280 163 3,088 3,057
Modbury Public Hospital 1 0 0 1 2 2
Noarlunga Health Service 3 0 0 0 3 2
TQEH 2 0 0 0 2 2
Total 8,113 388 1,602 767 10,870 10,642
Metropolitan private
Ashford** 1,386 4 72 16 1,478 1,442
Burnside War Memorial (BWMH)** 1,224 0 71 12 1,307 1,286
Calvary** 856 3 53 9 921 906
Flinders Private** 647 1 20 11 679 667
North Eastern Community (NECH)** 720 1 9 8 738 729
Total 4,833 9 225 56 5,123 5,030
Country
Major country
Mt. Gambier** 511 12 17 6 546 541
Whyalla 231 22 8 9 270 268
Subtotal 742 34 25 15 816 809
100-450 births per annum
Barossa Health (Tanunda Centre) 135 0 3 1 139 139
Gawler Health Service*** 405 4 9 1 419 419
Lower North Health Centre (Clare) 98 2 5 0 105 105
Mt. Barker 361 4 2 6 373 373
Murray Bridge Soldiers' Memorial 228 20 10 12 270 270
Naracoorte 161 1 2 7 171 171
Pt. Augusta 164 89 3 5 261 257
Pt. Lincoln 285 21 6 6 318 318
Pt. Pirie 122 11 1 4 138 138
Riverland Regional (Berri) 178 14 12 3 207 207
South Coast District (Victor Harbor) 108 3 4 2 117 117
Northern Yorke Peninsula Regional
Health Service (Wallaroo)
101 3 1 2 107 107
Subtotal 2,346 172 58 49 2,625 2,621
** 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.
Table 3b continued
Pregnancy Outcome in South Australia 2010 page 19
Mothers and Babies
Hospital Caucasian Aboriginal Asian Other Total births
Total number of
women who gave birth
50-99 births per annum n n n n n n
Kapunda 55 1 0 1 57 57
Loxton 72 5 1 0 78 78
Millicent 54 1 0 2 57 57
Southern Flinders Health Service
(Crystal Brook)
56 4 0 0 60 60
Subtotal 237 11 1 3 252 252
1-49 births per annum
Ardrossan 1 0 0 0 1 1
Booleroo 1 0 0 0 1 1
Ceduna 28 9 0 1 38 38
Cummins 2 0 0 0 2 2
Mid North Health (Jamestown
Campus)
36 0 0 0 36 36
Kangaroo Island 32 2 1 1 36 36
Keith 1 0 0 0 1 1
Mannum 0 1 0 0 1 1
Minlaton 2 0 0 0 2 1
Peterborough 5 0 0 0 5 5
Quorn 4 1 0 0 5 5
Roxby Downs 1 0 0 0 1 1
Southern Yorke Peninsula
(Yorketown)
1 0 0 0 1 1
Waikerie 34 2 1 5 42 42
Subtotal 148 15 2 7 172 171
Total (country) 3,473 232 86 74 3,865 3,853
Grand total 16,419 629 1,913 897 19,858 19,525
3 Maternal race
The distribution of women who gave birth, by race 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 (598 women),
Torres Strait Islander (13 women) and those who are Aboriginal and Torres Strait Islander (14 women). Aboriginal
women accounted for 3.2% of women and gave birth mainly in metropolitan teaching hospitals and country
hospitals. Asian women accounted for 9.6% of women, and gave birth mainly in metropolitan teaching hospitals, but
11.8% gave birth in private hospitals.
Table 4a: Race of women who gave birth, South Australia, 2010
Race Number of women % Women
Caucasian 16,263 82.7
Aboriginal 625 3.2
Asian 1,894 9.6
Other 885 4.5
Total 19,667 100.0
Table 3b continued
Pregnancy Outcome in South Australia 2010page 20
Mothers and Babies
Table 4b: Race and birthplace category of women who gave birth, South Australia, 2010
Birthplace
Race of women
TotalCaucasian Aboriginal Asian Other
Number % Number % Number % Number % Number %
Metropolitan
teaching
hospital
7,920 48.7 384 61.4 1,583 83.6 755 85.3 10,642 54.1
Metropolitan
private hospital
4,743 29.2 9 1.4 223 11.8 55 6.2 5,030 25.6
Country
hospital
3,463 21.3 231 37.0 85 4.5 74 8.4 3,853 19.6
Home 137 0.8 1 0.2 3 0.2 1 0.1 142 0.7
Total 16,263 (82.7) 625 (3.2) 1,894 (9.6) 885 (4.5) 19,667 100.0
4 Maternal age
Among the five-year age groups the largest number of women who gave birth was in the 30-34 years age group
(Table 4c). The proportion of women in this age group (30.8%) has exceeded that of the 25-29 years age group
(29.7%) since 2001. Teenage women accounted for 4.0% of women who gave birth and older women aged 35 years
or more accounted for 20.5% (Table 4c and Figure 3). Aboriginal women were generally younger than non-Aboriginal
women: 17.8% were teenagers and only 8.0% were 35 years or older. Among Asian women, on the other hand, only
0.7% were teenagers but 19.5% were 35 years or older.
The age-specific fertility rates have increased in the 30-34 age group and decreased in the teenage, 20-24, 25-29,
and 35-39 age groups, when compared with 2009 (Table 4d). The rate was highest in the age group 30-34 years
(121.1 per 1,000 women), followed by the 25-29 years age group (107.3 per 1,000 women). The general fertility
rate (see Appendix 1) was 60.8 per 1,000 women aged 15-44 years, down from 61.1 in 2009. The total fertility rate
(see Appendix 1) was 1.85 live births per woman, down from 1.91 in 2008, which was the highest for more than a
decade, but still below replacement level (2.1).
Table 4c: Age and race of women who gave birth, South Australia, 2010
Age
(years)
Caucasian Aboriginal Asian Other Total
Number % Number % Number % Number % Number %
<15 2 0.0 1 0.2 0 0.0 1 0.1 4 0.0
15-19 629 3.9 110 17.6 13 0.7 33 3.7 785 4.0
20-24 2331 14.3 221 35.4 209 11.0 197 22.3 2958 15.0
25-29 4739 29.1 159 25.4 666 35.2 278 31.4 5842 29.7
30-34 5107 31.4 84 13.4 637 33.6 224 25.3 6052 30.8
35-39 2816 17.3 44 7.0 314 16.6 121 13.7 3295 16.8
40-44 603 3.7 6 1.0 52 2.7 29 3.3 690 3.5
45+ 36 0.2 0 0.0 3 0.2 2 0.2 41 0.2
Total 16,263 (82.7) 625 (3.2) 1,894 (9.6) 885 (4.5) 19,667 100.0
Pregnancy Outcome in South Australia 2010 page 21
Mothers and Babies
Figure 3: Age and race of women who gave birth, 2010 (n=19,667)
Table 4d: Age-specific fertility rates, South Australia, 2010
Age (years) Number of live births
Estimated resident female
population*
Age-specific fertility rate per
1,000 women (ASFR)***
15-19 789** 52,583 15.0**
20-24 2,970 56,672 52.4
25-29 5,878 54,762 107.3
30-34 6,127 50,582 121.1
35-39 3,366 55,193 61.0
40-44 747** 56,900 13.1**
Total 19,877** 326,692 60.8**
* Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 2010. Canberra: ABS, 2010 (Catalogue No 3235.0).
** the number of live births and fertility rate for women aged 15-19 years include live births for younger ages, and the number and rate for women
aged 40-44 years include live births for older ages, while the total number and rate (general fertility rate) include all live births. Live births in this
table exclude terminations of pregnancy.
*** Sum of 5-year ASFRs = 369.9 per 1,000 women. Total fertility rate = 369.9 x 5 = 1,849.5 live births per 1,000 women = 1.85 live births per
woman.
5 Country of birth
The distribution of women by country of birth is provided in Table 5a by major group, and in Table 5b by specified
countries of birth that had 40 or more women who gave birth. Of the 21.2% of women born outside Australia, the
largest proportion was born in India (3.2% of women). This is the first time since country of birth was collected in
1991 that the main migrant group has not been from the United Kingdom and Ireland. Other countries contributing
relatively large proportions of migrant women were the United Kingdom and Ireland (2.9%), China (1.3%), Vietnam
(1.2%) New Zealand (1.0%), the Philippines (0.9%) Sudan (0.7%), Afghanistan, Cambodia, Malaysia (0.5% each),
South Africa (0.4%), South Korea, Indonesia, Thailand and the United States of America (0.3%), and Congo, Japan
and Pakistan, (0.2% each).
0%
20%
40%
60%
80%
100%
Caucasian
n=16,263
Aboriginal
n=625
Asian
n=1,894
Other
n=885
Total n
=19,667
Pe
rc
en
ta
g
e
o
f
w
o
m
en
14-19 20-24 25-29 30-34 35+ Age (years)
Pregnancy Outcome in South Australia 2010page 22
Mothers and Babies
Table 5a: Country of birth, major groups,* women who gave birth, South Australia, 2010
Country of birth Number %
1 Oceania and Antarctica 15,756 80.1
2 Europe and the USSR 1,003 5.1
3 The Middle East and North Africa 336 1.7
4 Southeast Asia 770 3.9
5 Northeast Asia 425 2.2
6 Southern Asia 874 4.4
7 Northern America 91 0.5
8 South America, Central America and the Caribbean 98 0.5
9 Africa (excluding North Africa) 314 1.6
Total 19,667 100.0
* Australian Bureau of Statistics. Australian Standard Classification of Countries for Social Statistics (ASCCSS). Canberra: ABS, 1990
(Catalogue No 1269.0).
Table 5b: Specified country of birth,* women who gave birth, South Australia, 2010
Specified country of birth Number
% of
women
% of migrant women who
gave birth (n=4,167)
1100 Australia 15,500 78.8 na
6104 India 630 3.2 15.1
2101-2107 UK & Ireland 577 2.9 13.8
5101 China 258 1.3 6.2
4110 Vietnam 230 1.2 5.5
1301 New Zealand 200 1.0 4.8
4107 Philippines 178 0.9 4.3
3207 Sudan 134 0.7 3.2
6101 Afghanistan 99 0.5 2.4
4102 Cambodia 92 0.5 2.2
4105 Malaysia 90 0.5 2.2
9220 South Africa 81 0.4 1.9
2504 Poland 63 0.3 1.5
5105 South Korea 63 0.3 1.5
4109 Thailand 59 0.3 1.4
4103 Indonesia 57 0.3 1.4
7104 USA 52 0.3 1.2
6107 Pakistan 48 0.2 1.2
5103 Japan 45 0.2 1.1
9106 Congo 40 0.2 1.0
All other countries 1,171 6.0 28.1
Total 19,667 100.0 100.0
* ASCCSS, Australian Bureau of Statistics
Pregnancy Outcome in South Australia 2010 page 23
Mothers and Babies
6 Marital status and type of patient
While 89.1% women who gave birth in 2010 were married or in a de facto relationship, 10.9% were single (9.6%
were never married and 1.3% were widowed, separated or divorced, Table 6a). Of never married women, a fifth
were teenagers and a third were 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 66.0%, Table 6b). Nearly a third of all
women were private patients (31.2%).
Table 6a: Marital status and age, women who gave birth, South Australia, 2010
Age
(years)
Marital status of women
TotalNever married Married/de facto
Widowed/
separated/divorced Unknown
Number % Number % Number % Number % Number %
<20 388 20.5 400 2.3 1 0.4 0 0.0 789 4.0
20-24 642 34.0 2,266 12.9 50 19.2 0 0.0 2,958 15.0
25-29 421 22.3 5,352 30.6 68 26.2 1 100.0 5,842 29.7
30-34 244 12.9 5,735 32.7 73 28.1 0 0.0 6,052 30.8
35-39 145 7.7 3,108 17.7 42 16.2 0 0.0 3,295 16.8
40-44 47 2.5 619 3.5 24 9.2 0 0.0 690 3.5
45+ 3 0.2 36 0.2 2 0.8 0 0.0 41 0.2
Total 1,890 9.6 17,516 89.1 260 1.3 1 0.0 19,667 100.0
Table 6b: Type of patient and marital status, women who gave birth, South Australia, 2010
Type of
patient
Marital status of women
TotalNever married Married/de facto
Widowed/
separated/divorced Unknown
Number % Number % Number % Number % Number %
Hospital/
public
1,734 91.7 11,565 66.0 238 91.5 1 100.0 13,538 68.8
Private 156 8.3 5,951 34.0 22 8.5 0 0.0 6,129 31.2
Total 1,890 9.6 17,516 89.1 260 1.3 1 0.0 19,667 100.0
Pregnancy Outcome in South Australia 2010page 24
Mothers and Babies
7 Occupation of father and mother
This categorisation 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 (24.5 v 0.5%) was included in the occupation home duties . Larger
proportions were also found for the groups of clerks and salespeople and personal service workers. More fathers were
managers and administrators, tradespeople, plant and machine operators and labourers. Occupation was unknown
for 9.6% of fathers and 3.6% of mothers.
Table 7: Occupation* of father and mother, women who gave birth, South Australia, 2010
Occupation
Father Mother
Number % Number %
1 Managers and administrators 3,126 15.9 1,451 7.4
2 Professionals 3,019 15.4 3,118 15.9
3 Para professionals 995 5.1 1,194 6.1
4 Tradespersons 3,447 17.5 601 3.1
5 Clerks 548 2.8 2,443 12.4
6 Salespersons and personal service workers 1,125 5.7 2,857 14.5
7 Plant and machine operators and drivers 1,220 6.2 96 0.5
8 Labourers and related workers 2,511 12.8 575 2.9
9 Students 509 2.6 871 4.4
Pensioners 104 0.5 42 0.2
Home duties 99 0.5 4,824 24.5
Unemployed 841 4.3 721 3.7
Other 234 1.2 164 0.8
Unknown 1,889 9.6 710 3.6
Total 19,667 100.0 19,667 100.0
* Australian Bureau of Statistics. ASCO. First Edition. Occupation Definitions. Canberra: ABS,1990. (Catalogue No. 1223.0).
Pregnancy Outcome in South Australia 2010 page 25
Mothers and Babies
8 Previous pregnancy outcomes
Forty-two percent of women had no previous birth and 31.0% were pregnant for the first time. Among Aboriginal
women and those of other races, these proportions were lower, with 33.3% and 33.3% respectively giving birth for
the first time. The proportion of women giving birth for the first time was the highest among Asian women (54.6%).
The proportion of women of parity 4 or greater was much higher among Aboriginal women (11.5%) and women of
other races (12.1%), than among Caucasian women (2.6%) and Asian women (1.6%) (Table 8a).
Table 8a: Parity by race, women who gave birth, South Australia, 2010
Parity
Race of women
TotalCaucasian Aboriginal Asian Other
Number % Number % Number % Number % Number %
0-primigravida 4924 30.3 147 23.5 779 41.1 242 27.3 6092 31.0
0-multigravida 1831 11.3 61 9.8 255 13.5 64 7.2 2211 11.2
1 5796 35.6 187 29.9 600 31.7 260 29.4 6843 34.8
2 2506 15.4 94 15.0 188 9.9 132 14.9 2920 14.8
3 789 4.9 64 10.2 43 2.3 80 9.0 976 5.0
4 250 1.5 29 4.6 18 1.0 40 4.5 337 1.7
?5 167 1.0 43 6.9 11 0.6 67 7.6 288 1.5
Total 16263 (82.7) 625 (3.2) 1894 (9.6) 885 (4.5) 19667 100.0
Among women with previous pregnancies (multigravid women), the proportions who had had previous specified
adverse pregnancy outcomes are shown in Table 8b. Just over a third of the women had had a miscarriage and a fifth
had had a termination of pregnancy.
Table 8b: Previous pregnancy outcomes, women who gave birth, South Australia, 2010
(multigravidae only, n= 13,575)
Previous pregnancy outcome Number %
Miscarriage 4,622 34.0
Termination of pregnancy 2,744 20.2
Stillbirth 212 1.6
Neonatal death 104 0.8
Ectopic pregnancy 283 2.1
Of the 11,364 women who had previously given birth, 3,435 (30.2%) had had a previous caesarean section.
Pregnancy Outcome in South Australia 2010page 26
Mothers and Babies
9a Gestation at first antenatal visit
In 2010 gestation at the first antenatal visit was reported as unknown for 9.2% of women (Table 9a). If these
women with an unknown number of visits are excluded, among the remaining women, 79.8% attended within
the first 14 weeks. This proportion was much lower for Aboriginal women (54.3%) than for non-Aboriginal women
(80.6%).
Table 9a: Gestation at first antenatal visit, women who gave birth, by race, South Australia, 2010 (n=19,667)
Gestation
at first
antenatal
visit
Race of women
TotalNon-Aboriginal Aboriginal
Number %
Adjusted %
(excluding
unknown )
(n=17,296) Number %
Adjusted %
(excluding
unknown )
(n=565) Number %
Adjusted %
(excluding
unknown )
(n=17,861)
<14 weeks
gestation
13,940 73.2 80.6 307 49.1 54.3 14,247 72.4 79.8
14 weeks or
greater*
3,356 17.6 19.4 258 41.3 45.7 3,614 18.4 20.2
Unknown 1,746 9.2 60 9.6 1,806 9.2
Total 19,042 96.8 100.0 625 3.2 100.0 19,667 100.0 100.0
*includes 24 women with no antenatal care
9b Body Mass Index (BMI)
Reported height and weight at the first antenatal visit were used to calculate the Body Mass Index (BMI, see Appendix
1) for women who gave birth. This was considered valid only for women who attended the first antenatal visit before
20 weeks gestation. Among these 16,815 women (85.5% of all women who gave birth), height and weight were
not reported for 2,794 women (16.6%), so that BMI could only be calculated for 14,021 women who gave birth in
2010 (71.3%). Table 9b shows that 7,058 women recorded a BMI >=25.0 (35.9% of all women giving birth), 3,285
(16.7%) had a BMI >=30.0, and 1,352 (6.9%) had a BMI >=35.0.
Table 9b: BMI of women who gave birth, South Australia, 2010
BMI
(based on height and weight at first antenatal visit where gestation
at first antenatal visit was <20 weeks) Number %
Adjusted %
(excluding unknown )
(n=14,021)
<18.5 (underweight) 436 2.6 3.1
18.5 24.9 (normal) 6,527 38.8 46.6
25.0 29.9 (overweight) 3,773 22.4 26.9
30.0 34.9 (obese) 1,933 11.5 13.8
35.0 39.9 (severely obese) 826 4.9 5.9
40 or more (morbidly obese) 526 3.1 3.8
Unknown 2,794 16.6
Total 16,815 100.0 100.0
Pregnancy Outcome in South Australia 2010 page 27
Mothers and Babies
9c Antenatal visits
Women who gave birth are grouped in Table 9c according to the number of reported antenatal visits: no visits, 1-6
visits, 7 or more visits. However, for 5.8% of women (8.6% of Aboriginal women), the number of antenatal visits
attended was not reported. If women for whom the number of antenatal visits was not reported are excluded, 29.9%
of Aboriginal women compared with 6.5% of Caucasian women were reported to have made less than 7 visits.
Among Asian women this proportion was 11.4%. A low frequency of antenatal visits may be taken, particularly in
term births, as an indication of inadequate antenatal care. It is hoped that the proportion of unknown number of
antenatal visits will continue to be reduced by wider use of the Pregnancy Record,5 which will also facilitate continuity
of care.
Table 9c: Antenatal visits by race, women who gave birth, South Australia, 2010
Antenatal visits
Race of women
TotalCaucasian Aboriginal Asian Other
Number % Number % Number % Number % Number %
None 16 0.1 8 1.3 0 0.0 0 0.0 24 0.1
1-6 976 6.0 163 26.1 202 10.7 112 12.7 1,453 7.4
?7 14,332 88.1 400 64.0 1,565 82.6 717 81.0 17,014 86.5
Unknown 939 5.8 54 8.6 127 6.7 56 6.3 1,176 6.0
Total 16,263 82.7 625 3.2 1,894 9.6 885 4.5 19,667 100.0
9d Type of antenatal care
Table 9d shows that the main types of antenatal care used were hospital clinics (45.4%), obstetricians in private
practice (31.2%), general practitioners (15.0%) and birth centres (7.9%). Individual women may have used more than
one type of antenatal care. There were 24 women (0.1%) who had no antenatal care.
Table 9d: Type of antenatal care, women who gave birth, South Australia, 2010 (n = 19,667)
Type of care Number %
No antenatal care 24 0.1
Hospital clinic 8,931 45.4
Obstetrician in private practice 6,143 31.2
General practitioner (GP) 2,958 15.0
Birth centre 1,558 7.9
GP/midwife (shared care) 1,495 7.6
Midwifery Group Practice (W&CH) 928 4.7
Obstetrician/midwife (shared care) in private practice 383 1.9
Home birth midwife 123 0.6
Northern Women s Community Health Centre (NWCHC) 118 0.6
Team midwifery Pt Pirie 38 0.2
Midwifery group practice Gawler 138 0.7
ABBP (Anangu Bibi Family Birthing program Pt Augusta) 55 0.3
RFBP (Regional Family Birthing Program at Whyalla) 14 0.1
Other 46 0.2
Not stated 31 0.2
Pregnancy Outcome in South Australia 2010page 28
Mothers and Babies
10 Smoking
Table 10a shows that 13.5% of all women were reported to be smokers at their first antenatal visit, and 3.9% had
quit smoking before their first visit. Smoking status was unknown for 1.4% of women. The proportion of all women
smoking during pregnancy has been declining in the state, from 25% in 1998 to 13.5% in 2009 and 2010.
The proportion of Aboriginal women who reported that they smoked at the first antenatal visit (52.8%) was lower
than the past decade, with the highest rate (61.2%) reported in 2005. However, this was considerably higher
than non-Aboriginal women (12.2%). Additionally, 4.8% of Aboriginal women reported that they quit smoking in
pregnancy prior to their first antenatal visit, compared with 3.9% of non-Aboriginal women.
Among age groups, the highest rates of smoking were among teenagers (32.6%) and women aged 20-24 years
(24.2%). Smoking rates were high among all age groups of Aboriginal women varying from 44.1% among teenage
women to 56.1% among those aged 20-24 years.
In the second half of pregnancy (Table 10b), 11.9% of women (2,338 women) were reported to be smokers and
0.5% (89 women) smoked more than 20 cigarettes per day, but the number of cigarettes smoked was not known
for 2.1% of women. In the second half of pregnancy, 49.1% of Aboriginal women smoked, compared with 10.7%
of non-Aboriginal women. A higher proportion of Aboriginal women (2.1% compared with 0.4%) also smoked more
than 20 cigarettes per day, but the number of cigarettes smoked was not known for 5.3% of Aboriginal women and
2.0% of non-Aboriginal women.
Table 10a: Tobacco smoking status at first antenatal visit, non-Aboriginal and Aboriginal women who gave
birth, South Australia, 2010
Smoking status
Non-Aboriginal Aboriginal Total
Number % Number % Number %
Smoker 2,330 12.2 330 52.8 2,660 13.5
Quit before 1st visit 740 3.9 30 4.8 770 3.9
Non-smoker 15,706 82.5 251 40.2 15,957 81.1
Unknown smoking status 266 1.4 14 2.2 280 1.4
Total 19,042 96.8 625 3.2 19,667 100.0
Table 10b: Average number of tobacco cigarettes smoked per day in the second half of pregnancy, non-
Aboriginal and Aboriginal women who gave birth, South Australia, 2010
Average number of tobacco
cigarettes smoked per day
Non-Aboriginal Aboriginal Total
Number % Number % Number %
None 16,633 87.3 285 45.6 16,918 86.0
Occasional (<1) 45 0.2 3 0.5 48 0.2
1-10 1,376 7.2 220 35.2 1,596 8.1
11-20 534 2.8 71 11.4 605 3.1
21-30 71 0.4 10 1.6 81 0.4
31-40 4 0.0 3 0.5 7 0.0
41+ 1 0.0 0 0.0 1 0.0
Unknown 378 2.0 33 5.3 411 2.1
Total 19,042 96.8 625 3.2 19,667 100.0
Pregnancy Outcome in South Australia 2010 page 29
Mothers and Babies
11 Medical conditions
Medical conditions were recorded in the current pregnancy for 7,187 women (36.5%). The frequencies of specified
medical conditions are provided in Table 11. Up to four conditions can be reported for each pregnancy.
Table 11: Medical conditions in current pregnancy, women who gave birth, South Australia, 2010
Medical condition Number % of women (n = 19,667)
1 None 12,480 63.5
2 Anaemia 1,236 6.3
3 Urinary tract infection 550 2.8
4 Hypertension (pre-existing) 210 1.1
5 Diabetes (pre-existing) 129 0.7
6 Epilepsy 106 0.5
7 Asthma 1,217 6.2
8 Other 5,148 26.2
12 Obstetric complications
Obstetric complications were recorded for 6,713 women who gave birth (34.1%). The reported frequencies of the
more common complications are presented in Table 12. Up to four complications can be reported for each pregnancy.
There was one direct maternal death in 2010 (see definition in Appendix 1) notified to the Maternal, Perinatal and
Infant Mortality Committee in 2010.3
Table 12: Frequency of some obstetric complications, women who gave birth, South Australia, 2010
Obstetric complication Number % of women (n= 19,667)
No complication 12,954 65.9
Threatened miscarriage 292 1.5
Antepartum haemorrhage (APH) - Abruption 116 0.6
APH Placenta praevia 98 0.5
APH Other & unknown causes 488 2.5
Pregnancy hypertension 1,383 7.0
Intrauterine growth restriction (suspected) 811 4.1
Gestational diabetes 1,092 5.6
Other complications (including 4 women with impaired glucose tolerance) 3,932 20.0
Pregnancy Outcome in South Australia 2010page 30
Mothers and Babies
13 Procedures performed in current pregnancy
Procedures performed are listed as reported in Table 13. At least one ultrasound examination was performed for
99.1% of women, amniocentesis for 3.6% and chorion villus sampling for 0.6%.
For a proportion of women, it was not known whether a specific procedure had been performed, eg 1.0% for
maternal serum alpha feto-protein (MSAFP) screening. It is hoped that the increasing use of the Pregnancy Record will
reduce the number of unknown entries. The listing of procedures on the Supplementary Birth Record will also be
improved, eg to distinguish first from second trimester Down syndrome screening.
Table 13: Procedures performed in current pregnancy, women who gave birth, South Australia, 2010
Procedure
Yes No Unknown
Number % Number % Number %
MSAFP (Neural tube defect screen etc) 4,325 22.0 15,145 77.0 197 1.0
Triple/Quadruple screen (Down syndrome etc) 13,272 67.5 6,204 31.5 191 1.0
Ultrasound 19,487 99.1 123 0.6 57 0.3
Chorion villus sampling 164 0.8 19,383 98.6 120 0.6
Amniocentesis 704 3.6 18,842 95.8 121 0.6
Cordocentesis 7 0.0 19,541 99.4 119 0.6
Other surgical procedure 114 0.6 19,553 99.4 0 0.0
14a Onset of labour
Labour occurred spontaneously in 53.0% of women who gave birth (Table 14a). It was induced in 29.6%, and the
methods of induction used were artificial rupture of membranes (ARM) in 67.1% of inductions, prostaglandins in
58.4% and oxytocics in 53.2% (Table 14b). In many cases more than one method was used.
Table 14a: Onset of labour, women who gave birth, South Australia, 2010
Onset of labour Number %
Spontaneous 10,417 53.0
No labour caesarean section 3,425 17.4
Induction 5,825 29.6
Total 19,667 100.0
Table 14b: Method of induction of labour, women who gave birth, South Australia, 2010
Method of induction Number
% of women
(n =19,667)
% of inductions
(n =5,825)
No induction 13,842 70.4
ARM 3,906 19.9 67.1
Oxytocics 3,095 15.7 53.2
Prostaglandins 3,400 17.3 58.4
Pregnancy Outcome in South Australia 2010 page 31
Mothers and Babies
14b Reasons for induction of labour
Up to two reasons could be provided for induction. These reasons for induction of labour are defined (see page 55) in
The Australian Council on Healthcare Standards Obstetrics Indicators Clinical Indicator Users Manual Version 5 for
use in 2007 .
Figure 4 demonstrates that 18.6% of women were induced for prolonged pregnancy (41 or more completed weeks),
14.1% for hypertension, 6.8% for diabetes (including gestational diabetes and glucose intolerance), 7.0% for
intrauterine growth restriction (IUGR) and 5.4% for premature rupture of membranes (PROM). Other defined reasons
accounted for smaller proportions. Other than defined reasons accounted for 52.3%.
Figure 4: Reasons for induction of labour, SA, 2010 (n=5,825)
The proportion of women giving birth who had labour augmented was 21.4%. Of the 10,417 women who went
into spontaneous labour, augmentation was used for 4,209 (40.4%). Methods used in augmentation were artificial
rupture of membranes (ARM) (74.2%), oxytocics (40.7%) and prostaglandins (0.7%). More than one method may be
used. It should be noted that prostaglandins are not recommended by the manufacturers as a method of augmenting
labour.
Table 14c: Augmentation of labour after spontaneous onset, women who gave birth, South Australia, 2010
Method of augmentation Number % of women (n=19,667) % of augmentations (n=4,209)
Any augmentation 4,209 21.4 100.0
1 ARM 3,121 15.9 74.2
2 Oxytocics 1,712 8.7 40.7
3 Prostaglandins 29 0.1 0.7
0 10 20 30 40 50 60
Other
Prolonged pregnancy
Chorioamnionitis
Fetal death
Fetal distress
Isoimmunisation
IUGR
Hypertensive disorders
PROM
Diabetes*
Percentage
*includes diabetes mellitus, gestational diabetes and glucose intolerance
Pregnancy Outcome in South Australia 2010page 32
Mothers and Babies
15a Presentation and method of birth
Of the women who gave birth, 55.2% had normal spontaneous vaginal births (Table 15a and Figure 5a). Caesarean
section was performed for 32.2% of women, with 15.5% of women having elective sections; forceps were utilised
for 5.4%, ventouse for 6.9% and breech birth for the remaining 0.3%. The method of birth given for women who
had multiple births is that for the first birth. The method of birth by presentation for all births is provided in Table 15b.
Breech presentation occurred in 4.5% of births and caesarean section was the method of birth for 90.6% of breech
presentations. Caesarean section was utilised for 91.9% of breech presentations in singletons (Table 15c).
Table 15a: Method of birth, women who gave birth, South Australia, 2010
Method of birth Number %
Normal spontaneous vaginal 10,861 55.2
Forceps 1,061 5.4
Assisted breech (no forceps) 20 0.1
Caesarean section (elective) 3,041 15.5
Caesarean section (emergency) 3,282 16.7
Ventouse 1,358 6.9
Breech extraction 6 0.0
Breech spontaneous 37 0.2
Assisted breech (with forceps for head) 1 0.0
Total 19,667 100.0
Figure 5a: Method of birth, women who gave birth, South Australia, 2010 (n = 19,667)
Ventouse (6.9%)
Caesarean section
(32.2%)
Forceps (5.4%)
Breech delivery (0.3%)
Normal
spontaneous
vaginal (55.2%)
Pregnancy Outcome in South Australia 2010 page 33
Mothers and Babies
Table 15b: Method of birth by presentation, all births, South Australian 2010 (n=20,2002)
Method of birth
Presentation
TotalVertex Breech Other Unknown
Number % Number % Number % Number % Number %
Normal
spontaneous
10,866 57.6 0 0.0 36 19.0 11 36.7 10,913 54.6
Forceps 1,060 5.6 0 0.0 7 3.7 2 6.7 1,069 5.3
Assisted breech
(no forceps)
0 0.0 24 2.6 0 0.0 0 0.0 24 0.1
Elective caesarean 2,607 13.8 505 55.7 44 23.3 5 16.7 3,161 15.8
Emergency
caesarean
2,982 15.8 316 34.9 92 48.7 10 33.3 3,400 17.0
Ventouse 1,362 7.2 0 0.0 9 4.8 1 3.3 1,372 6.9
Breech extraction 0 0.0 19 2.1 0 0.0 0 0.0 19 0.1
Breech
spontaneous
0 0.0 41 4.5 1 0.5 1 3.3 43 0.2
Assisted breech
(forceps)
0 0.0 1 0.1 0 0.0 0 0.0 1 0.0
Total 18,877 94.4 906 4.5 189 0.9 30 0.1 20,002 100.0
Table 15c: Method of birth in breech presentation, by plurality, all births, South Australia, 2010 (n = 906)
Plurality
Assisted*
breech
Elective
caesarean
Emergency
caesarean
Breech
extraction
Breech
spontaneous
Total
Singleton 19* 418 240 5 34 716
Twins 6 79 74 14 7 180
Triplets 0 4 2 0 0 6
Quads 0 4 0 0 0 4
Total 25 505 316 19 41 906
* in one of the assisted breech births forceps were applied to the head.
Pregnancy Outcome in South Australia 2010page 34
Mothers and Babies
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 caesarean sections only) and Figure 5d (emergency
caesarean sections only). The main reasons given for all caesarean sections were previous caesarean section (38.3%),
failure to progress/cephalopelvic disproportion (CPD) (28.0%), fetal distress (15.3%) and malpresentation (11.6%).
The main reasons for elective sections were previous caesarean section (66.6%), malpresentation (13.7%) and
multiple pregnancy (3.1%), and the main reasons given for emergency sections were failure to progress or CPD
(51.5%), fetal distress (29.4%), previous caesarean section (12.1%) and malpresentation (9.6%).
Figure 5b: Reason for caesarean section, 2010 (n=6,323)
Figure 5c: Reason for elective caesarean section, 2010 (n=3,041)
0 10 20 30 40 50 60
Other
IUGR
Multiple pregnancy
APH
Pregnancy hypertension/hypertension
Malpresentation
Fetal distress
Previous caesarean
CPD/Failure to progress
Percentage
0 10 20 30 40 50 60 70
Other
IUGR
Multiple pregnancy
APH
Pregnancy hypertension/hypertension
Malpresentation
Fetal distress
Previous caesarean
CPD
Percentage
Pregnancy Outcome in South Australia 2010 page 35
Mothers and Babies
Figure 5d: Reason for emergency caesarean section, 2010 (n=3,282)
16 Complications of labour and birth and perineal status after birth
Complications of labour or birth were recorded for 7,273 women who gave birth (37.0%). Up to four complications
can be recorded. The reported frequency of some complications is presented in Table 16. Among all 19,667 women
who gave birth, episiotomy was performed for 2,482 (12.6%). Among the 13,344 women who gave birth vaginally,
3,552 (26.6%) had an intact perineum after birth, 5,725 (42.9%) had a repair of a perineal tear, of whom 450 (3.4%)
had a third or a fourth degree tear; 18.5% had an episiotomy.
Table 16: Frequency of some complications of labour and birth, women who gave birth, South Australia, 2010
Complication of labour Number of women % of women (n=19,667)
None 12,394 63.0
Post-partum haemorrhage (PPH) primary (amount not specified) 43 0.2
PPH - 600-999ml 1,263 6.4
PPH 1,000 ml or more 777 4.0
Fetal distress 2,289 11.6
Retained placenta 294 1.5
Prolonged labour 204 1.0
Cord prolapse 31 0.2
Wound infection 33 0.2
Third degree tear (391) or fourth degree tear (31) 450 2.3
Failure to progress 2,587 13.2
Other 4,710 23.9
0 10 20 30 40 50 60
Other
IUGR
Multiple pregnancy
APH
Pregnancy hypertension/hypertension
Malpresentation
Fetal distress
Previous caesarean
CPD/Failure to progress
Percentage
Pregnancy Outcome in South Australia 2010page 36
Mothers and Babies
17 Fetal monitoring during labour
Cardiotocography (CTG) was performed during labour for 63.6% of women who gave birth. The majority of these
(51.9% of women) were external CTGs (Table 17a) while a scalp clip was used for 11.7%.
A fetal scalp pH was taken during labour in 186 women who gave birth (0.9%, Table 17b).
Table 17a: CTG performed during labour, women who gave birth, South Australia, 2010
CTG during labour Number of women % of women (n=19,667)
1 None 7,158 36.4
2 External 10,206 51.9
3 Scalp clip 2,303 11.7
Table 17b: Fetal scalp pH taken during labour, women who gave birth, South Australia, 2010
Fetal scalp pH taken Number of women % of women (n=19,667)
1 No 19,481 99.1
2 Yes 186 0.9
18 Analgesia for labour and anaesthesia for birth
These distributions are provided in Tables 18a and 18b. Epidurals were used for analgesia in labour for 31.7% and
for anaesthesia for birth for 26.7% of women. The proportion of women who had an epidural for either was 33.0%
(6,486 women). The proportion of women who had a spinal anaesthetic increased between 1991 and 2010 from
0.2% to 0.8% for analgesia and from 0.5% to 23.1% for anaesthesia. General anaesthesia was used for 2.1% of
births. It was used in 6.3% of caesarean sections. Approximately 36% of women who gave birth received none of the
specified methods for analgesia during labour.
Table 18a: Analgesia for labour,* women who gave birth, South Australia, 2010
Analgesia Number % of women
1 None 7,064 35.9
2 Nitrous oxide and oxygen 7,689 39.1
3 Narcotic (parenteral) 3,563 18.1
4 Epidural (lumbar/caudal) 6,237 31.7
5 Spinal 154 0.8
6 Other 344 1.7
7 Combined spinal-epidural 14 0.1
* more than one method may be used for each woman
Pregnancy Outcome in South Australia 2010 page 37
Mothers and Babies
Table 18b: Anaesthesia for birth,* women who gave birth, South Australia, 2010
Anaesthesia Number % of women
1 None 6,926 35.2
2 Local anaesthesia 2,658 13.5
3 Pudendal 199 1.0
4 Epidural (lumbar/caudal) 5,259 26.7
5 Spinal 4,537 23.1
6 General anaesthesia 408 2.1
7 Other 170 0.9
8 Combined spinal-epidural 85 0.4
* more than one method may be used for each woman
19 Postnatal length of stay of women
The distribution of length of stay of women who gave birth in hospitals is presented in Table 19a for public and
private patients. The median duration for all women was three days. It was three days for vaginal births and four days
for caesarean section births (Table 19b). The median duration of stay was two days longer for private patients for
vaginal and one day longer for caesarean births (four and five days respectively for private patients compared with
two and four days respectively for public patients).
Table 19a: Postnatal length of stay by type of patient, women who gave birth in South Australian hospitals, 2010
Postnatal length of stay (days)
Public Private Total
Number % Number % Number %
<1 767 5.7 27 0.4 794 4.1
1 2,321 17.2 77 1.3 2,398 12.3
2 3,369 25.0 236 3.9 3,605 18.5
3 3,137 23.3 736 12.2 3,873 19.8
4 2,162 16.0 2,443 40.4 4,605 23.6
5 1,104 8.2 1,761 29.1 2,865 14.7
6 314 2.3 545 9.0 859 4.4
7 or more 304 2.3 222 3.7 526 2.7
Total 13,478 100.0 6,047 100.0 19,525 100.0
Pregnancy Outcome in South Australia 2010page 38
Mothers and Babies
Table 19b: Average postnatal length of stay by type of patient & type of birth, women who gave birth in
South Australian hospitals, 2010
Average length
of stay
Public Private Total
Vaginal
(n=9,608)
Caesarean
(n=3,870)
Total
(n=13,478)
Vaginal
(n=3,594)
Caesarean
(n=2,453)
Total
(n=6,047)
Vaginal
(n=13,202)
Caesarean
(n=6,323)
Total
(n=19,525)
Mean number of
days
2.23 4.12 2.78 3.90 5.08 4.38 2.69 4.50 3.27
( SD) ( 1.85) ( 1.89) ( 2.05) ( 2.33) ( 1.17) ( 2.03) ( 2.13) ( 1.71) ( 2.17)
Median number
of days
2 4 3 4 5 4 3 4 3
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, all births, South Australia, 2010
Sex of baby Number %
Male 10,306 51.5
Female 9,696 48.5
Total 20,002 100.0
21 Birthweight and gestation
The birthweight distribution of all births is presented in Table 21. The percentage of low birthweight babies (<2,500g)
was 7.2%, and that of very low birthweight babies (<1,500g) was 1.5%. The mean birthweight was 3,331g (SD
618.1g), with birthweights ranging from 60g to 6260g. The proportion of low birthweight babies was 16.3% among
babies of Aboriginal women compared with 6.9% among babies of non-Aboriginal women. Among live born babies,
these proportions were 16.0% and 6.5% respectively.
Table 21: Birthweight distribution of all births, South Australia, 2010
Birthweight (g) Number of births Percentage of births
<400 54 0.3
400-499 15 0.1
500-749 55 0.3
750-999 52 0.3
1,000-1,499 119 0.6
1,500-1,999 298 1.5
2,000-2,499 849 4.2
2,500-2,999 3,182 15.9
3,000-3,499 7,226 36.1
3,500-3,999 5,950 29.7
4,000-4,499 1,885 9.4
4,500+ 316 1.6
Unknown 1 0.0
Total 20,002 100.0
Pregnancy Outcome in South Australia 2010 page 39
Mothers and Babies
In 2010, 1,442 babies (7.2%) were of low birthweight and 1,773 (8.9%) were preterm (<37 weeks gestation). The
proportion of preterm births was 17.1% among babies of Aboriginal women compared with 8.6% among babies of
non-Aboriginal women.
22 Birth injuries
Birth injuries were reported in 167 live births (0.8%). The most common injury reported was cephalhaematoma.
Fracture and nerve injury occurred less frequently (Table 22).
Table 22: Birth injuries* in 19,883 live births, South Australia, 2010
Birth injury Number of live births % of live births
None 19,716 99.2
Fracture 13 0.1
Nerve Injury 13 0.1
Cephalhaematoma 107 0.5
Other 46 0.2
*more than one injury may be reported for 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, which
shows that 84.2% of neonates did not receive any of these treatments.
Table 23: Neonatal treatment given, all live births, South Australia, 2010
Neonatal treatment Number % of live births
None of the treatments listed below 16,738 84.2
Oxygen therapy for more than 4 hours 897 4.5
Phototherapy for jaundice 1,393 7.0
Gavage feeding more than once 1,590 8.0
Any intravenous therapy 1,977 9.9
24 Level of care utilised
Table 24 shows that 83.8% of neonates utilised Level I care only. Level II care was used by 16.0% of neonates, Level
III care at the Women s and Children s Hospital or Flinders Medical Centre by 2.5% 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.
Pregnancy Outcome in South Australia 2010page 40
Mothers and Babies
Table 24: Level of nursery care utilised by birthweight, all live births, South Australia, 2010
Level of care utilised
Birthweight (g)
<1,500
(n=219)
1,500-2,499
(n=1,131)
2,500+
(n=18,532) Unknown
Total
(n=19,883)
Number % Number % Number % Number % Number %
Level I only 18 8.2 231 20.4 16,417 88.6 1 100.0 16,667 83.8
Level II 188 85.8 896 79.2 2,100 11.3 0 0.0 3,184 16.0
Level III (W&CH & FMC) 183 83.6 163 14.4 157 0.8 0 0.0 503 2.5
Level III (W&CH
Paediatric intensive care)
3 1.4 4 0.4 30 0.2 0 0.0 37 0.2
25 Length of stay of babies
Table 25 shows the distribution of length of stay of liveborn babies in hospital for preterm (<37 weeks gestation) and
term births (?37 weeks gestation). The mean duration of stay for all liveborn babies was 5.0 days (SD 10.79) and
the median duration 3 days. The mean duration was 3.4 days (SD 5.29) for term births and 21.9 days (SD 27.54) for
preterm births, while the median durations were 3 and 14 days respectively.
Table 25: Length of stay of liveborn babies in hospital, South Australia, 2010
Length of stay (days)
Preterm births Term births Total
Number % Number % Number %
<1 22 1.3 729 4.0 751 3.8
1 18 1.1 2,226 12.3 2,244 11.4
2 55 3.3 3,292 18.2 3,347 17.0
3 81 4.8 3,551 19.7 3,632 18.4
4 109 6.5 4,270 23.6 4,379 22.2
5 146 8.7 2,622 14.5 2,768 14.0
6 89 5.3 762 4.2 851 4.3
7-13 313 18.7 497 2.8 810 4.1
14-20 266 15.9 65 0.4 331 1.7
21-27 216 12.9 28 0.2 244 1.2
28 or more 360 21.5 23 0.1 383 1.9
Total 1,675 100.0 18,065 100.0 19,740 100.0
26 Congenital anomalies
Among the 20,002 births in 2010 there were 562 births (2.8%) notified with congenital anomalies, compared with
an average of 2.5% over the past decade.; 527 (2.6%) 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 4-digit classification of the ICD-9 (International Classification of Diseases. Manual of the International
Statistical Classification of Diseases, Injuries and Causes of Death, 1975 Revision. Geneva: World Health Organisation,
1977). Table 26 includes births with the more readily identifiable defects used for international monitoring (sentinel
defects) notified to the perinatal statistics collection in 2000-2010.
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 five 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.2
Pregnancy Outcome in South Australia 2010 page 41
Mothers and Babies
In 2010 the number of spina bifida cases reported at birth decreased from 18 cases in 2009 to 11 in 2010. Following
a statewide campaign to promote periconceptional folate in 1994 and 1995 the use of folate supplementation in
pregnancy increased, and rates of neural tube defects decreased.2 It is important to ensure that all women continue
to use supplementary folate periconceptually.
Table 26: Selected congenital abnormalities notified to the perinatal statistics collection, 2000-2010, South
Australia
Congenital abnormality Year
BPA* CODE 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Number of births = 17,871 17,704 17,745 17,844 17,522 18,196 18,803 19,757 19,970 19,901 20,002
74000-74029 Anencephalus 3 1 4 0 1 0 1 1 1 3 1
74100-74199 Spina bifida 5 9 4 7 5 5 8 5 4 18 11
74200-74209 Encephalocele 0 0 1 0 0 1 1 2 1 0 1
74230-74239 Hydrocephalus 4 4 3 7 6 9 10 12 11 14 4
74900-74909 Cleft palate 10 14 17 9 10 15 11 12 9 11 12
74910-74929 Cleft lip and palate
(Total cleft lip)
16 15 16 14 17 9 16 30 28 25 18
75030-75038 Tracheo-
oesophageal fistula, oesophageal
atresia and stenosis
2 10 3 2 2 5 4 12 5 6 3
75120-75124 Atresia and stenosis
of large intestine, rectum and anal
canal
9 3 9 6 6 12 4 7 9 7 9
75260-75261 Hypospadias and
epispadias
40 40 42 34 41 38 29 41 40 39 44
75300-75301 Renal agenesis and
dysgenesis
5 7 5 10 4 12 8 8 3 11 8
75520-75549 Limb reduction
defects
11 6 7 5 8 8 13 18 9 8 13
75660-75669 Anomalies of
diaphragm
7 6 7 4 4 7 12 7 9 9 6
75670-75679 Anomalies of
abdominal wall
8 13 10 13 12 9 10 7 9 17 7
75800-75809 Down syndrome 19 21 19 13 14 19 17 17 21 22 14
* British Paediatric Association Classification of Diseases. London: The British Paediatric Association, 1979.
27 Multiple births
Among women who gave birth there were 322 twin and 5 triplet pregnancies and 1 quadruplet pregnancy compared
with 19,339 singleton ones in 2010. Thus there was one twin pregnancy in every 61 pregnancies, one triplet
pregnancy in every 3,933 pregnancies among women who gave birth. Women who gave birth with twins, triplets
or quads comprised 1.7% of all women who gave birth. The total number of multiple births was 663 (3.3% of total
births).
A comparison of multiple births with singleton ones shows that multiple births were of lower birthweight (with
54.1% being of low birthweight compared with 5.6% for singletons, Table 27a), and gestation (with 58.4% being
preterm births compared with 7.2% for singletons, Table 27b). The proportion of live births in hospital at 28 days was
19.3% for multiple births compared with 1.5% for singletons. The perinatal death rate for multiple births was 9.0
compared with 8.1 deaths per 1,000 births for singletons, Table 27c).
Pregnancy Outcome in South Australia 2010page 42
Mothers and Babies
Table 27a: Birthweight by plurality, all births, South Australia, 2010
Birthweight (g)
Singleton births Multiple births
Number % Number %
<400 51 0.3 3 0.5
400-499 14 0.1 1 0.2
500-749 42 0.2 13 2.0
750-999 32 0.2 20 3.0
1,000-1,499 83 0.4 36 5.4
1,500-1,999 213 1.1 85 12.8
2,000-2,499 648 3.4 201 30.3
2,500-2,999 2,949 15.2 233 35.1
3,000-3,499 7,162 37.0 64 9.7
3,500-3,999 5,943 30.7 7 1.1
4,000-4,499 1,885 9.7 0 0.0
4,500+ 316 1.6 0 0.0
Unknown 1 0.0 0 0.0
Total 19339 100.0 663 100.0
Table 27b: Gestation at birth by plurality all births, South Australia, 2010
Gestation (weeks)
Singleton births Multiple births Total
Number % Number % Number %
<24 75 0.4 9 1.4 84 0.4
24-27 67 0.3 23 3.5 90 0.4
28-31 116 0.6 46 6.9 162 0.8
32-36 1,128 5.8 309 46.6 1,437 7.2
37-41 17,899 92.6 276 41.6 18,175 90.9
42+ 54 0.3 0 0.0 54 0.3
Total 19,339 100.0 663 100.0 20,002 100.0
Table 27c: Perinatal outcome by plurality, all births, South Australia, 2010
Perinatal outcome
Singleton births Multiple births Total
Number % Number % Number %
Stillbirth 118 0.6 1 0.2 119 0.6
Discharged within 28 days 18,900 97.7 529 79.8 19,429 97.1
In hospital at 28 days 282 1.5 128 19.3 410 2.0
Neonatal death 39 0.2 5 0.8 44 0.2
Total 19,339 100.0 663 100.0 20,002 100.0
Pregnancy Outcome in South Australia 2010 page 43
Mothers and Babies
28 Perinatal mortality
High crude perinatal mortality rates were associated with low birthweight births (Table 28a), low gestation births
(Table 28b) and multiple births (Table 27c). The perinatal mortality rate for all births (livebirths of any gestation and
stillbirths of at least 400g birthweight/20 weeks gestation) in 2010 was 8.1 per 1,000 births. The stillbirth rate was
5.9 per 1,000 births and the neonatal mortality rate was 2.2 per 1,000 live births.
The relationship between perinatal mortality and birthweight is demonstrated in Table 28a and Figure 6. The highest
perinatal mortality rate was observed for the lowest birthweight group weighing <500g (985.5 per 1,000). The
lowest perinatal mortality rate of 1.1 per 1,000 births was observed for births weighing 4,000-4,499g. The perinatal
mortality rate for the birthweight group 3,500 3,999g was 1.2 per 1,000 births, and the 4,500+g birthweight group
was 6.3 per 1000 births. The perinatal mortality rate for babies of normal birthweight (2,500g or more) was 2.2 per
1,000 births. The decline in perinatal mortality with increasing gestational age is demonstrated in Table 28b.
Table 28a: Perinatal mortality by birthweight, all births, South Australia, 2010
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
<400 54 11 43 796.3 10 909.1 53 981.5
400-499 15 6 9 600.0 6 1,000.0 15 1000.0
500-749 55 40 15 272.7 2 50.0 17 309.1
750-999 52 49 3 57.7 5 102.0 8 153.8
1,000-1,499 119 113 6 50.4 2 17.7 8 67.2
1,500-1,999 298 289 9 30.2 3 10.4 12 40.3
2,000-2,499 849 842 7 8.2 3 3.6 10 11.8
2,500-2,999 3,182 3,171 11 3.5 2 0.6 13 4.1
3,000-3,499 7,226 7,218 8 1.1 8 1.1 16 2.2
3,500-3,999 5,950 5,945 5 0.8 2 0.3 7 1.2
4,000-4,499 1,885 1,884 1 0.5 1 0.5 2 1.1
4,500+ 316 314 2 6.3 0 0.0 2 6.3
Unknown 1 1 0 0.0 0 0.0 0 0.0
Total 20,002 19,883 119 5.9 44 2.2 163 8.1
Figure 6: Perinatal mortality rate by birthweight, all births, South Australia, 2010
0.1
1
10
100
1000
<5
00 50
0-
75
0-
10
00
-
15
00
-
20
00
-
25
00
-
30
00
-
35
00
-
40
00
-
45
00
+
Birthweight (g)
Pe
ri
n
at
al
d
ea
th
s
p
er
1
,0
00
b
ir
th
s
(
lo
g
ar
it
h
m
ic
sc
al
e)
Pregnancy Outcome in South Australia 2010page 44
Mothers and Babies
Table 28b: Perinatal mortality by gestational age at birth, South Australia, 2010
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
<24 84 26 58 690.5 18 692.3 76 904.8
24-27 90 80 10 111.1 6 75.0 16 177.8
28-31 162 153 9 55.6 3 19.6 12 74.1
32-36 1,437 1,418 19 13.2 5 3.5 24 16.7
37-41 18,175 18,152 23 1.3 12 0.7 35 1.9
42+ 54 54 0 0.0 0 0.0 0 0.0
Total 20,002 19,883 119 5.9 44 2.2 163 8.1
The perinatal mortality rates for other specified minimum birthweights or gestational ages (where birthweight was
unavailable) are provided in Table 28c. The perinatal mortality rate recommended by the World Health Organisation
(WHO) for use in international comparison refers only to stillbirths of at least 1,000g birthweight (or, if birthweight
is unavailable, 28 weeks gestation) and to (early) neonatal deaths within the first 7 days of life. This rate was 3.2
per 1,000 births in 2010, with a stillbirth rate of 2.5 per 1,000 births and an early neonatal mortality rate of 0.7 per
1,000 live births. The perinatal mortality rate for births to Aboriginal women declined to 9.5 per 1,000 births in 2010
compared with 8.1 per 1,000 births for births to non-Aboriginal women (Table 28d). This was lower than the previous
year s rate of 14.6 in 2009 and 23.5 per 1000 in 2008, however, due to the small numbers involved; the perinatal
mortality rate for Aboriginal births may fluctuate considerably from year to year.
Table 28c: Perinatal mortality, South Australia, 2010 (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* 20,002 19,883 119 5.9 44 2.2 163 8.1
?500g/22 weeks 19,993 19,866 67 3.4 28 1.4 95 4.8
(WHO National
Statistics)
20** 1.0 87** 4.4
?1,000g/28 weeks 19,826 19,777 49 2.5 21 1.1 70 3.5
(WHO International
Statistics)
14** 0.7 63** 3.2
* includes live births of any gestation. There were 54 births of birthweight <400g
** only neonatal deaths within the first 7 days of life are included
Pregnancy Outcome in South Australia 2010 page 45
Mothers and Babies
Table 28d: Perinatal mortality by race, all births, South Australia, 2010
Race
Total births Stillbirths Neonatal deaths Alive at 28 days Perinatal deaths
Number Number Number Number Number
Deaths
per 1,000
births
Caucasian 16,558 90 31 16,437 121 7.3
Aboriginal 630 5 1 624 6 9.5
Asian 1,916 17 7 1,892 24 12.5
Other 898 7 5 886 12 13.4
Total 20,002 119 44 19,839 163 8.1
29 Home births
Supplementary Birth Records were received from home birth midwives regarding 136 women for 138 planned home
births which occurred at home in 2010. There were six unplanned home births in South Australia in 2010 which have
been excluded from the planned home birth statistics. These six women received antenatal care with the Midwifery
Group Practice at the Women s and Children s Hospital or the Northern Women s Community Health Centre, private
obstetrician or an Independent Midwife. Ascertainment of planned home births occurring at home in South Australia
for the year 2010 is estimated to be 96.4% (138 out of 141 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 woman had
been booked). In addition, 29 women who planned to birth at home were transferred to hospital care before birth.
Statistics for all 168 planned home births in 2010 are provided in Tables 29-32, by place of birth.
Table 29: Planned home births by age of women, South Australia, 2010
Age (years)
Birthed at home Birthed in hospital Total
Number % Number % Number %
<20 1 0.7 0 0.0 1 0.6
20-24 11 8.1 0 0.0 11 6.7
25-29 43 31.6 12 41.4 55 33.3
30-34 54 39.7 9 31.0 63 38.2
35-39 23 16.9 6 20.7 29 17.6
40-44 4 2.9 2 6.9 6 3.6
Total 136 100.0 29 100.0 165 100.0
Table 30: Method of birth in planned home births, South Australia, 2010
Method of birth
Birthed at home Birthed in hospital Total
Number % Number % Number %
Normal spontaneous vaginal 135 99.3 13 44.8 148 89.7
Forceps 0 0.0 2 6.9 2 1.2
Assisted Breech 1 0.7 0 0.0 1 0.6
Elective caesarean section 0 0.0 1 3.4 1 0.6
Emergency caesarean section 0 0.0 11 37.9 11 6.7
Ventouse 0 0.0 2 6.9 2 1.2
Total 136 100.0 29 100.0 165 100.0
Pregnancy Outcome in South Australia 2010page 46
Mothers and Babies
Table 31: Birthweight distribution of planned home births, South Australia, 2010
Birthweight (g)
Birthed at home Birthed in hospital Total
Number % Number % Number %
1,500-1,999 1 0.7 0 0.0 1 0.6
2,000-2,499 2 1.4 0 0.0 2 1.2
2,500-2,999 11 8.0 5 16.7 16 9.5
3,000-3,499 38 27.5 7 23.3 45 26.8
3,500-3,999 52 37.7 10 33.3 62 36.9
4,000-4,499 23 16.7 5 16.7 28 16.7
4,500+ 11 8.0 2 6.7 13 7.7
Unknown 0 0.0 1 3.3 1 0.6
Total 138 100.0 30 100.0 168 100.0
Table 32: Perinatal outcome in planned home births, South Australia, 2010
Perinatal outcome
Birthed at home Birthed in hospital Total
Number % Number % Number %
Stillbirth 1 0.7 0 0.0 1 0.6
Discharged within 28 days 136 98.6 30 100.0 166 98.8
In hospital at 28 days 1 0.7 0 0.0 1 0.6
Total 138 100.0 30 100.0 168 100.0
30 Birthing unit births
Statistics presented for births in birthing units in South Australia (Tables 33-36) relate to the birthing units at the
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 a birthing service. These statistics relate to all 2,411 women for whom it was reported that birthing
unit was their intended place of birth. Of these women, 1,214 gave birth in the birthing units while 1,197 women
(49.7%) gave birth in labour wards. Some of these women were transferred to labour wards because of medical or
obstetric complications. With the commencement of the Midwifery Group Practice model of care at Women s and
Children s Hospital in 2004, more of these women who gave birth in labour wards than previously did so because the
birthing unit was not available at the time. Among the women who gave birth in labour wards, 27.3% had caesarean
sections and 17.7% had instrumental births. These statistics have also been included in the statistics for the respective
hospitals. Eighty-two babies (3.4%) were of low birthweight and there were twelve perinatal deaths (perinatal
mortality rate 5.0 per 1,000 births).
Pregnancy Outcome in South Australia 2010 page 47
Mothers and Babies
Table 33: Planned birthing unit births by age of women, South Australia, 2010
Age (years)
Birthed in birthing unit Birthed in labour ward Total
Number % Number % Number %
<20 73 6.0 77 6.4 150 6.2
20-24 264 21.7 215 18.0 479 19.9
25-29 414 34.1 398 33.2 812 33.7
30-34 331 27.3 310 25.9 641 26.6
35-39 120 9.9 166 13.9 286 11.9
40-44 12 1.0 28 2.3 40 1.7
45+ 0 0 3 0.3 3 0.1
Total 1,214 100.0 1,197 100.0 2,411 100.0
Table 34: Method of birth in planned birthing unit births, South Australia, 2010
Method of birth
Birthed in birthing unit Birthed in labour ward Total
Number % Number % Number %
Normal spontaneous vaginal 1,171 96.5 655 54.7 1,826 75.7
Forceps 10 0.8 109 9.1 119 4.9
Assisted breech (no forceps) 0 0 1 0.1 1 0.0
Caesarean section (elective) 0 0 52 4.3 52 2.2
Caesarean section 0 0 247 21.7 247 10.7
( emergency) 0 0 275 23.0 275 11.4
Ventouse 33 2.7 103 8.6 136 5.6
Breech spontaneous 0 0 2 0.2 2 0.1
Total 1,214 100.0 1,197 100.0 2,411 100.0
Table 35: Birthweight distribution of planned birthing unit births, South Australia, 2010
Birthweight (g)
Birthed in birthing unit Birthed in labour ward Total
Number % Number % Number %
<1,500 0 0.0 13 1.1 13 0.5
1,500-1,999 1 0.1 14 1.2 15 0.6
2,000-2,499 13 1.1 41 3.4 54 2.2
2,500-2,999 109 9.0 173 14.4 282 11.7
3,000-3,499 418 34.4 409 34.0 827 34.2
3,500-3,999 482 39.7 376 31.3 858 35.5
4,000-4,499 163 13.4 150 12.5 313 13.0
4,500+ 28 2.3 26 2.2 54 2.2
Total 1,214 100.0 1,202 100.0 2,416 100.0
Pregnancy Outcome in South Australia 2010page 48
Mothers and Babies
Table 36: Perinatal outcome in planned birthing unit births, South Australia, 2010
Perinatal outcome
Birthed in birthing unit Birthed in labour ward Total
Number % Number % Number %
Stillbirth 1 0.1 7 0.6 8 0.3
Discharged within 28 days 1,211 99.8 1,174 97.7 2,385 98.7
Prolonged hospitalisation (in hospital
at 28 days)
0 0.0 19 1.6 19 0.8
Neonatal death 2 0.2 2 0.2 4 0.2
Total 1,214 100.0 1,202 100.0 2,416 100.0
Pregnancy Outcome in South Australia 2010 page 49
Mothers and Babies
III Terminations of Pregnancy
1 Numbers and rates
There were 5,048 terminations of pregnancy notified in South Australia in 2010. The termination of pregnancy rate
was 15.5 terminations of pregnancy per 1,000 women aged 15-44 years. Following the introduction of specific
termination of pregnancy legislation in 1970, the pregnancy termination rate rose to a peak of 13.9 in 1980, followed
by a period of relative stability in the 1980s. Another increase in the termination of pregnancy rate commenced in
1991 (Table 37 and Fig 7) and reached a peak of 17.9 in 1999. The rate declined considerably from 17.7 in 2001 to
15.3 in 2005, since which time it has remained relatively stable.
Table 37: Termination of pregnancy number and rate per 1,000 women aged 15-44 years, South Australia,
1970-2010
Year Number Rate Year Number Rate
1970 1,440 6.0 1991 4,696 14.1
1971 2,409 9.6 1992 4,717 14.2
1972 2,692 10.6 1993 4,959 15.0
1973 2,847 11.1 1994 5,140 15.7
1974 2,867 10.9 1995 5,475 16.9
1975 3,000 11.1 1996 5,545 17.2
1976 3,289 11.9 1997 5,609 17.5
1977 3,494 12.4 1998 5,488 17.2
1978 3,895 13.6 1999 5,679 17.9
1979 3,880 13.3 2000 5,580 17.6
1980 4,081 13.9 2001 5,579 17.7
1981 4,096 13.7 2002 5,467 17.5
1982 4,061 13.4 2003 5,216 16.7
1983 4,036 13.1 2004 4,931 15.9
1984 4,091 13.1 2005 4,715 15.3
1985 4,079 12.9 2006 4,889 15.5
1986 4,327 13.5 2007 4,884 15.4
1987 4,229 13.1 2008 5,101 16.0
1988 4,263 13.0 2009 5,054 15.6
1989 4,342 13.2 2010 5,048 15.5
1990 4,463 13.4
Figure 7: Termination of pregnancy rate per 1,000 women aged 15-44 years, South Australia, 1970-2010
0
4
8
12
16
20
19
70
19
72
19
74
19
76
19
78
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
20
08
20
10
Year
Pregnancy Outcome in South Australia 2010page 50
Termination of Pregnancy
2 Age of women
The age distribution of women who had pregnancies terminated is shown in Table 38. Among the five- year age
groups (Table 39), the highest termination of pregnancy rate was among women aged 20-24 years (26.2 per 1,000
women) followed by women aged 25-29 years (19.9) and teenage women 15-19 years (16.1 per 1,000 women).
Compared with 2009, pregnancy termination rates have fallen for teenage women (17.0 per 1,000 women in 2009)
and for women aged 20-24 years (29.6 in 2009 per 1,000 women.) The abortion proportion (induced abortion as a
proportion of induced abortions and live births) was 0.25; it was highest among teenagers (0.52), and was also high
among women aged 20-24 years (0.33) and older women aged 40 years or more (0.24). This indicates that about
53% of known teenage pregnancies were terminated. This proportion was highest for younger teenagers (0.87 for
those aged <15 years).
Table 38: Terminations of pregnancy by age, South Australia, 2010
Age (years) Number %
12 1 0.0%
13 2 0.0%
14 23 0.5%
15 59 1.2%
16 106 2.1%
17 151 3.0%
18 229 4.5%
19 300 5.9%
20-24 1,482 29.4
25-29 1,089 21.6
30-34 799 15.8
35-39 558 11.1
40-44 219 4.3
45+ 30 0.6
Total 5,048 100.0
The distribution of pregnancy terminations and live births by age in South Australia in 2010 (Table 39 and Figure 8a)
demonstrates that the largest proportion of pregnancy terminations 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
121.1 per 1,000 women. Teenagers accounted for 16.6% of the termination of pregnancy and 4.0% of the live births
in South Australia in 2010. 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. After that it declined again,
and, from 2003, this was associated with a decline in the teenage termination of pregnancy rate (Figure 8b). The
teenage pregnancy rate in 2010 was 31.6 per 1,000 women, and is the lowest rate recorded since 1970.
Pregnancy Outcome in South Australia 2010 page 51
Termination of Pregnancy
Table 39: Termination of pregnancy and live birth rates and termination of pregnancy proportions by age,
South Australia, 2010
Age
(years)
Number of
Termination
of pregnancy
Estimated resident
female population
August 4 2011*
Termination
of pregnancy
rate per 1,000
women
Number of
live births**
Fertility rate per
1,000 women
Termination
of pregnancy
+ live births
Termination
of pregnancy
proportion
<15 26 na na 4 na 30 0.87
15-19 845 52,583 16.6*** 785 14.9 1,630 0.52
20-24 1,482 56,672 26.2 2,970 52.4 4,452 0.33
25-29 1,089 54,762 19.9 5,878 107.3 6,967 0.16
30-34 799 50,582 15.8 6,127 121.1 6,926 0.12
35-39 558 55,193 10.1 3,366 61.0 3,924 0.14
40-44 219 56,900 3.8*** 702 12.3 921 0.24
45+ 30 na na 45 na 75 0.4
Total 5,048 326,692 15.5 19,877 60.9 24,925 0.20
* Australian Bureau of Statistics. Population Estimates by Age and Sex, South Australia 2010. Canberra: ABS, 2011 (Catalogue No 3235.0).
** Terminations of pregnancy are excluded from the numbers of live births.
*** The termination of pregnancy 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.
Figure 8a: Termination of pregnancy and live births by age, South Australia, 2010
0%
20%
40%
60%
80%
100%
Abortions Live births Abortions & Live births
Age (years)
Pe
rc
en
ta
g
e
o
f
w
o
m
en
<20 20-24 25-29 30-34 35-39 40+
n=5,048 n=19,877 n=24,925
Pregnancy Outcome in South Australia 2010page 52
Termination of Pregnancy
Figure 8b: Teenage pregnancy, termination of pregnancy and birth rates, South Australia, 1970-2010
3 Place of residence and place where termination performed
The proportion of women who were country residents (18.1%) was similar to previous years. As in previous years,
the proportion of pregnancy terminations performed in country hospitals (4.0%) was lower relative to the proportion
of country residents having terminations, indicating that the majority of country residents have their terminations in
metropolitan hospitals (Table 40). This was also evident in the Western Australian abortion statistics.1
Table 40: Terminations by place of residence, South Australia, 2010
Residence of women Number %
Metropolitan 4,135 81.9
Country 913 18.1
Total 5,048 100.0
As in previous years, the vast majority of terminations (94.4%) were performed in metropolitan public hospitals,
including 56.9% (2,873) at the Pregnancy Advisory Centre (Table 41).
Table 41: Terminations by hospital category, South Australia, 2010
Hospital where termination performed Number %
Metropolitan public 4,766 94.4
Metropolitan private 81 1.6
Country 201 4.0
Total 5,048 100.0
Doctors in family advisory clinics in teaching hospitals and the Pregnancy Advisory Centre performed 77.8% of
the terminations. Elsewhere, obstetricians and trainee obstetricians performed 21.0%, while general practitioners
performed 1.1%.
0
10
20
30
40
50
60
70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
Year
Pregnancy rate* Birth rate* Abortion rate*
Rate per 1,000 women aged 15-19 years
*Abortions and births to w omen aged less than 15 years are included in the numerator
Pregnancy Outcome in South Australia 2010 page 53
Termination of Pregnancy
Table 42: Terminations by category of doctor, South Australia, 2010
Category of doctor performing termination Number %
Obstetrician/gynaecologist 1.005 19.9
Trainee obstetrician/gynaecologist 57 1.1
Medical practitioner in family advisory clinic 3,928 77.8
General practitioner 58 1.1
Total 5,048 100.0
4 The reason for termination
The pattern of reasons for terminations of pregnancy remained similar to previous years, with 96.4% being performed
for the woman s mental health (including four terminations for pre-existing psychiatric disorders), 3.2% for serious
handicap of the fetus and 0.5% for specified medical conditions. Of the 160 terminations for fetal reasons, 66 were
for chromosomal abnormalities and 91 for other fetal abnormalities detected or suspected prenatally. Three were
performed for exposure during pregnancy to drugs which may cause fetal abnormalities (Table 43).
Table 43: Reason for termination for fetal reasons, South Australia, 2010
Reason for termination Number %
Identified chromosomal abnormality 66 41.3
Other identified fetal abnormality 91 56.9
Possibility of damage from drugs 3 1.9
Possibility of hereditary disease 0 0.0
Total 160 100.0
5 Gestation, method and complications
The majority of terminations (91.9%) were performed within the first 14 weeks of pregnancy and most frequently (in
73.5% of cases) by vacuum aspiration. There were 89 terminations performed at 20 weeks gestation or later: 54.4%
of these were performed for fetal reasons.
Tables 44a and 44b report complications by the number of termination procedures performed (5051), which included
three failed procedures. Two women had terminations after failed procedures, one following two unsuccessful
vacuum aspiration procedures and one following mifepristone administration.
Sixty-eight (1.3%) complications of termination procedures were identified. Sixteen of these were reported (24%)
on the abortion notification form, and 52 (76%) were identified through comparison with statistics from the South
Australian hospital morbidity collection, using codes for pregnancy termination. The abortion notification form is
usually completed about the time of discharge from the hospital where the procedure has been performed, allowing
identification and notification of more immediate complications.2
The main complication reported was retained products of conception (54 cases). Of the 35 complications reported
following terminations with mifepristone +/- misoprostol, 32 (91%) were due to retained products. Haemorrhage
complicated seven terminations.
Pregnancy Outcome in South Australia 2010page 54
Termination of Pregnancy
Table 44a: Complications* of terminations, South Australia, 2010
Complications Number % of complications Per cent of all
termination
procedures
Haemorrhage intra-operative 2 (2) 2.9% 0.0
Haemorrhage post-operative 5 (3) 7.4% 0.1
Perforation of or trauma to body of uterus 3 (2) 4.4% 0.1
Uterine rupture/hysterectomy 1 (1) 1.5% 76.1
Retained products of conception 54 (6) 75.0% 1.0
Failed procedure 3 4.4% 0.0
Infection 3 (1) 2.9% 0.0
Low BP requiring admission 1 (1) 1.5% 0.0
Total 68 (16) 100.0 1.3
* This table reports complications from the notification form and ascertained from the hospital morbidity database, with complications reported on
the notification form appearing in brackets.
Table 44b: Complications* by method of termination procedure, South Australia, 2010
Method of termination Number* of women
with complications
Number of
termination
procedures
Per cent of termination
procedure with
complications by method
Dilatation and curettage 0 168 0.0
Vacuum aspiration 19 (5) 3,712 0.5
Vaginal prostaglandin 9 (6) 60 15.0
Oral or vaginal misoprostol (2) 21 9.5
Mifepristone +/- Misoprostol 35 (3) 669 5.2
Dilatation and evacuation 3 418 0.7
Other 3 0.0
Total 68 (16) 5,051 1.3
* This table reports complications both from the notification form and ascertained from the hospital morbidity database, with complications reported
on the notification form appearing in brackets
Pregnancy Outcome in South Australia 2010 page 55
Termination of Pregnancy
6 Previous terminations. Total termination of pregnancy rate and total first
termination of pregnancy rate
Of the 5,048 women who had terminations, 1,767 (35.0%) had had a previous termination (Table 45a). Among the
teenagers 14.7% had had a previous termination; 31.7% of women aged 20-24 years and 41.0% of women aged
35-39 years had undergone a previous termination. The total induced abortion rate (TAR) for 2010 was 471.5 per
1,000 women aged 15-44 years (Table 45b). This represents the number of termination of pregnancy 1,000 women
would have during their lifetime if they experienced the termination of pregnancy rates of the different age groups
for 2010. As a woman may have more than one termination of pregnancy in her lifetime, to estimate how prevalent
termination of pregnancy is at these age-specific termination of pregnancy rates for 2010, a total first termination of
pregnancy rate (TFAR, Table 45c) may be calculated after exclusion of women with repeat terminations. This TFAR for
2010 was 313.5 per 1,000 women aged 15-44 years. This suggests that 31.3% of women would have a termination
of pregnancy in their lifetime if they experienced the termination of pregnancy rates of the different age groups for
2010.
Table 45a: Women with previous terminations by age, South Australia, 2010
Age (years) Number % % of age group
< 15 0 0.0 0.0
15 - 19 124 2.5 14.7
20 - 24 470 9.3 31.7
25 - 29 481 9.5 44.2
30 - 34 360 7.1 45.1
35 - 39 229 4.5 41.0
40+ 103 2.0 41.4
Total 1,767 35.0 35.0
Further details of termination of pregnancy in South Australia in 2010 may be obtained from the Eighth Annual
Report of the South Australian Termination of pregnancy Reporting Committee for the year 2010.6
Table 45b: Calculation of total abortion rate (TAR) for 2010 for South Australia*
Age
(years)
Number of women
who had terminations
Estimated female resident
population 4th August 2011
Termination of pregnancy rate
per 1,000 women
15-19* 871 52,583 16.6*
20-24 1,482 56,672 26.2
25-29 1,089 54,762 19.9
30-34 799 50,582 15.8
35-39 558 55,193 10.1
40-44* 249 56,900 3.8*
Total 5,048 326,692 15.5
* In these calculations, termination of pregnancy for women under 15 years are included in the age group 15-19 yrs and termination of pregnancy
for women aged 45 years or more are included in the age group 40-44 years, as is traditional.
Total termination of pregnancy rate = sum of termination of pregnancy rates for 5-year age groups x 5 = 94.3 x 5 = 471.5 per 1,000 women
aged 15-44 years.
Pregnancy Outcome in South Australia 2010page 56
Termination of Pregnancy
Table 45c: Calculation of total first abortion rate (TFAR) for 2010 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
4th August 2011
First termination
of pregnancy
rate per 1,000
women
15-19 871* 124 747* 52,583 14.2*
20-24 1,482 470 1,012 56,672 17.9
25-29 1,089 481 608 54,762 11.1
30-34 799 360 439 50,582 8.7
35-39 558 229 329 55,193 6.0
40-44 249* 103 146* 56,900 2.6*
Total 5,048 1,767 3,281 326,692 10.0
* In these calculations, termination of pregnancy for women under 15 years are included in the age group 15-19 yrs and termination of pregnancy
for women aged 45 years or more are included in the age group 40-44 years, as is traditional.
Total first induced abortion rate (TFAR) = sum of first termination of pregnancy rates for 5-year age groups x 5 = 60.4 x 5 = 301.9 per 1,000
women aged 15-44 yrs.
Pregnancy Outcome in South Australia 2010 page 57
Obstetric Profiles by Hospital Category
IV Obstetric Profiles by Hospital Category
Obstetric profiles for the three major metropolitan public hospitals and three hospital categories for 2010 are provided
in Table 46 and Figures 9-28.
These hospital categories are:
1. The Women s & Children s Hospital,
2. Flinders Medical Centre, (both the Women s and Children s Hospital and Flinders Medical Centre have neonatal
intensive care facilities)
3. The Lyell McEwin Hospital,
4. Metropolitan private hospitals,
5. The two major country hospitals (Mount Gambier and Whyalla) and
6. Other country hospitals (mainly smaller).
Six mothers who gave birth to 7 babies at Modbury Hospital, the Queen Elizabeth Hospital and Noarlunga Health
Service have been excluded from these hospital category statistics.
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 six hospital
categories.
The mean is the proportion for women who gave birth in all state hospitals (for maternal factors) or births in all
state hospitals (for baby factors),
e.g. % Aboriginal women
Where indicated (+) in Table 46, it is the mean (number of women who gave birth, or births) for the 24 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 & Children s Hospital
2. Flinders Medical Centre
3. Lyell McEwin Hospital
4. Ashford Hospital
5. Burnside War Memorial Hospital Inc
6. Calvary Healthcare Adelaide
7. Flinders Private Hospital
8. North Eastern Community Hospital
9. Mount Gambier & District Health Service Inc
10. The Whyalla Hospital & Health Services Inc
11. Barossa Health (Tanunda Centre)
12. Gawler Health Service
13. Lower North Health Centre (Clare)
14. Mount Barker District Soldiers Memorial Hospital Inc
15. Murray Bridge Soldiers Memorial Hospital Inc
x100
Total number of women who gave birth in state hospitals
Number of Aboriginal women who gave birth in state hospitals
Pregnancy Outcome in South Australia 2010page 58
Obstetric Profiles by Hospital Category
16. Naracoorte Health Service Inc
17. Northern Yorke Peninsula Regional Health Service (Wallaroo)
18. Port Augusta Hospital & Regional Health Service Inc
19. Port Lincoln Health Service Inc
20. Port Pirie Regional Health Service Inc
21. Riverland Regional Health Service (Berri)
22. South Coast District Hospital Inc (Victor Harbor)
23. Country hospitals with 50-99 births per year
24. Country hospitals with <50 births per year
The 10th percentile is the proportion below which 10% of the 24 hospital proportions, ie the two lowest hospital
proportions, would be found if the 24 proportions were ranked from highest to lowest. The 90th percentile is the
proportion above which 10% of the 24 hospital proportions, ie the two highest proportions, would be found if the
24 proportions were ranked from highest to lowest. As the two Level III hospitals which account for 39.0% 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 22 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 three major metropolitan public hospitals and three hospital
categories. 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 abnormalities3 and terminations of pregnancy. For country hospitals with less than
100 births per year, group reports have been provided.
Each hospital s statistics for each factor may be compared with those for state hospitals and for categories of
hospitals, eg 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).
Pregnancy Outcome in South Australia 2010 page 59
Obstetric Profiles by Hospital Category
Table 46: Obstetric profiles by hospital category, South Australia, 2010: live births of any gestation and
stillbirths of >=400g or >=20 weeks gestation**
Factors
All state hospitals Metropolitan hospitals Country hospitals
Mean
10th
percentile
90th
percentile
W&CH FMC LMCE Private Major Other
Maternal factors
Women (n=19,519) 813+ 117 2828 4751 2828 3057 5030 809 3044
% Aboriginal women 3.2 0.1 8.2 3.9 2.1 4.5 0.2 4.2 6.5
% Antenatal visits <7* 8.0 0.1 12.8 12.3 12.8 11.5 0.7 6.4 5.9
% Teenage women 4.0 0 11.2 3.4 4.5 8.0 0 9.5 5.8
% Women ?35 years 20.5 12.3 32.9 20.5 17.6 12.6 31.1 15.2 15.0
% Single women 11.0 1.9 17.3 17.3 11.1 14.1 2.4 12.2 11.8
% 4+ prior live births 3.0 0.4 5.8 3.7 3.3 4.8 0.5 3.1 3.7
% 1+ prior perinatal deaths 1.6 0.4 2.2 2.3 1.8 1.8 0.8 2.1 1.1
% Obstetric complications 34.3 18.4 37.0 40.9 48.2 35.8 26.5 30.2 23.6
% Labour complications 37.2 24.4 45.9 48.2 45.9 38.6 26.4 30.2 30.1
% Induction 29.8 19.6 35.7 31.8 28.7 28.1 32.2 28.2 26.0
% Emergency caesarean 16.8 9.6 20.8 16.2 19.7 16.9 17.1 14.2 15.2
% Elective caesarean 15.6 9.4 24.7 11.6 13.9 11.5 23.9 15.5 13.7
% Total caesarean 32.4 25.2 42.7 27.8 33.6 28.4 41.0 29.7 28.9
% Ultrasound examination* 99.5 98.1 100.0 99.8 99.4 99.5 99.5 98.9 99.3
% Amniocentesis* 3.6 0.9 5.9 4.6 2.9 2.5 5.0 3.5 1.8
% Episiotomy 12.7 6.3 17.2 13.6 9.3 12.4 16.9 11.5 8.0
% Repair of perineal tear 29.3 21.3 35.1 34.2 26.3 22.9 32.4 27.9 25.9
% Epidural analgesia 32.0 8.8 45.3 35.7 28.9 23.7 43.6 30.5 18.3
% Spinal analgesia .8 0.5 1.9 0.2 0.4 1.1 0.9 1.1 1.4
% Private patients 31.0 1.3 100.0 8.9 1.4 2.6 100.0 15.3 11.4
% Primiparous women 42.3 32.2 45.3 45.3 44.2 38.5 44.9 38.4 36.5
% Previous caesarean 17.5 11.3 22.6 15.3 15.8 15.7 21.9 18.5 16.9
% PPH 10.6 3.7 14.3 17.4 11.7 12.4 4.6 9.5 7.5
Baby factors
Births (n=19,851) 827+ 117 2888 4887 2888 3088 5123 816 3049
% Birthweight <2,500g 7.2 0.6 9.2 13.0 9.8 5.7 4.2 4.9 2.7
% Gestational age <37
weeks at birth
8.9 0.9 9.2 14.9 12.0 8.6 5.7 6.7 2.6
% Prolonged hospitalisation
(>27 days)
2.0 0 1.9 4.4 4.3 0.6 0.5 0.6 0.6
% Neonatal intensive
care (Level III or W&CH
paediatric intensive care)
2.6 0 3.5 5.3 5.1 1.0 .8 .7 1.0
% Birth defect 2.8 1.0 3.5 4.2 3.2 3.1 1.7 2.5 1.9
* adjusted for missing values
+ mean number of women who gave birth, or mean number of births for the 24 hospitals or groups of hospitals
** 6 mothers who gave birth to 7 babies at the TQEH, Modbury hospital and Noarlunga Health Service have been excluded from this table
Pregnancy Outcome in South Australia 2010page 60
Obstetric Profiles by Hospital Category
Figure 9: Percentage of Aboriginal women by hospital category
Figure 10: Percentage of women with <7 antenatal visits by hospital category
Figure 11: Percentage of teenage women by hospital category
Figure 12: Percentage of women 35 years or more by hospital category
0
2
4
6
8
10
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
0
2
4
6
8
10
12
14
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
0
2
4
6
8
10
12
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
0
5
10
15
20
25
30
35
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
Pregnancy Outcome in South Australia 2010 page 61
Obstetric Profiles by Hospital Category
Figure 13: Percentage of single women by hospital category
Figure 14: Percentage of women with 4 or more prior livebirths by hospital category
Figure 15: Percentage of women with 1 or more prior perinatal deaths by hospital category
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
20
18
16
14
12
10
8
6
4
2
0
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
6
5
4
3
2
1
0
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
2.5
2
1.5
1
0.5
0
Pregnancy Outcome in South Australia 2010page 62
Obstetric Profiles by Hospital Category
Figure 16: Percentage of women with obstetric complications by hospital category
Figure 17: Percentage of women with complications during labour or birth by hospital category
Figure 18: Percentage of women with induction of labour by hospital category
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e 90th percentile
Mean
10th percentile
50
40
30
20
10
0
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
60
50
40
30
20
10
0
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
40
30
20
10
0
Pregnancy Outcome in South Australia 2010 page 63
Obstetric Profiles by Hospital Category
Figure 19: Percentage of women having epidural analgesia by hospital category
Figure 20: Percentage of breech births by hospital category
Figure 21: Percentage of emergency caesarean sections by hospital category
Figure 22: Percentage of elective caesarean sections by hospital category
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
50
40
30
20
10
0
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
0.8
0.6
0.4
0.2
0
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
25
20
15
10
5
0
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
30
25
20
15
10
5
0
Pregnancy Outcome in South Australia 2010page 64
Obstetric Profiles by Hospital Category
Figure 23: Percentage of total caesarean sections by hospital category
Figure 24: Percentage of births with birthweight below 2,500g by hospital category
Figure 25: Percentage of births with gestation less than 37 weeks by hospital category
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
45
40
35
30
25
20
15
10
5
0
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e 90th percentile
Mean
10th percentile
14
12
10
8
6
4
2
0
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
16
14
12
10
8
6
4
2
0
Pregnancy Outcome in South Australia 2010 page 65
Obstetric Profiles by Hospital Category
Figure 26: Percentage of births with prolonged hospitalisation by hospital category
Figure 27: Percentage of live births requiring neonatal intensive care by hospital category
Figure 28: Percentage of births with birth defects by hospital category
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
5
4
3
2
1
0
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e
90th percentile
Mean
10th percentile
6
5
4
3
2
1
0
1 2 3 4 5 6
Hospital category
Pe
rc
en
ta
g
e 90th percentile
Mean
10th percentile
5
4
3
2
1
0
Pregnancy Outcome in South Australia 2010page 66
Obstetric Profiles by Hospital Category
V Clinical and Maternity Performance Indicators
1 Clinical indicators
These clinical indicators were selected from The Australian Council on Healthcare Standards (ACHS) Clinical Indicator
Users Manual Version 2010 and were reported for the state in pages 55-58. They were also reported for hospital
categories and individual hospitals in the Pregnancy and Neonatal Care Bulletin 2010.
Some data informing the ACHS clinical indicators were not collected on the Supplementary Birth Record and the
indicator was not able to be calculated.
For the purpose of Indicators 1.1 1.4; 3.1 - 3.6 selected primipara was defined as:
> a woman who was 20-34 years of age at the time of giving birth
> giving birth for the first time at ?20 weeks of gestation
> singleton pregnancy
> cephalic presentation
> at 37 to 41 weeks gestation.
Indicator 1: Outcome of selected primiparae
Rationale: The selected primiparae represented an uncomplicated pregnancy whereby intervention and
complication rates should be low and consistent across hospitals. Use of the selected primiparae
(rather than all women giving birth) as the basis for inter-hospital comparison of maternity care
controlled for differences in case mix and increased the validity of those comparisons.
For the purpose of Indicators 1.1 1.4 the denominator was total number of selected primiparae who gave birth.
> Clinical indicator 1.1: Total number of selected primiparae who had a spontaneous vaginal birth.
Clinical indicator 1.1 = (95%CI 45.5%-48.1%).
> Clinical indicator 1.2: Total number of selected primiparae who underwent induction of labour.
Clinical indicator 1.2 = (95%CI 37.5%-40.0%).
> Clinical indicator 1.3: Total number of selected primiparae who underwent an instrumental vaginal birth
which was defined by the use of forceps or vacuum extraction.
Clinical indicator 1.3 = (95%CI 24.1%-26.4%).
> Clinical indicator 1.4: Total number of selected primiparae undergoing caesarean section.
Clinical indicator 1.4 = (95%CI 26.8%-29.1%).
2,679 x 100
5,720
= 46.8%
2,414 x 100
5,720
= 38.7%
1,442 x 100
5,720
= 25.2%
1,599 x 100
5,720
= 28.0%
Pregnancy Outcome in South Australia 2010 page 67
Clinical and Maternity Performance Indicators
Indicator 2: Vaginal birth following caesarean section (VBAC)
Rationale: This indicator related to those women giving birth vaginally following a previous primary (first)
caesarean section and having NO intervening pregnancies greater than 20 weeks gestation.
> Clinical indicator 2.1: Rate of vaginal birth following primary caesarean section
Numerator: Total number of women giving birth vaginally following a previous primary caesarean section.
(n=444).
Denominator: Total number of women giving birth who have had a previous primary caesarean section and
NO intervening pregnancies greater than 20 weeks gestation. (n=2,412).
Clinical indicator 2.1 = (95%CI 16.9%-20.0%).
Indicator 3: Major perineal tears & surgical repair of the perineum selected primiparae with an intact
perineum
Rationale: This indicator has been included because a high incidence of an intact perineum is considered a
desirable outcome.
> Clinical indicator 3.1: Total number of selected primiparae who gave birth vaginally and had an intact
perineum
Numerator: Total number of selected primiparae with an intact perineum
Denominator: Total number of selected primiparae giving birth vaginally.
Clinical indicator 3.1 = (95% CI 7.8%-9.5%).
Indicator 4: General anaesthesia for caesarean section
Rationale: This indicator monitored the number of women who had a caesarean section performed under
general anaesthesia. General anaesthetic included women undergoing a primary general
anaesthetic and included conversions from regional to general anaesthetic where intubation
was required to control the airway.
> Clinical indicator 4.1: General anaesthesia for caesarean section
Numerator: Total number of women having a general anaesthetic for a caesarean section (n=399).
Denominator: Total number of women having a caesarean section (n=6323).
Clinical indicator 4.1 = (95% CI 5.7%-6.9%).
Indicator 5: Antibiotic prophylaxis & caesarean section
Antibiotic prophylaxis was not collected on the Supplementary Birth Record and this indicator was not able to be
calculated.
Indicator 6: Pharmacological thromboprophylaxis & caesarean section
Pharmacological thromboprophylaxis was not collected on the Supplementary Birth Record and this indicator was not
able to be calculated.
444 x 100
2,412
= 18.4%
355 x 100
4,121
= 8.6%
399 x 100
6,323
= 6.3%
Pregnancy Outcome in South Australia 2010page 68
Clinical and Maternity Performance Indicators
Indicator 7: Postpartum haemorrhage / blood transfusion
Rationale: Postpartum haemorrhage (PPH) is a potentially life threatening complication of birth that occurs
in about 3-5% of vaginal births. The condition remains a leading cause of maternal morbidity
and mortality.
Blood transfusion is required following massive blood loss of equal to/or more than 1000mL or
in response to a postpartum haemoglobin level of less than 80g/L.
*Blood transfusion was not collected on the Supplementary Birth Record and this indicator was
calculated from reports of postpartum haemorrhage equal to/or more than 1000mL.
> Clinical indicator 7.1*: Incidence of postpartum haemorrhage ? 1000mL.
Numerator: Total number of women who give birth vaginally who were reported to experience a
postpartum haemorrhage of 1000mL or more (n=479).
Denominator: Total number of women who give birth vaginally (n=13,344).
Clinical indicator 7.1 = (95% CI 3.3%-3.9%).
Indicator 8: Intrauterine growth restriction (IUGR)
Rationale: Profound IUGR is a major cause of perinatal mortality and morbidity with mortality increasing
with IUGR in late pregnancy. This indicator aimed to identify undiagnosed IUGR for babies born
at term.
> Clinical indicator 8.1: Incidence of IUGR at 40 weeks gestation.
Numerator: Total number of births with birth weight less than 2750g at 400 weeks gestation or beyond
(n=139).
Denominator: The total number of babies born at 400 weeks gestation or beyond (n=7,999).
Clinical indicator 8.1 = (95%CI 1.5%-2.0%).
Indicator 9: 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 9.1: Apgar score of 6 or below at five minutes after birth among all babies except
antepartum fetal deaths
Numerator: The number of babies born with an Apgar score of 6 or below at five minutes post birth
(n=281).
Denominator: The total number of babies born (excluding fetal deaths in utero diagnosed prior to
commencement of labour) (n=19,932).
Clinical indicator 9.1 = (95%CI 1.3%-1.6%).
479 x 100
13,344
= 3.6%
139 x 100
7,999
= 1.7%
281 x 100
19,932
= 1.4%
Pregnancy Outcome in South Australia 2010 page 69
Clinical and Maternity Performance Indicators
Indicator 10: 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 10.1: 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=93).
Denominator: The total number of term live babies born (n=18,206).
Clinical indicator 10.1 = (95%CI 0.4%-0.6%).
2 Maternity performance indicators, hospitals with at least 500 births per year
Six clinical indicators are presented. Five are selected from The Australian Council on Healthcare Standards ( ACHS
Clinical Indicator Users Manual Version 2010 ) and are presented for hospitals with at least 500 births per year.
Additionally, the sixth indicator presents the standardized perinatal mortality ratio.
These six indicators are as follows:
1. Proportion of selected primiparae who underwent induction of labour
This was as defined for Clinical indicator 1.2 (page 56) and was 38.7% for the state in 2010 (and 38.9% for state
hospitals) in 2010.
2. Caesarean section rate for selected primiparae
This was as defined for Clinical indicator 1.4 (page 56) and was 28.0% for the state in 2010 (and 28.1% for state
hospitals) in 2010.
3. VBAC: proportion of women who gave birth vaginally following a previous primary (first) caesarean
section and no intervening births.
This was as defined for Clinical indicator 2.1 (page 56) and was 18.4% for the state in 2010 (and 18.1% for state
hospitals) in 2010.
4. Proportion of selected primiparae with an intact perineum following vaginal birth.
This was as defined for Clinical indicator 3.1 (page 57) and was 18.4% for the state in 2010 (8.3% for state
hospitals) in 2010.
5. TERM NICU: proportion of term babies admitted to neonatal intensive care (NICU) for reasons other than
congenital abnormality.
This was as defined for Clinical indicator 10.1 (page 58) and was 0.5% for the state (as well as for state hospitals)
for 2010.
6. SPMR: Standardized perinatal mortality ratio for all births.
This is as defined8 in the Pregnancy and Neonatal Care Bulletin 2010. 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.
93 x 100
18,206
= 0.5%
Expected number of deaths
Observed number of deaths
SPMR = x 100
Pregnancy Outcome in South Australia 2010page 70
Clinical and Maternity Performance Indicators
To obtain the expected number of deaths for a hospital, the state hospital perinatal mortality rate for 2010 for each
of the birthweight groups in Table 28a 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 Committee3), 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 2008. The SPMRs and 95%CIs for
individual hospitals and categories of hospitals have been programmed using indirect standardization methods.11
Statistics for the six maternity performance indicators for 2010 are provided in Figures 29A 29F for the ten hospitals,
A J, with at least 500 births in 2010. SPMRs for the preceding five years combined, 2006-2010, are provided in
Figure 29G. Metropolitan teaching hospitals and Mount Gambier Hospital have been named with their permission
and are as follows:
A. Women s and Children s
B. Flinders Medical Centre
C. Lyell McEwin Hospital
D. Mt Gambier Hospital
For the last 5 years the Women s and Children s Hospital SPMR (ranging from 67 93) has been significantly lower
when compared with state-wide hospital data.
Otherwise, none of the elevations in the SPMR for the individual hospitals for 2010 or for the last five-year period
2006-2010 (Fig 29G) was statistically significant.
Figure 29a: Induction of labour proportion for selected primiparae, SA hospitals with >=500 births per year,
2010
0
10
20
30
40
50
A B C D E F G H I
Hospital
%
Induction of labour %
*SA hospitals = 38.9%
Pregnancy Outcome in South Australia 2010 page 71
Clinical and Maternity Performance Indicators
Figure 29b: Caesarean section rate for selected primiparae, SA hospitals with >=500 births per year, 2010
Figure 29c: VBAC: Proportion of women who had a vaginal birth following a previous primary (first)
caesarean section & no intervening births, SA hospitals with >=500 births per year, 2010
Figure 29d: Proportion of selected primiparae with an intact perineum after a vaginal birth, SA hospitals
with >=500 births per year, 2010
60
50
40
30
20
10
0
A B C D E F G H I
Hospital
%
Caesarean section %
*SA hospitals = 28.1%
40
30
20
10
0
A B C D E F G H I
Hospital
%
VBAC %
*SA hospitals = 18.1%
40
30
20
10
0
A B C D E F G H I
Hospital
%
Primip no repair %
*SA hospitals = 8.3%
Pregnancy Outcome in South Australia 2010page 72
Clinical and Maternity Performance Indicators
Figure 29e: TERM NICU: proportion of term babies admitted to NICU for reasons other than congenital
abnormality, SA hospitals with >=500 births per year, 2010
Figure 29f: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with >=500 births per
year, 2010
Figure 29g: SPMR (Standardized Perinatal Mortality Ratio) for all births, SA hospitals with >=500 births per
year, 2006-2010
1.2
1
0.8
0.6
0.4
0.2
0
A B C D E F G H I
Hospital
%
Term NICU %
*SA hospitals = 0.5%
300
250
200
150
100
50
0
A B C D E F G H I
Hospital
%
SPMR %
*SA hospitals
200
150
100
50
0
A B C D E F G H I
Hospital
%
SPMR %
*SA hospitals
Pregnancy Outcome in South Australia 2010 page 73
Clinical and Maternity Performance Indicators
VI Trends in Perinatal Statistics in South Australia, 1981-2010
Perinatal statistics are presented in Tables 47 and 48 for both socio-demographic and obstetric aspects for each
year from 2001-2010, as well as for 1981, when the perinatal data collection was commenced. Some features are
illustrated in Fig 30.1 30.8 for the years 1985-2009. The trends noted between 1981 and 2010 are as follows:
1 The total fertility rate stabilising at 1.84 live births per woman, following a steady increase from 1.71 in 2000 to
1.91 live births per woman in 2008 and 2009.
2 The increase in the proportion of Asian women from 1.8% in 1981 to 9.6% in 2010 and of Aboriginal women
from 1.5% in 1981 to 3.2% in 2010.
3 The decrease in the proportion of teenage women giving birth from 7.8% in 1981 to 4.0% in 2010. Over
the past decade, there has been a general decline in both the teenage birth and abortion rate. The teenage
pregnancy rate in 2010 of 31.7 per 1,000 women was the lowest recorded since 1970, when abortion statistics
were first collected, enabling calculation of a pregnancy rate.
4 The increase in the age of women giving birth. The proportion of women who gave birth who were 35 years or
older increased from 4.6% in 1981 to 20.5% in 2010, following a peak of 21.1% in 2008 and 2009. Amongst
primiparous women the proportion in 1981 was 1.2%, and in 2010 12.5%. (It was 12.8% in 2009). The mean
age among women giving birth increased from 26.55 years to 30.14 years and among primiparous women from
24.42 years to 28.34 years.
5 The proportion of single women giving birth peaked in 1996 at 14.9%, since which time there has been a
gradual decrease to 10.9% in 2010, which is the lowest in the past two decades.
6 In the last decade, the proportion of births in country hospitals, especially in small country hospitals, has gradually
declined from 24.9% in 1997 to 19.3% in 2010. The proportion of births in teaching hospitals was highest
in 2000 at 54.6%, and following a low of 49.6% in 2000, has gradually increased to 54.3 in 2010. In 2010
metropolitan private hospitals accounted for 25.6% of births. The number of births in birthing units in teaching
hospitals increased from 125 (0.6%) in 1992 to 1,214 (6.1%) in 2010. Home births increased from 44 (0.2%) in
1997 to 144 (0.7%) in 2010.
7 The increase in the proportion of multiple births, related to assisted conception pregnancies, and the older age of
women, from 2.0% in 1981 to a peak of 3.6% in 2002 and 2003. After that the proportion declined to 3.0% in
2008 and 2009, but rose to 3.3% in 2010.
8 The induction rate increased from 22.1% in 1981 to 29.3% in 2002, after which it declined slightly. It was
29.6% in 2010. Fifty-two percent of inductions in 2010 were performed for other than defined indications.
9 The fall in the proportion of normal spontaneous vaginal births (from 66.1% in 1981 to 55.2% in 2010, but
stable for the last five years), breech births (from 1.1% to 0.3%) and forceps births (from 15.2% to 5.4%). The
proportion delivered by ventouse increased from 0.7% to 6.9%, and by caesarean section, from 16.9% in 1981
to 32.2% in 2010. The caesarean section rate has been relatively stable for the last five years.
10 The gradual increase in the proportion of low birthweight births from 5.8% in 1981 to a peak of 7.6% in 2005.
This proportion has been around 7.0% in the last four years (7.2% in 2010). The proportion of preterm births
also increased from 5.5% in 1981 to a peak of 9.0% in 2005, but was 8.9% in 2010.
11 The proportion of births with congenital abnormalities identified before discharge from hospital after birth has
been relatively stable at 2.3%-2.8% during the last decade (2.7% in 2008 and 2009). In 2010 it was 2.8%.
12 The increase in the proportion of babies utilising Level II care from 6.7% in 1982 to 16.6% in 2002 and 2003,
followed by a decline to 15.3% in 2009. In 2010 this proportion was 16.0%.
13 The proportion of babies utilising neonatal intensive care has decreased from 3.0% in 2000 to 2.5% in 2010,
while the proportion using paediatric intensive care remained at 0.2%-0.3%. The proportion in hospital at 28
days has been between 2.0% and 2.5% (1.9% in 2010).
14 The considerable fall in the perinatal mortality rate, despite the increasing proportion of preterm births. The
perinatal mortality rate for national statistics (for babies of at least 500g birthweight or 22 weeks gestation
if birthweight unavailable) has fallen from 11.6 in 1981 to 4.4 per 1,000 births in 2010, while the rate for
international statistics (for births of 1,000g or 28 weeks if birthweight unavailable) has fallen from 7.2 to 3.2 per
Pregnancy Outcome in South Australia 2010page 74
Clinical and Maternity Performance Indicators
1,000 births during the same period. The fall in this neonatal mortality rate (for early neonatal deaths) has been
particularly outstanding, reaching 0.6 per 1000 live births in 2007 and 2008, the lowest recorded in the state.
This figure was 1.0 per 1,000 livebirths in 2010. The fall in perinatal mortality is reflected in the standardized
perinatal mortality ratio which has been calculated in Table 48 for each year utilising perinatal mortality rates for
500g birthweight groups for the years 1981-1989 combined as the standard. It was 57.6 in 2010 compared with
117.6 in 1981.
Table 47: Socio-demographic aspects of perinatal statistics, South Australia, 1981 and 2001-2010
Characteristic
Year
1981 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
1 Total births 19,052 17,704 17,745 17,844 17,522 18,196 18,803 19,757 19,970 19,901 20,002
2 Live births 18,905 17,584 17,623 17,710 17,409 18,067 18,663 19,624 19,819 19,761 19,883
3
Women who
gave birth
18,857 17,427 17,421 17,517 17,229 17,897 18,519 19,471 19,672 19,604 19,667
4
Total fertility rate
per woman
1.75 1.71 1.73 1.75 1.74 1.82 1.82 1.91 1.91 1.87 1.84
5 Place of birth (%)
Teaching hospital 52.2% 51.6% 49.6% 50.6% 49.9% 51.6% 52.1% 52.6% 53.2% 53.7% 54.3%
Private hospital 19.7% 25.2% 27.9% 28.1% 27.2% 26.5% 26.7% 26.6% 26.5% 25.7% 25.6%
Country hospital 27.8% 22.9% 22.2% 21.3% 22.5% 21.6% 20.8% 20.2% 20.3% 19.9% 19.3%
Domiciliary* 0.3% 0.2% 0.3% 0.3% 0.4% 0.3% 0.5% 0.5% 0.5% 0.7% 0.7%
(65) (37) (48) (60) (67) (63) (87) (107) (101) (134) (144)
6 Race (%)
Aboriginal 1.5% 2.3% 2.5% 2.7% 2.8% 2.7% 3.0% 3.0% 3.2% 3.1% 3.2%
(Women who
gave birth)
(277) (399) (445) (468) (484) (487) (548) (578) (624) (607) (625)
(Births) (280) (401) (452) (473) (491) (492) (559) (590) (637) (618) (630)
Asian 1.8% 4.4% 4.8% 4.7% 4.8% 5.3% 5.1% 6.2% 7.0% 8.1% 9.6%
7 Age
Mean age (years) 26.55 29.52 29.62 29.77 29.81 29.86 30.01 30.05 30.11 30.14 30.14
Teenage (%) 7.8% 5.4% 5.6% 5.4% 5.3% 5.2% 4.8% 4.6% 4.5% 4.1% 4.0%
?35 years (%) 4.6% 16.3% 17.0% 17.6% 17.9% 18.7% 20.4% 20.2% 21.1% 21.1% 20.5%
8 Marital status (%)
Never married 7.6% 12.3% 12.3% 11.9% 11.8% 12.5% 11.7% 11.0% 10.7% 10.0% 9.6%
Widowed/
divorced/
separated (%)
2.0% 1.6% 1.6% 1.5% 1.3% 1.3% 1.3% 1.4% 1.2% 1.2% 1.3%
(Single) (9.6%) (13.9%) (13.9%) (13.3%) (13.0%) (13.8%) (13.0%) (12.5%) (11.9%) (11.2%) (10.9%)
9 Primiparae
Mean age (years) 24.42 27.77 27.91 28.13 28.02 28.20 28.30 28.24 28.27 28.34
Teenage 15.4% 11.3% 10.9% 10.0% 10.1% 9.5% 8.9% 8.8% 8.4% 7.8%
?35 years 1.2% 9.5% 9.9% 10.6% 11.0% 11.4% 12.6% 12.5% 12.7% 12.8% 12.2%
* includes unplanned home births
Pregnancy Outcome in South Australia 2010 page 75
Trends in Perinatal Statistics in South Australia
Table 48: Obstetric aspects of perinatal statistics, South Australia, 1981 and 2001-2010
Characteristic
Year
1981 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
1 Plurality
Multiple births (%) 2.0% 3.1% 3.6% 3.6% 3.3% 3.3% 3.0% 2.9% 3.0% 3.0% 3.3%
Twins (363) (550) (632) (626) (578) (570) (552) (544) (592) (578) (644)
Triplets (21) (3) (12) (21) (6) (21) (12) (21) (3) (12) (15)
Quadruplets (0) (0) (0) (0) (0) (0) (0) (0) (0) (0) (4)
2
Induction of
labour (%)
22.1% 28.3% 29.3% 29.0% 27.9% 28.3% 28.9% 29.8% 28.6% 29.4% 29.6%
3 Method of birth
Normal
spontaneous
66.1% 59.5% 58.7% 57.8% 55.9% 55.8% 56.0% 56.0% 56.0% 55.4% 55.2%
Elective caesarean 8.2% 11.9% 12.6% 13.3% 14.0% 14.6% 15.5% 15.3% 15.4% 15.7% 15.5%
Emerg caesarean 8.7% 15.8% 16.6% 16.7% 17.6% 17.6% 17.4% 17.1% 16.8% 16.7% 16.7%
Forceps 15.2% 6.1% 5.9% 4.8% 5.0% 4.2% 3.7% 4.1% 4.2% 4.6% 5.4%
Breech 1.1% 0.4% 0.4% 0.4% 0.4% 0.4% 0.4% 0.4% 0.5% 0.4% 0.3%
Ventouse 0.7% 6.3% 5.9% 6.9% 7.1% 7.3% 7.0% 7.1% 7.1% 7.2% 6.9%
Total caesarean (16.9%) (27.8%) (29.2%) (30.0%) (31.5%) (32.3%) (32.9%) (32.3%) (32.2%) (32.4%) (32.2%)
4 Birthweight <2,500g
Singletons 4.9% 5.5% 5.4% 5.3% 5.3% 5.9% 5.5% 5.5% 5.5% 5.7% 5.6%
Multiples 52.1% 46.3% 50.5% 53.0% 55.8% 57.7% 53.4% 53.6% 53.4% 59.8% 54.1%
5
Gestational age
<37 weeks
5.5% 8.1% 8.3% 8.4% 8.7% 9.0% 8.2% 8.5% 8.6% 9.0% 8.9%
Singletons 4.8% 6.7% 6.6% 6.7% 7.0% 7.3% 6.8% 7.1% 7.0% 7.2% 7.2%
Multiples 41.1% 50.8% 52.2% 54.6% 58.4% 58.4% 54.4% 57.2% 59.3% 67.5% 58.4%
6
Congenital
abnormalities
3.4% 2.5% 2.4% 2.3% 2.5% 2.5% 2.3% 2.6% 2.7% 2.7% 2.8%
7 Level II care Na 15.2% 15.8% 16.6% 16.6% 16.2% 15.3% 16.1% 15.4% 15.3% 16.0%
8 Level III care 3.3% 2.6% 2.8% 2.7% 2.9% 2.9% 2.5% 2.3% 2.5% 2.9% 2.5%
9 W&CH ICU care Na 0.3% 0.2% 0.2% 0.2% 0.3% 0.2% 0.3% 0.3% 0.3% 0.2%
10
Hospitalisation for
28 days or more
4.2% 2.1% 2.2% 2.2% 2.3% 2.4% 2.0% 2.1% 2.2% 2.2% 2.0%
11 Neonatal deaths 96 64 54 42 52 63 38 55 51 49 44
12 Stillbirths 147 120 122 134 113 129 140 132 151 140 119
13 Perinatal deaths 243 184 176 176 165 192 178 188+ 202 189 163
14
Perinatal mortality
rate per 1,000 births
?400g/20 weeks 12.8 10.4 9.9 9.9 9.4 10.6 9.5 9.5 10.1 9.5 8.1
?500g/22 weeks* 11.6 6.9 6.8 6.5 5.7 6.2 4.9 5.2 5.3 4.9 4.4
?1,000g/28 weeks* 7.2 3.9 4.0 3.9 3.5 3.7 3.1 2.6 3.4 3.5 3.2
15
Standardized
perinatal mortality
ratio
117.6 70.6 70.3 68.1 66.9 66.5 63.0 65.1 67.3 65.2 57.6
* only neonatal deaths within the first 7 days of life are included, as recommended by the World Health Organisation for national and international
statistics.
Pregnancy Outcome in South Australia 2010page 76
Trends in Perinatal Statistics in South Australia
Trends in Perinatal Statistics in South Australia (SA), 1985-2010
Figure 30.1: Percentage of teenage women among women giving birth in SA
Figure 30.2: Percentage of women aged 35 years and over among women giving birth in SA
Figure 30.3: Percentage of primiparous women aged 35 years and over in SA
0
2
4
6
8
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
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97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
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06
20
07
20
08
20
09
20
10
Year
Pe
rc
en
ta
g
e
24
20
16
12
8
4
0
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
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95
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98
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99
20
00
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01
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02
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10
Year
Pe
rc
en
ta
g
e
15
10
5
0
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
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94
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95
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98
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99
20
00
20
01
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02
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03
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04
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05
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06
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07
20
08
20
09
20
10
Year
Pe
rc
en
ta
g
e
Pregnancy Outcome in South Australia 2010 page 77
Trends in Perinatal Statistics in South Australia
Figure 30.4: Percentage of Aboriginal women and Asian women among women giving birth in SA
Figure 30.5: Percentage of women never married and with no de facto partner among women giving
birth in SA
Figure 30.6: Percentage of multiple births among births in SA
12
10
8
6
4
2
0
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
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00
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09
20
10
Year
Pe
rc
en
ta
g
e
Asian Aboriginal
0
3
6
9
12
15
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
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Pe
rc
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e
Year
0
1
2
3
4
19
85
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86
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09
20
10
Year
Pe
rc
en
ta
g
e
Pregnancy Outcome in South Australia 2010page 78
Trends in Perinatal Statistics in South Australia
Figure 30.7 Percentage of low birthweight babies among births in SA
Figure 30.8: SA standardised perinatal mortality ratio (SPMR)
0
2
4
6
8
19
85
19
86
19
87
19
88
19
89
19
90
19
91
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92
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Year
Pe
rc
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0
50
100
150
19
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10
Year
SP
M
R
Pregnancy Outcome in South Australia 2010 page 79
Trends in Perinatal Statistics in South Australia
VII Summary Statistics for 2010
These statistics refer to all live births of any gestation as well as stillbirths of at least 400g birthweight or 20 weeks
gestation. Fifty-four babies of less than 400g birthweight have been included.
1 Number of births
Reported number of births (from monthly notifications): 20,002
Notified births with Supplementary Birth Records: 20,002
Notified women who gave birth with SBRs: 19,667
Crude birth rate: 12.2 live births per 1,000 population.
Total fertility rate: 1.85 live births per woman
2 Place of birth
Home births: 144 home births in all (0.7%), of which 138 were planned home births (0.7% of births in the state).
Metropolitan teaching hospitals: 10,870 (54.3%)
Metropolitan private hospitals: 5,123 (25.6%)
Country hospitals: 3,865 (19.3%)
3 Sex
Males 10,306, Females 9,696. Male: Female sex ratio = 1.06:1
4 Plurality and condition at birth
Condition at birth
Plurality
Total
Singleton Twins Triplets Quads
Live birth 19,221 643 15 4 19,883
Stillbirth 118 1 0 0 119
Total 19,339 644 15 4 20,002
5 Race of women
Race Number of women %
Caucasian 16263 82.7
Aboriginal 625 3.2
Asian 1,894 9.6
Other 885 4.5
Total 19,667 100.0
6 Obstetric interventions in 19,667 women who gave birth
Induction of labour was performed for 5,825 women (29.6%) and labour was augmented for another 4,209 women
(21.4%) who gave birth.
Forceps were utilised for 1,061 women (5.4%), ventouse in 1,358 (6.9%) and episiotomy was performed for 2,482
women who gave birth (12.6%, or 18.5% of women who gave birth vaginally).
Caesarean section was performed in 6,323 women who gave birth (32.2%), of which 3,041 (15.5%) were elective,
and 3,282 (16.7%) emergency operations.
Pregnancy Outcome in South Australia 2010page 80
Summary Statistics for 2010
7 Low birthweight (<2,500g)
Number of singleton births of low birthweight =1,083 (5.6% of singleton births).
Number of multiple births of low birthweight =359 (54.1% of multiple births).
Number of all births of low birthweight =1,442 (7.2% of all births).
8 Congenital abnormalities
Births notified with congenital abnormalities: 561 (2.8%).
9 Perinatal mortality 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 (including live births
of any gestation)
(119) 5.9 (44) 2.2 (163) 8.1
2 ?500g/22 weeks if birthweight
unavailable (WHO National Statistics*)
(28) 3.4 (20) 1.0* (87) 4.4*
3 ?1,000g/28 weeks if birthweight
unavailable (WHO International/
Standard Statistics*)
(49) 2.5 (14) 0.7* (63) 3.2*
* Only neonatal deaths within the first 7 days of life are included.
10 Terminations of pregnancy
Total number of terminations notified: 5,048
Induced abortion rate per 1,000 women (15-44 years): 15.5
Total induced abortion rate per 1,000 women (15-44 years): 464.4
Total first induced abortion rate per 1,000 women (15-44 years): 301.9
Induced abortion proportion: 0.20
Pregnancy Outcome in South Australia 2010 page 81
Summary Statistics for 2010
References
1. Scott J, Chan A. South Australian Perinatal Statistics Collection. Guidelines for the Supplementary Birth Record.
Adelaide: Pregnancy Outcome Statistics Unit, South Australian Department of Health, 2006.
2. The South Australian Birth Defects Register. 2007 Annual Report. Adelaide: Women s and Children s Hospital,
Children, Youth and Women s Health Service, 2011.
3. Maternal, Perinatal and Infant Mortality Committee. Maternal, Perinatal and Infant Mortality in South Australia
2010. Adelaide: SA Health, Government of South Australia, 2012.
4. Statewide Service Strategy Division. Standards for Maternal and Neonatal Services in SA 2010.
Adelaide: Department of Health, 2010.
5. 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.
6. South Australian Abortion Reporting Committee. Eighth Annual Report For the Year 2010.
Adelaide: SA Health, Government of South Australia, 2012.
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. Roberts CL, Lancaster PAL. Australian national birthweight percentiles by gestational age. MJA 1999;170:114-8.
10. Women s Hospitals Australasia. Supporting Excellence in Maternity Care. The Core Maternity Indicators Project.
Turner, Australian Capital Territory: Women s Hospitals Australasia, 2007.
11. Breslow NE, Day NE. Statistical methods in cancer research Vol II. The design and analysis of cohort studies.
Lyon: International Agency for Research on Cancer, 1987.
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 1985), website: www.health.sa.gov.au/pehs/pregnancyoutcome.
htm.
2. Maternal, Perinatal and Infant Mortality in South Australia. Annual Report of the Maternal, Perinatal & Infant
Mortality Committee (from 1985), website: www.health.sa.gov.au/pehs/pregnancyoutcome.htm.
3. Committee appointed to examine and report on abortions notified in South Australia Annual Report
(from 1985 to 2002). South Australian Abortion Reporting Committee Annual Report (from 2003).
4. Pregnancy and Neonatal Care Bulletin (from 1985): 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 Australian Institute of Health and Welfare National Perinatal
Statistics Unit in Sydney for their reports.
Pregnancy Outcome in South Australia 2010page 82
References
These reports are as follows:
1. The South Australian Birth Defects Register Annual Report (from 1986).
South Australian Birth Defects Register, Public Health Research Unit, Women s and Children s Hospital, Children, Youth
and Women s Health Service, 72 King William Road, North Adelaide, South Australia 5006.
Telephone (08) 81616518
Website: www.wch.sa.gov.au/services/az/other/phru/birthdefect.html
2. Australia s Mothers and Babies (from 1991) and
3. Congenital anomalies in Australia (from 1981)
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: www. npsu.unsw.edu.au
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, Hann 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.
Pregnancy Outcome in South Australia 2010 page 83
References
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 for the South
Australian Cerebral Palsy Research Group. The prevalence of inherited thrombophilias in a Caucasian Australian
population. Pathology 2005;37:160-163.
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 for the South Australian Cerebral
Palsy Research Group. Associations between inherited thrombophilias, gestational age and cerebral palsy. Am J
Obstet Gynecol 2005;193:1437.e1-1437.e12.
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 Clin Mol Teratol 2005:73;605-611.
30. Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA for the South Australian Cerebral Palsy
Research Group. Neurotropic viruses and cerebral palsy: a population bases case-control study. BMJ ,doi:10.1136/
bmj.38668.616806.3A (published 6 January 2006).
31. Sharpe PB, Mulpuri K, Chan A, Cundy P. Differences in risk factors between early and late diagnosed DDH.
Arch Dis Child 2006;91:F158-162.
32. Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA for the South Australian Cerebral Palsy
Research Group. The association between inherited cytokine polymorphisms and cerebral palsy. Am J Obstet
Gynecol 2006;194: 674.e1-674.e11.
Pregnancy Outcome in South Australia 2010page 84
References
33. Gibson CS, MacLennan AH, Janssen NG, Kist WJ, Hague WM, Haan EA, Goldwater PN, Priest K, Dekker GA for
the South Australian Cerebral Palsy Research Group. Associations between fetal inherited thrombophilia and
adverse pregnancy outcomes. Am J Obstet Gynecol 2006; 194: 947.e1-947.e10.
34. Gibson CS, MacLennan AH, Dekker GA, Goldwater PN, Dambrosia JM, Munroe DJ, Tsang S, Stewart C, Nelson
KB. Genetic polymorphisms and spontaneous preterm birth. Obstet Gynecol 2007;109:384-391.
35. Muller PR, Cocciolone R, Haan EA, Wilkinson C, Scott H, Sage L, Bird R, Hutchinson R, Chan A. Trends in state/
population-based Down syndrome screening and invasive prenatal testing with the introduction of first-trimester
combined Down syndrome screening, South Australia, 1995-2005. Am J Obstet Gynecol 2007;196:315.e1-315.e7.
36. Gibson CS, MacLennan AH, Goldwater PN, Haan EA, Priest K, Dekker GA for the South Australian Cerebral Palsy
Research Group. Mannose-binding lectin haplotypes may be associated with cerebral palsy only after perinatal
viral exposure. Am J Obstet Gynecol 2008;198:509.e1-509.e8.
37. Khoo NS, van Essen P, Richardson M, Robertson T. Effectiveness of prenatal diagnosis of congenital heart defects
in South Australia: a population analysis 1999-2003. Aust NZ J Obstet Gynaecol 2008;48:559-563.
38. Chan AC, van Essen P, Scott H, Haan EA, Sage L, Scott J, Gill TK, Nguyen A-M T. Folate awareness and the
prevalence of neural tube defects in South Australia, 1966-2007. MJA 2008;189: 566-569.
39. Djukic M, Gibson CS, MacLennan AH, Goldwater PN, Haan EA, McMichael G et al. Genetic susceptibility to viral
exposure may increase the risk of cerebral palsy. Aust NZ J Obstet Gynaecol 2009: 49:247-253.
40. De Souza, Halliday J, Chan A, Bower C, Morris JK. Recurrence risks for trisomies 13,18, and 21. Am J Med Genet
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.
Pregnancy Outcome in South Australia 2010 page 85
References
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.
Pregnancy Outcome in South Australia 2010page 86
References
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.
42. Freak-Poli R, Chan A, Tucker G, Street J. Previous abortion and risk of spontaneous preterm birth. Perinatal
Society of Australia and New Zealand 10th Annual Congress. Perth Convention Exhibition Centre, Perth, Western
Australia, 3-6 April 2006, FC17.1, p 165.
43. Scott J, Chan A. South Australian Perinatal Statistics Collection. Guidelines for the Supplementary Birth Record.
Adelaide: Pregnancy Outcome Statistics Unit, South Australian Department of Health, 2006.
44. Budde MP, De Lange TE, Dekker GA, Chan A, Nguyen AM. Risk factors for placental abruption in a
socio-economically disadvantaged region. J Matern Fetal Neonat Med 2007 Sep; 20(9):687-93.
45. Freak-Poli R, Chan A, Tucker G, Street J. Previous abortion and risk of pre-term birth: a population study.
J Matern-Fetal Neonat Med 2009;22(1):1-7.
46. Kennare R, Keirse M, Tucker G, Chan A. Planned home and hospital births in South Australia, 1991 2006:
differences in outcomes. MJA 2010; 192: 76 80.
47. Dodd J, Grivell R, Nguyen AM, Chan A, Robinson J. Maternal and perinatal health outcomes by body mass index
category. ANZJOG 2011: 51,2: 136 140.
Pregnancy Outcome in South Australia 2010 page 87
References
48. Grivell RM, Reilly AJ, Oakey H, Chan AC, Dodd JM. Maternal and neonatal outcomes following induction of
labor: a cohort study. Acta Obstet Gynecol Scand 2012; 91:198 203.
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.
10. De Lange TE, Budde MP, Heard AR, Tucker G, Kennare R, Dekker GA. Avoidable risk factors in perinatal deaths:
a perinatal audit in South Australia. Aust NZ J Obs Gynaecol 2008;48:50-57.
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.
Adelaide Convention Centre, Adelaide, South Australia, March 13-16 2005, A 127.
6. Kennare R, Tucker G, Heard A, Chan A. Risks of adverse outcomes in the next birth after caesarean delivery.
Obstet Gynecol 2007;109:270-276.
7. Dekker G, Chan A, Luke C, Priest K, Riley M, Halliday J, King J, Gee V, O Neill M, Snell M, Cull V, Cornes S. Risk
of uterine rupture in Australian women attempting vaginal birth after one prior caesarean section: a retrospective
population-based cohort study. BJOG 2010;117:1358 1365.
Pregnancy Outcome in South Australia 2010page 88
References
Appendix 1: Definitions
Women who gave birth (previously called confinements): Women who gave birth to a live birth of any gestation or
a stillbirth of at least 400g birthweight or 20 weeks gestation.
Primigravida: A woman pregnant for the first time.
Multigravida: A woman who has been pregnant more than once.
Parity: The total number of previous live births and stillbirths.
Primipara: A pregnant woman who has had no previous pregnancy resulting in a live birth or stillbirth.
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 & TSI: persons of both Aboriginal and Torres Strait Islander descent.
6. Other: Races other than (1) - (5). Include women from the Middle East and Africa.
Guidelines for use regarding Indigenous Status categories (2), (4) and (5).
There are three components to the definition:
> descent
> self identification
> community acceptance
It is not possible to collect the three components of the definition in a single question. The Australian Bureau of
Statistics (ABS) proposes that the focus of a single question should be the descent, the first component of the
definition. The ABS therefore proposes the use of the following alternative questions, depending on whether the
person is present or not.
Where the person is present : Are you of Aboriginal or Torres Strait Islander origin? ;
OR
where the person is not present and someone who knows the person well responds for him/her: Is the person
of Aboriginal or Torres Strait Islander origin?
If the response is Yes , then clarify whether the person is of Aboriginal origin (2), Torres Strait Islander origin (4)
or both Aboriginal and Torres Strait Islander origin (5).
Self reporting of descent is not equivalent to self reporting of identity but because of the absence of a second
identity question some respondents will interpret the origin question to mean both descent and identification.
What identification in the context of the variable Indigenous Status should measure is an individual s self assessed
historical and cultural affiliation.
Pregnancy Outcome in South Australia 2010 page 89
Appendix
Body Mass Index (BMI): weight (in kg) height2 (in metres).
This is used as a standard for recording obesity statistics and also as a measure of underweight. However the
categories do not take into account factors such as frame size, muscularity, varying proportions of components such
as fat, bone, cartilage and water, and may be misleading in athletes, children and some ethnic groups. The categories
for describing weight using BMI are:
BMI category Name
<18.5 Underweight
18.5.24.9 Normal
25-29.9 Overweight
30-34.9 Obese
35-39.9 Severely obese
40 or greater Morbidly obese.
Induction of labour: An intervention undertaken to stimulate the onset of labour by pharmacological or other
means.
Caesarean section: Birth 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.
Pregnancy Outcome in South Australia 2010page 90
Appendix
Crude birth rate:
Age-specific fertility rate:
General fertility rate:
Total fertility rate (TFR): The sum of age-specific fertility rates (live births at each age of women 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.
Fetal death: Death prior to the complete expulsion or extraction from a woman 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, and 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:
Number of live births and stillbirths in that year
Number of late fetal deaths or stillbirths in any year
x 1,000=
Neonatal death: Death of a liveborn infant within 28 days of birth.
Neonatal death rate:
Number of live births in that year
Number of neonatal deaths in any year
x 1,000=
Perinatal death: Includes late fetal death (stillbirth) and neonatal death.
Perinatal mortality rate (PMR):
Number of stillbirths and live births
Number of stillbirths and neonatal deaths
x 1,000=
For South Australian statistics, the rate refers to live births of any gestation and stillbirths 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 the World Health Organisation (WHO)) and neonatal deaths
occurring within seven days of birth.
For international comparison, 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 is 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.
Estimated resident population of women of that age group in the same year
Number of live births to women in an age group in a year
x 1,000
Total number of live births in a year
Estimated resident population of women aged 15-44 years in the same year
x 1,000
Pregnancy Outcome in South Australia 2010 page 91
Appendix
Average population in that year
Number of live births in any year
x 1,000=
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.
Termination of pregnancy: Termination performed by a medical practitioner in a prescribed hospital in South
Australia, on specified grounds under the Criminal Law Consolidation Act and notified under the Criminal Law
Consolidation (Medical Termination of Pregnancy) Regulations 1996. Terminations of pregnancy at gestations of 20
weeks or later or where the fetus weighs at least 400g, performed by induction of labour resulting in a birth are
included in the South Australian perinatal data collection. These are usually for congenital abnormalities or medical
reasons.
Abortion rate:
Estimated resident population of same group in the same year
Number of induced abortions in a group of women in a year
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:
Abortions + live births
Abortions
=
This is often called the abortion ratio, which is strictly:
Total abortion rate = the sum of the five-year age-specific induced abortion rates multiplied by 5.
This represents the number of induced abortions 1,000 women would have during their lifetime if they experienced
the rates of the year shown.
Live births
Abortion
Pregnancy Outcome in South Australia 2010page 92
Appendix
Appendix 2: 2010 Supplementary Birth Record Form
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
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 number of tobacco cigarettes
smoked per day in 2nd half of pregnancy
? None
? Number per day = ............................................
? <1 (occasional)
? Unknown number
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 &
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
4 Hour of birth
(24 hour clock)
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 & 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 > 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)
Number of days .......................
3. ? Neonatal Intensive Care Unit (NICU)
- FMC/WCH (Level 3)
Number of days .......................
4. ? Paediatric Intensive Care Unit (PICU)
- WCH
Number 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
2010 SUPPLEMENTARY BIRTH RECORD
Mother s name .............................................................................................................................
Surname Given Names
Child s surname (if different) ........................................................................................................
Mother s address .........................................................................................................................
..................................................................................................... Postcode
Personal information above this line is confidential 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 & 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 Number of previous pregnancies
8 Number 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 Number 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
16a Number of antenatal visits
16b First antenatal visit
Gestation (weeks)
Height (cm)
Weight (kg)
BMI
Please return top copy to:
Pregnancy Outcome Unit, PO Box 6,
Rundle Mall, Adelaide SA 5000
27 Method of delivery
1. Normal spontaneous
2. Forceps
3. Assisted breech (no forceps)
4. LSCS (elective)
5. LSCS (emergency)
If LSCS state reason/s:
...................................................................
6. Ventouse
7. Breech extraction
8. Breech spontaneous
9. Unknown
10. Assisted breech (with forceps for head)
28 Complications of labour, delivery and
puerperium
1. ? None
2. ? PPH (Primary)
?600 - 999ml
?1000ml or more
3. ? Fetal distress
4. ? Retained placenta
5. ? Prolonged labour
(>18 hrs)
6. ? Cord prolapse
7. ? Wound infection
8. ? Failure to progress (specify)
...................................................................
9. ? Other (specify)
...................................................................
29 Perineal status after delivery
Tick tear, repair & 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) ............................................
7. ? Combined spinal-epidural
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) ............................................
8. ? Combined spinal-epidural
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
FOR COMPLETION BY MIDWIVES AND NEONATAL NURSES
Hospital/Place of birth.........................................................
Mother s Case Record Number ..........................................
Plurality (1=single, 2=twin, 3=triplet, 4=quad)
For multiple births, please complete a separate baby form for each baby.
.
Pregnancy Outcome in South Australia 2010 page 93
Appendix
Appendix 3: Congenital Abnormality Form
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,
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 & specify where relevant right/left, anterior/posterior)
Office use only
NAME OF NOTIFYING DOCTOR ................................................................................ Signed ....................................................................Date .......................................
NAME & 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 ................................................................................................
..................................................................................................................
SBR No.
Pregnancy Outcome in South Australia 2010page 94
Appendix
Intentionally left blank.
Pregnancy Outcome in South Australia 2010 page 95
Intentionally left blank.
Pregnancy Outcome in South Australia 2010page 96
Appendix
Pregnancy Outcome in South Australia 2010 page 97
Making a submission
For more information
SA Health
Pregnancy Outcome (Statistics) Unit
Epidemiology Branch
162 Grenfell Street
Adelaide 5000 South Australia
Postal Address
SA Health
Pregnancy Outcome (Statistics) Unit
PO Box 6, Rundle Mall,
Adelaide 5000 South Australia
Telephone: (08) 8226-6382
Fax: (08) 8226-6291
Web: www.health.sa.gov.au/pehs/pregnancyoutcome.htm
www.dh.sa.gov.au/pehs/pregnancyoutcome.htm
E-mail: Pregnancy.Stats@health.sa.gov.au
If you do not speak English, request an interpreter from SA Health
and the Department will make every effort to provide you with
an interpreter in your language.
Department for Health and Ageing, Government of South Australia.
All rights reserved. ISSN: 0819-3835
FIS: 12065.1. Printed June 2012.
www.ausgoal.gov.au/creative-commons
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